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HomeMy WebLinkAboutBuilding Permit #116-12 - 43 VEST WAY 8/8/2011 I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: , 'L Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER ���G�LG� Unit# Print MAP NO: PARCEL:J(aq ZONING DISTRICT: Historic District yesry b Machine Shop Village ye no 100 year-old structure yes 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 � I Septic. ®,Well NO -❑FloodplamA I W�etlandsl ' F®" Wa�,f`errshedtD strict - - ' DESCRIPTION OF WORK TO BE PERFORMED: (Identi n Please T e or Print Clearly) - .Y Y) c��- OWNER: Name: ` fi'�QL��S�rJi Phone 01— Address: CONTRACTOR Name: G /Yli�/ ,� f—�%J� Phone: Address: / 7,_�7 Supervisor's Construction License: �(b Exp. Date: Home Improvement License: ZWI�2d r Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ � FEE: $_ oft- Check No.: Receipt No.: " - NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signaturgofggent/Owner~� , y~ � 1 Signatureof contactor�� ,_ �_w .a 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 i, HEALTH Reviewed on Signature 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 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 i I Dimension i Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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 2011 June/mi 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 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: Doc.Building Permit Revised 2008mi ` Location I L1 ,2 V�°'° No. /L2Z-- Date Na^TM TOWN OF NORTH ANDOVER 3?O�,t`•o !•,ho0 f A i y • � ; , Certificate of Occupancy $ �Ss�cwusE` Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #24457 1 t� Building Inspector tkORTH Town of Andover 0 o , dover, Mass., O — LAKE co MIC HE WICK V ✓�S RATED A BOARD OF HEALTH Food/Kitchen Septic System ..PE� RMIT T D BUILDING INSPECTOR THISCERTIFIES THAT...........................N#W......S.m./........... ......................................................................................... Foundation has permission to erect........................................ buildings on ........... . ...... 't�+..T... .W .................:. Rough to be occupied as.............. ....... ............. !......... .!!`#. ........ Chimney ' e provided that the person acceptin this permit shall in every respect nform to the t ms 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 PERM1 i a`�_ X MS Al VA6THS� rA 7cELECTRICAL INSPECTOR JINLESS CONS UCi 1 SMk Rough =w5.......... .................. ..... 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. ry w L � of C' = � Sumer Affairs a-ad us ss R.gatlon \vim 10 Park Ply m SUite_`5170 Boston, tts 02"116 ` Oinenienjao��Registration e rout ' Registra4aon- 349223 Type: p6vats Co1AO tiop :s- a [ y� ® Mi _ ' i �;4 visa#"sora: 3216/2011 ar4 R:G ir�-�;\ 1 LA 6g n0A 011830 .y. andreturn card-Mark cesse .a �GiJi•b4lOe.;�012 i8 - �achu+,cTtzs• Dep aarftent e,-pubik S;rfct> Board� of BuIldirng-, ;3�ti �i<srti3�ls i9`+ Construction Supervisor uiearse Uccrnse: CS 78930 R.CHARD.3 LAwERT Q4 ppr_nnII i y RC; HAMPSTEAD, NH 0384-1. EX;irefim 602012 T--: 30062 T. EIN#51-050-3313 i Haverhill MA 978.374.9224 MA Reg.HIC#149221 amber. Lawrence MA 978.687.7339 MA Lic.UCS#18130 Hampton NH 603.929.9224 BBB. Single-Ply License#1711 LR�ofing Hampstead NH 603.329.8200 Sw�cei2932 �p, Toll Free 1.888.SOS.ROOF 265 Winter Street Haverhill NIA 01830 n� y *Licensed ,Insured Factory Trained *Factory Certified Name: Date: Telephone: 7S � 1 09 Alt.Telephone: E-Mail: Billing Address: L.I ,/ S� �a-Y Job Address: sE v-- ---- Scope of Work J�and Re-roof r El Re-roof Approximate Roof Area: ®Prepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected. 1 Zqf�o've 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 SE If individual sheets are found to be rotted/or de-laminated, removal, disposal and replacement will be performed at*$ 6- per sheet.If any trim boards are rotted, replacement will be performed at*$ 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*$. JK- If wood deck,siding,and flashing is sound,we will re-nail any.loose wood to rafters, sweep deck,and prepare for roofing. ©-rnstall 8"drip edge to all rakes and eaves. Color ®-Apply ice&water shield.(UNDERLAYMENT)as per manufacturers'specifications and/or 5�<pRLy premium(UNDERLAYMENT)to the balance of the exposed wood deck. �Re flash all.plumbing stackpipes,and any roof penetrations as required,and dictated by good roof practice to ensure water tightness. �a-If upon inspection,we discover chimney lead to be worn or deteriorated,replacement will be performed at*$ Install a new: Year ❑ Traditional i--Architectural ❑ Designer j iI!�,Furnish and Install a new shingle over style ridge vent system ❑Soffit vent system *$ A2 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. ~i I Special Notes UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF---4- YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND, 5a�9YEARS 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 materia nd labor spec above for the total sum of: $�� (*) l a�f c7" _Gt 47CI fs�. f f•�•' �L a�GQ'i (Dollars) Payment will-be made according to the following work schedule: $ Com/. 00deposit 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 CgNT32ACT IF THERE ANY BLANK SPACES Acceptance of the Contrr' ct Proposal fifi,, l/ Home Owner(s)Signature(s� ,�`�x._ LI; `1114F�fkDate: CJ l 5l t Contractor's Signature: Dater/0,4-*,/ I WWW.lambertroofing.Com (Please see reverse side) 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: • Commence the described work on or about days. • Complete the described work in approximately 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 him/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 TGLRC Inc.dba Lambert Roofing 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. Arbitration The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, e co tractor may submit ch ute to a private arbitration service which has been approved by the Office of Consumer Affairs and Bu mess gulation and tye c 'ns m r11Fbe r u ed to submit to such arbitration as provided in MGL cp142A. Owner: Date: Contractor: � �C� >/.l.:. Date: g�s v > � Contractor Registration 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.1301 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 register formal 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 other than an address of 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. INITIALS NM-30-2010 TUE 04:05 PM ALLAN INS AGNCY FAX N0, 078+745+5483 P: 01 DATE(MU'DO/YYI PR S CERTIFICATE OF LIABILITY INSURANCE 1L,30�201Q THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ALLA14 INSURANCE AGF-NCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE t HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 63 1/2 JA�fer$on Avenue 2nd F ALTER THE COVFRAGE AFFORDED BY THE POLICIES BELOW. .O. BOX 511 SALEM MA 01970-0511 COMPANIES AFFORDING COVERAGE COMPANY A Seneca Insurance Company _..... INSURED COMPANY TC-LRC INC 6Ja Lam Ort g Safety insurance Group 265 WINTERSTRZ> 1; , COMPANY Landmark Insurance Company SAVFRFI.'LL YdA 01830 __.... COMPANY �j National Union Piro InsgrdTlC6 COVERAGES THIS IS TO CERTIFY THAT THE POUGIES OF INSURANCE LISTED BE!_OVJ HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH Tt11S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIQ CLAIMS. ?YPEOPINSURANCE POLICY NUMBER POLICY E.FFECTIVEPOLICY EXPIRATION LIMITS LTR DATE(MM/DD/YYI DATE(MMiDDlYY) GENERAL LIABILITY BODILY I-� IBODILY INJURY UGC -XJCOJPRcHEN51VE FORM OQO PReMIE ATI}N$ INJURYACG Z 000,000 UNDERGROUND PROPERTY OArvACECC [ $ 2/OOO,OOOi EXPLOSION&COLLAPSP HAZARD / PRGPERTY DAMAGE AGG $ 2,000,DOO Xy PRODUCT*/COMPLETED OPER Ol&pp CUMBltJEED CCf,. X(CONTRACTUAL 11/12/2010 11/12/2011 016 PD C OMBIND AGG $ INDEPENDENT CONTRACTORS PtRSONAL IN.IURY Ape s 1,000,006 BROAD FORM PROPERTY OAMACE Medical Pzym®nt 5,000 X'PERSONAL INJURY '- - AUTOMOBtLE LIABILITY -_— _ ANY AUTO BODILY INJURY E X ALL OVJNFD AUTOS(Priv:.to Paaa; 6203819 (Por porson) 5 ` gLLcvNEpAUTos 07/16/2010 07/16/2011 BODILYINJURY X.1(O'.hnr than Private RaBi engpr) :Per,ccidonti X HIRED AUTOS X PROPERTY DAMAGE NON-O'duNED AUTOS / / _ GARAGE LtADILITY BOAiLY INJURYB PROPERTY DAMAGE b 11000,000 -. _. COMBINLDF-XC _ _. _. Ess LIABILITY C X I UtdBRELtA FORM .EACH D�GJRRENCE S 5 r 000,OQ G HAO54597 11/12/2010 11/12/2011 AGGREGATE 5,060 000 OTHER THAN UWSRELLA FORM g'--- D I WORKERS COMPENSATION AND I VJC—Z-TATLf- I OTH EMPLOYERS'LIABILITY 009934145 / / / / _.TORY UMIrp._L?�,. ER __.r.. EL_EACH ACCIDENT �g...... 1,000,000 [__�IOFFICERSAFZ HE PRUrR1ETDRf I ......_..__... ... ... _ ARTNERS/EX[CUTPJE I X INCL MA, NR 08/,18 �OIO O$ rL DISEASE-POLICY LIMIT 3 1,000,00.0 IE: ExCLi ^^ / _ /20/ZQ 17 EL DIREASE-EA EMP(DYES , 1,0 0,000 OTHER Ir '_ S RiP tION OF ORERAT1CrPl3ILOCATIONSNEHICLESJSPEClAL ITEMS CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE D€SCRIi3ED POUC(ES kE CANCELLED BEFORE THk EXPIRATION DATE THEROF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE To THE CERTIFICATE HOLDER NAMED TO THE(-EFT, BUT FAILURE TO MAIL SUCH NOTICE SHAI.1.IMPOSE NO OBLIGATION OR LIABILITY egg OF AN MND UPON YHE COMPANY,ITS AGENTg OR REPRESENTATIVES. AUTHORIZ D PRU NTATIVE _ ACORD 25-N f ifBS} 0 CORD CORPORATION 1988 The Commonwealth of Massachusetts Prrnt-Form, ; Department of Industrial Accidents vOffice of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Z1r ✓%J ` Address: 2�S/�/!I%C/2 � City/State/Zip: 0/ Phone #: Are you an employer?Check the appropriate box: �-t Type of project(required): 1 -employer with / �/ 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, [] Demolition working for ni, n any capacity. employees and have workers' insura>>ce.$ 9• ❑ Building addition comp.[No workers' camp:insurance P• required.] 5. We are a corporation and its ME] Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their ILEI Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.]t c. 152, §](4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] Any applicant that checks box#I must also fill 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 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: Policy#or Self-ins. Lic.#: ���j�/ Expiration Date: Job Site Address:? �K�_ City/State/Zip:/I/� j1 � Attach a copy of the workers'comp sation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as require 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 I ai nd penalties of perjury that the information provided above is true and correct. Signature: Date: �O G 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#: