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HomeMy WebLinkAboutBuilding Permit #261-12 - 193 FOSTER STREET 9/27/2011 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 0q61- Date Received Date Issued: 27 IMPORTANT:_Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Unit# �f Print MAP NO.AR, PARCEL: ZONING DISTRICT: Historic District) yes no Machine Shop Village yes no 100 year-old structure 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 ❑=.=11tic ❑ Well , O Floodplain (] Wetlands) ate_ rshedTljiIj`stn�ct E®Water DESCRIPTION OF WORK TO BE PERFORMED: I� i (Identificgon Please Type or Print Clearly) OWNER: Name: -� U �/ C (�>//I/J Phone: e���/ -F Address: /7" �� %�i� S%/�e�l_ N`��� ° � CONTRACTOR Name: t e7 Phone: Address: � _ � GlJ /c�i� �/� �?�r�t'�%l� ,•!/�l� Supervisor's Construction License: ��/J�o Exp. Date: Home Improvement License: ���� Exp. Date: I ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDIN4PRMIIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COSTBASEDON$925.00PER S.F. Total Project Cost: $ FEE: $ 7 Check No.: Receipt No.: NOTE: Persons contra �wunregivtered contractors do not have access to the guaranty fund :-. . _.. : gni pati irt�:n llPnt 1A/n P. .: _Sinriature of,contractoi-.'.: Location ' No. �'l—�'�' Date q s i. TOWN OF NORTH ANDOVER 3? .. p 1 f w F: + Certificate of O cupancy $ MUst< Building/Frame ermit Fee $ Foundation Per, it Fee $ Other Permit Fee $ Y pTOTAL $ Check # s: -070 k 246 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 Siqnature 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 FIRE DEPARTMENT -Temp Dumpst site yes no Located at 124 Main Street Fire Department signature/date / 7/2,,o COMMENTS I I't 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 2011 June/mi Building Department j 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 o Workers Comp Affidavit 1 o Photo Copy of H.I.C. And C.S.L. Licenses 1 o 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 o 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 o Engineering Affidavits for Engineered products V®TE: 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: Doc.Building Permit Revised 2008mi �ORTFI _ Andover Town of ILL _ - No. 4 tx _ ; }( �, o '� over, Klass., �7/j/ LA T O ' K 'Q �CO:",CtiE WICK �1. Ora, DRATED pPa��S '9S U 9 BOARD OF HEALTH MIT T D Food/Kitchen Septic System BUILDING INSPECTOR E THIS CERTIFIES THAT�.. ............:...............................................�........................................................... Foundation � ................................. haspermission to erect........................................ buildings on ... ................ .................. .................................................... Rough to be occupied as................................5 ....../�./a-1:i!n �.4f1. © Chimney { provided that the person accepting this permits every respect conform 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, Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR i UNLESS CONSTRUCTION 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. Smoke Det. SEE REVERSE SIDE yJ Pl;aza � ,.a 0"�T . �-R� S�J® � ,=`'.:y 4�_. •, � .��...�-? .-� �_-` JON Roat ' v`J$•��ia'iair`+_�+�35'9'� �:ali.iii i9t ucEnse: CS 78330 ®• flSE- f baa p'r�anea a RD '"PSTEAD, NH 038.4" T ® DATE JMMIDDIYY) ACORD09/06/2011 ,aCERTIFICATE OF LIABILIY NSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ALLAN INSURANCE AGENCY INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 63 1/2 Jefferson Avenue 2nd r ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. BOX 511 COMPANIES AFFORDING COVERAGE .................. ....................- ............... SALEM MA 01970-0511 COIiPANY A Seneca Insurance Company ---——----- ............... ...............11111 ............ ................ INSURED COVIPANY Safety insurance Group TGLRC INC dba Lambert Roofing ............... ....... . ................. ........................... ............................... 265 WINTER STREET C.OMPANY C Landmark Insurance Company ..... ............ ................... ................-................ ................... ..................... HAVERHILL MA 01830- . COMPANY National Union Fire Insurance D COVERAGES ('HIS IS TO'CERI IFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POHGY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VINICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEECT TO ALL TI tE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: ........... ............. ................ ....... .......... ............ ........................................... ............. ...... CO� 'TYPE,OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS I TR DATE{MMfDD[YY) DATE(MMIDDIYY) GENERAL LIABILITY BODILY INJ RY OCI, 1,000,000 __ .................. X COMPREHENSIVE FORM SCL3000422 11/12/2010 11/12/2011 BODILY INJURY AGG 2,000,000 X iPRFmisT; 1 -,si0PERA1 IONS PROPER]Y DAMAGE OCC 000000 AWNDEFIGROUND -6SION&COLLAPSE H.AZJRD PROPERrY DAMAGE A s 2,000,000 ------------......... P R 0 D U C I SIC 0 MPL E T E 1)0 P E R POCOMBINED OCC $ ............... rONTRACTUAL COMBI NE D AGG BI�!C $ --.11-1 1............. ............. 11NIDEPENDF-110'CONTRACTORS PERSONAL INJURY AGG 1,000,000 ............ ..................--........................... X BROAD FORM PROPERTY DNAA(W Medical Payment 5,000 ..................................... ................. X-i PERSONAL INJURY ....AU,TOMOBILE LIABILITY BODILY INJURY (Per ww,l) ANY AW 0 B X-1 At 1-01,14NED AUTOS{Private PasS0 16203819 BODILY IN,,URv OwN[I'1AjJT;.)S ;Per ................ ............ I(Offic�1hoo Privake Pas X 14ilREDAUTOS 07/16/2011 07/16/201.2 PROPFR I Y DAMAGE NON-OVNFD AUTQS BODILY bRYi OARAGE.LtA1311 ITY 1,000,000 PROPERTY MVAACE ............ EXCESS LIABILIrY jELH�OCCURkENL`C 5,000,000 C X]UMBRELLA FORM LHAO54597 11./12/2010 /12/2011 IAGGRE 5,000,000 I01HERTHAN UMBRELLA FORMIC — 6 T D WORKERS COMPENSATION AND 009934145 EMPLOYERS'LIABILITY E"1.FACH ACCR)ENT 0.0 ...........--................. TFIE PROPRIETOWX INCL IPL DISEASE-POLICY LIMIT 11000,000 PARTNERS;EXF CUI NH 08/28/2011 08/28/2012 Y E..- ............i.."1 0 11 0 11,0 0 0 1.0- OFFICERS ARE -XCL EL DISEASE-FA P-P S OTHER .......................... ........... .......... .......................... ............. ......................... ------------ DESCRIPTION OF OPER.ATIONSILOCATIONSNEHICLESJSPECIAL ITEMS CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCR18ED POLICIES BE CANCELLED BEFORE T14E EXPIRATION DATE THEROF,THE ISSUING COMPANY WILI ENDEAVOR TO MAIL Lambert Roofinq Co. 30 GAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT', BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 265 Winter St. OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Haverhill MA 01830- AUTHORIZ EPRESENTATIVE ACDRD 25-N(1195) 0 CORD CORPORATION 1988 The Commonwealth ofMassachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street 5� Boston,MA.02111 www.mass gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le ibl Name(Business/organization/lndividual): Address: City/State/Zip: - i /�� D' Phone Are you an employer?Check the appropriate box: I am a employer with Part-time).* 4. ❑ I am a general contractor and I 'pe of project(required): ployees(full and/or h 6• p ) have hued the sub-contractors ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheget. t 7. ❑Remodeling ship and have no employees These sub-contractors have working for mein any capacity. workers'comp.insurance. 8' ❑Demolition [No workers' comp.insurance 5. ❑ We are a corporation and its 9• ❑Building addition 3.Elrequired.] officers have exercised their 10-ElElectrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions Myself [No workers' comp. c. 152, §1(4),and we have no insurance required.]r employees.[No workers' 12•0 Roof repairs COMP,insurance required.] 13•❑Other *Any applicant thatchecks 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. 'Contractors 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 information. my employees Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: y Expiration Date: Job Site Address: S' � City/State/Z Attach a copy of the workers'cip ompensation policy declaration page(showing the policy number and expii ation date). Failure to secure coverage as required Wider 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby certify un tie pai s andpenalties ofperjury that the information provided above is true and correct. >i nature: Date: � 'hone 4. 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.Electric 6. Other al Inspector 5.Plumbing Inspector Contact PPrcnn Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be djeemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance-or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers',compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of - insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmatiort of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,;please call the Department at the number listed below. Self-insured companies should enter their ,self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a referencd number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Com moriweaU or MassaclCtl?setts Depart cent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. 617-727-4900 ext 4406 ox 1-877--MA.SSAFF, Rm r;#617-797-7749 L ' EIN#51-050-3313 Haverhill MA 978.374.9224 MA Reg.HIC#149221 M4e Lawrence MA 978.687.7339 BBB'r MA Lic.UCS#78130 Hampton NH 603.929.9224 . Single-Ply License#1711 acting Hampstead NH 603.329.8200 S:w►cPiY932 Toll Free 1.888.SOS.ROOF 265 Winter Street Haverhill MA 01830 \ t *Licensed *Insured *Factory Trained *Factory Certified Name: \ d \ Date: -4" -`� Telephone:nff t_11r7 '10'-1 Alt.Telephone: Email: Billing Address: 1\ City: oo" V -- State: eN <- c-._ Job Address: City: State: Scope Work and Re-roof ❑Re-roof Approximate Roof Area: . Zre��e for re-roofing-by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected. a existing layers of shingles down to roof deck and dispose of in a legal fashion from the'ob site. spect wood deck,if we discover any rotted wood,replacement will will performed at*$ , !' 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 de-laminated,removal,disposal and replacement will be performed at*$ <`/� per sheet.If any trim boards are rotted, replacement ent will be performed _ at P P $��_per LF for new pre primed pine.Inspect siding at roof line and all flashing behind siding,if we discover any damaged flashing or siding at the roof line,replacement will be performed at*$� ,� If wood deck,siding,and flas g is sound,we will re-nail any loose wood to rafters, wee deck,and prepare for roofing. EK 8"drip edge to all rakes and eaves.Color Z,-f✓4'r �■ y ice&water shield(UNDERLAYMENT)as per manufacturers'specifications an 2"A premium UNDE RLAYME NT to P ( the balance of the exposed p sed wood deck. e- sh all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness. upon inspection,we discover chimney lead to be worn or deteriorated,replacement will be performed at*$ v Install a new: �Year ❑ Traditional chitectural ❑ Designer Furnish and Install a new shingle over style ridge vent system ❑Soffit vent system*$ �7�debris generated by Lambert Roofing Co.,Inc.will be cleaned up and disposed of from the job ' e in a legal fashion.Under no circumstances will the watertight integrity of the building be compromised. *Denotes potential ad ' 'onal c sts above the total estima W price. Special Notes ca _5�i 2�► G � � : -� &_4 cnit/ /,:m UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE A WORKMANSHIP GUARANfEE FOR A PERIOD OF YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND S�—YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE$ TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor grees to perform_ � the work,furgish the �teri��labor specified above for the total sum of:$ r''(*) 4 (Dollars) Payment will be made according to the following work schedule: '�49 ; $ 21000- .5701 deposit upon signing contract $ by_/ /_or upon completion of $ by_/_/_or upon completion of $ aQ upon completion of contract. (Law forbids demanding full payment until contract is completed to both party'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 Acceptance of the Contract Proposal Home Owner:_A �� Date: Home Owner(s)Signature(s): Date:�E449 Contractor: Date: Contractor's Signature: ' � Date: /www.lambertroofihg.com (Please see reverse side)