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HomeMy WebLinkAboutBuilding Permit #241 - 190 ACADEMY ROAD 9/27/2007 BUILDING PERMIT of ",°oT",A> TOWN OF NORTH ANDOVER c? APPLICATION FOR PLAN EXAMINATION '' Permit NO: Date Received2* O �ss�c►+us��. Date Issued: IMPORTANT:Applicant must complete all items on this page x v ii 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 C Others: ❑ Demolition ❑ Other - A Mw mz DESCRIPTION OF WORK TO BE PREFORMED: r �D Coo Identifica ' n Please Type or Print Clearly) OWNER: Name: Phone: Address: Jq'- x r 6' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.,$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ G FEE: $ T� Check No.: Receipt No.: ao NOTE: Persons c ntracting with unregistered contractors do not have access o the g a and I l l UtG Clf 1 r - z....-�.x,r xsr„a..xvas sxw.•r �.:'ra=,., Location Ab A4di23 No. Date 4,4-4 MaRTM TOWN OF NORTH ANDOVER h 9 Certificate of Occupancy $ ; cNusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �� ✓ 20640 K 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 Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 4 ' f t 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 XIM '43 1 110 y i w Dimension i 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 I ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 I 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 PP Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract j ❑ 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 j ❑ 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 NORT11 Town of No. ?. dower, 1Viass., • COCHICHEWICK y� ORATED P6 C2 S BOARD OF HEALTH PERMIT D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....N.�r` .............. ..�...... . .... �i.. .✓. !.�1.. .......... Foundation has permission to erect........ .... v..........................p ........................... buildi gs on ...��....... .............. �...........to*.f� Rough to be occupied as.............. ........ �' .......��.�, . � Chimney .. . . . .. . . . .......................................................................... provided that the person acceptin is permit shall in every respec nform to the terms of the application on file in Final 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 q4"Imow PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TS Rough ................ Service BUILDING INSPECTOR Final 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. AUG-31-2007 FRI 08:51 AM BOYLE INS, FAX N0, 7819339048 P, 01/1 AUG, 30, 2001 6:00 ASSOCIATED INSURANCE NO, 6909-P, 1/1 JSStM I1A.TF 08/30007 "R-ODtUJCER THIS CSRT(FICATEIS ISSUED AS A rAATTZR OF INFORMATIONONLYATID g�noy hlo CONFERS NO RIOHTS UPON THE CERTIFICATE HOWTa THIS CERTIFICATE DORS NQT AINEND�EXTEND OR ALTER THE COV 5MOE AFFORDED BY THS 0 Boy 606 POLICIES 9Ei.OW, !, obam,MA 01801 COMPANIES AFFORDING COVEgAGE suRxD I G L R C Inc COMPANY A A•I.M.Wall IMT8nCC CO ba Lambert P-Dafing CO. LBTTBR 65 Wiaror Strict ;avurhill,MA 01830 W HAVE BBEN ISSUED TO POLICY THIS 1S TP CER WY THAT THE POLICIES OF INSURANCE LISTED E RM OR CONDITION OF ANY COIN I RaC C O OTHEX DOCUMENT WIE INSUREP NAMED ABOVE FOP,TH RESPECT PCRIOD INDICATbO,NOTWiTH&TENDING ANY RI�QUIMHNT� 70 WHICH THIS CERTIFICATE MAY BE IsSU6D OR MAY PERTAIN,THB rNSURA14M AFFORDFsl3 BY THT3 POLiCLES D>35CRffiED HEREIN t5 SUBIEC f TO ALL Tl'I6 TERMS R=LUSIONS AND CONDITIONS OF SUCH POIICLTPbCYIPS.LIMlT3 SHO MAY HAVE eB5N REDUCED EY PAID CLAIM9. ►aLICYV6 toL�SYIIxnUAnon IOLTCYNu�+sCA L1M�Ts Co TYPE Of 1M(EURANCC DATE(MN1Pa'm DA"(MMtT>w" cTn OBHPRA4AOOImCATII CEN AALLIA6{NMY pn ro► Q COHMEACIALQEHDRAL"Lm. PM913 IAL k ADY.EIMtY Q�cWMs w�w[�Ocauu EACH OCCURRM40 (�OwNeas A COMZ4ACM'9 PART. Fus wx=UAYWAtin) N+a Y 4*m(Ayr rn CON9DiED Ali"ma "UAIMLRY iltaalJs CODISY IWURY MCNEDIAED AurasRaD�Y QDULY EIRnD AUrOO {Pa icdd�ed )4ON10WNRP AUTO[ OARACE UAAILMIY ►IIOTEaTV AANAOII caW1 gCcusBNCa FAC9m"111TY AWRE"TA tmmRaLLA POM! oTH=TNa LU RELLAFORM ATUT'ORY UMTS THER wORMOM S COMPENSATION AND X EMPLOYEIW LIABILITY EL EACH k=DW�t 500.000 H!►RDPomw A pg=AAT-- 6009966012007 08/26/2007 08/26/2008 ELDISEAs13.�FOLICYLIMrr 500,000 INCL (� ECD161ASE—FACH 500,000 SUPLOY$8 C0gK f DE$C1iIP I0N OF OI'EILATIONS OR LOCATIONSt stfOULD ANY Of THE AgovE 17i.SCRIDSD f OLIOES➢S CAM FLED 119POAE TR I)OMATION DAIS FIEREAf,THA MS&UJNG CowANY WILL E mgAvoR TO Mlk.1S wRMITBN NOTMCE TO THE CI XTIPICA TE OWN OF WINCHESTER OLDIANLITYT��(p poNTHSCOM TAN rrgAaENT6QL SUCH ORRSPICE�M�ESFNTALL ��eoOwWQAT(ON l MOUNT VERNON ST _ 1 WIN CHESTER,MA 011190 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 Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/StatelZip: Z( Phone #: Are you an employer?Check the appropriate box: Type of project(required): lam a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. $ E] Remodeling i 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 officers have exercised their 10.[] Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ 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#I 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. lContractors 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 workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Q Expiration Date: Job Site Address: '�7D' �WA City/State/Zip: Attach a copy of the workers' coiWensation 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 certif er z pains and penalties of perjury that the information provide bove is true and correct. Si nature: Date: '�� Phone 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#: I Board of Building Regulations and Standards License or registration valid for Indivldul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Ro.gls.tration: 149221 Board of Building Regulations and Standards EzplcAli ; 12f¢/2007 One Asbburton Place Rm 1301 Type: Private Corporation Boston,Ma, 02108 LAMBERT ROOFitr10:CO RICHARD LAMBERT 265 WINTER STREET zz-, HAVERHILL,MA 01830 Adminlstrotor Not valid without 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 ch OPS-CAI 0 SOM-04/05•PCO690 0 Address CD Renewal C) Employment Cj Lo. Board of Buiidin Req ulations One Ashburton Place, Fpm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Number: CS 078130 Expires:06/02/2008 Birthdate: 06/02/1972 Restricted To: 00 RICHARD 1 LAMBERT 95-MAPLE A VE ATKINSON, NH 03811 II, Tr.no: 27100 Keep top for receipt and change of address notification. OPS-CAI 0 SOM•04/05•PO8498 i r ARTICLE 1 THE WORK OF THIS CONTRACT The Contractor shall fully execute the Work described in the Contract Documents,except to the extent specifically indicated in the Contract Documents to be the responsibility of others. ARTICLE 2 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION §2.1 The date of commencement of the Work shall be the date of this Agreement 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. (Insert the date of commencement, if it differs from the date of this Agreement or,if applicable, state that the date will be fixed in a notice to proceed.) OG?'t ,247"1 j72.01.E GdH?"IHvo%A�y"vNT►L- 'r-0Ln aas TD 1tt §2.2 The Contract Time shall be measured from the date of commencement. §2.3 The Contractor shall achieve Substantial Completion of the entire Work not later than 21 days from the date of commencement,or as follows: (Insert number of calendar days.Alternatively,a calendar date may be used when coordinated with the date of commencement. Unless stated elsewhere in the Contract Documents, insert any requirements for earlier Substantial Completion of certain portions of the Work.) subject to adjustments of this Contract Time as provided in the Contract Documents (Insert provisions, if any,for liquidated damages relating to failure to complete on time or for bonus payments for early completion of the Work.) ARTICLE 3 CONTRACT SUM §3.1 The Owner shall pay the Contractor the Contract Sum in current funds for the Contractor's performance of the Contract.The Contract Sum shall be Twenty Thousand Six Hundred Dollars and Zero Cents ($20.600.00),subject to additions and deletions as provided in the Contract Documents. §3.2 The Contract Sum is based upon the following alternates,if any,which are described in the Contract Documents and are hereby accepted by the Owner: (State the numbers or other identification of accepted alternates.If decisions on other alternates are to be made by the Owner subsequent to the execution of this Agreement,attach a schedule of such other alternates showing the amount for each and the date when that amount expires.) §3.3 Unit prices,if any,are as follows: Description Units Price($0.00) replacement of rotted roof boards board foot $3.95 ARTICLE 4 PAYMENTS §4.1 PROGRESS PAYMENTS §4.1.1 Based upon Applications for Payment submitted to the Architect by the Contractor 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.The period covered by each Application for Payment shall be one calendar month ending on the last day of the month,or as follows: i Init. AIA Document A107TM—1997.Copyright©1936,1951,1958,1961,1963,1966,1970,1974,1978,1987 and 1997 by The American Institute of Architects. All rights reserved. WARNING:This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum 2 / extent possible under the law. This document was produced by AIA software at 17:57:32 on 09/24/2007 under Order No.1000289742 1 which expires on 3/4/2008,and is not for resale. — User Notes: C (1544758015) §17.3 If the Contractor fails to correct nonconforming Work within a reasonable time,the Owner may correct it in accordance with Section 7.3. §17.4 The one-year period for correction of Work shall be extended with respect to portions of Work first performed after Substantial Completion by the period of time between Substantial Completion and the actual performance of the Work. §17.5 The one-year period for correction of Work shall not be extended by corrective Work performed by the Contractor pursuant to this Article 17. ARTICLE 18 MISCELLANEOUS PROVISIONS §18.1 ASSIGNMENT OF CONTRACT Neither party to the Contract shall assign the Contract without written consent of the other. §18.2 GOVERNING LAW The Contract shall be governed by the law of the place where the Project is located. §18.3 TESTS AND INSPECTIONS i Tests,inspections and approvals of portions of the Work required by the Contract Documents or by laws, ordinances,rules;regulations or orders of public authorities having jurisdiction shall be made at an appropriate time. Unless otherwise provided,the Contractor shall make arrangements for such tests,inspections and approvals with an independent testing laboratory or entity acceptable to the Owner,or with the appropriate public authority,and shall bear all related costs of tests,inspections and approvals.The Contractor shall give the Architect timely notice of when and where tests and inspections are to be made so that the Architect may be present for such procedures.The Owner shall bear costs of tests,inspections or approvals which do not become requirements until after bids are received or,negotiations concluded. §18.4 COMMENCEMENT OF STATUTORY LIMITATION PERIOD { As between Owner and Contractor,any applicable statute of limitations shall commence to run and any alleged cause of action shall be deemed to have accrued: .1 not later than the date of Substantial Completion for acts or failures to act occurring prior to the relevant date of Substantial Completion; .2 not later than the date of issuance of the final Certificate for Payment for acts or failures to act 4 occurring subsequent to the relevant date of Substantial Completion and prior to the issuance of the {� final Certificate for Payment;and .3 not later than the date of the relevant act or failure to act by the Contractor for acts or failures to act occurring after the date of the final Certificate for Payment. ARTICLE 19 TERMINATION OF THE CONTRACT §19.1 TERMINATION BY THE CONTRACTOR If the Architect fails to recommend payment for a period of 30 days through no fault of the Contractor,or if the Owner fails to make payment thereon for a period of 30 days,the Contractor may,upon seven additional days' written notice to the Owner and the Architect,terminate the Contract and recover from the Owner payment for Work executed and for proven loss with respect to materials,equipment,tools,and construction equipment and machinery, including reasonable overhead,profit and damages applicable to the Project. §19.2 TERMINATION BY THE OWNER §19.2.1 The Owner may terminate the Contract if the Contractor: .1 persistently or repeatedly refuses or fails to supply enough properly skilled workers or proper materials; f .2 fails to make payment to Subcontractors for materials or labor in accordance with the respective agreements between the Contractor and the Subcontractors; .3 persistently disregards laws,ordinances,or rules,regulations or orders of a public authority having jurisdiction;or Init. AIA Document A107TM—1997.Copyright ©1936,1951,1958,1961,1963,1966,1970,1974,1978,1987 and 1997 by The American Institute of Architects. All rights hts reserved. WARNING:This AIAs Document is protected by U.S.Copyright Law and international Treaties.Unauthorized reproduction or 5 distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 17:57:32 on 09/24/2007 under Order No.1000289742_1 which expires on 3/4/2008,and is not for resale. (1544756015) User Notes: Certification of Document's Authenticity AIA®Document D401 TM —2003 I,David W.Torrey, hereby certify,to the best of my knowledge,information and belief,that I created the attached final document simultaneously with this certification at 17:57:32 on 09/24/2007 under Order No. 1000289742_1 from AIA Contract Documents software and that in preparing the attached final document I made no changes to the original text of AIA®Document A107TM— 1997-Abbreviated Standard Form of Agreement Between Owner and Contractor for Construction Projects of Limited Scope where the basis of payment is a STIPULATED SUM,as published by the AIA in its software,other than changes shown in the attached final document by underscoring added text and striking over deleted text. �V (Signed) (Title) (Dated) I AIA Document D401T —2003.Copyright©1992 and 2003 by The American Institute of Architects. All rights reserved. WARNING:This AIA®Document Is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA Document,or any portion of it, 1 may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 17:57:32 on 09/24/2007 under Order No.1000289742_1 which expires on 3/412008,and is not for resale. User Notes: (1544758015) I e