HomeMy WebLinkAboutBuilding Permit #060-15 - 4 EAST WATER STREET 7/17/2014 NORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER24ry,� ` 0�
PLICATION FOR PLAN EXAMINATION801
a
Permit No#: Date ReceivedTED
/ ��SSACHUS����
Date Issued: '
MPORTA IT:Applicant must complete all items on this page
LOCATION _ 1 �'< S2
.--tet
PROPERTY OWNER zZid 0 Z2
q Print o Year Structure Ve!/
no
MAP l PARCEL: ZONING DISTRICT: Historic District Machine Shop Village o
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
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
w
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name4p4k � hone:
Address: /
c�lv
Supervisor's Construction License: Exp. Date: -' �Z
Home Improvement License: /Y'�7(�0 Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.MOO PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ b d FEE: $ ' 1 �r
Check No.: L �� J
< < Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of A ent/Owner
9 _ �irj-nature of contractor
4r�Location 0,-,T ki r,
No. v Date —711
• - TOWN OF NORTH ANDOVER
f
Certificate of Occupancy
aar
Building/Frame Permit Fee $4, .�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
6-4
Building Inspector
Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑
_T_Y_P_E_.O.ESEVi-ERAGE_DISP_O_SAL—
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiiiuping 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 Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
�E: A'
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
i
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Di.mens_ion
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)
i
I
❑ Notified for pickup Call Email
Date Time Contact Name
i
Doc.Building Permit Revised 2014
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
o Building Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
Li Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
Li Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
Li Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
Li 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:Building Permit Revised 2014
NORTH
own of E ndover 0
h ver, Mass, "
coc�Ic"t.... 1'
.QAo ft`s
Argo jk?
S V
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ... BUILDING INSPECTOR
.................-;►-11GG ............. ..............................
................ Foundation
has permission to erect .......................... buildings on ....... ........�.:....�.�...............��
Rough
tobe occupied as ..............s... .. .... ....�-... �� ............................................................ Chimney
provided that the person accepting this ermit shall in every res t conform to the terms of the ap lication
p Final
on 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 IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI S3 TS Rough
Service
.................... ............. .......................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required 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.
Smoke Det.
TGLRC Inc. dba Lambert Roofing.:Company =
... M In Business Since 1932
T-
am6e �
SLvcr 2932�g
July 17, 2014
Name: Mr. Glenn Gary Construction,
60 Island Street Lawrence,MA 01840
(978)557-5981 /ggary@glenngarygc.com
Job Site: 4 East Water Street North Andover,MA 01845
New Residential Steep Slope Roofing System Contract
TGLRC Inc. dba Lambert Roofing Company will provide certificate of insurances demonstrating
that we are fully insured for workers compensation, general liability, automobile liability and a
$5,000,000.00 umbrella policy. This documentation will be sent through the US mail or VIA E-
MAIL/FAX to the above named party if not already provided.
Upon completion of the roof and final payment, a manufacturers standard warranty will be
issued and a 10 Year Workmanship warranty from TGLRC to above the named party.
Work to be Performed And Materials to be Utilized
Conditions:
• A manufacturer's standard warranty and 10 year on workmanship from TGLRC.
• Under no circumstance will the watertight integrity of the building be in any
way compromised.
• All work will be performed to the standards and expectations dictated by
the(IBC)building code and proper roofing practices found in the NRCA roof
covering and waterproofing manual and manufacturers specifications.
1) A pre-roof walk around will be executed to observe and document any pre-existing
conditions and or any special considerations.
2) Ensure landscaping and dwelling is and will remain properly protected.
Please take special note that during demo of the existing roof system all valuables non-
fastened are subject to falling during demo and debris will fall in the attic so preparing
for this will reduce a disappointment and inconvenient clean up.. Lambert Roofing
will not be responsible for the above mentioned preparation.
3) Prepare for re-roofing by ensuring all safety measures are taken in accordance with
OSHA and CMR Standards. . _
1
EIN#51-05033313. 265 Winter St Haverhill,MA _
MA Reg..Hic# 149221 n Phone(978)374-9224 Fax(978)521-5791
A14-DE UCS 078130 0 . E-Mail at lambertroofing,(a)aol.com
Single Ply lac_41711 -Please visit us on the Web at WWWAambertroofingmet i-.s_ i >4 +� �•.: . .zrz. ;.:i_ w�,;. ;.s
TGLRC Inc. dba Lambert Roofing .Company_
_ In Business Since 1932
4) Remove existing layers of shingles down to the wood roof decking and properly
dispose of debris from the jobsite. T.G.L.R.C., INC. will arrange for disposal.
5) Inspect wood roof decking, if we discover any rotted wood, removal and replacement
will be performed at an additional cost of-
*
f• $3.95 per foot for rough pine removed and replaced.
• $65.00 per sheet of CDX Plywood removed and replaced.
• $12.00 per foot for trim removed and replaced.
6) Labor Rate $65.00 an hour,per man,plus materials.
If we discover any pre existing conditions we will notify owner for approval. No work will be
started without notification and owner approval. If wood roof decking and trim is sound, we
will re-attach any loose wood to the rafters,sweep deck and prepare for installation.
7) Attach aluminum F8 drip edge to all leading edges. Color(White)
8) Apply Starter Course to rakes and eaves and ice and water shield to the leading edges
6'up and all roof to walls,valley's, chimneys and penetrations. The balance of the roof
deck will receive a synthetic.roof wrap. _ .. . .
We use, as our standard,a hurricane nailing system recommended4n:north-east
regions This means, we install six(6) nails per shingle to reduce the risk of shingles
being damaged by high winds and the weather changes we encounter.
9) Install a new GAF TIMBERLINE HD "OYSTER GREY"limited lifetime Architectural
style shingle roof system.
10) Install new premium Ridge vent and Ridge Caps.
11) All debris generated by TGLRC Inc. dba Lambert Roofing Company will be
cleaned up on a daily basis and properly disposed of from the jobsite.
CHIMNEY RE-LEADING AND NEW RUBBER EPDM ROOF ON SIDE
LOW SLOPED ROOF IS INCLUDED IN THIS CONTRACT
Roofing Warranties:
UPON COMPLETION AND PAYMENT IN FULL A MANUFACTURERS WARRANTY
AND A 10 YEAR TGLRC WORKMANSHIP WARRANTY WILL BE ISSUED.
TGLRC Inc. dba Lambert Roofing Company agrees to:
• Commence the described work on or about JUNE 10TH 2014
• The described work will be completed in about(2)working days per Building
• Shall not be held liable for delays due to circumstances beyond our control
2
EIN#51-05033313 - 265 Winter St Haverhill,MA
MA Reg.Hic#149221 Phone(978)374-9224 Fax(978)521-5791
MA Lic. # UCS 078130 E-Mail at lambertroofmg@,aol.com
Single Ply Lic. #1711 Please visit us on the Web at www.lwnbertroofing.net
_ I
TGLRC Inc. dba Lambert Roofing Company y
In Business Since 1932
• Shall not be held liable for any damages to landscape, attics and or fixtures due to
circumstances beyond our control
• Shall not be held liable and roofs are not covered under the workmanship warranty,
for pre-existing conditions including but not limited to:
o Mold and or wood rot
o Defective, faulty, rotted or worn building counterparts such as,but not limited to:
siding, gutters, masonry,plumbing and windows, all of which may jeopardize the
watertight integrity of the structure if not in sound condition
• Unless otherwise noted within this document,the contract shall not imply that any
lien or other security interest has been placed on the residence
Required Permits
A building and dumpster permit may be required to remove and replace your roof. It is
our obligation to secure these permits if required as the homeowner'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
Additional Attached Documents,Agreements or Provisions }
• Insurance Documentation if not already provided
• Arbitration Agreement
• Contractor Registration Information
• Notice of Cancellation Form
- This contract is the complete contiact"unless a signed Change OrdeP f►as b`eenfexeeuted:between "•lcc. s`r.�. :
TGLRC Inc.dba Lambert Roofing Company and the Homeowne
Contract Price and Customer Obligations 4-; �=-Z:_
- The total cost for;all permits, warranty, labor and-materials-is.
$9,800.00
------NINE THOUSAND EIGHT HUNDRED-------
Payment Terms: To Be Determined
• A finance charge of 1.5 %per 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 TGLRC Inc. dba
Lambert Roofing Company before the work begins may not exceed the greater of
3 .
_. EIN#51-05033313 265 Winter St Haverhill,MA -.
MA Reg.Hic# 149221 Phone(978)374-9224 Fax(978)521-5791
MA Lic. # UCS 078130 E-Mail at lambertroofine(a,aol.com
Single Ply Lic.# 1711 Please visit us on the Web at www.lambertroofing:net t-r s � _ . u,,• :<t ;,,�� .,,
Fwd;Contract imap://mail.lambertroofing.com:993/fetch>UID>.INBOX>457?hE
II
UUM Inc. d Lambert Roofing Company
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Board of.150ding Re Mations a a2;����r.,
r.-e-rse CS-078130
ppI//HA.RD
265 VVDMMI STREET.
HaverMU MA 101830.
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Office.of Consumer Affairs and Business "Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 149221
TYPe: Private Comoration
T.G.L.R.0 dba Lambert Roofing Company Expiration: 12w615 Tr# 24m13
RICHARD LAMBERT
265 WINTER STREET
HAVERHILL, MA 01830
Update Address and return card,Mark reason for change.
[] Address (3 Renewal Employment E] Lost Card
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na►ne a logo are red Rmft of ACQE��
the Commonwealth ofMassachusetts -
Deparku nt oflizdifstrigl Aceldents
Office o,f Investzgatrons
600 Washington Street
Boston,AM 02111
wommass govIdla
Workers'Compensation Insurance Affidavit:EuiXderslCony°actors)ElectricianslPlt*T
Applicant Mornaatiton Please Print Le 'bX
Name,(Business/ ''za'onllndzvidual): '
Address:
City/Stade/dip: C� hone#: ����
.Are you arm employer?check the appropriate box: Type of project(required):
�
4. []I am a general contractor anI�mployex with d b. New cdnstzuction i
employees(i'iallanc7loxpaxt time)* have hired the sub-contractors
2.E] I am a sola proprietor or partner
listed on the attached sheet. 7• Remodeling
ship and`haveno.employees These sub-contractors have 8. []Demolition
wort ing for me in any capacity. workers'comp,insurance. , g. []Bullft addition
PTO workers'comp.insurance 5. [(We are a corporation and its 10.[]Electrical repairs or additions
required.] officers have exercised-their
3.❑ 1 am a homeowner doing all work right of exemption per MGL ll.[]Plumbing repairs or additions
myself:[No workers'comp. c.152,§1(4),andwehaveno 12.❑Roofrepairs
insurancare ed.]i employees.[No workers'
comp.insurance required.] 13.❑Other
Mny applicant that checks box#I must also fill out the section below sfiowingtheir workers'compensationpoHoy information.
f'Homeowners who submitthis affidavit indlcatingthey 94 doing allworle and then hire outside contractors must submit anew affidavit indicating such.
lContractors that cheekthis box must attached an additional sheet showingthe name ofthe sub.-contractors andtheir workers'comp.policy information.
lam an employer that sprovidittg workers'corpzpetzsatzon insr�rance foam employees Beton is the v lie car2cijoh Me
information.
Iusuxance CompanyName:_
Policy#or S elz ins.Lic.#: ? ( Expiration.Date:
Cz /State/Zi �S�'
lob Site Address:
.Attach a copy of Me woxlters'comp ensationTolzey declaration page(showing the policy mmBber and expiratzola date).
)Failure to secure coverage as requixedunder Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of a
fine up to$1,50 0.00 andlox ones TWO
iviprisonment,as well as civil penalties in the form of a STOP WORT,ORDER and a fine
ofup 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.
Xdohereby eertfunder tliepaWandpenaltiesofperfaaryMat Meinformationproviderd�Jalcoverstreeandeorrect. -
Sim Date:
Phone#: ? ��
Oficial use only. Do not write hi this area,to he co&Wleterllry city or town official
City or Town: Permi(Mcense#
Issuing Authority(circle(3ne):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Piectrical Inspector 5.Plumbing Inspector
6.Other - - -
'01, 4b
Information and Instructxons
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation fox their employees.
Pursuant to this statute,an ervployee is defined as"...everypexson in.the service of another under any contract ofhire,-
express orimplied,oral orwxitten."
An empfoye�iq defined as"an individual,partnership,association,corporation or other legal entity,or any two oxmoxe
Of the A6regoiugengaged inajointenterprise,and includingthelegalrepxesentatives ofaAoceasedemployex,.ortbe
xeeeiver or tnistee of'an individual,partnership,association ox other legal entity,employing employees. However the
owner of a dwelling house having notmore than three apartments and who xesides 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 orbuilding appurtenant thereto shall not because of such employmentbe deemed to bean employer"
UQL chapter 152,§25C(6)also states that"every state or Ideal 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 regnired."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance
xequimments ofthis chapterhave beenpresented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
heeegsary,supply sub-contractors)name(s),address(es)and phonenumber(s)along with their certificate(s)of
insurance. LimitedLiabilityCompanies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
mclubers orpartners,are notrequired to carry workers'compensation insurance. If au LLC orLLP does have
employees,apolicyisrequired. D a advised thatthis' affidavitmay be submitted to the Department of Thdiistrial
Accidents for confirmation of insurance coverage. Also be suxe to sign and date the affidavit. The affidavit should
be retamed 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'
compensationpolicy,please call the Department at the number listed below. Self insured companies should enter their
self-insurance,license number on the appropriate line.
0ty or Town Ofncials
Please be sure that the affidavit is complete andprintedlegibly. 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 pennit/lzcense number whichwill 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(ifnecessary)and under"Job Site Address"the applicant shouldwxite"all locations in (city or
town).".A:copy ofthe affidavit thathas been officially stamped or marked by the city or town maybe provided to the
applicant as Proof a valid aft%davitis on f1e fox future permits or licenses. A new affidavit must be flied out each
year.Where a home owner or citizen is obtaining a license ox permit not related,to any business
or commercial venture
(i.e.a dog license orpermit 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 cfuestions,
please do not hesitate to give m a call.
The Department's address,telephone and fax number:
Tho GQxr_ Qxl-woalth of -
PaPaftcul Ofkdu*ial AaddoiM
• (.�f�ce o�'Tu�'e�ti�a�Zo�� '
X44 Wasigtm street
:Boston,MA 021It
TO, 6174- 49
247, W- 406 or 1-8,7-7-
M
Revised 5-26-05 F0 �
WWW—Mavago.-VI(Iia.