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HomeMy WebLinkAboutBuilding Permit #267-13 - 47 MILTON STREET 10/4/2012 0* AO BUILDING PERMIT 'tr.RD T" J 0 TOWN OF NORTH ANDOVER 0 Vft APPLICATION FOR PLAN EXAMINATION Permit NO: ;7 Date Received Date Issued: ACH IMPORTANT:Applicant must complete all items on this page i, . 7.Z 11!bdAT,"I 6 NZ I rintf. PROPERTY OW NER, ye"s .1'1 r�t � 0 z'PARCEL ONING DISTRICT., t is ric -,--, 10 P MAU-.Sh6p', i I I a g e!,,,.Ye8:': 9's 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 Watershed-D Well: :"FI6bdr)I6in '\40tidn'd, DESCRIPTION OF WORK TO BE PREFORMED: s- Identification Plpase Type oArint Clearly) OWNER: Name: Phone: Address: ib -,, X. M; Q !T QR Supero S t' o-htttubtion'L " - -'7 E" bAtoi X Home Imp y�,Rp nicense; Pa 6 ARCHITECT/ENGINEER 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: $ le, FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of contractor.' Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBodyArt 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes LPlanning Board Decision: Comments !`Conservation Decision: Comments Water & Sewer Connection/Signature &Date- Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE.DEPARTMENT " _ ..,a YTemp"DumpSter on site 'es - =�: - -;c_;�- -�::=.�.�..•.4=-= _ - - -�;_-{=�. `Fire% e "�.. k....�....._-`+��., ti ``•'}-.�-r:v, '.:'" •. .t +'1 t1 r n t. -, •.. .{r,. t. D` par`tM-ent_signature/date,' 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) El Notified for pickup - Date Doc.Building Pennit Revised 2008 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No Date-Ar - • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ " Building/Frame Permit Fee $ Foundation Permit Fee $ " Other Permit Fee $ TOTAL $ Check#19 25786ui ding Inspector NORT1y F Town o-111 . Andover No. _ 4 : _V-p �� �� i hAj '/ h ver, Mass 4C04W 1�� C0C.48"t WIC.[ I- 4A7-sco) Pk- C2 S U ' BOARD OF HEALTH PER T LD Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .............jL..1R.. .................................... ..... ....................... .. .� ; �� � Foundation has permission to erect :..............:.. .... buildings on ... ......... .................................. Rough tobe occupied as ........................... .e.. .:. ::........................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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 wsPEcroR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC;TI S 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. SEE REVERSE SIDE s The Commonwealth of Massachusetts Department of Mdustrial ticeidents 4 Offce oflnvestigations 600 Wasli ngtol,Street Boston,AL1 02111 )vwwanass gov/dia Workers' Compensation Insurance Affidavit:Builders!Contractors/Elects icians/Plumbers Applicant Information Please Print L 'bI r Name(BusinesslOrganization/Individual): Address: City/State/Zip: 4 Phone#: 7 � Are you an employer? Check the appropriate box: I�n a employer with _ 4. E] I am a general contractor and I �Cype of project(required): �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 me in any capacity- employees and have workers' [No workers'comp.insurance comp.insurance_# q- ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I tun a homeowner doing all work officers have exercised their 11. Plumbing r Myself ❑ g epairs or additions y No workers' comp. right of exemption per MGL insurance required.] t C. 152, §I(4),and we have no 12❑Roofrepairs employees. [No workers' 13.❑ Other comn.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 and then hire outside contractors must submit a new affidavit indicating such. rContractors 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 isproviding workers'compensation insurance for my employees. Bela) is the policy and job site information. Insurance Company Name: C.ei .�/J ,olilCQdr Policy#or Self-ins.I ic. Expiration Date:e ^ Job Site Address: / /�,� �s�/ City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failtue to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and 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 ztpde-r th pains and penalties ofperjury that the information provided above is true and correct. Sianature: �, Date: Phone#: Official ttse only. Do not write in this area,to be completed by city or town of lciaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3. City/Town Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other Boai-d of 9'Ji"61,19 Co-n%truction Superl kc,r CS-078130 '00 RjOjARD J LAjOERT,..3,,-.-,,r 245 WINTER Haverhill MA 01930 06fe2j2OU W-1 Off ke of ana onsumer, Aff . 91 10*Park P1 - Suito 5170 tostoni,m ss i.., 02116 mpr Reo l0e: Private Crj55,R` Enlration: 1216/20115 -;,LR-.0 dh*.4--,ambW lRioirf, RICHARID LAMBERT 265 'NINTftR STREET HAVERHILL, MA 01830 Update Addtm and TrmurR c;gpj& AC"Rdot CER ..'k E�,Mlhi;:)U;Y Y Y Y TWICATE OF LIABILITY INSURANCE 2�,C,aT 0 1'2 THIS CERTIFICATE ii-S iR.�R71 IS ISSUED AS A i> ATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERrif;'CATE HOLDER. THIIS CERTIFICATE DOES NOT AF'FIRMAINELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED �,�iY Tk4i= POLICiES BELOW. THIS CERTJF!CATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(3,1, A_ UTHORIZED, REPRESENTATNIE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT-. If the certificate holder is an ADDITIONAL INSURED, the policy(ies', must be endorsed. if SUBROGATION 19 WAIVEZ), subject to the terms and conditions of the Dolicy,certain policies may reouire an endorsement. A statement or. this certif`cate does rt-k ronfiiir�"ights to Hite certificate holder in Nevi of sud"t ondoisement(si I PRODUCER T CONTACT NAMEi Je_-rOld Kameras ALLAN INSURANCE AGENCY !NC. (978) 745-5905 AFarX 63 1/2 Jefferson Avenue 2nd P.';,_oor P.O. BOX Sli eS REP��J,Ai_--cRRDtN COVERAGE SAL REM NLA 01.970-05-11 ................ Specialty ins. Co. .......... INSURED ,.N,suRER.3Safet:v insurance Co:r;,an=., TGLRC Inc. j ';NSURFR CAI terra Excess Fx S7ar-pj,_,s ins, dtba Lambe rtRoof ing Compaioy F,1'iURER0:Ace A-mericanC_ ............. 265 -viinter Street o "SURER E [Haverhill 0 11 83 0 COVERAGES CER i'IFICATE NUMBER: REVISION NUMBER: THWS IS TO CER 1 1FY I HA 1 -1 H=- P L J C!E`' 0 F 014S t)RA N C E L I'-T[7 D B E L 0 0i HAVE BEEN !S 3 U E D ICJ E 1 N S 11 R F 1) NAMED AB OVE i7 0R I I INDICA"I EC) NOTVVATHST AND;W; Av"Y tff'QUIROIAENT TDRfo OR CCiilDi"r iON 017 ANY C0NTR,-,,C`," 1 10 THEP� DOCuk"IF:N i "N'l i i�4 RESPIDC-i "u., CERTIFICATE MAY BE iSSUED, OR MAY PE-RTAIN. THE !NSURANCE AFFOROEF2, BY 1HE POUCfIES 0E-S,;R!B1ED HER:z 5'1i1DjF(___; 7'0 "'LL EXCLUS!ONS AND C,ONDMONS OF FJK',H l:10L11_'.1E_1'> U101TS�HOVVN MAYHAV[-._.fiEEN REDUCED L�v PAID CILAJM,�', LTR l TYPE OF NNSIJIRANICE POLICY EFF pall5y I WVD! POLICY NUMBF13 (1.1Ni!!oDfyyYy11 iPAWDDfy1eYyi GENERAL LIABILITY c; X I A PALO—P t 0 0 0 0 6 9 2/2 0 12 j11 ----------- 2,00-1, jooj -.3 R G A I L t t,ii A f 11. c. i AUTOMOBILE LIA21UTV C.'0,411WNi 1-1 S INC,1. I t-H ANY B FX 2 0 3 8 19 ------- 1 AU T 0S, PIOD:i 11 P i 6.120 12 10';/16 2 G ----------- X 1;RLD AU 0,� ! -x- UMBRELLA(.!Aq IX i LjX�EXCESSUAB t :J t WORKERS COMPFNSATPON VP',F T A AND EMPLOYERS'LIA8JUTY X N A D Y-)" 014294 L E A ru fklandatory it)NH) ;0 14 2 9 5 4 �O 2 3/2 0 12 FD 8 0 3. 0!,C, I j �Jjl 71 C, _J- A 01 0 DESCRIPTION OF OPE RA I 1ONS r LOCA T 4 N S I V E H i C S (Alia 01 ACORD 101.Addition", 11Ialil-Schedule,it P`01L'SP11C0 fS C[Lllre-'? CERTIFICATE HOLDER CANCELLATION 7'GLRC, Inc 1 SHOULD ANY OF THE ABOVE DE�CPIBEZ)PO!_?CIES BE CANCF_-LLED BEFOPE THE EXPIRATION DATE THEREOf�, NOTICE WILL BE DELIVEREC iN z: ACCORDANCE WTH THE POLICY PROV!310N�S DBA Lambert Roofing Cr_ 265 Winte_� SLreell- fZ�iKORIZEO REF RESEWATIVE Faverhill wit J1.9 30 13I ACORD 25(2010105) INS0251­;,,,)i�-jcj,�, 1988-2010 ACORD C(DIRPORATION.. All riohts r(�czerv,­ij, 1 hp ACORD itariie an-d' logo are registered marks of ACORD T. EIN#51-050-3313 Haverhill MA 978.374.9224 S40 MA Reg.HIC#149221 ambe Lawrence MA 978.687.7339 MA Lic.UCS#78130 Hampton NI-I 603.929.9224 BBB Single-Ply License#1711 Roofing Hampstead NH 603.329.8200 S%nc e�1932 Co, Toll Free 1.888.SOS.ROOF 265 Winter Street .�., Haverhill MA 01830 3 Ltcc,a+1g Factory Trained {Factory Certified ��^^ S Date: Telephone-K)6.7 ' elephone- C.7R f 3'�At.Telephone: Email: BillingAddress: �i +� Ci3� L :f l ra , n' State: - job Address:- ball '�E City: State: Scope of Work 12 rip and Re-roof ❑Re-roof Approximate Roof Area: 6 PPrepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations4anlandscape is properly protected. 1-7Aemove existing layers of shingles down to roof deck and dispose of in a legal fashion frooo site. ❑Anspect wood deck, if we discover any rotted wood,replacement will will performed a * per LF for roof deck boards. If substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$ 1> per SE If individual sheets are found to be rotted/or de-laminated,removal, disposa6md replacement will be performed at*$ �per sheet.If any trim boards are rotted, replacement will be performed at*$ - I OL 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*$ . If wood deck,siding,and flashing is sound,we will re-nail any loose wood to rags sw cmc;and 51f pare for roofing. 'Install 8"drip edge to all rakes and eaves. Color ❑apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or ❑ Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck. II/Re-flash all plumbing stack pipes, and any roof penetrations as required and dictated by good roof practice to ensure water tigh ess. upon inspection,we discover chimney lead to be worn or deteriorated,pplacement will be performed at*$ Install a new: Year ❑ Traditional V'Architectural ❑ Designer Col offurnish and Install a new shingle over style ridge vent system .�Seffi�veet�sy�trm*�� }❑ 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 circumstancesAw' 1 Akertightt graty-bf ._e b 'I i tg i emp ised.– j Sp Mi. - 101U � UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE A W4KM SEIP GUARANTEE FOR A PERIOD OF YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND YEARS H6ID AND ISSUED BY-THE SHINGLE MANUFACTURER. ❑"�.4A UfA-&,�TItER WP-GRADE *$--- f ` *Denotes potential additional costs above the total estimated price. I TOTAL CONTRACT PRICE MD PAYMENT SCHEDULE The Contractorl,ag1 s Merl he work,furnis�b them ter' and lalo cifiab dr the total sum of: $ (*� v (Dollars) .,,tPaymN will be made according to the following work schedule: ;, t f $ deposit upon signing contract $ by—//—or upon completion of $I.1 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 4. . third business day following the signing of this agreement. See attached notice of cancellation for for an explanation of this right. £xt T SIGN THI��ta RACT IF THERE ANY BLANK SPACES 4� . ' a Aca of the Cont act Proposal �? Home Owner(s)Signa re(s): Date: `d / / f✓ Contractor's Signature: Date: / www. ambertroofine.com (P1P(]CP CPP T'PVPPCP cifio)