HomeMy WebLinkAboutBuilding Permit #318 - 13 MAIN STREET 10/24/2007 i
BUILDING PERMIT of"O DT bgti
TOWN OF NORTH ANDOVER �? '`"`- -'' '° to
APPLICATION FOR PLAN EXAMINATION
Permit NO: 1Y Date Received Arp'.p�
�SSACHU`�E�
Date Issued: '
(7y
IMPORTANT:Applicant must complete all items on this page
:LOCATION / '.
��,rint
PROPERTY OWNER A67e L
MAP NO: PARCEL: ZONING DISTRICT: Historic District: yes no
Machine Shop Village ---yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic 1Nell. Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
mss/
Identification Please Type or Print Clearly)
OWNER: Name: Phone.
,f
Address: 1r,
77
CONTRACTOR ','Name, oa =< Phone: c3' y' a
Address:
Supervisor's Construction License: d8/�3C Exp. Date: -- -- '
Home Improvement License: . Exp. Date:-
ARCH ITECT/ENGI NEER
ate:ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: ��(D� — ReceiptNo.: d�
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty nu d
Signature of Agent/Owner Signature of contractor
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well Tobacco Sales
Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
i
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature&Date Driveway Permit
Located at 384 Osgood Street
FIRE DEPARTMENT -Temp Dumpster onsite yes no
'Located at 124 Main Street
Fire Department signature/date
COMMENTS
i
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
1
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use
I
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit ,
❑ Photo Copy Of H.I.C. And/Or C.S:L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
Location A� IM-0 S�
No. Date
p
TOWN OF NORTH ANDOVER
f q
C? - • 0
h 9
i y
Certificate of Occupancy $
Building/Frame Permit Fee $
SAGMUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # c2
20727 _
Building Inspector
T00
o_ ORToi
owoG_
W
over
_ 0
No.
C% dover, Mass. QW
O - LA
COCHICHEWICK
0'04'A T E 0
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
00=20 BUILDING INSPECTOR
THIS CERTIFIES THAT... 5... 'o.40ox................................... ......... . .. ...................................................................... Foundation
has permission to e t........................................ buildings on ....... 441707W.............. Rough
Chimney
to be occupied as.D 4s ......fy%...•r........ ......Re. Ii Final
provided that the per accepting this permit shall in every respect conform to the terms application on file in
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN, 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU S S
T TS Rough
...... ..... .. .... ..................
......<t .......... BUILDING ECTO Service
TO
Finad ,
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous -Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
��4. �oo„rrsronu�sa!!/i o�,/�uaaac�cuasll3 .—'--•—Board of of Building Regulations And Standards License or registration valid for Individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Regittr4tlon: 149221 One Asbburtoa Place Rrn I301
EXpltitlent fkIp/2007 Boston,Ma.02108
T3+fre: private Corporation
LAMBERT ROOFIt46:00
RICHARD LAMBERT
265 WINTER STREET ..
HAVERHILL,MA 01830 Administrator Not valld Wltbout signature
Board of Building Regula ions and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts'02108
Home Improvement Contractor Registration
Registration: 149221
Type: Private Corporation
Expiration: 12/6/2007
LAMBERT ROOFING CO
RICHARD LAMBERT
265 WINTER STREET
HAVERHILL, MA 01830
Update Address and return card.Mark reason for
OPS-CAI n soM•o+ros•Pcsaoa O Address 0 Rtnewsil 0 Employment C) I
guy Board of BuildingC� Regulations .
One Ashburton Place, Fpm 1301
Boston, Ma 02108-1616
License: CONSTRUCTION SUPERVISOR LICENSE •
• Birthdate: 06/02/1972
Number: CS 076130 Expires: 06/02/2008
Restricted To: 00
RICHARD 1 LAMBERT
95,MAPLE AVE
ATKINSON, NH 03811
Tr, no: 27100
Keep top for receipt and change of address notification.
OPS•CA1 0 SOM•(WOSrC/Ofa
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AUG-31-2007 FR1 0851 AM BOYLE INS,
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PRODUCERMW THIS CSRTIFICATO IS ISSIJ&D A +TT�R QF +ORt iP►TlaN ONLY AND
CONFERS NO RJORTS UPON THE CERTIFICATI+IiDLI)M THIS CERTIFICATE
cyto irsuroca AVICY Inc, D1 13 IAS BE�WDI EXTEND OR ALT9R THE COUP AGE AFFORDED BY THS
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09/21/2014 22:54 FAX 19782585793 REYES GROUP INC la001
T . G . L . R . C . INC . , DBA / LAMBERT ROOFING CO .
.In business since 1932
T
AI�
October 22,2007
I
ATTN: REYES GROUP INC.,
A
SUBJECT: FOR NEW ROOF SYSTEM @ 13 MAIN STREET NORTH
ANDOVER,MA 01845
I
PHONE: (978) 683-3800 E-MAIL: IZZY-REYESOCOMCAST.NET
WE PROPOSE:
To the following Single-ply roof construction on the building @ the above address
as per detailed description listed below. Approx. total roof area: 2,800 +or-SF."
SINGLE-PLY ROOF SYSTEM
1) T.G.L.R.C., Inc. will ensure Mr. Reyes that we are fully insured by
requesting a certificate of insurance be drafted for Workers Compensation,
General / Auto Liability and a $1,000,000 Umbrella policy sent by fax and
via US mail to the required party upon request.
2) Pre-pare for re-roofing by ensuring all safety measures are taken in accordance
with OSH.A,. standards and landscape is properly protected.
3) Remove existing rubber membrane and wet insulation down to built-up
roofing and dispose of debris in a legal fashion.
4) Furnish and Install new 1" wood blocking to perimeter as required by
manufacturer.
TWO SIXTY FIVE WINTER STREET HAVERHILL, MA. 01830
(978) 374-9224 (FAX) 521-5791 OR VIA E-MAIL
LAMBERTROOFING@AOL.COM OR VISIT US ON THE WEB Co
WWW.LAMBERTROOPING.NET
EIN# 51-05033313 UCS# 078130
09/21/2014 22:54 FAX 19782585793 REYES GROUP INC 2002
72- OCTOBER 22,2007
P
5) Mechanically fasten new 1n Rigid POLYISOCYANURATE (R-6.5) to the
existing built-up roof using roof plates and fasteners as per manufacturers
specs.
6) Furnish and install a new EPDM (Rubber) membrane roof system over new
V ISO insulation.
7) Furnish and Form Flash all roof penetrations including but not limited to
RTU's (roof top units), soil pipes, vent stacks, mechanical equipment and
perimeter as required by manufacturer and dictated by good roof practice to
ensure water tightness.
8) Perimeter edge will new receive new drip edge style flashing.
All debris generated by the T.G.L.R.C., Inc. will be cleaned up and disposed of from
the jab site in a legal fashion. Under no circumstance will the watertight integrity of
the building be compromised.
Exclusions: Prevailing wages, Interior preparation, deck replacement and/or
alterations, disconnects of equipment and any other trade related construction such as
but not limited to electrical, mechanical, plumbing, framing and ,masonry.
Please note: Any additional work beyond the above scope of work will be done at an
additional cost to be arranged and negotiated.
NOTE: We understand this is not your average roofing project. Below find our
pledge to ensure pre, work in progress and post construction is a safe, comfortable
and speedy process.
"All workmanship will be performed to the standards and expectations enforced by the
7' Edition Massachusetts Building Code. Unrestricted construction supervisor
license #UCS 078130 will be on site and/or accessible diligently through out the
project. We will discuss in detail the project agenda prior to starting and follow our
commitment to the best of our ability. We recognize that you are running an
important business and we will come to a consensus together on how best to plan this
project with out interference."
i
T.G.L.R.C. INC. agrees to commence described work in the month of(OCT/NOV 07) and the
described work will be completed in about (2-3)working days. T.G.L.R.C.INC. shall not be held
liable for delays due to circumstances beyond our control. T.G.L.R.C.INC. may not be held liable
for any damages to landscape, attics and/or fixtures due to circumstances beyond our control.
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09/21/2014 22:54 FAX 19782585793 REYES GROUP INC 0003
3 OCTOBER 22,2007
T.G.LA.C. INC. shall not be held liable for pre-existing conditions including but not limited to
mold and/or wood rot. Defective, faulty, rotted or worn building counterparts such as but not
limited to siding, gutters,masonry,plumbing, and windows that jeopardize the watertight integrity
of the building are not covered under the roofing warranty. The following work includes all
labor, materials and disposal needed to complete your job in a professional workmanship like
manner.
UPON COMPLETION AND PAYMENT IN FULL A 10 YEAR WARRANTY
WILL BE HONERED AND ISSUED.
The total cost for all permits, warranty, crane work, disposal, labor & materials is
$16,000.00.
*PAYMENT TERMS: 1/3 Down payment, Upon completion payment in full.
Net 30 days, a finance charge of 1.5 % per month (18% per year) will be added to
all invoices on the 31 day. All legal and or collection fees will be paid by the
binding holder of this contract.
Acceptance of proposal:
Signature &w Date b- 3-04 Please sign and return
one copy upon acceptance. N07T.Due to volatile pricing on building products this proposal is
void if not accepted within 25 days of reception,
"Quality Workmanship You Can Trust"
Our Proof is on Your Roof!
Safety first,
T.G.L.R.C.INC.
RICHARD J.LAMBERT
President/Quality Control
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Kashington Street
Boston, .MA 02111
www.ntass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ley_ibly
Name (Business/Organization/Individual): lf'/lfi°I
Address: S
City/State/Zip: z/x'.3o Phone #:
Arc ou an employer? Check the appropriate box: Type of project(required):
1. Iain demployer with 4. ❑ I am a general contractor and 1 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.]
officers have exercised their ]0.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.]t employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box III must also fill out the section below showing their workers'compensation policy information:
t Homeowners who subunit this aflidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workerscompensation insurance for my employees. Below is the policy and job site
information. _
Insurance Company Name:
Policy It or Self-ins. Lic. #: �� � lotaD�a fin Expiration Date: LTs�F OF
Job Site Address: �� i/�S%y0 �/ �"— City/State/Zip: ,�,rj/
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crinunal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify funder the pains and penalties of perjury that the information provided
/above is true and correct
signature: Date:
Phone#: 7
Oficial use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1.Board of health 2.Building Department 3.City[Town Clerk 4.Electrical Inspector 5..Plumbing Inspector
6. Other
Contact Person: Phone#: