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Home My WebLink AboutBuilding Permit #62 - 25 HOLLOW TREE LANE 7/27/2007BUILDING PERMIT TOWN OF NORTH ANDOVER f� APPLICATION FOR PLAN EXAMINATION Permit NO: `� '" Date Received TO BE PREFORMED: (!f /T<Z /= Identiification,Please Type or Print Clearly) OWNER: Name: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDIRMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $7 FEE: $ "!S JL, Check No.:Receipt No.: NOTE: Persons contracting with un fired contractors do not have access to the gW#��nn fund 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 DATE REJECTED a C DATE APPROVED El - DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED HEALTH 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 Located at 384 Osgood Street 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 IVU I t5 and DATA — For department use ❑ Notified for pickup - Date i Doc -Building Permit Revised 2007 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 ❑ 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 Construction (Single and Two Family) ❑ 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. 6 Date 40Rr#q TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 1 20424 Building Inspector a J 0 z O i rA .. A o w° Tas a cin 0 W z "i Wato o CIS w° C2 c U x 0 H W a a" m w 0 �' W U a W 940 u CY x o H � C7 °�° C2 m w w A �i i.r w N cA O z cin a'i Q 0 cn t ip o o= u 40 CM m C .. c N R CD O :��3p H J C m CCO mg H W H S : O O .mm H m o� C O � C. Qe m G = m :moo mom~ W._. 'O r=m.. LLm �,• C F. ,H �C.t H G W .E V = CO3 I V m 0 m c N C. _ (a m 0 y = E— $ C. w CO -mi L- it! VeH O caH C O m cm c m 0 cm c N m z O Z O g O F. A z O U v v O 43 O L O V Z °) 0. O y C cm CA p 'O CD yCD m m •CD O O 0 o c O CD O d CMQ C O � C CD c Z G3 V h O C COD c is T. Ein # 51-05033313 MA Reg. Hic # 149221 robe MA Lic. # UCS 078130 ofing Single -ply Lic. # 1711 Gvuei2932 �, 265 Winter Street, Haverhill, MA 01830 We are: ✓ Licensed ✓ Insured ✓ Factory Trained ✓Factory Certified Installers Date: 2-% //1 PPZjL- -20o-7 Estimate for:4gaizy t'IXLER Telephone 1: G 75oy Telephone 2: Address: 25 Nou-ow 2EC LV City/Town: AJ. iqwpoy-6n- State:, h%9 Zip: SSEa� A44,r c� c BBB MEMBER Job Location: Sq rr7 E City/Town: State: Zip: L.R.C. agrees to commence described work on / or about /'3 w16- and described work will be completed in about I- Z working days. L.R.C. shall not be liable for delays due to circumstances beyond our control. L.R.C. shall not be liable for any damage to landscape, attics, interior walls or ceilings and/or fixtures due to cii stances beyond our control. L.R.C. can not and will not be held liable for any damage to the surface that the disposal container is placed on. L.R.C. shall not be held liable fo existing conditions including but not limited to mold and/or wood rot, defective, faulty, rotted or worn building counterparts such as but not limited to siding, gutters, masonry, pl ing, and windows that jeopardize the watertight integrity of the building and are not covered under the roofing warranty. The following work Includes all permits, labor and materials needed to complete your job in a professional workmanship like manner. Stoop slope Quick -quote proposal to furnish and install the following: Approximate roof area Z O S, F. t/UcISE e T>6aAGE w Roof ❑ Re -roof ❑ Gutter ❑ Repair ❑ Ventilation U Prepare for re -roofing by ensuring all safety measures are taken in accordance to 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 $ 3v' ' per LF for roof deck boards. If substantial deck rot is discovered, re -sheathing of roof deck can be performe $/ � —, per SF. If individualsbeets are found to be rotted and/or delaminated, removal, disposal and replacement will be performed at $2-2-1 • per sheet. If any trim boards are rotted, replacement will be performed at $ �?s ` per LF for new pre -primed pine (not to exceed 1" x 8"). If wood is il� ound, we will re -nail any loose wood to rafters, sweep deck and prepare for roofing. �stall 8° Drip edge ❑ Install 5" Drip Edge C3Install Hug edge (Re -roofs only) ALL- Pf21 Mf-rE2 Color W 14 r7M pply ice & water shield (UNDERLAYMENT) as per manufacturers' specifications and or 2 Go v2s Es Er,Apply _# felt paper (UNDERLAYMENT) to the balance of the exposed wood deck. flash all stack pipes, tie-ins, chimneys and/or any roof penetrations as required and dictated by good roof practice to ensure water tightness. IS3' If upon inspection, we discover chimney to be worn or deteriorated, replacement will be performed at $ 3-16. 'per chimney for single flue and per chimney for mutt' le flues. i�all anew 26 Year Traditional El Architectural style shingle roof system Color Manf. nish and Install a new shingle over style ridge vent system ❑ Soffit vent system $ ' 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. specialNotes: 2642 Warranty options: ❑ Standard LRC ❑ Manufacturers Upgrade $ * Denotes additional costs above the total estimated price. UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF TEN YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. This document can serve as a contract, however if a more elaborate contract is desired we will issue it at the owners request. Please sign and return one copy upon acceptance. NOTE.• if this contract is not accepted h -days, it may be withdrawn by LRC. Financing is available A finance charge of 1.5% per month (18% per year) will be charged on past due accounts over 30 days. Total Estimate Price: $ 707S- / Payment to be made as follows: Date of Acceptance (Home/Business owner) Signature (LRC) Signature Haverhill MA 978 374-9224 • Lawrence MA 978-687-7339 • Atkinson NH 603-362.9500 • 1.888 -SOS -ROOF (767-7663). Fax: 978 521- "Our Proof is on Your Roof" unmw Inn,hortrnnitnn not The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� 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:LC- /��D/�3� Phone #: gyou an employer? Check the appropriate box: , I am a employer with dZ9 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. + ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # I must also till 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 their workers' comp. policy information. 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. #: Expiration Date: Job Site Address: City/State/Zip: 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under and penalties of perjury that the information provided above is true and correct. Si nature: Date: /'� 'd Phone #: 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. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ,p\ 07. Po�,Y,xo uea o�✓�laaoa�u�aet�O �—\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 149221 up Expiration: 1-Z10/2007 Type: Private Corporation LAMBERT ROOFING=CO RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Administrator License or registration valid for Individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid without signature IV Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement -Contractor Registration LAMBERT ROOFING CO RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 DPS -CAI 0 SOM•04/05•PC8698 Registration: 149221 Type: Private Corporation Expiration: 12/6/2007 Update Address and return card. Mark reason for chang Address [D Renewal C] Employment 0 Lost C.. Board of Buildingg RBqqulations One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Number: CS 078130 Expires: 06/02/2008 RICHARD J LAMBERT 95 -MAPLE AVE ATKINSON, NH 03811 DPS -CAI 0 50M-04/05•PC8698 Birthdate: 06/02/1972 Restricted To: 00 Tr. no: 27100 Keep top for receipt and change of address notification. CERTIFICATE OF PRODUCER Boyle Insurance Agency Inc INSURANCE ISSU13llA"1'Lr (MM/UU/ T i) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE P O Box 606 Woburn, MA 01801 INSURED T G L R C Inc COMPANY A A.I.M. Mutual Insurance Co dba Lambert Roofing Co. 265 Winter Street Haverhill, MA 01830 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH I CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COPOLICY LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE(MM/DD/YY) POLICY EXPIRATIO DATE(MM/DD/YY) LDHITS GENERAL LIABILITY GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGO. S COMMERCIAL GENERAL LIABILITY PERSONAL & ADV. INJURY $ LAIMS MADE�CCUR EACH OCCURRENCE $ OWNER'S & CONTRACTOR'S PROT. FIRE DAMAGE (Any one lire) $ MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ BODILY INJURY S (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE S GARAGE LIABILITY EXCESS LIABILITY EACH OCCURRENCE S AGGREGATE $ MBRELLA FORM THER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY NCL PA RTN ERS/EXECUTI V E THE PROPRIETOR, RXCL OFFICERS ARE: 6009966012006 08/28/2006 08/28/2007 • WC STATUO XTH- ORY S L DI EASE--P IC LIMIT S 500,000 EL DISEASE—EA EMPLOYEE S SMO 000 OTHER DESCRIPTION OF OPER.ATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR T' MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION 0' LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS O] REPRESENTATIVES. AUTHORIZED REPRESENTATIVE