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Home My WebLink AboutBuilding Permit #455-13 - 224 BRIDLE PATH 12/10/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �� /0/�-2- Date Issued: ' IMPORTANT:Applicant must complete all items on this page `LOCATION - rin`t PROPERTY OWNER - ee4. P.riht 100 Year.Old StructureAyesnoMAP NOA PARCEL' l�V ZONING DISTRICT .:Historic District.'.Machine.Shop Villa t _ - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic Well f 11,Fleodplam,¢ ❑V1letlands Watershed District r , 0-Water/Sewer t DESCRIPTION OF WORK TO BE PERFORMED: Identification Please T e or Print Clearly) OWNER: Name: �� — e&-,' Phone: i Address: :CONTRACTOR 'Name: -•,,� � i'•Y• ;1 i f i S ,i.''t �1 •r f � "- �f T f- CJ r ::. a y ' .�� >Address : s .s r •� C, 4 ,icen• se:� �.Supervisor, Construatlon L _ � s . Home.Improvement.License to -'Exp Date. 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. 9- Total Project Cost: $ FEE: $ �� Check No.: Receipt No.: —1161 � l I NOTE: Persons co tracting with*unregistered contractors do not have access to the guarantyfund Signatum of Agent/OWner re of�contra 9 Si natuctor - _ _ - - -. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ t Location 1 Date `eZ -/0 No. 1 TOWN OF NORTH ANDOVER Certificate of Occupancy $_ Building/Frame Permit Fee $ ' Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check# l 26021 Building Inspector >:l i j i 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 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 D pster on yes. �: no * s� Located at 124 MainStreet Fire Departinerit.signature/dat i COMMENTS Ii 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 _ I DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use I i I i ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 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 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 Constructio nSin le and Two Family) i � 9 Y) ❑ 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: Doc.Building Permit Revised 2008 i CS-075134 . PICIIAO J UMBERT 245 WINTER STREET Haverhill MA 01ft 0610212014 Ay Office of Consumer Affairs and Business Regulation =_r 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 T vpe: Private Floroatation Expiration: 1216/2013: Tr# 218745 1.t'--.L.R.0 dba Lambert Roofing Cofnpany €RiCHARQ LAMBERT _ --- �..----- —_— 265 WINTER STREET HAVEPKUL, MA 01830 --- --..—. — -- -- Update Address and return card.Mark reason for change. - �'. Address -j Renewal %i. Eng p➢oyment f i Lose Care. i 4 l CERTIFICATE OF LIABILITY INSURANCE08/271/2012 i T I' C.ERT HCA r L IS €SSUED AS A MATTER OF INFORMATION' ONLY AND CONFERS NO RIGHTS UPON THE CE;RT`FfCA 3 E HOLDER.DER, THIS RTIFICA I E ,DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED I?Y THE POLiCiES � BELOW. THIS CERTIFICATEOF INSURANCE DOES NOT CONSTITUTE A CONTRACT SE RNEEN THE ISSUING INSI tRER(S), AUTHORIZEC, � REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. t FOORTANT: If ?res C-Vtifbate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.-_If SUBROGATION IS WAIVED,subject 10 Y rns and conditions of the policy,certain policies may require an a'2CIoFsEi4lClft. A statement C1 this Certificate does AOR rC/if'Pr rigiztS t Ilse l m It-cane e aper in Ileo of such e�wcrse€rent(s). _ I CONTACT r NAME: u Er roll Karneras f s o s.-SURAN; ."ENC:x INC= PNQNt (98FAX --_ - --1 , i5 Oq = ' e— wr e - DDJerro!dCaallanxns-arance.cr € BOX -r - s WS RER€5)AFFOROLUG COVERAGE ANAIC 9 n, 14 015710-tl511 — INSURE,RA.SeaeCa Specialty ins. Co. _ INSURER a:raEes ?z7s rarce C i,ivarny z ASUREeZ C_zkl Serra Excess a s"a--D s Ins. e fN5URERp: Ace American ITns'E,.-ance Co, -- —_ �p� p INSURER E" INSURER F ABCs CERTIFICATE NUMBER; REVISION NUMBER: i S !S TO CER Ty T ,T SHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE E FCR �f is.PO i,Y -� 'La T,.r1 ✓•IS,AN9 NG ,EASY REQUIREMEN--, TERM OR CONDITION Of'ANY CONTRACT OP O T€iER COM—MEN T 4 if f rI RESPECT TO '-ICH �,kv 3G. ISSUE!• OR MAY PERTAIN. THE INSURANCE AFFORCED BY THE POLICIES DcESCRISED HEREIN I5 SUBjEC T TO AU THE. TERMS-3. f LLS 7;NS AND CONDMONS OF SUCH POLICIES.LIMITS SHOWN NlAY HAVE BEEN REDUCED BY PP#D CLA,� Sy- t:Ft�F INSURANCE - AQDi§� - pO3Ul ?04CY E=F POLICY EXFlCYgiaEA AhPdlsDGlt`YY:' PPS loar'Y:{a LIMITS c:E_RA ;I .i_!Ty y E I f A3 � � / zG �12%zc1-uR 3i fAFD — �`� i;v✓v; ----- E i PERSON%1.& ,.t?Vlta�?.t•c. F-1 PRO- , t ( jPT`t _( m `i;a CS L,C•I cr1V, Vit)"' .3 r �.-.—...,..-kJ SatOE:Lc i{H:3.3..' r` �s'� t�. ... �..,... l` l 1 1 f 1 f CO u[?:tacJ SiN�Ls-LI..:i s i j a 1 E a i z LL �x-r-:. j-1 HE0tf:E`i � Io20vf3�.3 "n•. r-+ �r, ,;� .'ttr<1 ? W E30liftYit; X NONLOVNED "1-MS t € € F .� l f ( c- SER t'f Ll• k-.._�__...__ - " .__---- �,.-. Si_i.A L'n i r` ' �E95 LeAEXCESS :i i tvi,4tPIS4.9A^ua=� `- 13 L'C5000000 _-- - E r:p C,0 Q l It, lilt IES „t'i5la.i!$z(2Gdd tVORKERS COMIPENSATION I l! N e IF[OYERS t LI BILI Y t t= i i7-C)RY r;a c A JCEE �� s} 5,r . coo,il.ii [14i hr"a2 „ =--t - r +, y rNFL !01$29.5.4 49e/Z3{Zfl1Z108{ I4Ji`C.Ft iAa r: S w /} t I r LS I I ' =:i •,v,•t 7r !trE41C..ES(Attach ACOR{}SCS,Add(tianat RenFarke StRe4+ute,Ei more,space is requir¢cF} f I I R _ IFICA E HO'DER. CANCELLATION .. _ LGLRC, r=. I SHOULD ANY OF THE ABOVEZIESMSED POLICIES BE CANCELLED BEFORE f THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I ACCORDANCE 6 rrH THE POLICY FFOVISIotP'S. i x k Dai _air:ne- RoofiincrCo. 1 26'5 r,�.a`r e-- s t—re e t AtITPORf-LEU REPRESENTATIVE MIA 01630- ,11988-201s.AGC€D CORPORATION. All rights reserves;, '�"�� The ACORD name and logo are rogistered marks of ACORO The Commonwealth of Massachusett's Department of Industrial Accidents l Office of Investigations ,r 1' 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: 14,ZZ�i1G 9W Phone#: � Y e4�1tP FA e you an employer? Check the appropriate box: 1. I am a employer with � 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp, insurance.t 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑ Plumbing repairs or additions i myself. [No-workers'. comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *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. $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.#:_ �/ `l ��5Expiration Date:_D —62F I& Job Site Address: �O �( / ' (( City/State/Zip: zf, A-lace 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 f Investigations of the DIA for insurance coverage verification. I do hereby certify un the ains andpenalties ofperjury that the information provided above is true and correct. Si nature: Date: Phone#: F nly. Do not write in this area, to be completed by city or town official.: Permit/License# ority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: I t NORTH own of � t E 6 ndover No. 00 3 +S6 i o LAK, h ver, Mass, _ - 10 COCNIC.EWICK ,-�• S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT`^ ...aA..►� .1! .................. ................. BUILDING INSPECTOR .................... ...................................... • Foundation has permission to erect .......................... buildings on ...?-a.. ......... .. :�Gl. .. !�.. ...................... Rough to be occupied as ....... ........P.......f-..........f,..e.L:0.-Pj—........4k ................................................. Chimney provided that the person accepting this permit shall in every respect co.form to the terms of the application Final on file in 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 PERMIT EXPIRES IN ONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTJON S TSRough Service ...................................................... ...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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