HomeMy WebLinkAboutBuilding Permit #640 - 190 ACADEMY ROAD 5/1/2008Permit NO: U
Date Issued: v
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
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
1Naters'hed Distract
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
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: $ FEE: $ 3 0
0
Check No.: 5� Receipt No.: 07
NOTE: Persons contracting with unregistered contractors do not have access to the Guaranty fund
Location �f
No. (a Date d
40RT" TOWN OF NORTH ANDOVER
3?� •OL
f 9
♦ i #
Certificate of Occupancy $
cMus t<�' Building/Frame Permit Fee $ 3
s�
t
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
2 23
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
Y . INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
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
r
Planning �3oard Decision:
Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
Located at 384 Osgood Street
FIRE DEPARTMENT� Temp Dumpster onsite fres zno
'Located at 124 Ma1n.Street
3
Fire..=Department sjonature/tate
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
NU I L5 and DA( A — (For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
F-1
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
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
o Floor Plan Or Proposed Interior Work
o 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
o 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
o Mass check Energy Compliance Report
o 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
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T.G.L.R.C. INC., DBA/LAMBERT ROOFING CO.
Sambert
Co.
In business since 1932
.April 24, 2008
ATTN: DEBB PUTNUM AT THE NORTH PARISH CHURCH,
SUBJECT: NEW ROOF SYSTEM AT 190 ACADAMY ROAD NORTH ANDOVER,
NIA 01845
PHONE: (978) 687-7948
STEEP -SLOPE ROOFING SYSTEM OVER BATHROOMS CORRIDOR HALL
ROOF FRONT AND BACK
T.G.L.R.C., Inc. will ensure the North Parish Church that we are fully insured by requesting
a certificate of insurance be drafted for Workers Compensation, General / Auto Liability
and Umbrella policy sent by fax and via US mail to the required party. We will also submit a
sample warranty from the shingle manufacturer illustrating the terms of the warranty being
issued as well as a cover letter indicating our "Select Single Roofers" status which will
permit us to offer the upgraded warranty to the church.
1) Pre -pare for re -roofing by ensuring all safety measures are taken in accordance with
OSHA standards and landscape is properly protected. A pre -construction walk thru
will be executed to observe existung conditions and parameters.
2) Remove existing layers of shingles down to roof deck and dispose of in a legal
fashion from the job site. Inspect wood deck, if we discover any rotted wood
replacement will be performed at $65.00 per (4' x 8') sheet plywood and screwed to
deck. If wood is sound we will re -screw any loose wood to rafters, sweep deck and
prepare for roofing.
3) Install metal (Aluminum) "F8 drip edge" to all roof rakes and eaves of roof
(perimeter) as required. Color to be: white.
4) Apply "Certainteed Winter guard" ice & water shield (UNDERLAYMENT) to the
balance of the roof deck.
5) Furnish and install a new "Certamteed Landmark" 30 -Year Architectural (algae
resistant) style shingle roof systein using a hurricane nailing system recommended in
the northeast regions. Color to be: match the existing church roof.
6) Re -flash all base tie-ins using (5"x7") step flashing as required, all roof pipe
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.LAMBERTROOFING.NET
EIN# 51-05033313 UCS# 078130
-3- Ai,itii, 24, 2008
The cost for trim replacement if required is $5.00 per foot maximum 1" x 6" pre -primed
trim boards.
Labor rate for any additional work will be at the rate of $63.75 per mechanic and $36.50 per
skilled laborer per hour, plus materials at cost plus 10% if needed.
The total cost for all permits, warranty, labor & materials is $2,400.00
NOTE: Work to start in MAY 2008 and completed with in 14 working days form job
commencement.
*Payment 'Terins: No money down, 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:
Signatures }
)d.�-�
Date <<
-� C. c' Please sign and return
one copy upon acceptance. NOTE: Due to volatile pricing on building products this contract is
void i( not accepted within 15 days of reception.
"Quality Workmanship You Can Trust"
Our Proof is on Your Roof!
Safety fust,
T. G.L.R. C. INC.
RICHARD J. LAMBERT
President/Quality Control
o��
RUG -31-2007 FRI 08rfln IYV, f 51 AM BOYLE INS, u uv-vN0, 6909--"P. 1/1
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obum, MA 01801
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n., Board of Building Regulations and Standards License or registration valid for individ 1 use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 149221 Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Expiration: 12/6/2009 Tr# 262486 Boston, Ma. 02108
Type: Private Corporation
LAMBgRT ROOFING CO
RICHA D LAMBERT
i
265 WINTER STREET
HAVERHILL, MA 01830
LAMBE
RICHA
265 WI
HAVEF
OPS -CAI i, 50M-07/07.PC8490
"an c�
Administrator
Not vat wit out signature
X7ro7ru
lding Regulat ons an =an�ards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
RT ROOFING CO
ZD LAMBERT
VTER STREET
HILL, MA 01830
Registration: 149221
Type: Private Corpration
Expiration: 12/6/2009 Tf# 262486
Update Address and return card.
Address [:] Renewal [] E
Board ofBuildin�g Regulations
One Ashburton P ace m 7 301
Boston, Ma 02108-1618
e' CONSTRUCTION SUPERVISOR LICENSE Blrthdato
r, CS 076130 Expires: 06/02/2009 Restricted To
�
RIC�ARD 1 LAMBERT
95 M PLE AVE
ATKMSON, NN 03811
oP5.Cni n fouo�oSrii�ee
reason for change.
ment F� Lost Card
06/02/1912
00
Tr, no: 27100
Koop top for receipt and than a of addross noWicallon
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: Builders/Contractors/Electricians/Plumbers
Please .Print Leeibl,
Applicant Information
r
Name (Business/Organization/Individual):
Address���
City/State/Zip: � G�'�i`u ,r2,hL9f
&9/F3) Phone .#: e?%o-3%
�rl`'gc`/4""'
Type of project (required):
Are you an employer? Check the appropriate box:
1, a employer with
4. [] I am a general contractor and I
6 E] New construction
— *
employees (full and/or part-time).
have hired the sub -contractors
listed on the attached sheet.
7. ❑Remodeling
2. ❑ I am a -sole proprietor or partner-
These sub -contractors have
g. � Demolition
ship and have no employees
working for me in any capacity,
employees and have workers'
comp. insurance.$
9 ❑ Building addition
[No workers' comp. insurance
5. We are a corporation and its
10. E] Electrical repairs or additions
required.]
3. ❑ I am a homeowner doing all work
officers have exercised.their
11.❑ Plumbing repairs or additions
myself. [No workers' comp,
irght of exemption per MGL
exe
r152and we have no
12.E] Roof repairs
insurance required.] t
,
employees. [No workers'
13.❑ Other
comp. insurance required,]
•Any applic= that checks box #1 must also fill out the section below showing their workers' egmpensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subrnit'a new affidavit indicating such.
2Contractors 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' cornp. policy number,
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. /} _
Insurance Company Name;
Policy # or Self -ins. Lic. #:e�i�l1�cG9C1 Expiration Date:
Job Site Address: j�6 �/� �Gtt- r7 City/State/Zip: %y,�/OS
Attach a copy of the workers' coin ensation 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 verificat=on.
Ido hereby certify under the pains and penalties ofperiwy that the information provided above is true and correct.
Signature: Date:
Phone #:
use onlv. Do not
City or Town:
area, to be completed by city or town offcclaL
Issuing Authority (circle one):
1. Board of Health 2. Building Department
6, Other
Contact Person:
Permit/License #
City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
Phone #: