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Home My WebLink AboutBuilding Permit #415 - 44 OLD VILLAGE LANE 11/20/2006 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o*No RT b gtio o� O A Permit NO: Date Received C Date Issued: 4, 3� �q,T.o SSACHU`�E IMPORTANT: Applicant must complete all items on this page LOCATION ' QGbyJL L A CvC 1AA1,6 Print PROPERTY OWNER R0�9Q/2T" oX _ Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: Q(Repair,replacement ❑Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED /P.EwRUoJr Soo rA. Identification Please Type or Print Clearly) OWNER: Name: A000emr Lox Phone: 978 (682,W53 Address: S/y OLb V;",o4 41e 1-44/ CONTRACTOR Name: L4/14Aevt.T ,egd F J11G' Phone: q76'314 4 j y Address: (o.S W��1'te.1ti I�i'-• I�IEt/P.IC.�/!� � � Ij114, d /�(�d Supervisor's Construction License: 0719/30 Exp. Date: �A& Home Improvement License: Al al I Exp. Date: I V& r7 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost Sa�J a.d° FEE:$ Check No.: ' Receipt No.: Page I of 4 - -- Ir i TYPE OF SEWERAGE DISPOSAL Swimming Pools El ❑ Tanning/Massage/Body Art ❑ Public Sewer 1 Well Tobacco Sales ❑ Food Packaging/Sales El❑ ` Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project 4 NOTE: Persons contracting with unregistered contractors do not have access to the gdar my fund Signature of Agent/Owner Signature of contract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 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 FIRE DEPARTMENT = Temp Dumpster on site yes`•i', n Fire Depariment signature/date 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 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) Page 3 oP4 Doc:INSPECTIONAL SERVICES DEPARTMENT BPFORM05 Created JMC.Jan.2006 i 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 ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks i ❑ Building Permit Application i ❑ 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) 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 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:BPFORM05 Page 4 of 4 NORTH Town of : t 19Andover No. &1/J T CO LA E c dover, Mass.,&1.0 •� {r COCHICKEWICK V 7�ADRATED PPa` CC `r BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... . ..........Gx......................................................... .............................................. Foundation has permission to erect ...................................... buildings on ..W.....4.1.6(....n.�.�.(.� ....�. 04..4L. Rough to be occupied as I�t� �� coney ............................................................ Chi provided that the person accepting thi ermit shatF revery resp conform to the terms 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TS ^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 Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): o0Pk' " Address: City/State/Zip:Awl Q (/Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1NI am a employer with )]S_ — 4. ❑ I am a general contractor.and I 6. ❑ New construction employees(full and/or part-time).` have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attacbcd sheet. $ El Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp..insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 111-1 Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.9 Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 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'end then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information. I am art employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ._ y�,7 �, Insurance Company Name: • AV /`/�COTC 1,4 �-TxxP, ` o Policy#or Self-ins. Li c.M 4/a D ?go/ /1)06� Expiration Date:. 8�yl7 ite Address: L,b AAJE City/State/Zip: /U, AA)Dyy2y !/j'1 t4 Job S L -. Attach a copy of the workers' compens ion policy declaration page(showing the policy number and expiration date). Failure to secure coverage asrequired under Section 25A of MGL c. 152can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well a&civil penalties in the form of a STOP WORK ORDER and a foie 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 f6r insurance coverage verification. 1 do hereby certify under t sad enalties of perjury that the information provided above is true and correct: Signature: "",• Date. Phone#: ?7 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#: • I Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 149221 Board of Building Regulations and Standards Expiration: 1P/6/2007 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 LAMBERT ROOFING CO RICHARD LAMBERT 265 WINTER STREET HAVERHILL,MA 01830 Administrator Not valid without signature Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement-Contractor Registration Registration: 149221 Type: Private Corporation Expiration: 12/6/2007 LAMBERT ROOFING CO RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Update Address and return card.Mark reason for change. DPS-CA1 0 5OM-04/05-PC8698 Address 0 Renewal Employment E] Lost Card Board of Buildingg Regulations One Ashburton Place, Fpm 130 Boston, Ma 02108-1618 1 License: CONSTRUCTION SUPERVISOR LICENSE Number: CS 078130 Expires: 06/02/2008 Birthdate: 06/02/1972 Restricted To: 00 RICHARD J LAMBERT 95 MAPLE AVE ATKINSON, NH 03811 Tr.no: 27100 DPS-CA1 is 50M-04/05-PC8698 Keep top for receipt and change of address notification. A CORDJDATE(MMOD/YYYY) TM. CERTIFICATE OF LIABILITY INSURANCE 10/16/2006 PRODUCER Phone: (781)933.3100 Fax: (781)933-9048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SALEM FIVE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOYLE INSURANCE SERVICES HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 445 MAIN ST BOX 606 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WOBURN MA 01801 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NAUTILIUS INSURANCE CO T G L R C INC INSURER B: COMMERCE INSURANCE COMPANY DBA LAMBERT ROOFING INSURER C: 265 WINTER ST INSURER D: HAVERHILL MA 01830 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW 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 THIS 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD-0 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION LIMITS LTR INSR DATE MM/DD DATE MMIDD/YY GENERAL LIABILITY NC 609679 10/12/06 10/12/07 EACH OCCURRENCETO $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGES(RENTEDEaocwrence) PREMISES( $ 1,000,000 CLAIMS MADE F_X] OCCUR MED.EXP(Any one person) $ 5,000 A PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 1,000,000 - POLICY JECPROT LOC AUTOMOBILE LIABILITY ZT6915 07/16/06 07/16/07 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY (Per person) $ 500,000 X SCHEDULED AUTOS B X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ 1'000'000 PROPERTY DAMAGE $ 500,000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION$ $ WC WORKERS COMPENSATION AND TORY LIMITY LIMIT 07THER TOS EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS WORK COMP CERTIFICATE WILL BE SENT DIRECT TO YOU FROM A.I.M.MUTUAL WORK COMP CERTIFICATE HAS BEEN REQUESTED. CERTIFICATE HOLDER CANCELLATION —– SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: Gerard F 13074f ACORD 25(2001/08) Certificate# 6694 ©ACORD CORPORATION 1988 CER08129/2006TIFICATE OF INSURANCE ISSUE DATE(MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Insurance Boyle IAInc DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE III y POLICIES BELOW. P O Box 606 COMPANIES AFFORDING COVERAGE Woburn, MA 01801 INSURED T G L R C Inc COMPANY A.I.M. Mutual Insurance Co dba Lambert Roofing Co. LETTER A 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 PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS 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 PAID CLAIMS. COPOLICY EFFECTIVE POLICY EXPIRATIO LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ LAIMS MADE[:::]DCCUR PERSONAL&ADV.INJURY S OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one lire) S MED.EXPENSE(Anyone person) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) S GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ MBRELLA FORM AGGREGATE $ THER THAN UMBRELLA FORM WORKER'S COMPENSATION AND X I .P WCSTATU- OTH- EMPLOYERS'LIABILITY R LIMI 71 6009966012006 08/28/2006 08/28/2007 $A THE NERSI XECUTOR, X INCL $PARTNERS/EXECUTIVE EL DISEASE--POLICY LIMIT 500 OOO OFFICERS ARE: EXCL EL DISEASE—EA EMPLOYEE S 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �� T. G . L . R . C . INC . , DBA / LAMBERT ROOFING CO . In business since 1932 November 8,2006 ATTN: MR. &MRS. FOX, SUBJECT: FOR NEW ROOF SYSTEM @ 44 OLD VILLAGE LANE NORTH ANDOVER,MA 01845 PHONE: (978) 682-9553 E-MAIL: DANAFOX@COMCAST.NET WE PROPOSE: To the following Single-ply roof construction on the building @ the above address as per detailed description listed below. SINGLE-PLY RE-ROOFING PROJECT Job description: rear low pitched roof section approx. 500SF 1) Pre-pare for re-roofing by ensuring all safety measures are taken in accordance with OSHA standards and landscape is properly protected. 2) Remove all existing roofing material and dispose of. 3) Mechanically anchor new '/2 rigid POLYISOCYANURATE insulation to the existing roof deck as per specified using insulation plates & screws as per manufacturers' specification to fasten (1 fastener every 2 SF). 4) Furnish and install a new RPI fully adhered roof system using .060 ml membrane. All the proper sealants and/or caulking will be performed to ensure secondary containment as per manufacturers' specifications. 5) Perimeter edge will receive white trim drip edge coping style flashing. 6) Re-flash all walls, stack pipes, and/or any roof-top penetrations as required and dictated by good roof practice to ensure water tightness. 7) Install new ridge vent. 8) Make repair to upper shingle roof as discussed with owner. TWO SIXTY FIVE WINTER STREET HAVERHILL, MA. 01830 (978) 374-9224 (FAX) 521-5791 OR VIA E-MAIL LAMBERTROOFING@AOL.COM OR VISIT US ON THE WEB @ WWW.LAMBERTROOFING.NET EIN# 51-05033313 UCS# 078130 -2— NOVEMBER 8,2006 Exclusions: Prevailing wages, Interior preparation, deck replacement and/or alterations, any other trade related construction such as but not limited to electrical, plumbing, framing and masonry. Please note.Any additional work beyond the above scope of work will be done at an additional cost to be arranged and negotiated. All debris generated by the T.G.L.R.C., Inc. will be cleaned up and disposed of from the job site in a legal fashion. Under no circumstance will the watertight integrity of the building be compromised. NOTE: We understand this is not your average roofing project. Below find our pledge to ensure pre, work in progress and post construction is a safe, comfortable and speedy process. "All workmanship will be performed to the standards and expectations enforced by the 61h Edition Massachusetts Building Code. Unrestricted construction supervisor license #UCS 078130 will be on site and/or accessible diligently through out the project. We will discuss in detail-the project agenda prior to starting and follow our commitment to the best of our ability. We recognize that you are running an important business and we will come to a consensus together on how best to plan this project with out interference." T.G.L.R.C.INC.agrees to commence described work in the month of(ASAP) and the described work will be completed in about (1) working days. T.G.L.R.C. INC. shall not be held liable for delays due to circumstances beyond our control. TG.L.RC.INC.may not be held liable for any damages to landscape, attics and/or fixtures due to circumstances beyond our control. TG.L.R.C. INC. 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 counterparts such as but not limited to siding,gutters,masonry,plumbing,and windows that jeopardize the watertight integrity of the building are not covered under the roofing warranty. The following work includes all labor, materials and disposal needed to complete your job in a professional workmanship like manner. UPON COMPLETION AND PAYMENT IN FULL A TEN YEAR NON PRO-RATED GAURANTEE WILL BE HONERED AND ISSUED FOR ALL WORKMANSHIP BY "T.G.L.R.C. INC". A TWENTY YEAR WARRANTY WILL BE ISSUED FOR SINGLE-PLY ROOF MATERIAL BY MANUFACTURER. . -3- NOVEMBER 8 2006 r vt � C l ,� 1 co � The total cost for all warranty, labor&materials is $2,950.00 r *Payment Terms: 1/3 down payment, upon completion payment in full. Net 30 days, 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. Acceptance of proposal: - Signature �l .0 Date 61 ACS,`& Please sign and return one copy upon acceptance. NOTE:Due to volatile pricing on building products this connect is void if not accepted within 15 days of reception. "Quality Workmanship You Can Trust" Our Proof is on Your Roofl Safety first, T.G.L.RC. INC. RICHARD J.LAMBERT President/Quality Control i Location No. th Date J NORTH TOWN OF NORTH ANDOVER Of .go , '�h.0 .�? OL + Certificate of Occupancy $ r Building/Frame Permit Fee sACNus Foundation Permit Fee Other Permit Fee TOTAL $ Check # 19820 ._ building Inspector