HomeMy WebLinkAboutBuilding Permit #212 - 39 SUTTON PLACE 9/26/2007 (3) NORT11
BUILDING PERMIT 0 "'U190 .6
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TOWN OF NORTH ANDOVER o? 6
APPLICATION FOR PLAN EXAMINATION 4t 70
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Permit NO: Date Received �q�rEo 4y
9SSACHU`���
Date Issued: h`
IMPORTANT:Applicant must complete all items on this page
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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
Selaft�c U17e11 _ Floodplatrt� 1�taads Wafhe ?�strict
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DESCRIPTION OF WORK TO BE PREFORMED:
77n
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address: _70" S7—
_
s-004WTR14
cTOR ( ae�
4�5 MON
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Su,pnr�sor'sTCcstrution�Lcerrs
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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: $ 7, FEE: $
.-Check No.: / Receipt No.: ���
NOTE: Persons contracting wi nre 'stered contractors do not have access to the guaranty fund
SgnafiureofAcent/�wner _ _ •S�gna#ure df contractor
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
A
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Siinature&Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
A'
F?REDE� Rfi1�lE y x L
-'771-7t1 'p �. 'D. .S1iP..�
"Locatea at 129 4-- ¢ �, M & q
�..' ,'
Fireepartments�grrt»rellate � t �
n "s�+..:.,.� �n
,��:
COIYIMTt7 ,xna t .�, : r� k Y4 # rv�t � r
i.
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
NOTES and DATA— For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
i
f
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
i
❑ Building Permit Application
❑ Workers Comp Affidavit i
❑ 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
i
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
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
P p 9
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
Location �1 ��� ✓� sr
No. Date
f
NOR*� TOWN OF NORTH ANDOVER
Certificate of Occupancy $
�'�s'•^° Eta' Building/Frame Permit Fee $ _
MMus
Foundation Permit Fee $
t �
Other Permit Fee $
TOTAL $
Check #
r
21 5 �6
Building Inspector
8 /25 / 2008 3 : 07 :46 PM 8740 2 02 / 02
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3 `+. I E D \''F' 081125/_71008
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THIS C. TFICATF IS ISSUED AS A MATTER OF INFORMATION ONLY AND
'Ulan In urance Agency Inc CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTII'1CATE
IP 0 Box 51 1 DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
�SLlem,MA 0 19 70 -- -----------------_--. ...
COMPANIES AFFORDING COVERAGE:
—
IrGLRC' Inc
clba Lambert Roofing Co. COMPANY A A.I.M. Mutual Insurance Co
'265 Winter Street LETTER
Haverhill,MA 01330
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ua;,xh,.?,., ,r• ,``L., :'t 3�,,.+. r ,ti,,.: 1a,4,.i'.•c .;n t v, '. `Z`.1be.Z. `y..,,«sS«,Ss,;:<%''�«g8'«;4 xs««ka«t,.-,««;3w:�i,*:,•«*`ts;S1;�M1�.kS 'Z S ,
:` ,'.tfifi.t.,Y,'Ixti•«i{»'; `��'Zi'§`s'ati ti `�3{, .{:•,hs��«,..ird�,t`;tbi�+d;.rY?,{,tlt{taS{-a?3�l.Iy'iY;rt«�Tdt.,`n.2j# d.s '`{i.5ir3tsit .,.�t,d,,.'c�E4Y':? ;
! THIS IS•1'O CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIC'
PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEC.'
TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HFRETN IS SUBJEC
TO AIL THE"PERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
STI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITSDATE(Mlii /YY) DATE(MMIDD/YY)
j GENERAL LIABILITY GF.IJ EF:AL AOOR E7P.l'E 1
t
._P_ ___—
i Ir PRI:�D!ICTS.-.
MIM ER.;IAL GEN ER.AL LIAE-ILIT'r
' PERSl:-t•IAL&AU`.' IIJJiIR`,' :4
I[-1[--I'LAI MS MADE F__�i1,-,�,UR
i —
I EA H VRh RI C '
WNEF•'S�'4JTP.A.J'iu RS PR07 .._ .. .. -._. _ -.-.. _.. .. _..
FIRE DAM..OL(A ns brei f
MED EXPENSE
AUTOMOBILE LIABILITY — —
,;UM P.UJED SIN,,ILE t
LIMIT
ALL:)WrJED AUTOS BIIDILY INJURY
INANY
SCHEDULED A171:11 (Pet person) I _ ---
HIRED AUTOS
NON,jWNED AUTOS BODILY INJURY
GARAGE LIABI LITY (E'er acclAeul) 5
I
PROPERTY DP.MAGE
EXCESS LIABI LIT EACH OCCURRENCE 9
�UPARRELLA FO RM AGGREGATES
OTHERTHAN LIMBRELLA FORM `e;J(;yaiSi tii^S'„+,`tSS,'%.''i`isiL�lSa?i'ww",.+;«„3
4:$rYe '"o �• �::,+ f l�x,n.3., .ysa4ilAr�,,y,•.Vlur;'''S+iK).xJ�.i."t
WORKERS COMPENSATION AND STATUTORY LIMITS OTHER
EMPLOYERS LIABILITY X
HE PROPRIETOR/ EL EACH ACCIDENT $ 1.000,000
A PARNERS\EXECUTIVE
OFFICIERSARE 6009966012008 08/28/2008 08/28/2009 EL DISEASE•-POLICY LIMIT 1000,O0O
• RdCL C�EXCL
EL DISEASE--EACH
EMPLOYEE
C'ONIMI;NTS/DESCRIPTION OF OPERATIONS OR LOCATIONS:
lWORICER.S' CONIFENSATION COVERAGE APPLIES TO MASSACHUSETTS EMPLOYEES ONLY
II
i
_ I
'«Vi _nABOVE
a`.SHOULD
`O.ULtxnD'^AkN,...Y'.,O•F�Z1T,aHiz,E ABOVE DES..,C..z.Rl,.IBEk-tD PYaeOL«S sICZkI2ES.;B.s;r1?E;',u•,.CAN.,a.til%,ur',CAlwg.w.,E��t L,lY.lL�,E.koD BEFO£hR•°>t1Ev5MiYTtnItZ tE+.iN\Tt�xI�RtA}T«l�IiaO,i.,.N\:�D.1.\SsSA,
«T..E
HEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 WRITTEN NOTICE TO THE CERTm xCb
'.A:T_
OLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
OR LIABILITYOF ANY KIND UPON TIM COMPANY,ITS AGENTS OR REPRESEN I.A'I'IVES.
UTHORI-LED REPRESENTATIVE
4791 -
NORTIy
Town of Andover
No.
= Or dover, Mass.,
• WN0 LA o
/fesCOCHICHEWICK
ADRATED i �C
S BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT......... A A.V ..^....... ........ ...�.�..�.I..��
Foundation
has permission to erect....................... ............... buildings on ��I........�V. .1#.....JZ.......................... Rough
t0 b8 occupied aS......... .. ..�..... ...... .. �.. Chimney
.................. . .:...............................................
provided that the peri cceptl this permit shat every respect conform to the s of the application on file in Final
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
$6 . PERMIT EXPIRES IN. 6 MONTHS
UNLESS CONSTRU ARTS ELECTRICAL INSPECTOR
Rough
Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.
The Comptonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street -
e�
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information f Please.Print Le ibl
Name (Business/Organization/lndividual): . 1141
Address: Sr GU/%�%C� S'%
City/State/ZO/,hone.#: � ��
Are you an employer?Check the appropriate box: Type of project(required)-
1.MI am a employer with t?V 4. ❑ I am a general contractor and I
employees(full andJor part-time).* have hired the sub-contractors 6. E]New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. F-1.Remodeling
Ship and have no employees These sub-contractors have g_ ❑Demolition
workingfor me in an capacity. employees and have workers'
Y P t3' $. 9. ❑Building addition
[No workers' comp.insurance comp.insurance.
required.] 5. ❑ We are a corporation and its. 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised.their 11.❑.Plumbing repairs or additions
myself. [No workers' comp. Tight of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),.and we have no
employees..[No workers'. 13.❑ Other
comp,insurance required.]:
*Any applicant that checks box 41 must also fill out the.section below showing their workers'c4.mpensationpolicy 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: L I-,V7
Policy#or Self-ins.Lic.#: elo �61�9l2,Q D h� Expiration Date:
Job Site Address:J 2 S4//1 SE City/State/Zip: ego
,
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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify un er the pains and penalties of perjury that the information provided above is true and correct
Simature: Date:
Phone#: l �Q
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#:
Boar u"i I cl=n gg e agu I a at/o�n't s/an =and�arcls
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 149221
Type: Private Corporation
Expiration: 12/6/2009 Tr# 262486
LAMBERT ROOFING CO
RICHARD LAMBERT
265 WINTER STREET
HAVERHILL, MA 01830
Update Address and return card. Mark reason for change.
Address Renewal i- EjnpIoyrncn t Lost Card
CPS-CAI D 5OM-07/07-PC8490
Board of Buildin--, mid �tandard"
Construction Supervisor License
License: CS 78130
Restricted to: 00
RICHARD J LAMBERT
95 MAPLE AVE 4
ATKINSON, NH 03811
Expiration: 6/2/2010
Tr= 27762
Ein#51-05033313 T.G QPSSERN M4,,
MA Reg. Hi(# 121981 ii
" ry
MA Li(. #UCS 078130
ofngd B
Single-ply Li(. #1711 cY+"<-. 2 2'ag
265 Winter Street,Haverhill,MA 01830 MEMBER
We are: ✓ Licensed V Insured ✓ Factory Trained V FactoryCertifiedInstallers
Date: �J I Imo! �J1 '} Estimate for: 1'y/42-1f/ �!/1�A�AiIICAy
Telephone 1: Telephone 2: 276 6 :5-.5196
Address: '3 fU�U%!C3�J j- City/Town: OJ?H 1�-ID61107- State: fit- Zip:
Job Location: City/Town: State: Zip:
L.R.C. agrees to commence described work on/or about /-3:.I,t1KS -and described work will be completed in about Jworking_days.I.R.C. shall not be held
liable for delays due to.circumstonces beyond our,control..11k shall,hot be'liable for any damage.to landscape,attics,interior walls or ceilings and/or fixtures due to circum-
stances beyond our control..L.R.C. can not and will not=be held liable for any damage'to the surface thatthe disposal container is placed on. L.R.C. shall not be held liable for pre-
existing conditions including but not limited to mold and/or wood rot,defective,"faulty,rotted or worn building cob nterpartssuch as but not limited to siding,gutters,masonry,plumb-
ing,and windows'that leopardize_the watertight integrity of the building and arenot covered under the roofing warranty.
The following work includes all permits,labor:and materials needed to-complete your;job in.a professionalworkmanship like manner.
Steep slope Quick-quowproposal tofurnish;and instali.thefollowing: Approximate roof area vZ 10
C11 New Roof ❑ Re-roof ❑ Gutter ❑ Repair ❑. Ventilation
®'P epare for re-roofing by ensuring all safety measures are to ken:iayccordance to OSHA standard regulations and landscape is properly protected.
Remove existing layers of roof material down to roof deck and inspect wood. If upon inspection we discover ony.rotted wood,replacement will be performed at
S per LE* If substantial deck rot`is discovered,re-sheathing of roof deck can be performed at S .% 2S per SF.* If wood is sound,we will
r -nail any loose wood to rafters,sweep-deck-and prepare for installation.
C9' install 8"Drip edge ❑ install 5"Drip Edge ❑ Install Hug edge(Re-roofs only)< AeG .P'61Zt rn Color
pply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and or .Gou,2s s
VReflash
pply ."� #felt paper(UNDERLAYMENT)to the balance of the•exposed wood deck.
all stack pipes,tie-ins,chimneys and/or any r° ' irotio�s as required and dictated by good roof practice to ensure water tightness.
❑ .Re seal chimney base using cement&ff ric. �" Re-Lead ❑ Re-point chimney ❑ Re-build chimney $
Zall a new ' Year CT Traditional ❑ Architectural style shingle roof system Color GV,$,.V Monf.
rish and Install anew 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.
Special Notes:
f tl 0ye f Dowii' c?ui " fw1j ' 4'4_
Warranty options: C9'Standord'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 . 2 S^ YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER:
This document'conserve as o€ontradhowever,if a more elaborate contract is desired we will issue it at the owners request.
j Please.sign and.return one copy uponacceptance. _NOTE:if this contract is not accepted in days,itmaybe withdrawn by IRC.
NOTE: We accept major-credit cards*"&finai.itng.is avajlable! *Due to merchant related costs there will be a 2.3%service charge.
*A finance charge of 1.5%per month(18%-per year)will be charged an past due accounts over 30 days.
Total Estimate Price: $ / Date of Acceptance
Payment to be made as follows: (Home/Business owner)
/ Signature
f �lP`1 L /1,0A./ (LRC)
Signature
Haverhill MA 978 374-9224 • Lawrence MA 978-687-7339 • Atkinson NH 603-362-9500 • 1-888-SOS-ROOF (767-7663) • Fax: 978 521-5791
"Our Proof is on Your Roof"
www.lambertroofing.net