HomeMy WebLinkAboutBuilding Permit #639 - 172 CHESTNUT STREET 5/1/2008Permit NO: W J�
Date Issued: 5 - / - 0
0167_11tiISl,l
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this naize
16'�NO
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to
Residential
Non- Residential
New Building
Print
PROPERTY OW ER . 6i '-' ro' �. ,/•� a f s�Cd
Print
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 Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
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Please Type or Print Clearly)
OWNER: Name:
Address: /12)
CONTRACTOR Name: Zal;w % A60 Phone:
Address: 9 4 * .S�
Supervisor's Construction License: -6 2-k Exp. Date: ''Q ?
Home Improvement License:
Date:
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: $ 9 %r.S� FEE: $.. 3
Check No.:U Receipt No.: C2 1 1
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
Location
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Ar.ki
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # �Sd I j
Building Inspector
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
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
s
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster onsite yes �k no
Located at 124 Main Street •
Fire Department signature/date''
COMMENTS
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)
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
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 2.2008
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The Comtnonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
R 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Please .Print Le ibl
Applicant Information 0
Name (Business/prganization/Ind ividual):/� `
Address: 2,1
City/State/Zip:_9-Qv"lZc- i-�d-4 Phone #:W
Are you an employer? Check the appropriate box:
4. ❑ I am a general contractor and I
1. p2�4. am a employer with
(full and/or part-time).*
have hired the sub -contractors
employees
2. ❑ I am a sole proprietor of partner-
listed on the attached sheet.
These sub -contractors have
ship and have no employees
employees and have workers'
working for me in any capacity.
comp. insurance.$
[No workers' comp. insurance
5• ❑ We are a corporation and its
required.]
3. ❑ 1 am a homeowner doing all work
officers have exercised. their
right of exemption per MGL
myself. [No workers' comp.
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.7 Electrical repairs or additions
11.❑ Plumbing repairs or additions
12, E] Roof repairs
13. ❑ Other
«Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit 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 state whether or not those entities have
employees. if the 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 the policy and job site
information, j
Insurance Company Name:
Policy # or Self -ills. Lic. #: Expiration Date: -40 —101, cP—e Y
01
Job Site Address: 1,7d /%/% _S City/State/Zip:_��AX��M, l)ae,
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 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 insurance coverage verification.
I do hereby certify y,44er theme pains and penalties ofperjuiy that the information provided above is true and correct.
&f -ficial use only. Do not
City or Town:
area, to be completed by city or town official
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 #:
�oon�ncY2ureas/,Cii o f'✓GZaaaacftuaeGia
Board of Building Regulations and Standards
{ HOME IMPROVEMENT CONTRACTOR
Registration: 149221
Expiration: 12/6/2009 Tr# 262486
Type: Private Corporation
LAMBERT ROOFING CO
RICHARD LAMBERT
265 WINTER STREET
HAVERHILL, MA 01830 Administrator
License or registration valid for individ I use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
Not va without signature
�lat ons an tandards
X7roMucilding Reg
One Ashburton Place -Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 149221
Type: Private Co
Expiration: 12/6/2009
LAMBERT ROOFING CO
RICHARD LAMBERT
265 WINTER STREET
HAVERHILL, MA 01830
Update Address and return card.
Address [:]Renewal 0 E
DPS -CAI C, 50M-07/07.PC8490
Board of Building Regulations
One Ashburton P ace, Fpm 1301
U17 Boston, Ma 02108-1616
P
ition
Tr# 262486
reason for change.
nent 11 Lost Card
License: CONSTRUCTION SU ER 1,1-P-) FA LICCE Birthdate 06/02/1972
Number: OS 078130 Expl es: 06/0: )08 1/ Restricted To 00
RICHARD J LAMBERT
95 MAPLE AVE
ATKINSON, NH 03811
Tr, no: 27100
Keop top for receipt and than a of address noU/lcatlon
CPS CA' O 5oti+.owiro�ue
b
T.G.L.R.C. INC., DBA/LAMBERT ROOFING CO.
In bu.finess since 1932
March 7, 2008
ATTN: SUTTON MANAGEMENT CO., INC.,
SUBJECT: FOR CONSTRUCTION @ "GREY ROCK" NORTH ANDOVER, MA
01845
PHONE: (978) 689-9994 FAX: (978) 685-8593
WE PROPOSE:
To the following specified construction on the buildings @ the above address as per
detailed description listed below.
BUILDING 172 AS PER SPECS
Item #3 Component: south balcony $3,075.00
NOTE: if storm door does not operate properly, add $1,800.00 for custom fit door. Includes labor and
all associated materials.
Item #4 Component: rear deck $9,350.00 (All nem Composite deck boards).
Item #7 Component: north balcony $50.00 per man, per hour.
Component: outrigger extension of existing rafters $2,800.00 (gutter price listed with gutter quote).
"Quality Workmanship You Can Trust"
Our Proof is on Your Roof!
Safety first, 4
TG.L.R•4�• IN
W -"V RTC1MD J. LAMBERT
President/Quality Control
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 @
WWW. LAMB ERTROOFING.NET
EIN# 51-05033313 UCS# 078130
ARTICLE 8
THE WORK OF THIS CONTRACT
8.1 The Contractor shall execute the following portion of the Work described in the Contract Documents, including
all labor, materials, services and other items required to complete such portion of the Work, except to the extent
specifically indicated in the Contract Documents to be the responsibility of others
Plans by Denco Engineering, and Specifications by Burns and Associates
The following specified construction on the buildings at the 172 and 156 Chestnut Street, North Andover as per
detailed description listed below. Cwkl-YX %
BUILDING 172 AS PER SPECS
Item #3 Component: south balcony
1. Remove existing wrought iron hand rails and roof system down to roof deck and dispose of in a legal
fashion. If wood is discovered to be rotted (T & M) will apply.
2. Furnish and install a new EPDM .060 Ml. Fully Adhered roof system.
3. Furnish and install new PT pine deck over PT wood sleepers to protect EPDM membrane.
4. Furnish and install new wrought Iron hand rails to meet local building code.
NOTE: if storm door does not operate properly, add $1,800.00 for custom fit door. Includes labor and all
associated materials.
$3,075.00
Item #4 Component: rear deck
1. Remove existing deck frame, deck boards and railings and dispose of.
2. Provide flashing behind new ledger board if wood rot is discovered, (additional T & M will be applied).
3. Furnish and install rear deck using PT wood lumber as per plans provided.
4. Furnish and install new composite deck boards to the newly framed structure.
5. Furnish and install new composite rail system.
$9,350.00.
Item #7 Component: north balcony
1. Demo existing structure to expose any wood rot or structural damage.
2. Re -construction to be performed according to engineer's recommendations.
$50.00 per man, per hour plus materials.
Item #8 Component: outrigger extension of existing rafters
1. Provide a 12" wide overhang using wood lumber to construct structure.
2. Trim out newly installed wood structure using pre -d pine. (Excludes paint).
$2,800.00 (gutter price listed with gutter quote).
The following statement applies to all items and components listed in the above contract:
MOTE: Any pre-existing conditions such as but not limited to wood rot, structural damage found during the
construction and/or any other related trades such as but not limited to electrical, plumbing and/or
mechanical will be treated as T & M.
NOTE 2: Upon commencement of construction if any of the buildings structures do not meet local building
code Lambert will not be held responsible to correct structure under this contract. Further, if required this
type of work will be treated as T & M.
ARTICLE 9
DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION
9.1 The Contractors date of commencement is the date from which the Contract Time of Paragraph 9.3 is
measured; it shall be the date of this Agreement, as first written above, unless a different date is stated below or
provision is made for the date to be fixed in a notice to proceed issued by the Owner.
9.2 Unless the date of commencement is established by a notice to proceed issued by the Owner, or the Owner has
commenced visible Work at the site under the Contract, the Contractor shall notify the Owner in writing not less
than five (5) days when he will mobilize on the project.
9 3 The Work of this Contract shall be substantially completed not later than July 30, 2008, subject to adjustments
of this Contract Time as provided in the Contract Documents.
9.4 Time is of the essence of this Contract.
9.5 No extension of time will be valid without the Owners written consent after claim made by the Contractor in
accordance with Paragraph 5.2.
ARTICLE 10
CONTRACT SUM
10.1 The Owner shall pay the Contractor in current funds for performance of the Contract the Contract Sum as provide
10.2 The Contract Sum is based upon the following alternates, if any, which are described in the Contract Documents
There will be no Change Orders for extra Work/Monies on this Project unless authorized in writing by the Owner.
10.3 Unit prices, if any, are as follows: Hourly rate is $50.00 per man hour.
ARTICLE 11
PROGRESS PAYMENTS
11.1 Based upon applications for payment submitted to the Owner by the Contractor, corresponding to
Applications for
Payment submitted by the Owner to the Architect, and Certificates for Payment issued by the Architect, the Owner
shall make progress payments on account of the Contract Sum to the Contractor as provided below and elsewhere
in the Contract Documents.
11.2 The period covered by each application for payment shall be one calendar month ending on the last day of the
month, or as follows:
The Billing cycle is every four weeks
Retainage is 5 %.
11.3 Provided an application for payment is received by the Owner not later than the thirtieth (30th) day of a month
the Owner shall include the Contractors Work covered by that application in the next Application for Payment
which the Owner is entitled to submit to the Architect. The Owner shall pay the Contractor each progress payment
THIS IS NOT A PREVAILING WAGE RATED PROJECT.
within three (3) working days after the Owner receives payment from the Owner if the Architect does not issue a
Certificate for Payment or the Owner does not receive. payment for any cause which is not the fault of the
Contractor, the Owner shall pay the Contractor, on demand, a progress payment computed as provided in
Paragraphs 11.7 and 11.8.
11.4 If an application for payment is received by the Owner after the application date fixed above, the Contractor's
Work covered by it shall be included by the Owner in the next Application for Payment submitted to the Architect.
11.5 Each application for payment shall be based upon the most recent schedule of values submitted by the
Contractor in accordance with the Contract Documents. The schedule of values shall allocate the entire Contract
Sum among the various portions of the Contractor's Work and be prepared in such form and supported by such
data to substantiate its accuracy as the Owner may require. This schedule, unless objected to by the Owner, shall be
used as a basis for reviewing the Contractor's applications for payment.
03/24/2008 MON 12:58 FAX 978 685 8593 Sutton Mgt
U002
03/20/2008 THU 15:47 FAX 978 685 8593 Sutton Mgt 16001
Fxh
14A Thi Oder shall fiunash and iriake IVIWAble to tb1z Cgntrwwr the following temporary facili 'es. equiplllent
and services. these shall be iiunished at Wcosi to the Contractor unless otherwise indicated belo each Sub
vune= is responsible for his owz�tenlP• fac=ilities, Services
1..1.2 Specific ti':Orking conditiOW: NIA
ARTICLE 15
MISCELLANEOUS PROVISIONS
15.1 w-lere reference is axade in this Agreement to a provision of the General Conditions or arxo er Conaact
Document, reference referS to that provision as amextded of supplemented by oxher provisions of e Contract
D��cuxneixts.
15.2 Payments due and unpaid wed" this Cgpn=x shalt bear interest ftom the date Payment is du at such rate as
The , parcics 111ay ague upon iia wntix>& or, in the abscwe thereof,. at
the legal rate prevailing; from c to time at the
place where the Project is locoad .
A_R'HCLE xs
ENUMTRA.TION OF CONTRACT DOCUMENTS
16.1 The Contract Documents, except for Modifications issued after execution of this Agr=111ciA aM entunerated
as follows:
16.1.1 This executed Standard Forte of Agre ucnt Between Owner and Contractor
163.2 Tlie Contract consisting of the Ageemerit between the Owner and Owtler dated as first ertt rid above and
the other Catztracs AQcuents e�umeYated in the Owner AgzezmT: Conditions of the Coniraci ( crieral,
Supplementtaxy and other Conditions), Diawiags, 3percifieatiork5, Acldeada acid other docmnents z vrrterated
therein:
16.1.3 The following Modifivaf=5 to the Contras`. if any, issued Svbsequenx to the execution of I
Agreement but prior to the execution of this Agreement:
Modifications Date
16.1.3 Other poewnetits, if any, fox -ling Put of the Contract Docuiuents are as follows:
This Agrorment =tarred into as of the Clay and year.*st w6Tt n above.
Otivner: Grey Rock CoUdO111iniLml Associar=
ate Cr
Coi vatic or T.G-L.F� C:- Inc, Roof g�`S�
Dote
Owner -Owner
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