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Home My WebLink AboutBuilding Permit #349 - 292 REA STREET 10/30/2012 ,AORTH BUILDING PERMIT TOWN OF NORTH ANDOVER F . APPLICATION FOR PLAN EXAMINATION *y yy* T Z h T °.pco I. Permit N0: Date Received �qs RareZ-00 t ° SAC14 Date Issued IMPORTANT:Applicant must complete all items on this page J g Z0" t IiAAE"`NOS —PARCEL ONING D�'STRICTHistarJc Dis#riot yes r 'n 4 s 1111 tip V�Ilag es 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 ❑Sept►c ❑111Je1fi� 3 Floodplain n". -ib❑ illfatershed7D�istrictj r � y❑Water/Sewer;- � � � ` DESCRIPTION OF WORK TO BE PREFORMED: �S r Print Clearly) Please Te o y) OWNER: Name:?denti"cation 2Phone:Addresse Q S%ffiG'�l ✓�/� �/�d'Q�/�� TSS, d�� Ei- �CONTRACTORName 1?hone Zrl °EAddress K" , a � x Supervisor's C6httruetion L�censea x _ Exp' pate t Nome Improvement L, In - Epp Date w r'' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 660 FEE: $ �� Check No Receipt Receipt No.: NOTE: Persons contracting with unre istered contractors do not have access to the g aranty fund All .. � Signature �?f Agent/Ovvner ighature of contractor s 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Toning 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 FIREDEPA�TMENT TempRDumpst�r,on site yes �o Located at 1 24 Main Street, r ar _ k Fire Department signature%date Wu tr .s. L A 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.s10o-s1000 fine NOTES 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 ❑ 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 allcases if a P P q 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 Locatio No. Dat • ' TOWN OF NORTH ANDOVER • Certificate of Occupancy $ 4 Building/Frame Permit Fee $ "t Foundation Permit Fee $ Other Permit Fee $ TOTAL Check#-�O � 25884 Widrng Inspector NORTH F Town of E �. Andover No. - o y ver, Mass, lo C30 • l c�--- coc is Nl WICK , ! 04ATED U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT it A.A . ... BUILDING INSPECTOR ............ ....�i. G� has permission to erect :......................... buildings on ... :.t -... ................. .�............................ Foundation Rough .... to be occupied as ..... ..... ....... ... .......................&.-- on ....... ....... ................................................... Chimney provided that the persona cepting this permit shall in every respect conform to the terms of the application Final 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES. lid FMNTHS ELECTRICAL INSPECTOR Ui�LESS CONSTRUCTITA Rough Service ............... ...................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. i Smoke Det. SEE REVERSE SIDE 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:—. ,? ,� 'ViXIleg S7- City/State/Zip: i` �L�p/� fj Phone 4: re you an employer?Check the appropriate box: Type of project(required): 1m a employer with_9 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. y p t3'• 9. F]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 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 12.❑Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] OAny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ram an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site reformation. :assurance Company Name: ' 1�/I olic #or Self-ins.Lic.#: y ��7` Expiration Date: fob Site Address: .�% �� City/State/Zip: attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ,ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 ,f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby cernify under t ains and penalties of perjury that the information provided above is trite and correct. ;inature: � � 30 Date 'hone#: 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#• 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 deemed 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 confirmation 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 reference 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 T _ www.mass.gov/dia EIN#51-050-3313 ambe Haverhill MA 978.374.9224 MA Reg.HIC#149221 Lawrence MA 978.687.7339 '_ MA Lic.UCS#78130 Hampton N14 603.929.9224 BBB. Single-Ply License#1711 ®o �� g Y Hampstead NH 603.329.8200 "S±,v�ce�2932 CO- 265 Toll Free 1.888.SOS.ROOF Winter Street Haverhill MA 01830 Licensed -Insured :Factory Trained ;:Factory Certifi Name: Date: fO Telephone: Alt.Telephone: Email: 4 Billing Address: 1129i—/Ce"L City' ,'' G't ` G ��.�' State Job Address: ate.^- City: State: Scope-of WorkIB_q p aP"fin Re-roof ❑Re-roof Approximate Roof Area: ®off' are for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected. I, 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 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*$ _30— per sheet. If any trim boards are rotted, replacement will be performed at*$_zO=_per LF for new pre-primed pine.Inspect siding at roof line and all flashing behind siding,if we discover any damaged flashing or siding at the roof line,replacement will be performed at*$ elQ .If wood deck,siding,and f!�ng is sound,we will re-nail any loose wood to rafters sweep deck,and prepare for roofing. ❑ 1 stall 8"drip edge to all rakes and eaves.Color �1�~ n Apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or ��IIfupron ly premium(UNDERLAYMENT)to the balance of the exposed wood deck. ashallplumbing stack pipes, and any roof penetrations as required and dictated by good roof practice to ensure water tightness. inspection,we discover chimney lead to be worn or deteriorated,replacement will be performed at*$ �Tnstall a new: �"� Year ❑ Traditional �.A • ctura' ❑ Designer Color Er-flaiish and Install a new shingle over style ridge vent system ❑Soffit vent system *$ 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 ertig integrity of the building be compmised. Special Notes 4-'e I ;"� �' �� G�c,,--- UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF e<�_ YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE *$ *Denotes potential additional costs above the total estimated price. TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work/furnish the material d labo ecif pd above for the total sum of: $ � C (Dollars) Payment will be made according to the following work schedule: $ ;.2 eOi41. 47G deposit upon signing contract by_/_/_or upon completion of $ `^ 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 67t Home Owner(s) Signature(s): 75 Date: /,r / i Contractor's Signature: % '®' Date: /-::5F—/ www.lambertroofing.COm (Please see reverse side) ACOW0 CERTIFICATE OF LIABILITY INSURANCE DA TE J MAND01Y YY Y) 1 08,127/2012 THIS CERTIFICATE )$ ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND T14F CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(jes)must be endo ad, If SLIBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of Such endorsement(s). PRODUCER CONTACT---- NAME: Jerrold Karneras ALLAN INSURANCE AGENCY ITNC. PHONE 1AIC,No. (978) 745-5905 rix 973 '145-S4 63 j 63 1/2 Jefferson Avenue 2nd Floor t-mAIL - (AfC�No -A_nDRrzss.-, errold@alla.qins-oxance.com P-0- BOX 511 SALEM. MA 01,970-0511 INSURER(S)AFFORDING COVERAGE N A T�' ------- -,INSURERA:Seneca Special�y_jns- Co- IMSURED, fNsuRER B:Saf�t .�Y..surance Co!Lioanv MSURER C.Al terra Excess & Surrlus Ins. cUba Lambert Roofing Company -INSURERI):Ace Ami ercan Insurance Co. 265 Winter Street INSURER t: lHaverhill MA 01830- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I`PIS IS -10 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOXIV HAVE BEEN ISSUED TOTHE INSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTOsITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER 00CUMENTWITH RESPECT TO Vv�jllcii- K' � S CERTIFICATE MAY BE !SSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE IS SUBJECT TO AU L EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS, THE TERMiS. INSR ADDLISUBRI T TYPE OF INSURANCE INSR VTIM I POLICY N TO—LICYFFF —EOCR�Tww LIMITS GENE-PAL LIAMLITY FACH OCCU'RENCE S 1,000,000 X COMMERCIAL GENERA[.LJA134J—i C-AA4AG-'rjS�—ilu-4I-}.' fEa Z'ZCurrk., S 50,coo A r-1A,%IS-,,,AD1- Lt?CCLIR 1.1000 "ED—E-xv"'1- RSONAL&ADV tf,JJV�!�I' 1,000,000 :9305 .[,GAT IMENE At AGGRVG'rf-- 1 2,000,000 H AVPIJE�i PER E LI P,0, PP(J-D-!';G-'S-COk,03 W AGG, 'T' 2,000 u I oocy 1 AUTOMOBILE LIARMTY ODO ANY AUTO I X F,Li-0 NN SCHEDULED 16203819 A, B(jDlLy jWj_,Ry'rp, ' x D X I-PRED A:',!1`05 Aj-,,(.)S PROPERTY DAMAGE i UMBRELLA LIAB XOCCUR --4 C-,A,'F1 OCC;JRPIENCE V. 5,0o0,o 0 o EXCESS LIABCLA$iS-MADE Vmx3EC50000040 / / / / - GREGAJ E 1 s 5,poo.000 I Gni? RFTENIIQN� 11/21/20 11 ill/12/2022 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY x P ti ANY I"POPR IAI El�EACH ACC-MEN3 ft"GndatM in NHF I D i 142554 08/228/201 8/28/20131 i, -.�,,r.3 r F�L MSEASE'.EAEMPU DESCRIPTION OF OPE:Pj�:TIONS bcHovt 1—�� --L 0001 000 E L.MSIASE 11000,000 DESCRIPTION OF OPERA"PONS I LOCATIONS I VEHICLES (Attach ACORD 101.AdditionM RenjarRs sctiedute,if morespace is required) CERTIFICATE 1-40LDER CANCELLATION TGLRC, inc. SHOULD ANY OF THE ABOVE DESCRIBED PCNL[DAYS RE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVESZO IN ACCORDANCE WITH THE POLICY PROVISIONS. DBA Lambert Roofing Co. 265 Winter Street ALITHORJZFD REPRESE14TATIVE Haverhi 11 M- 01830- ACORD 25(2010(05) 1988-2010 ACORD CORPORATION. All rights reserved. INS025 The ACORD name and logo are registered marks of ACORD t 4 C.S-078130 RICHARD J LAMBERT 245 WINTER STREET Haverhill MA 0193o 0610212014 _ Y o/W/ ✓mer Office of Consumer Affairs and business Regulation 10 Park Plaza m Suite 5170 Boston, Massachusetts 02116 Morrie Improvement Contractor Registration Reqistration: 149221 Tvpe: Private Corporation Expiration: .,1:2/6/2013; T r# 218746 T.C.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT ----- _—_ -- --- -- 265 WINTER STREET — HAVERHELL, MA 01830 Update Address and return card.Mark reason for change. Address _i Renewal '--! Employment .I Lost Card The- Commonwealth of Massachusetts Department of Fire Services Office of the State.Fire Marshal P:0.Box.I025 SratcRoad,Stow-NL4 01775 APPL1CATlON FOR PERMIT Date: N. A nA o v e r Permit-No Dig Safe Numb (City or Town.) (if Applicable) In accordanar with the provisions of NLG1. Chapter 10 as / f2 providedinSectica 527 . CMRe;4 applicatio¢,shereby made _ Start Date byeeoR " (Fullname.of person,Firm: rporadoa) State clearly Address �'fy��% �Sl�'�c purpose for (Street or P.O.Box City or Town) which.per mit Forp.emussioato laca.te dumpster for const ruction/renovati nn /riamnl i ti nn is requested . of building. Comments-'-, dumpster must be .25 '/froji st ucture or coverede at (Give location by shut and no.,or descri a in suchmauner as.to provied adequate identification of location) Name of competent-operator Cert N.C. (IfAppdable) Dattlssued-rejected By (Signature of-Applicsnt) " Date eecspiration Fee S 50 .00 Paid Due s The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire-Marshal P.0.Box 1025 StatepRoad,Staw,M.4 OI775 PERMIT Date: North Andover ]Permit No er (City of Town) (if Applicable) � Di gSafe Num In accordance with the provisions of N G.L.14 8 Chap.ter1(L as provided in section• 5 7 7 f lMR 34 Start Dace This Permit is granted to: FuU name ofperson,Firm or Corporation Permissioato locate dumpster for construction/renovation/demolition of building. Comments dumpster must be , 25 ' from structure if unable to place with required Restrictions:clearance dumps-ter must be covered with Plywood or tarp end of 'work -day at _ (Give location by street and no.,or descn-be in such manner as to rovied equ to identification of location) FeePaid$ 50 .00 Fire Chief This Permit will expire. (S ignature o r&n ting perm) 5fEical granting permit (Tide)