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HomeMy WebLinkAboutBuilding Permit #94 - 25 CARRIAGE CHASE 8/2/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �4 Date lssued:--6�� IMPORTANT: A LOCATION PROPERTY OWNER. - 'MAP NO.:- J4-0AkCLL,4-D- Z� Date Received must complete all items on this pa t-nni ING -DISTRICT.-.. Historic District Machine Shop Vi �0 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 $eptic e -Floodpldin vv6tlarids -'hed Diifil&t Waters S, Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRAC1,00. Nam e*: .Address:-,�) �-,zvi of 1-3 Supervisor's Construction Lice n se" -Ex'. Date: Home lmpr(?vement License: IE�p t Pei e ARCHITECT/ENGI NEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. MOO PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: Check No.: 2- 3 ____:.Receipt No.: NOTE: Persons contracting with unregistered contractors'do "not have access to the guarantyfund §ignature of.A Signature of con --qent/Owne-r— IV r)5- r e- Locatioo --k", No. Date�� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee TOTAL Checkdx'-2s�- 25576 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATEAPPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: - —Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: 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 MGL Chapter 166 Section 21 A —F and G min.$100-$1000 fine NOTES and DATA — (For de Ll Notified for pickup - Date Doc.Building Pennit Revised 2008 nt use No 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 c3 Building Permit Application Ei Workers Comp Affidavit Ei Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract 13 Floor Plan Or Proposed Interior Work Li 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 Ei Workers Comp Affidavit • Photo Copy of H.I.C. And C.S.L. Licenses • Copy Of Contract L3 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) u Building Permit Application Li Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses Ej 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 L3 Engineering Affidavits for Engineered products NOTE: All d.umpster 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 2.2008 CO) m m m m m m CO) a m 0 vi, 10 Ej7 0 0 CD 0 Z CO r-lok o CD CL 2) 03 co) > co -0 0 0 CD CD 0 CL cr CD CL CD 0 :N CD —f -0 0 " IM U) CD 0 U) CID 0 0 CD 0 CD l qb Ol 0 orm""Mmv C: z r- m m cn Cj) — 0 1 0 M 2E X cn m U) 0— Z cn cn C:: , cn: a : m 0 0 < 00-0 =r 0 0 = " 0) Ra n 0. r -,r (D E 0 CD 0 --M -% p 0 0 CL m r X z ror 0 (A 0 = rn, 0) F)- T. 0 0 c L 0 Fn h cn m CD =Dr W - U) N COD , - 0 CD 2 CL a) @ : -% > CD 0 05 CRL = ca 0 =r C') (D CD comma =r CD CL 0 0 (A CD 0 f=A -0 oz CD 0 CD cn 0 < CL 0 cm 2. 0 0- (n 2 0 CL C<D (n U) CD cn CL CD CD * CD C) : .0 �r * * (n Xi - 0 0 cm Ab 0 0 W CD CD U) CD U) 0 -h 5 -. : =r > CD CD 0 03 0 CL Ln Ln -n. 3 -- 5 :;o o -n VI rD 0 (D 3 c 0 o 0 0 rD 0 fD r- c c �o 0 rD (D OrQ 3 aq :3 0 z m =3 CL rD 0 (D lu LA m 0 r- w (D rD m c c: 3 :3 m P 0 a 2 m 'a z > G) ra) 0 m z -M V V V m m 0 m m m z 0 0 0 14' 0 m ow 40 The Commonwealth ofMassachusetts Department of 1-ndustpial_4ccidents Off'6e Of Lnvesligations, 600 Wa.shington Street Boston, MA 02.111 Www.mass.gov1dia Workers' Compensation insurance Affidavit: RuDders/Contractors/lEl 3n)irnnf Ynfnv-rno+;-- ectricians/Plumbers Name (Business/organizafioa/Individual) - z Address: J", Z, City/State/Zip: Phone#: 2 4e - Are you an employer? Check the appropriate boxz I )M -Lam -- a employer with 4. M I am 11 general contractor and I employees (Ul and/or part-time).*' 2 -El I am a sole proprietor or have hired the" sub -contractors listed partner- on the attached sheet I ship and have no employees These sub -contractors have worldug for me in any capacity. [No workers' comp. insurance workersi comp. insurance. 5- El We are a corporation and its required.) 3. EIJ am a homeowner doing officers have exercised their all work right Of exemption per MGL myself [No workers' comp. C. 152, § 1(4), and we have no in . surance required.] t employees- [No *orkers, COMP. insurance required.] ch c! -box i. *Amy aRDicant that c ks must a! so 111117 oz-Affies-cction below Ebelp'Lng 4�6 T eir Type of project (required): 6. F-1 New construction 7. E] Remodeling 8. .[1 Demolition 9. E] Building addition 10 -El Electrical repairs or additions ILEI Plumbing repairs or additions 12 -El Roof repairs 1311 other MmeownerS who submit this com:p= PO-11CY MtOrmatio_�L affidavit indi ating they are dqig all work and then hire outside contractors ,contractors that check this box must attach' c must submit a -new 'affidavit indicating such. ed an additional sheet showing the name of the sub -contractors and their workers' cOMP. Policy information. 1am an employer that isproviding workers'cOmpensation M�'Surancefor my employees. Belom, is thepolicy informadom andjoh site e_­� Insurance COmpEipy Name: C1061 -47—r, Ir Policy # or Self -ins. Lic. #: 10_4915�& , -% r,*' Expiration.Date:_ 01V _1/ Job Site Address: --d I" 3ol Attach a copy of the workers", com sation policy declaratiOn page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a fine, up to $1,500.00 and/or one-year imprisomnent, as well as civil Penalties in the form of a STOP WORK ORDER a�d a fine of up. to $250.00 a day again9t the violator. Be advised that a cOPY Of this �tatement may be for'warded to the OfFice of Investigations of the DIA for insurance coverage verification. I do herc`�Y certify.under dpenalfies QfPeri"731 that the information provided above is true and correct A Phone#: .11 ---------- ------------------------- __ Wflclal use only. Do not write, in this apea, to he completed by ciiy 01. town - officiaL City or Town: PermitfLic—ca Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town C .1 lerk 4. Electrical Inspector 6. Other 5- Plumbing Inspector Contact Person: Phone Information aiid Instructions Massachusetts General Laws chapter 152 requires all employ- ers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every pc--rson in the service of another under any contract of hire, express 6r implied, oral or written." Am 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 employe; or the receiver OT 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 employ-sprrsons to-do -maintenance, construction or-ropair-work on such dwelling -house or on the grounds 6r building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,'g25C(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 coinpliance with the insurance coverage required.." Additionally, MGL chapter 152, §25C(7) states "Neither the common alfh nor any of its political subdivisions shall enter into any contract fo.r the performance.of public work imtil acceptable M'idence of compliance with the insurance requirements of this chapter have. been presented to the contracting authority." Applicants Please fill cut the workers' compensation aff * i6vit completely, by checking the boxes that apply to your situation and, if necessary, supply sub1contractor(s) name(s), address(es) and phone number(s) along with their certificat�(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) wit�.no employees other 11m 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 submittedto the Department of Industrial Accidents for confirmation of insurance coverage. Also be siure to sign and date -the affidavit. The affidavit should be rotuarned to the city or town thatt. 60 apphicavion. for the Pem 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 Towm Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space -at the bottom of ' the affidavi ' t 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 permithicense number which will be -used as a referencemumber. In addition, an applicant that must submit multiple permit/license applications in any given year., need onlv 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 rn,�y 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 homeowner or citizen is obtainin a license. or permit not related to any business. or commercial venture (i.e. a dog license or permit to bumlea.ves et�.) said person is NOT required to compl6te this affidavit. The Office of Investigations would'like to thank you in advance f6r your cooperation and should you have any questions, please do n'ot-hesitate to give us a call. The Department'$ address, telephone and fax number. The Commonwealth of Massachusetts Departmont of Industrial Accidents Office of Inrestigations 600 Washington Street Boston, M.A 02111 Tel. P 6.17-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 6.17-727-7749 Dew con%truction Supcn iior License: CS -078130 RICHARD J LA1OERT,-.,.-.--,�, 245 WINTER STREEV HaverWUMA 01930 tts :02 116 If6tae-Im-provement Regist. a nn� 177 l0e: Private Como ExPkafion: 12161201' db LzMb . .... ..... PICHARD LAMBERT 265 "VINTftR STREET HAVERHILL MA 01830 U 0 A&llr p y I DATE A -A N E CERTIFICATE OF LIABIL S ED -S A MA RQ .4-= 1S ;S. U TTER OFINF AM E DOES NOT AFF ON, ONLY Cyw. UWATIVELY OR f4m. 'IS CER -i IFI- R1 UPO WGATW=�LY 1AMEAID, EXT N THE i-EgITIFIC.-it TE CATE OF INSURANCE DOES END, OR ALT T COft-M r_R: TH-E COVERAGr P�F- REPRESENTATiVE O'R MODUCER, AND TE A QCq,11-RACT ORDI�.-j SIMfEEN TNz upi-c, Sy THE POL!C.� Iss ­4PORTA M7- ItAsu rermcate holder is RERM, AUTHQMZi M AWJTV�L condstiorls 01. ffie pcgiCy, ME!?, �he certain poaoie�a must bee,71_. ed. requirt an end I IS WAIVEi� 9F N C 'p 1;2i! Of Such endor-Seinent(s, Oml-irlf-M A O%-thiscartific ak? does not'-amer rights tc, - -E. -k(.".z_wmy 1NC, IVA . Oerrold� raTe_ Pvezue 2rjd Floor L MA INSURER --insurance t2r 't _y 0 -!,a -xCess- t" ir-. Suz -U, IMVREPD-ChartiE; _18,,arance L _MA CE INSU r.R r RWICATE KM BER: ----- r�z, T �HE poLr . ................... . IES ( I- 11,11 1 �,, ''' - -,NCEUS7Mr) BF -LOW FAVE-: BE. iz, RNG� ANY PEOWREMENT. ­ZU"D TO T41-1 Pei TEPM OR CONDITION OF A4, " ;Y BE !S�SVED cR Wy p 8 W -E T, U, R E D _Pj� ERTAIN. TPZ jt4 Up 'A ' 67P Hc PoL7,(;T.�� C L 10, NS A. -N A, y NTRAC, OR 0THEP, 00C�jg, D CON' 01MON,,3 CjF SUCH pOLIC A Q WORDED BY Tij.,,-^ i ­tin,,_ESPECTTn�jtj�i�C IES, No 11 -1 . H '77� x um S WN fm JESCRISED REREIN',� TYPE OF tt"_L�re, Y -HAVE BEEN, REj3�IC:F Dr, C -r F,:) ALL y PND CLAINI-q. POLICY NUAap 'ULICY E'.. POI _I�Ri yy _R -UR 1, C, PUI GENER AL -�MF Sl� HF-.* IMUZ. LAN s B00fLY .zip LQCAIgt4S I VEHICLES (AttachAC Z'.nd Devejo-o ert Lj�C, ORD 1;;7Addiftn,,j R�W�,Im S,�Mqd.,4" ?,an Ne-bu-Y'L` levelopment mold:,� ��Dre sPRCP 1_� '-T'"'bUrl—t-Ort DevelopMen rAS1 V"C,Xev?bu,�j1pr-.oDeratj,,, t L L. 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UCS # 78130 1_�=M, Single -Ply License# 1711 265 Winter Street FILicensed Name: MR. Anthony Monteiro T. IS ON mbe YOUR ROOF' pofing SL ];; 19 3 R CO- Tbfl Free 1.888.SOS.ROOF Haverhill MAO 1830 FlInsured 0 Factory Trained Haverhill, MA 978.374.9224 Lawrence MA 978.687.7339 Hampton N�H`603.929.9224 Hampstead NH 603.329.8200 D Factory Certified Date: 07 — 28 — 12 Telephone: 978 685 5160 Alt. Telephone: E -Mail: N/A Billing Address: 25 Carriage Chase RD, North Andover Ma. Job Address: Same Scope of Work o Strip and Re -roof entire house. • Prepare for re -roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected. • 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 $3.50 per ft for boards. $ 50 per sheet of ply wood. Chimney flashing $ 375.00 Ei Install 8" drip edge to all rakes and eaves. Color White. o Apply ice & water shield (UNDERLAYMENT) as per manufacturers' specifications 6'and up all roofs to walls. Ei Apply premium (UNDERLAYMENT) to the balance of the exposed wood deck. o Re -flash all plumbing stack pipes, and any roof penetrations as required and dictated by good roof practice to ensure water tightness. Ei Install a new: Certainteed Landmark Limited Lifetime Architectural shingle. o Furnish and Install a new shingle over style ridge vent system or equal. Ei All debris generated by Lambert Roofing Co., Inc. will be cleaned up and disposed of from the job site in a legal fashion. Under no circumstances will the watertight integrity of the building be compromised. *Denotes potential additional costs above the total job cost. UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF 10 YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND A LIMITED LIFETIME HONORED AND ISSUED BY THE SHINGLE MANUFACTURER (SEE WARRANTY TERMS AND CONDITIONS AT WWW CER TA INTEED. COM). TOTAL JOB COST ... Fourteen Thousand Five Hundred Dollars: $ 14,500-00 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE Payment will be made according to the following work schedule: - $4,500.00 Deposit with signed contract. $ 10,000.00 Due upon completion of rooC (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 an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES Acceptance of the Contract Proposal Owner(s) Signature(s)- Date: Contractor's Signature: Date: www.lambertroofing.com Company Insurances TGLRC Inc. DBA Lambert Roofing Company will provide certification of insurances, demonstrating that we are fully insured for worker's compensations, general liability, automobile liability and an umbrella policy. This documentation will be sent through the US mail to the above named party if not already provided. TGLRC Inc. dba Lambert Roofing Company agrees to: 0 Commence the described work on or about 08- 2012 • Complete the described work in approximately 2-3 Days • Not be held liable for delays due to circumstances beyond our control. • Not be held liable for any damages to landscape and or fixtures due to circumstances beyond our control. • Not be held liable and not covered under the workmanship warranty, for pre-existing conditions including but not limited to: • Mold and or wood rot, defective, faulty, rotted or worn building counterparts such as, but no limited to: siding, roofing, masonry, plumbing and windows, all of which may jeopardize the watertight integrity of the structure. • Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. • This contract is the complete contract unless a signed Change Order has been executed between TGLRC Inc. DBA Lambert Roofing Company and the Homeowner/Business Owner or Agent. Permits A building permit may be required to remove and replace your roof It is our obligation to secure these permits if required as the home owner'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. Accelerated Payment A contractor may not demand payments in advance of the dates specified on the,payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems hirn/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Payment Terms A finance charge of 1.5% a 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 TGLRCInc-. dba Lambert Ro6fing Company before work begins may not exceed the greater of - 0 1/3 of the total contract price or: 0 The actual cost of Special or Custom made materials which must be special ordered in advance to meet the completion schedule. - 0 Arbitration The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. Owner: Date:— Contractor: Date: z --- Contractor Repistration All home improvement contractors and subcontractors must be registered, any inquiries about a contractor or subcontractor relating to a registration should be directed to: Contractor Registration: Director of Home Improvement Contractor Registration Board of Building Regulations and Standards One Ashburton Place, Rm. 13 01 Boston, MA 02108 (617) 727-3200 Home Improvement Contractor Law: Consumer Information Hotline Commonwealth of Massachusetts Office of Consumer Affairs and Business Regulations 10 Park Plaza, Rm. 5170 Boston, MA 02116 (617) 973-8787 For assistance with informal mediation of disputes or to registerformal complaints against a business, call: Consumer Complaint Section Office of the Attorney General (617) 727-8400 AND/OR Better Business Bureau (508) 652-4800 (508) 755-2548 (413) 734-3114 Cancellation You may cancel this agreement if it has been signed by a party thereto at a place othdr than an addressof the seller, which may be in 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, no later than that midnight of the third business day following the signing of the agreement. 'IN'ITIALS