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
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ING -DISTRICT.-.. Historic District
Machine Shop Vi
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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
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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
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PICHARD LAMBERT
265 "VINTftR STREET
HAVERHILL MA 01830
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EIN # 51-050-3313
TAA Reg. HIC # 149221
BBB_ MA Lie. 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