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HomeMy WebLinkAboutBuilding Permit #658-16 - 152 WAVERLY ROAD 11/25/2015 NORTH BUILDING PERMIT O� (ZLED ,6 gq•0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION r� ! . Permit No#: t� � Date Received � SAeHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER W-C�u,0 : 9-)r"r'f\-k, Print k� 1 Ob YeAr Structure yes no MAP 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 XAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ❑ Septic [I Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer - - - DESCRIPTION OF WORK TO BE PERFORMED: c'e ' Identification- Please Type or Print Clearly OWNER: Name: ' f Phone: y 1�' Address: a &C -13 pJ+� Contractor Name:` �Ci�10U'l� ��- Phone Qa-e4 Email: C��M f CO nn Address. (p UC e� — x-�1�1\ xcx Supervisor's Construction License: Exp. Date: ILP Home Improvement License: Exp. Date: 1a- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ CSb qC7�� FEE: $ l Check No.: Receipt No.: l 'Z NOTE: Perso s con ra ting with unregistered contractors do not have access to the my fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimmi'19 Pools �❑ Well ❑ Tobacco Sales ❑ ; Food Packaging/Sales. ti Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on__ Signature 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 DPW Town Engineer' Signature: Located 384 Osgood Street I FIRE DEP.AR�TMENT � p "' Tem Dumpst r on sit yesa=.. ��" nri {L�°ocated at 1®24 Main Fire Deprf nt� gnatu a ate° C®MM` ENWTqS � — -- - L Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 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) f i Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 - - - - - 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 OTE: 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) :re Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4 Building Permit Application :6 Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses 4. Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 Location �- V No. 14 Date r • = TOWN OF NORTH ANDOVER Certificate of Occupancy $ r Building/Frame Permit Fee $ 7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Q 13 29740 Building Inspector r , F NORTh . W. 1 ve,. . 0 o h ver, Mass, S COC NIC. .C. 1' PERMIT T D U BOARD OF HEALTH i Food/Kitchen Septic System THIS CERTIFIES THAT................ .Qr. „ „ ....0,�C- /vl ....... . ........................................................ BUILDING INSPECTOR has permission to erect.......................... buildings on sfolt Foundation Rough to be occupied as ....... . . .P. ..... ...........P . .... ........................................................................... Provided that the person accepting.this permit shall in ery respect conform to the terms of the application Chimney on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough i Final I PERMIT EXPIRES IN 6 ONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC T S Rough Service ............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Roi,gh 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. Smoke Det. T. EIN#51-050-3313 arr�be Haverhill MA 978.374.9224 MA Reg.HIC#149221 Lawrence MA 978.687.7339 MA Lic.UCS#78130 Hampton NH 603.929.9224 BBB. Single-Ply License#1711 aofing Hampstead NH 603.329.8200 _ Sin�cP�1932 Co, Toll Free 1.888.SOS.ROOF 265 Winter Street Haverhill MA 01830 *Licensed *Insured *Factory Trained .Factory Certified Name: !Y�/• b � �11r.� Date: r' ^ ,n Telephone: q-7,?-7`��f Z0_5L6 Alt.Telephone: Email: Billing Address: r 5 2 !. 0 City: State: Job Address: City: State: Scope of Work Strip and Re-roof ❑Re-roof Approximate Roof Area: ❑ Prepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected. ❑ Remove existing layers of shingles down to roof deck and dispose of in a legal fashion frorrl.Ahe,�ob site. ❑ Inspect wood deck,if we discover any rotted wood,replacement will will performed at*$ . E e per LF for roof deck boards. If substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$ per SF.If individual sheets are found to be rotted/or delaminated,removal,disposal and_replacement will be performed at*$ per sheet.If any trim boards are rotted, replacement will be performed at*$ I per LF for new pre-primed pine.Inspect siding at roof lir a and all flashing behind siding,if we discover any damaged flashing or siding at the roof line,replacement will be performed at If wood deck,siding,and flashing is sound,we will re-nail any loose wood to rafters,swev deck,and prepare for roofing. ❑ Install 8"drip edge to all rakes and eaves.Color b)r t ❑ Apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or S� ❑ Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck. ❑ Re-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness. ❑ If upon inspection,we discover chimney lead to be worn or deteriorated,replacement will be performed at*$-4z4 ❑ Install a new: Year ❑ Traditional ,19 Architectural ❑ Designero1C or� ❑ Furnish and Install a new shingle over style ridge vent system ❑Soffit vent system*$ ❑ All debris generated by Lambert Roofing Co.,Inc.will be cleaned up and disposed of from the job site in a legal fashion.Under no circumstances will the watertight integrity of Pe builling be compromis d. �f � ..---, Special Notes '' �S r A UC.4�t�f S i n� `cS c UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF—ff?— YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND YEARS HONORED A11(D ISSUED Y THE 60 SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE *$ 5 LQ C�� hc7U � *Denotes potential additional costs above the total estimated price. TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE l The Contractor agrees to perform the work,furnish the materials and labor specified above for the total sum of:$ (*) (Dollars) Payment will be made according to the following work schedule: $ deposit upon signing contract $_._by_/_/_or upon completion of $—.—upon completion of contract. (Law forbids demanding full payment until contract is completed to both parry s satisfaction) You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram or by delivery,not later than midnight of the third business day following the signing of this agreement. See attached notice of cancellation for for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES ,��e ce of the Contract Proposal Home Owner(s)Signature(s): Date:.,,// Contractor's Signature: Date: _1 hertroofinexom (Please see reverse side) Company Insurances TGLRC Inc.DBA Lambert Roofing Company will provide certification of insurances,demonstrating that we are fully insured for worker's compensations, general liability,automobile liability and an umbrella policy.This documentation will be sent through the US mail to the above named party if not already provided. TGLRC 1-mc.dba Lambert Roofing Company agrees to: • Commence the described work on or about • Complete the described work in approximately days. • Not be held liable for delays due to circumstances beyond our control. • Not be held liable for any damages to landscape and or fixtures due to circumstances beyond our control. • Not be held liable and not covered under the workmanship warranty,for pre-existing conditions including but not limited to: • Mold and or wood rot,defective,faulty,rotted or worn building counterparts such as,but no limited to:siding,roofing,masonry, plumbing and windows,all of which may jeopardize the watertight integrity of the structure. • Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. • This contract is the complete contract unless a signed Change Order has been executed between TGLRC Inc.DBA Lambert Roofing Company and the Homeowner/Business Owner or Agent. Peis A building permit may be required to remove and replace your roof.It is our obligation to secure these permits if required as the home owner's agent.Note: Homeowners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c.142A. Accelerated Payment A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Payment Terms A finance charge of 1.5%a 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. • The law requires that any deposit or down payment required by TGLRC Inc.dba Lambert Roofing Company before work begins may not exceed the greater of- 0 1/3 of the total contract price or: 0 The actual cost of Special or Custom made materials which must be special ordered in advance to meet the completion schedule. Arbitration The contractor- and the homeowner_hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such disptite 6-a private arbitration service which has been approved by the Office of Consumer Affairs and Busines egulati n an�� uTer shall be r ed to submit to such arbitration as provided in MGL c 142A. Owner: Date: Contractor: �`� `"� Date: Contractor Registration (' E All home improvement contractors and subcontractors must be be directed to: registered,any inquiries about a contractor or subcontractor relating to a registration should � Contractor Registration: Director of Home Improvement Contractor Registration Board of Building Regulations and Standards One Ashburton Place,Rm.1301 Boston,MA 02108 Home Improvement Contractor Law: (617)727-3200 Consumer Information Hotline Commonwealth of Massachusetts Office of Consumer Affairs and Business Regulations 10 Park Plaza,Rm.5170 Boston,MA 02116 (617)973-8787 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 Cancellation (413)734-3114 You may cancel this agreement if it has been signed by a parry thereto at a place other than an address of the seller,which may be in the main office or branch thereof,provided you notify the seller in writing at the main office by ordinary mail posted,by telegram sent or by delivery,no later than that midnight o third business day following the signing of the agreement. '77 TNTTT A T.0 ,ace CERTIFICATE OF LIABILITY INSURANCEDATEIMM/DD/YYYY) 11/13/2015 /THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONAME:NTACT Jerrold Kameras ALLAN INSURANCE AGENCY INC. PHONE . (976) 745-5905 FnxAC. t97el 745-5483 63 1/2 Jefferson Avenue 2nd Floor EMAIL .Jerrold@allaninsurance.com P.O. BOX 511 INSURERS AFFORDING COVERAGE NAIC k SALEM MA 01970-0511 INSURERA:Associated Ind Ins Co. INSURED INSURERB:Safety Insurance Co. TGLRC INSURERC:National Union Fire Ins Co. dba: Lambert Roofing co. INSURERDAce American Insurance Co. 265 Winter Street INSURERE:Ace American Insurance Co. Haverhill MA 01830- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE IN%R VIND POLICY NUMBER POLICY EFF MPO1ICY EXP LIMITS GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000 _ffT M - M K0 I 9U X COMMERCIAL GENERAL LIABILITY PREMISES A (Ea occurrencei $ 50,000 A CLAIMS-MADE a OCCUR ABS1028029 11/12/20 15 11/12/2016 MED EXP(Any one person) S 1,000 X per progect Agg / / / / PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. f / / / PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY PRO- LOC / / / $ AUTOMOBILE LIABILITY / / / / COM81NEDISINGLE LIMIT E1,000,000 ANY AUTO / / / / BODILY INJURY(Per person) S B ALI.OWNED SCHEDULED 6203819 7/16/2015 7/16/2016 AUTOS I` AUTOS 6001LY INJURY(Per accident) $ NON-OWNED / ` / / PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per acckt / / / / $ X UMBRELLALIAS X OCCUR / / / / EACH OCCURRENCE $ 51000,000 C EXCESS LIAB CLAIMS-MADE E018335635 11/12/201511/12/2016 AGGREGATE $ 5,000,000 DED RETENTION S / / / / _ S WORKERS COMPENSATION / / / / X I INC STATU- 0TH- AND EMPLOYERS'LIABILITY Y/N L" ' 9. ANY PROPR[ETORIPARTNERIEXECUTIVE 651621IB-2e09875-2-15 MA 03/25/2015 03/25/2016 E.L.EACH ACCIDENT $ 1,000,000 O"FICERIMEMBER EXCLUDED1 � NIA •- D (Mandatory in NH) / / / / E.L DISEASE-EA EMPLOYE $ 11000,000 if yes,describe under DESCRIPTION O1=OPERATIONS below / / / / E.L.DISEASE-POLICY LIMIT S 1 000 000 E Worker's Compensation NH / / / / same limas as 1,000,000 6S62UE-8081311-16-14 NH 12/22/201412/22/2015 policy above 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION TGLRC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. dba: Lambert Roofing Co. 265 Winter Street AUTHORIZ EP_R_6 NTATIVf ,yam ,,�••�"f.'f�r� Haverhill MA 01830- ACORD 25,2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are re red marks of ACORD i r' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street .Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Buflders/Contracto>rs/Electricians/]Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual): Z , 1 Address:_ City/State/Zip: . Phone A e you an employer. Check the appropriate box: general contractor and I Type of project(required): 1. am a employer with4._ ❑ I am a g employees(full and/or part-time).* have hired the sub-contractors 6 E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.? 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No`workers'. comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ZContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. lfthe sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#:�P�nJ UQ�^ )e o9M�a-,� 6S Expiration Date: _3J 1 Co Job Site Address: UJ ave_f City/State/Zip: 3 4nJy ge r �-A ,L. Attach a copy of the workers'compensa on 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 criminal 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' ance coverage verification. Ido hereby certify under t n a rjlAqdr o perjury that the information provided above is true and correct- Si nature: - 11— Date: Phone#: ql Wo T Official 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#: . II� CS4=30 18 +I •a RICHARD J LANPW 263 WIlV'E'BR tiTIL6&T HawwbN MA 01$30 Office.of Consumer Affairs and Business Reaulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 Type: Private Corporation Expiration: 1211 O15 Trp 248813 T.G.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Update Address and return curd.Mark retmo for clrano. Address [3 Renewal C] Employment Lost Card I I