The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #696 - 190 GRANVILLE LANE 6/15/2009TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 6 '^7 4-- Date Received — �5Date Issued: 6 /� IMPORTANT: Applicant must complete all items on this LOCATION Name: L` � % Phone: Z rint PROPERTY OWNER_4g /'i'C�i4 �r�-I'4, XY,-'�—" Print pp MAP NO (� V 6 -PARCEL `-� ZONING DISTRICT: _L TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 0 Addition 0 Two or more family ❑Industrial 0 Alteration No. of units: ❑ Repair, replacement 0 Assessory Bldg ❑ Commercial ❑ Demolition 0 Moving (relocation) 0 Other 1 ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Sw 4111 �� Vii= Identification Please Type or Print Clearly) OWNER: Name: L` � % Phone: Z Address: �6 �r�-I'4, XY,-'�—" CONTR Address Supervisor's Construction License: Exp. Date: Home Improvement License: / Y��% Exp. Date: f 49-61-0 7- ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PER IT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED nCOST BASED ON $125.00 PER S.F. Total Project Cost :$ Z9 FEE:$ 7f Check No.: Receipt No.: Page 1 of 4 Location/P No. && Date NOItTIy TOWN OF NORTH ANDOVER 0 s Certificate Occupancy $ of ��a ••°' Et J�CMus Building/Frame Permit Fee $ Foundation Permit Fee $ —— Other Permit Fee $ TOTAL $ Check # -,11 22"t i b Building Inspector TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ Electric Meter location to 7�TATT project 11.,1 L.. r eFauna cun«uuing wire Un MUM contractors do not have access to the guars nd Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS J 1 DATE REJECTED DATE REJECTED 11 Q DATE REJECTED FIRE DEPARTMENT - Temp Dumpster on site Fire Department signature/date COMMENTS DATE APPROVED DATE APPROVED 0 DATE APPROVED yes no Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Shmature & Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA — For department use Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC. Jan1006 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application o 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) New Construction (Single and Two Family) o 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 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:BPFORM05 Page 4 of 4 The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations d 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/State/Zip: Phone.#: .3'� �� Are ou an employer? Check the appropriate bog: Type of project (required): 1. am a employer with 4. I a general contractor and I ❑ am 6. ❑ New construction employees (full and/or part-time).* 2. El I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.t -9. ❑ Building addition [No workers' comp. insurance required.] 5. We are a corporation and its 10. El Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised. their 11. Plumbin repairs or additions ❑ g p myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.❑ Other employees.:[No workers' comp. insurance required.] *Any applicant that checks box 41 must also fill out the. section below showing their workers' cQmpensation policy information. . t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submnif a new affidavit indicating such. $Contractors_ 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. Insurance Company Name; Policy # or Self -ins. Lic. #: ®e 9 Expiration Date: Job Site Address:-/ /1a/aZ11 City/State/Zip: /v �/✓ �C,� 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 Invesdeations of the DIA for insurance_ coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 6F-3 7 use only. Do not write in this area, 16 -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 #: 8/25/2008 3:07:46 PM ;:A11an In,�ultlnee Agency Inc P0Rox.5l1 jSidern, MA 01970 (INSURED — FGLRC'Inc dbn Lnrnberi Roofing Co. 1265 Wuiter Sheet IHaverlidl, MA 01330 8740 2 02/02. ISSUr DATE O8i25' 201 THIS CERTIFICATE IS ISSUED AS A N4ATTFR OF TNF(:!RIvIA I [ON 0NIN A CONFERS N RIGHTS UPON THE CERTIFICATE Hul_UER. THIS CER (rI( DOES NOT "ND. EXTEND OR ALTER'CHE CCOVERAGil.' AFFi1Rt)F.f) RY POLICIES BELOW. COMPANIES AFFOR-T) NG COVERAGE COMPANY , . A.I.M. Mutual Insurance Co LETTER .M ti r:;Ys ...... ,...•, THIS IS TO CERTIFY THAT THE POLICIES OF MURANCE LISTED BELOW H VE BEEN ISSUED TO THE INSURED NAMED ABOVE FORT PER.1 1D INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM ORONDITION OF ANY CONTRACT' OR OTHER DOCUMENT LVi'I TO WHICH THIS CERTIFICATE MAY BE ISSUED ORMAY PERTAIN, THE INSIRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 'I( ALI_'1'HF TFRfy(C 1;Y( -T TlcrnT.rc A'Km — -'--- — �u TYPE OF INSURANCE LTH - - -- -- -- POLICY NUMBER _ •-t=•..�J POLICY EFFECTIVE DAT E(M M/DD/YIYI Jrlvvvly Ivan: nfkVr- POLICY EXPIRATION DATE(MMIDD/Y`f) YSZP-N KrUUUEL) 13Y PAIL) CLAIM LIMITS C:ENER4L LIABILITY ' 1 Fn FF L A( .- _____- ...,.. .... -._.. _.... MADEnOCCIIfi I PEE,:>�:'I!AL R::\iI :' III I��R •: '.'V.'P:EF.'S S Ci�MTf:P.CT?F.'=�. PR!JT I 1 -_ �.-_ �_ FIRE Un. tnA-E �Arn•�.,x „r,•. MED E?;PEIJ:EF. IAfrverrc p?r; nil AUTC)hIO.1 L1AB1 LIT1' -------...... ------------- --..... ""MEINED LIMIT If- At1Y AUT'".. A 'L. �:�WNEDg11Tt,S GOli1LY IhI1VR''. �--HEDULEU AUTCI°. I (Per prr;nn) III RED Al M)SIW't; PnDILY INA!R\•L_I (Per. ---U I -,WNED AUT]S i-.,ARfi.l-,ELIAP.ILITY I I '- I I PRGFERT`! DP.MA GF. -- I '-'-CESS LIABILITY _ 11ME'EEEUA F(IRYA I --- --- EACH Gi.r LiRF ENCS r ITHEF. THAN UPIPRELI,A FORM WORK COMYENSAI ION AND �IIFAIPLOYERS LIABILITY I AOi REGATE 'Ty �1 WIN 1 STATUTORY LIMITS X OTIiL'R '` Y1 jiHE. PROPRIETLIPJ IIV \F,1?ERS\EaEGI ITIV E I js -- EL EACH ACCIDENT --'"- — 1,000, 1 i FF;�:I ERS .4R E 6009966012008 I 08/28/2068 08/28/2009 EL DISEASE: -POLICY LIMITs 1,00('1, EL DISEASE--EACIf LOYL1,000, �, NVORKFRS' COIVI!'ENSATION COYE]RA.GE APPLIES TO MASSACHUSETTS MPLOYEES ONLY I I I i I 1 I i IA I )ULD ANY O THE ABOVE DESCRIBED POLICIES BE CANCELLE7 BrYORE THE E\PI2 MEOF, TIM I SITING COMPANY WII,I, ENDEAVOR TO MALT_ 10 W ITTEN NOTICE TO T !,DER NAMM TO THE LEFT, BLIT FAILITRE TO MAIL SUCH NOTICE SHALL IMPOSE NO LIABILITY 0 W ANY KIND UPON THE COMPANY. 1I:S AGENTS Ok k[PRESENTA I fV rS LrrHORIZED AEPRESENCATIVE 4I7 91 B 0 0( i aat 1onAj � Coa7r=uildingg egul s an t Cd ards One Ashburton Place - kloom 1301 �'l� Boston. Massachusetts 02108 Home Improvement Contractor Registration LAMBERT ROOFING CO RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 DPS -CAI Cr 5010-07/07-PC8490 Reqistration- 149221 Type: Private Corporation Expiration: 12/6/2009 Tr# 262486 . ... ............ !Update Address and return card. Mark reason for chang I - Address Renewal Employment Lost C Board tit Btiildiil, Rc,--iikililms mid "Iqandar( J" Construction Superk,lisor Licens'e License: CS 78130 Restricted to: 00 RICHARD J LAMBERT 95 MAPLE AVE ATKINSON, NH 03811 Exptration: 6Y2/2010 I Tr= 27762 TGLRC Inc. dba Lambert Roofing Company In Business Since 1932 Name: Mr & . Mrs Holasek T. 041*' mbcrt offing June 10, 2009 Address: 190 Grandville Ln, North Andover Ma . .lob Site Address: Same as above Phone: (978) 269 - 4733 Salesperson: M Fiscel New Roofing System Proposal TGLRC Inc. dba Lambert Roofing Company will provide certificate of insurances demonstrating that we are fully insured for workers compensation, general liability, automobile liability and a $5,000,000.00 umbrella policy. This documentation will be sent through the US mail or VIA E- MAIL/FAX to the above named party if not already provided. Upon completion of the roof and final payment, a shingle manufacturers warranty and our executed two (2) year workmanship warranty will be sent to the named party. Work to be Performed And Materials to be Utilized Conditions: • A Standard two (2) year workmanship warranty applies in addition to a (30) year manufacturer's warranty. • Under no circumstance will the watertight integrity of the building be in any way compromised. • All work will be performed to the standards and expectations dictated by the 71h edition building code and proper roofing practices founded in NRCA roof covering and waterproofing manual.. i) A pre -roof walk around will be executed to observe and document any pre-existing conditions and or any special considerations. 2) Ensure landscaping and dwelling is and will remain properly protected. Please take special note that during demo of the existing roof system all valuables non - fastened are subject to falling during demo and debris will fall in the attic so preparing for this will reduce a disappointment and inconvenient clean up. Lambert Roofing will not be responsible for the above mentioned preparation. 3) Prepare for re -roofing by ensuring all safety measures are taken in accordance with OSHA and CMR Standards. 1 FIAT # 51-05033313 265 Winter St Haverhill, MA AM Reg. Hic # 149221 Phone (978) 374-9224 Fax (978) 521-5791 YA Lie. # UCS 078130 E -Mail at lambertroofmgciaol.com Single -Ply Lie. # 1711 Please visit us on the Web at ww .lambertroofing.net TGLRC Inc. d.ba Lambert Roofing Company In Business Since 1932 4) Remove existing layers of shingles down to the wood roof decking and properly disposed of debris from the jobsite. T.GL.R.C., INC. will arrange for disposal. 5) Inspect wood roof decking, if we discover any rotted wood, removal and replacement will be performed at an additional cost of: • $3.95 per foot, for rough pine removed and replaced. • $50.00 per sheet of CDX Plywood (4'x 8'sheet over existing boards). 6) Inspect Fascia and Rake boards, if we discover rotted wood, removal and replacement will be performed at an additional cost of: • $6.00 per lineal foot of Fascia and rake board, pre -primed pine up to 1" x 8" width • Crown and Cornice Molding will be custom quoted depending on the material required All removed, disposed of and replaced. If wood roof decking and trim is sound, we will re- attach any loose wood to the rafters, sweep deck and prepare for installation. 7) Inspect any and all siding that lies on the roof line if it needs to be replaced it will be billed as Time ($50.00 per hour per man) plus Material. 8) Apply lee & Water Shield Underlayment 6' up roofs transition, around all roof penetrations including chimneys, skylights, pipes and base tie-ins to wails. 9) Attach premium felt paper to the balance of the wood deck. 10) Furnish and install Shingles on house only. • Shingle Type: "CERTAINTEED " 30 Year Architectural style shingle accompanied by premium hip and ridge caps o Color: To Be " CHARCOAL " We use, as our standard, a hurricane nailing system recommended in northeast regions. This means, we install six (6) nails per shingle to reduce the risk of shingles being damaged by high winds and the weather changes we encounter. 11) Chimney Re -Leading o Chimney re -leading will be included in this quote if required. 12) Roof Flashing: • Re -flash all base tie-ins using (5"x7") Step Flashing of counter flashings as needed if required • All roof penetrations will receive new Flashing or Pipe Boots as required and dictated by proper roofing practices 13) Ridge Vents - Roof Vents: Cut back roof decking a minimum of 2" as per manufacturers specifications Furnish and install new "Air Vent". Shingle Vent II shingle cap over style Ridge Vent System. Also install bathroom vents>@ Soffit. 2 EI.N # 51-05033313 265 Winter St Haverhill, MA ALM Reg. Hic # 149221 Phone (978) 374-9224 Fax (978) 521-5791 MA Lic. # UCS 078130 E -Mail at lambertroofi ga?aol.coni Single -Ply Lic. # 1711 Please visit us on the Web at www.lambertroofingnec TGLRC Inc. dba Lambert Roofing Company In Business Since 1932 14) All debris generated by TGLRC Inc. dba Lambert Roofing Company will be cleaned up on a daily basis and properly disposed of from the jobsite. Roofing Warranties: UPON COMPLETION AND PAYMENT IN FULL A TWO YEAR NON PRO -RATED GAURANTEE ON ALL WORKMANSHIP WILL BE HONERED AND ISSUED BY "T.G.L.R.C. INC". A THIRTY YEAR PRO -RATED WARRANTY WILL BE ISSUED ON SHINGLES BY MANUFACTURER. TGLRC Inc. dba Lambert Roofing Company agrees to: • Commence the described work on or about June 2009 • The described work will be completed in about (4) working days • Shall not be held liable for delays due to circumstances beyond our control • Shall not be held liable for any damages to landscape, attics and or fixtures due to circumstances beyond our control • Shall not be held liable and roofs are not covered under the workmanship warranty, for pre-existing conditions including but not limited to: o Mold and or wood rot o Defective, faulty, rotted or worn building counterparts such as, but not limited to: siding, gutters, masonry, plumbing and windows, all of which may jeopardize the watertight integrity of the structure if not in sound condition Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence Required Permits A building and dumpster permit may be required to remove and replace your roof. It is our obligation to secure these permits if required as the homeowner'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 Additional Attached Documents, Agreements or Provisions • Insurance Documentation if not already provided • Arbitration Agreement • Contractor Registration Information • Notice of Cancellation Form This contract is the complete contract unless a signed Change Order has been executed between TGLRC Inc. dba Lambert Roofing Company and the Homeowner E11V# 51-05033313 265 Winter St Haverhill, MA MA Reg. Hic # 149221 Phone (978) 374-9224 Fax (978) 521-5791 MA Lic. It UCS 078130 E -Mail at lambertroofmg_@aol.com Single-Plv Lie. # 1711 Please visit us on the Web at wlvw.lambertroofing.net TGLRC Inc. dba Lambert Roofing Company In Business Since I932 Contract Price and Customer Obligations The total cost for all permits, warranty, labor and materials is: $6,750.00 THE EXTRA'S ARE NOT TO EXCEED MORE THEN $ 2000.00 Payment Terms: a deposit of 1/3 is due with the signing of contract • Upon completion, Balance is due in full • 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 The law requires that any deposit or down payment required by TGLRC. Inc. dba Lambert Roofing Company before the work begins may not exceed the greater of- * 1/3 of the total contract price or: o The actual cost of Special or Custom made materials which must be special ordered in advance to meet the completion schedule Acceptance of the Contract Proposal DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES OR ANY UNRESOLVED ITEMS NOTE: Due to volatile pricing on building products, this contract is valid for 15 days of receipt. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be 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, not later than midnight of the third business day following the signing of the agreement. Because of the three (3) day Notice of Cancellation, work may not commence for a minimum of seven (7) days after we receive this signed contract unless the contract is signed p at our office. Signatures `moiz .. ! >�s-�� s Date: Blease sign, keep a copy and return one copy upon acceptance. r "Quality Workmanship You Can Trust" Thank you for the opportunity to provide you with this proposal and or contract. Sincerely, Marc Fiscel TGLRC, Inc. dba Lambert Roofing Company 4 EIN # 51-05033313 265 Winter St Haverhill, MA MA Reg. Hic # 149221 Phone (978) 374-9224 Fax (978) 521-5791 MA Lie. # UCS 078130 E -Mail at lambertroofmga),aol.eom Single-Pli, Lie. # 1711 Please visit us on the Web at wwwdambertroofinf net Ems* M= pe to W Cd 9 x O c y- 0 0 U z O o � o � . (� x W a W C Z w O � CO) C z W CL c w,w ± M ea t�v U o LE a to A W C W GL°' U m w iu w U W 'Coo u cn w c no d w00 Pa' r.. V o cn m CL P w r The Commonwealth of Massachusetts Department of Fire Services Office of the Stade Fire Marshal P. 0. Box 1023 State Road, Stow, MA 01775 PERMIT O c y- 0 m c O o � CD . (� O N C Z v U O � CO) C CL c w,w ± M ea W CD C CO2 W .= m m Z � co)a I � c C: :mO r.. V m CL E� :_ P w r The Commonwealth of Massachusetts Department of Fire Services Office of the Stade Fire Marshal P. 0. Box 1023 State Road, Stow, MA 01775 PERMIT O O CD . (� L _O Z °D C. O � CO) C O CM C w,w ± � Q W CO2 W .= m m Date: e North Andover ]Permit No Dig Safe Num er (City of Town) (if Applicable ) In accordance with the provisions of M: G.L14 $ .Chapter—ID— as provided in section -5 -2 -L -LM P, 34 Start Date This Permit is granted to: ky a Full name of person, Firm or Corporation Permission to locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be 25from structure if unable to place with required Restrictions: clearance dumpster must be covered with plvwood or tarp end of work day at 2 .c 9 ( Give location by street and no., or desF ribe in such manner as to prov%ied adequate identification of location ) Fee Paid$ 50.00 %IfAV _ ��%,,,,n.... � Fire Chief This Permit grill expire - d ( Signature o offical granting permit Offical grantor emut Title