Loading...
HomeMy WebLinkAboutBuilding Permit #435 - 48 LINCOLN STREET 11/22/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NOd ��- Date Received Date Issued: IMPORTANT:AP licant m st complete all items on this pqge LOCATION 4-5 �d /wee 7 p �- Print _PROPERTY OWNER �l1�<`S/�/� t Unit# Print � MAP NO: _PARCEL: 2 ZONING DISTRICT: Historic District ye no Machine Shop Village ye no !I 100 year-old structure ye no I 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� `.." max. AF t �® Floodplaina E© Wetlands3 Sfn��t� - -�� _ - - - f lWatershedD'i ��®Water/Sewers _ • _ �_ � � � DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Ty e or Print Clearly) OWNER: Name: 6 � Phone: r. Address: 2o ��� � o .mss -S ate � � A/1 CONTRACTOR Name: Phone: Address: GU Supervisor's Construction License: D���.� Exp. Date: Home Improvement License: / / c2Z Exp. Date: !a ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.-BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F, Total Project Cost: $ /!, -Do FEE: $ Check No.: NOTE: Persons contracting with unregistered contractors do Jotth 'ave access F unci/Owne :Zguaran I 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 n Zon,`ing Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments i Water & SewerConnection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgmod Street FIRE DEPARTMENT -TempDumpster ite yes r/ no Located at 124 Main Street Fire Department signature/date' �j COMMENTS I 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.$10041000 fine f I NOTES and DATA-- For department use ilj I i 4 i ® Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi I ure of contractor:..:_ 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 isE uance 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 t nce of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H " ❑ Worke Co ffidavit ❑ Two S s Iding Plans (One To Be Returned) to Include Sprinkler Plan And Hydraul c Calcu ations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 To wn clerks from the]Board of Apeals that the appeal period is over. The applicant mut then get this recorded at the Registry of Deedscice must stamp the dersion One copy and proof of recording must be submitted with the building application I - Doc: Doc.Building permit Revised 2008mi i. COIVI1V1ElV 1 - Location No. '"" Date NORT1y TOWN OF NORTH ANDOVER Certificate of Occupancy $ CM�s<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #��Q 24867 Building Inspector i4ORTL_ ONM Of over . 0 No. ... ........A/3SO01 LAKE o . dover, Mass., • COCHICMEWICK C ��. ORATED P? BOARD BOARD OF HEALTH Food/Kitchen Septic System .PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT r' .�i.!!►............ ......r io................. .......................... ..................................... ......... Foundation has permission to erect........................................ buildings on ....q1k.®. .........�.,.�. �.V. ..........� .a Rough to be occupied as.............. ... .........*.... ... ... O ........16.10... ...... Chimney provided that the person accep ng this permit shall in every r ect conform to the rms of the application on i in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspect! n, 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 6Ya PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC T 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 SLIDE smoke Det. . =DATEDfYYYY )T OF LIABILITY IN U A THIS CERTIFICATE IS ISSUE M2011F INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Ttil: CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TETE COVERAGE AFFORDED BY THE POLICIE; BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BET Y�EEIU THE ISSUING AF ORDED BY HE POLICIEC REPRESENTATIVE OR PRODUCE9.AND THE CERTIFICATE HOLDER. IfiAPt7RTANT: if the certificate holder Is an ADDITIONAL INSURED,the Policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject tc the terms and conditions of the Policy,certain Policies may require an endorsement, A statement on this certificate does not confer rights to thl certificate Molder in lieu of such endorsement(s), PRODUCER C NTAGT JerrC+ld TCF3M4SY'} g NAME: ALTS INSTjR.ANCR .AGRNC'Y INC. I_C, '-(478) Kam, 5 - 63 1/2 Jefferson Avenue 2nd Floor EBIA(L C 009918) 745.5483 Jerrolftallanins.urance.com P.O. BOA 511 _. _ SALEINSURERS AFFORDING COVERAGE MAIC Al ASA 0197tI-4511 _ INSURERA:3�&lk'ca Specialty Ins € INSURED INSURERB:Safet Insurance-06 ITGLRC Inc. INSURER C:.A.lterra Excess & Sur lug Ins. dba Lambert Roofing Company INsuRERu:Chartis Insurance Company 265 Winter Street Haverhill MA 01830- INSURER E ------`— ..---'._ INSURER F; COVERAGES CERTIFICATE NUMBER; REVISION.NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF.Il>ISURANCE LISTEDBE. W NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOI, INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI; CERTIFICATE MAY BE: ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM E:KCLUSIONS AND CON-.^T-ONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS., S INSR LTR TYPE OF WSUI:ANCE "' ADDL _• ....._. POLICY EPF MPOLICY EXP POLICY NtIM1KBER -- LIMITS_ GENERAL LIAQIUTY / I / / _ [ACH OCCURR FN(E 3 1000( X COMMrRO GENERAL LIABILITY / / / t D A E J N " -- 1 PRe":I ISF a gcgurrerkm 5 5 0( A I CIAW;tAADE X OCCUR J-CGLOOD0000696-01 11/12/201111/12/2012 MED EXp{An onaporcen) PERSONAL&ADV INJURY $ 1 00(I I GENERAL AGGREGATE s 2000, G[N'L A<>CREI;d�1L:Lif11T APPLIES PER: / / PRO- / ! PRODUCTS,COMPIOPAGC`, °u 2000{ POLICY LOC J / AUTOMOBILE LIABILITY l f _777- B !B i ANY AUT•n ! / ! / IJOUILY INJURY(Per pofson, S ALI.,.ISOWNED r SCwEDUI.ED 6203814 o7116Jao1i t1151xo 2 i AUT,.IS AUTOS POUILY INJURY(I'+er.iccrort»I) 5 11fREUA:UTOS X NON•OVITIED AJ / / / PROPERIYDAMAfE UTOS Per accider,I 3 UMBRELLA I.IAQX OCCIiR ! ✓ / / EACH OCCiIRRENCE $ 5000 C X EXCESSLI:AQ CLAIMS-MADE 3SC50000040 .1/12/201111/12/2012 AGGREGATE S 5000 DED RETENTION S WORKERS COMPENSATION Y+,'ti JTAI U- X OIYI- AND EMPLOYERS'LIABILITY �:N S1 ANY PROPRIETOR;PARTNERIEXECUTIYS / / f J OFFICSR)ME BER EXCLUDED? � NIA El EACH ACCIDENT S 1000 jMsndatoryInNH) 0001-60-2396 08/28/201108/J28/2012 �- ,f:ps,describe under E L DISEASE EA EMPLOYE g 1.00 0 -'()ESCRIPTION OF OPERATIO14S be:0n4 El DISEASE-POLICY LIMIT 5 1000 DESCRIPTION OF OPERATIONS i LOCATIONS 1 VEHICLES (Attach ACORD 101,Additionaf Remarks Schedule,if more SPace Is ragWredl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOi THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELEVERED ACCORDANCE WITH THE POLICY PROVISIONS. AUTK0RrZF0 REPRESENTATIVE I i ACORD 25(2010105) Q 1988.20'10 ACORD CORPORATION. All rights reser IIVS025{ clons)os The ACORD name and logo are registered marks of ACORD - t I r md Sr ,p `i f♦ Board 4B�a 6'a(3j�2,�'i. R:'E�t2�ii @4)dad i8 inu 'Sla - i>icerlse: C S 78130 RICHARD J ::'.:.:. LAMBERT 94 PICADILLY RD - HAMPSTEAD, NH 03841 E xPxrati-on: 6/2/2012 30062 f��onrunzo�n��,� �v�aeax,�isi Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Re istrati Expsrat ;~ 11 Tr# 2907.68 Type' Fsrfsaration LAMBERT ROOA RICHARD LAMB 1T%' 265 WINTER STRI=ET..:`3:, •,..; C� HAVERHILL, MA 01 g30'`.::":`' Undersecretary i }� �4 T. EIN#51-050-3313 ambe' Haverhill MA978.374.9224 MA Reg.HIC#149221 Lawrence MA 978.687.7339 MA Lic.UCS#78130 Hampton NH 603.929.9224 MRoofin Single-Ply License#1711 9 1. Hampstead NH 603.329.8200 Swu.e1932 Co. Toll Free 1.888.SOS.ROOF 265 Winter Street Haverhill MA 01830 icensed :Insured rFactory Trained *Factory Certified Name: � Dater Telephone: � �i Alt.Teleph ne: E-Mail: Billing Address: �> . C �� , >+o s 1�JobAddress: z, ._ ec / S Scope orip and Re-roof ❑Re-roof Approximate Roof Area: repare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations andlandsc properly mo existing layers of shingles down to roof deck and dispose of in a legal fashion from e ob s'te. P p p y protected. Q,Ispect 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 beerformed at P $_ er SF.If individual sheet --.z�--P s are found to be rotted/or de-laminated, removal,disposal and replacement will be performed at*$ jn2. 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*$_/ If wood deck,siding,and is sound,we will,re-nail any loose wood to rafters,sweep deck,and prepare for roofing. f lla�s itnn drip edge to all:rakes and.-eaves.Color_j�l f ,C e&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or / .�T App premium(UNDERLAYMENT)to the balance of the exposed wood deck. e-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness. E.-I upon inspection,we discover chimney lead to be worn or deteriorated,replacement will be performed at*$ _. Install a new: _50 Year ❑ Traditionalrtectural ❑ Designer Furnish and stall a new shingle over style ridge vent system ❑Soffit vent system *$ ebris 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 _Pte l r P � UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF� YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND. YE ARS HONORED AND ISSUED BY THF SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE *$ *Denotes potential additional costs above the total estimated price. TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor es to perform the work,furnish the mate is and�bq. �iedpbove fo the t um of: $ C. � (Dollars) Payment will be made according to the following work schedule: $ . C-42 deposit 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 th li 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 CONTRACT IF THERE ANY BLANK SPACES Acceptance of the Contract Proposal Home Owner(s)Signature(s): 1 €� GSL Date: Contractor's Signature: - Dater/ /� www_lamhartrnnfinre ��.,, ,.., The Commonwealth of Massachusetts ;Print Form 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 Le ibl Name (Business/Organization/Individual): Address: ('' City/State/Zip: elfk Phone Are ou an employer?Check the appropriate box: p y � 4. ❑ I am a general contracto7andl Type of project(required): 1. I am a em to er withemployees(full and/or part-time).* have hired the sub-contr6. ❑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 8. ❑ Demolition working for mP;,i.n any capacity. employees and have workers' [No workers' c6mp. insurnce comp. insurarce.# 9. ❑ Building addition 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. right of exemption per MGL 12 ❑ Roof repairs insurance required:] t c. 152, §1(4),and we have no employees. [No workers' 13.0 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 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.#: /,/�l �� 07�79� Expiration Date:,F-A-162 Job Site Address: *T-7 Zlwal ��% City/State/Zip:4 yl Attach a copy of the workers'compensation policy declaration page(showing the policy number and expil ation 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ' a penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i The -Co' .mmenwealth of -Massachusetts Departmeht•of Fire Services Office of the State ' • F�.re Marshal _ P.0.Box 1025 State•Roozdd,.Stcw,MA 01775 • PERMIT Date: �� aa► North Andover ]Permit No .(City of Town) (If Applicable) Dig Safe Num er In eecordancc.with the provisions of 1K G.L l 4$ Ghap.ter_jQ as provided in section —U—=MR. 3 4 . This Permit is granted to:. O o 1/i Start Date Full name oferso Firm or Co oration locate dum ster - fo Pcrmissionto P r construction re no novation demolition/ ztion of bu • ilding. Ccn=cnts: dumpster. must be . 25 ' from structure if unable to lace with re uired Restrictions: clearance dumps-ter must be covered wit, ,,,.. 1: wood -or tarp end of 'work -day �f at o /� (Give location by street And no.,or c c in su ma a ti.Fcation.of Ibcatioa) Fee Paid,S 50 .00 /f Fire Chief This Permit will expire' fol— — (Signature of offical granting permit) Offical granting pernut (Title) L . w�', ,r� �; � 'P3 R t�. n�1�. H ell PAY i� ^Y e p rnd --- - � ��1� a� S, P.r.1�di r f,��LQ ,per.w.�•?R � any w j r via LAI AM Ou +^�I ��._ ,r 111 ► �:�� � �®'"i1 t�d^FYI f.�'/N� 1^ I I I .91 14 rtT "S�a�ji i} 74 IRA '"a rl �1ty �°� c f Q a� �►.�. w ' VA i lt V! 3 r - ` "Y' a �v..a:.ra:e+ .+Y.,....«+uaK.xmsr:.w...�.•:.: ..."`ems",..,._a�� rw�.�xas:�w+.w:�.=a.,�,w,+,;..,.:.. ..n.�,.r. .:M�^...,.r., .. .. 17 .CBt, fl„ is i S � I v q `t a sh IOL 00, 9 y P i U, �� ORTH Town of Andover - ev . _fir LAKE -O dower, Mass., `0 COCHIC HE WICK ��. A0 ATED P' C5 SS BOARD OF HEALTH Food/Kitchen .PERM .IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............... ........... � �i. � t oundation v has permission to erect..:...........:......................... buildings on ...... ...... .�. ......C^1.... .. ...... .................................. Rough �!.t. ..��1e....�l ......... .../....C?....... �✓� Chimney to be occupied as........................... 7r .. �'� S. `.�``� .... y provided that the person accepting this permit shall in every respect 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 UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough � .......... ........................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy 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. y ` f tl i. a x w • 7a rc( ;Q PIV 3-taL w14-h p .• lit Ce�lum Qat pVG at% fiqA Rood txi ca se r^. .^ �1 f kA` v sd e �VOJT : x 1 � r ad@ ; oix 0 if lK \ POO I'd 9X • {{{ ja tea - 4-P® 49 -0 i @ 9