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HomeMy WebLinkAboutBuilding Permit #266-13 - 55 BRIGHTWOOD AVENUE 10/4/2012 NORTH BUILDING PERMIT s6 o TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION O D Date Received ^TAD Permit NO: l �SSgCHus�`� Date Issued: ' v IMPORTANT Applicant must complete all items on this page z £ e c a #f $13I lli� e y �. .w rte' n, y.►+ PROPERT��'OWIVER�� g MAt?`NO; �e. � PARCEL' �ZONING D1SlTRiCT Historic Dis#rtct ` �yes� � dos �� _� � . z Mach�rtez$hQp�Village Y�eS�., na.�. a rEi PE OF IMPROVEMENT PROPOSED USE Non- Residential Residential New Building 0 One family Addition ❑ Two or more family . ❑ Industrial ❑ Alteration No. of units: Q Commercial ElRepair, replacement [IAssessory Bldg ❑ Others: ❑ Demolition ❑ Other f ❑ Watershed`Districtf , ❑�eptEcy- ❑Welfi� _ � _ ��Floo�pl�in°` tII.Wetlands � � rr DESCRIPTION OF WORK TO BE PREFORMED: Identification Please ype ort�arly) OWNER: Name sl r3 - Phone: Address: /�� ���`�� ' �" le- Pe— I! k COf�TRAC,;ORv Name ; 4�4 s °Add , 7 50 f M zn T� +� C i d:. w " '� EX Dates r Supervisor's Constna'ction -133 Lhcense a Home 1rri rovement license Exp r Da#e 1 k w . 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: FEE: $ f� Check No.: o k / Receipt No.: r(� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund v 5 Oh t A g e,a �or Signature �f Agent/Owner= I natur #c n ract Location� � No. Date • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ _ Foundation Permit Fee Other Permit Fee $ TOTAL $ Check#I43— 25785 Building Inspector I 1 Plans Submitted ❑ Plans Waived ❑ .-Certified"Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL I Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ A i i I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE AP PROVED PLANNING & DEVELOPMENT El DATE COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submittedY es Planning Board Decision: Comments 4 Conservation Decision: Comments i Water & Sewer Connection/Signature& Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT Tem { stet on site yes { p p nom .z, l OCated,at 1�A Mam$treetgti a 3` r .yr<. � ,�,.s. S. '7 '. � � - r = t it , � � x"s 4 s. ti ,U M'�'.•7Y ,,s"' a` Fire ©eparti�en#s�gnatiure/da#e xti x ` k ; �.� i}� ri' r t `" 1 s`'�,,. s § � ,p: sg}i_ S y ®'i,. +� s ..r T `7't - � .y � n,. r•. a N a;. COMMENTS Al v 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.s100-s1000 fine NOTES and DATA— (For department use) ;Ll Notified for pickup - Date ...................................................... ............................ .................. Doc.Building Permit Revised 2007 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 j ❑ 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 LiFloor/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 L3 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 I, Revised 2.2007 1 � X10 R T►i own of EAndover No. - /rte h ver, Mass, V ' coc NIC Nl WICK y1' A04ATEo S fJ BOARD OF HEALTH Food/Kitchen PER &$ L D Septic System THIS CERTIFIES THATA4BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .....1 `. �.flr.�.�t�1 .'.l!1�. 1�. ...... ... ...�... Rough r to be occupied as ................ .. .......................... ............... �. .................,.... ........ Chimney provided that the person a pting;tPermit shall in every respect conform to th rms 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 INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTH ELECTRICAL INSPECTOR UNLESS CONSTRUM ST S 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 oflklassacliirsetts �,�, �epartrnent ofbidusaialAccidents ff� oflnvestigatzons 600 Washington Street z � Boston, 1 02III tvww-Inass govldia Workers` Umpensafibn Insuffi rance Adavit: Builders/Contractors/Eieciricians/Plumbers A ]scant Information Please Print Y,e 'bI NaMC(Business/Organization/Individual): �/!1�/ 'gei Address: CitytState/ZiP= �liG /�:3a Phone#: You� Are an employer?y p yer. Check the appropriafe box: i;Fl-Itm a employer with�� 4. ❑ I am a general contractor and I Type of Project(required): employees(hull and/or part-time).* have hirers the sub-contractors 6. ❑New construction 2.❑ I am a sole ro rietor or arta - listed on the attar P P p er bed sheet _ 7 ®Remodeling ship and have no employees These sub-contractors have $e Demolition working for me in any capacity- employees and have workers' [No warIcers'comp.insurance comp.iusurance_t g- ❑Building addition .required.) 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their 1 I Plutnbin myself. NO workers' comp, right of exemption per MGL ❑ g repairs or additions insurance required.] t c. 152, 1and we 12-Q Roofrepairs 9 ) § (4), have no employees. (No workers' 13.❑ Other comp.insurance required,) 'Any applicant that checks box f;l must also fill out the section below showing theirworkers'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. tContraciom that check this.box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employers. If the subcontractors have employees,they must provide their workers'comp.policy number. I an, an employer that isproviding workers'compensation insurance for nay employees. Below is the policy and job site information. hisurance Company Name: Policy#or Self-ins.Lic.#: �� Yl Expiration Date: Job Site Address: Il �Oaep J� _ ��Q City/State/2ip:_/Nr Alzll lfJ l�S Attach a copy of the ivurkerss cotmpensation policy declaration page(showing the policy number and expiration 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 farm of a STOP WORDalPe of up to$250.00 a day against the violator. Be advised that a co o - ORDER and a foie copy f this statement may forwarded to the Q$'uce Investigationsof of the DIA,for insurance coverage verification. I do Hereby certify crude_ _ pains and penalties ofperjrrry that the inforynation provided above is true and correct Simature. Date: Phone#: Oficial use only. Do not write in this area,to be completed by city or town off ciaL City or Town- Permit/License# Issuing Authority(circle one): 3.Board of Health 2.Building Department 3. City/Town Cleric 4.Electrical Inspector 5.Plumbintr IncnPetnr CERTIFICATE OF LIABILITY INSURANCE 0 /2 27 201 8 -2 THIS CERTIFICATE IS iSSUED AS A MATTER OF INFORMATION ONLY AND CONIFERS NO RIGHTS UPON THE OERPFiCATE HOLDER. THIS t CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER. THE COVERAGE AFFORDED S Y THI E P 0 L I C 1 E S- BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCE R,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certi holder Is an ADDITIONAL INSURED, the poliCy(ieS) 1)USt be endorsed- If SUBROGATION IS 'A'AIVED, subject 40 1 the terms and conditions of the policy',certain pcl cies may require 43P erid- orseirei-A. A statement or,this certfificatc-does not CoWer`4Qhts io the certificate holder in hPLI Of SUC,, endoi-sement(s). PRODUCER CONTACT Kameras -NALIE� Jerre ALLAN INSURANCE AGENCY !NC -145-5905 _JA.'CO.NiA 63 112 Jefferson A-venue 2nd Filoor PURE jerr.id@al lanins-u.ance.com P.0- BOX 5,11 Ai3F SALEM MA C-1.9-1 0 015 i i ,SU RER A S ev-ec specialty Ins. Co. INSURED i.NsuRE,3.:3-Safety lnr;; rance C,o TGLRC Inc. .,JSLjR=RC Alterra Excess F. Sur pias Ins iba Lambert Roofing Compa-zy Ace American Insuraii.ce Co. ------------ ........... 265 Winter Stree� LIN S U R E R --------------- Haverhill MA 01830- COVERAGES CERTIFICATE NLIIVIBER: REVISION NUPABER: P-I!S !S TO CERTIFY THAT HE 1101-r'IES OF 1jQSIJRAkNCF LISTED BEL-5 7,�7;—'kTj—HE". -,,:o TH E iNSURED NAMED ABOVE FcjR EH� "--L; -'y PER1,0D i INDICATE�[) N0T'v%ATf4STAND'N1' ANY TERM OR CONDI :OOF ANY CIGNTTRA("�' OR OTHER fO VVITH 1';ERTIHCATE NIAV 1BE iS'SUED OR ty.AY PERTAIN. THE NSI>J JPANCE AFF ORDED BY -I HE ICIES DFScr-11BED HEWEII�� 1-S S )NDITION OF SUCH L'OLP-JE,'i 1 SHOV�.N P,-1A)'HAVE SEEN REIDUCED BY PAID CLAIM,-, EXCLUSIONS AND Cii- S ... ........ --—------- 11',;S—R I I D D-L��-U-EiR r— 1 POLICY EFF 1 POLICY EXP LTR TYPE OF INSURANCE POLICYNUNIOLIR ?JI"V0"YyY";UNAIDWYYY U41sTL GENERALLIAGIUTY AL iT�' 1 112 2 0 11 Pei s x 1 C, GLIN i AC-�-C�R-GAT' I Pot I,Y I t AUTOMOBILE LIAWLITY "P'5—ic; '0 i AN B ALL CIVINLI) X AUT)11" x x PURED'-U f03 WEIRFLI-A UMI X C x EXCE X SS UAG NIA 1-.-.C 5 1)0 0 040 iV"4 Ri i 1� Dr."E ,F'I i N /1-1/tri 2 WORKIERS COMPENSATION F--j, AN _RS'LIASILA TY t ' AND et M P LO Y x L ------ C;'�N I-:i N: 0 C D ItAan'datel'y in'14") O'l 2i 29 b 2 i 2 v 12 JOB/22/ oil,I if yes d'�Cr;t DIC SIrRIP f 1 r )F UPERA TICa4" DESCRIPTION OF OPERATIONS I LOCATIONS I VEIill LEF iAU-1Cf1 ACOR-)1GI kddilionai R01111afk5 Schldule,if mo.-C,spacc is ruquired) CERTIFICATE HOLDER CANCELLATION TGLRC, Inc. 1 SHOULD ANY OF THE ABOVE DES-R16GE-I 7G'-.ECIES cE CAN'CELLE.D REF RE rHE =EXPIRATION DATE -r MEREOF, 1-40TICE VVILL SE DELIVEREc ACCORDANCE WITH THE POLICY PROM!ONS. DBA Lambert Roofing Co. 265 Winter Street ZIVORIiEoEPR�3ENTA-0,�Va ' H ave r LI i"1 3, 01 18 3 0- ACORD 25(2010105) 11988-2010 AECORo CORPORATION. Aft rights reserved, INS025 -fhe AC()RD nan i,2;.irij jogo re r;?gistered rraarks of ACORrj CS-078134 P RICHARD J BERT 245 WINTER STREET Haverbill MA flib#3t6 0610=014 Office of Consumer Affairs and 11usiness Regulation - .r 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 Type: Private Corporation Expiration: A202"013.202"913: Tr# 218746 T.C.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT -- 265 WINTER STREET ---- ---- -- -- ..— — HAVERHILL, MA 01830 -- --...— — —_- Update Address and return card.Tarte reason for change. '--, Address Renewal I-I Employment i_i Lost Card 26- T. -- 'OUR PROOF IS ON dmbe " � EIN # 51-050-3313 YOUR ROOF .�� . Haverhill, MA 978.374*9224 �� MA Reg. HIC # 149221 oofing Lawrence MR 978.687.7339 , . ilMA Lic. UCS # 78130 Hampton 14 603.929.9224 Single-Ply License# 1711 s:hc�a9�z CO. Hampstead NH 603.329.8200 Toll Free 1.888.SOS.ROOF f 265 Winter Street Haverhill MA 01830 *Licensed *Insured *Factory Trained 'Factory Certified Bill Hutchins Date: 09/27/2012 V-flwe Telephone: 1-978-697-0845 E-Mail: fflWt. f Billing Address: 55 Brightwood Ave, N andover,Mass 19 1 L h►pr's���� i0-/Ma" � ,lob Address: Same SCOPE OF WORK +/ sq: feet Rear porch roof, driveway side bump out (lst floor), front bay window ( only) Prepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected. **Inspect chimney for possible re-leading and report to owner Remove 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 be performed at $3. 95 per ft for boards and $50. 00 per sheet of plywood if we need to skin over any roof area. If wood is sound we will re-nail any loose boards and prepare for roofing. *Apply Ice & water shield (UNDERLAYMENT) as per manufacturers' specifications 6' and up all roofs to walls to include entire surface of rear porch, front bay window and bump out on driveway side of house . *Install 8" drip edge color to be decided by owner *Install new: Architectural Shingles. Color to be selected by owners' certainteed landmark pewterwood architectural shingles j *All debris generated by Lambert Roofing Co. , Inc. will be cleaned tip and disposed of from the job site in a legal fashion. Under no circumstances will the watertight integrity of the building be compromised. UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP WARRANTY AND ISSUED BY Lambert Roofing c Company for (10) YEARS AND A MFRG WARRANTY ISSUED BY THE SHINGLY; MANUFACTURER (SEE WARRANTY TERMS AND CONDITIONS AT WWW GAF. COM or �W. CERTANTEEO COM **Denotes possible additional expense TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE $1, 550. 00 (One thousand five Hundred fifty dollars) Payment will be made according to the following work °schedule 1/3 down prior to commencement of work: ------------------------ —$500. 00 (five Hundred dollars) Balance in full upon completion of work ----- $1, 050. 00 (One Thousand fifty Dollars) LINE ITEM: ADDITIONAL COST G Wrap rake. boards on both gable ends of house with . 025 white aluminum coil stock to include casement window trim on left end (as viewed from front of house) $920. 00 ( Nine hundred twenty dollars) (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 an explanation of this right. SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Accepts the Contract Proposal Owner(s) Signature(s) : ! Date: e Contractor' s Signature Date: / / l of www. lambertroofing. com Company Insurances P Y 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 SEPT 2012 • Complete the described work in approximately (1) day • 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. 1.42A. 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 31S` 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 - 1/3 of the total contract price or: . 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 .:ontractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. Owner: Date: Z0 Contractor: Date: I 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