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Home My WebLink AboutBuilding Permit #1152-2016 - 56 ELM STREET 5/17/2016 NORTh Adl -r� t �.' BUILDING PERMIT O�S�LED ,bgge y N l/� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: ll 1J I Date ReceivedD " ADRATED,.PP`y�J gSSACHUs�� Date Issued: IMPORTANT: Applicant must complete all items on this page 1 LOCATION � V-n Y `` ,��, i1 not PROPERTY OWNER S 11J1 tT�f S� Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building tr6ne family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic []Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer ESCRIPTION OF WORK TO BE PERFORMED: cuA 1 k dy-ky�Q 1 Ideti! tion- Please Type or Print Clearly OWNER: Name: �a�► 1 Phone:U-1 Address: Is rVL Contractor arae: Phone: Email: Address: ' 1 Supervisor's Construction License: � .-)8( W Exp. Date: &)' 'q- 1 �P Home Improvement License: `LA9 oqcr�-1 Exp. Date: �a 0' r" 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: $ Q�, FEE: $ j�)D "— Check No.: Receipt No.: �Z NOTE: Persons contracting with unregistered contractors do not have access t e aranty�nd - -- - ------- 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Violater & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: LnpKd 384 Osgood Street FIRE DEPARTMENT - Temp:Dumpster on site yes _ no Located,at 124-Main Street Fire Department signature/date � i � c � y-� /G COMMENTS Location No. i > J - C I( . Date 3 I`I • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL Check _ J�7 ✓ Building Inspector ! �. �.10RTFr 2 Town .�► ._ ' ndover No. s C, "h ver, Mass, (A.4 COCMICNIWICK 1' U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT PERMgT . . BUILDING INSPECTOR has permission to erect .. buildings ... Foundation p .. ..4. ...... g .. .. ....M.... ............::. ..... . . . .. .. . kfravoof Rough to be occupied as ....... ...... ..�e ..... ..... .. .. ........ .,('1,� 0. Chimney provided that the person accepti g 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,Altera Construction of Buildings in the Town of North Andover. 6 reap„ � k� PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST 10 Rough Service .. �. Final UILDIN, SPECT R GAS INSPECTOR Occupancy Permit Required to Occupy Building ry 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. EIN f;51-0503313 T- Haverhill MA 978-374-9224 h MA Reg.HICN149221 mbert Lawrence MA 978-687-7339 -� MA Lic. UCS 1#78130 Hampton NH 603-929-9224 BBB oofing Hampstead NH 603-329-8200 Toll Free 1-888-SOS-ROOF WWW.I AM BE RTROOF 1 NG.CoM 265 Winter Street Haverhill MA 01830 Name: I Dave Hirst Date: 14/26/2016 Telephone: 617-775-8070 Cell Phone: Click here to enter text. Email: dhirst@gmail.Com Billing Address: 56 Elm St City: N.Andover State: MA Job Address: 56 Elm St City: N.Andover State: MA Scope of Work ®Strip and Re-Roof []Re-Roof Approximate Roof Area: ®Prepare for re-roofing by ensuring all safety measures in accordance with OSHA regulations and landscape is properly protected. ®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 LF for roof deck boards.If substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$1.25 per SF.If individual sheets are found to be rotted/or de-laminated, removal, disposal and replacement will be performed at*$65.00 per sheet.If any trim boards are rotted,replacement will be performed at *$12.00 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 *$12.00.If wood deck,siding and flashing is sound,we will re-nail any loose wood to rafters, sweep deck,and prepare for roofing. ®Install 8"drip edge to all rakes and eaves.Color: ®Apply ice&water shield(UNDERLAYMENT)as per manufacturer's specifications and/or ®Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck. NRe-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness, Elf upon inspection,we discover chimney lead to be worn or deteriorated,replacement will be performed at*$450/ea ®Install a new:Year 03 Tab NArchitectual ODesigner Color: N Furnish and install a new shingle over style ridge system Soffit vent system*$n/a NAZI debris generated by Lambert Roofing Co.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:6'of ice and water shield to be installed to entire building. Synthetic paper to be installed above ice and water shield. 40 yr architectural shingles. Ridge vent all applicable areas. Front porch to be completed along with driveway side of rear addition. UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE A WORKMANSHIP WARRANTY GUARANTEE FOR PERIOD OF 10 YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANYAND LIMITED LIFETIME YEARS HONORED AND ISSUED BYTHE SHINGLE MANUFACTURER MANUFACTURER'S UPGRADE *$N/A *Denotes potential additional costs above the total estimated price. TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work,furnish the materials and labor specified above for the total sum of:$2,400.00(*) Two Thousand, Four Hundred (Dollars) Payment will be made according to the following work schedule $ 800.00 deposit upon signing contract $ by or upon completion of $Balance upon completion of completion. (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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES , Date: ,t, cce tante of the Contract Proposal yP40 Home Owner(s)Signature:_ Contractor's Signature: r-- ''� Date: www.lambertroofing.com(Please see reverse side) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 .Boston, MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: QDS L0�l 1 City/State/Zip,. �(1 ) Phone #: Are you an employer? Check the appropriate box: Type of project(required): L�,1 am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ 1 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' insurance.* 9. ❑Building addition con [No workers' comp, insurance p• required.] 5. ❑ We are a corporation and its 10.F] Electrical repairs or additions 3.❑ 1 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.] c. 152, §1(4),and we have no 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. '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. #: R)—OSE 091MS ^a—((p Expiration Date: Job Site Address: 1�_?�o L m S _ City/State/Zip: N -I�ncloyer got— Attach otAttach a copy of the workers' compensation 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 form of a STOP WORK ORDER and a fine of up to S250.00 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 herehy certify under th a d pen perjury that the information provided above is true and correct. Si ature: Date: 14, a - (Q0 (; Phone#: �� 'Ga 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#• ATE , 11. R CERTIFICATE OF LIABILITY INSURANCE D3/28lDD016 03/28/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jerrold Kameras NAME: ALLAN INSURANCE AGENCY INC. PHONE (978) 745-5905 FAX ,(978) 145-5483 63 1/2 Jefferson Avenue 2nd Floor EMAIL .Jerrold@allaninsurance.com P.O. BOX 511 INSURERS AFFORDING COVERAGE NAIC p SALEM MA 01970-0511 INSURERA-Associated Ind Ins Co. INSURED INSURERB:Safety Insurance Co. TGLRC INSURERC:National Union Fire Ins Co. dba: Lambert Roofing co. INSURERD:Ace American Insurance Co. 265 Winter Street INSURERE:Ace American Insurance Co. Haverhill MA 01830— 1 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS 'INSR ADDLSUBR TYPE OF INSURANCE POLICY NUMBER MMI IDIYYYY MCY EFF M! EXP LTR ICY YYY LIMITS GENERAL LIABILITY / / / / EACH OCCURRENCE S 1.000,000 X COMMERCIAL GENERAL LIABILITY / / / / PREMISES -aoccurrence) S 50,000 A CLAIMS-MADE ❑X OCCUR hEs1028029 02 11/12/2015 11/12/2016 MED EXP(Any one person) S 1,000 X per progect Agg National Roofers Assoc. / / / / PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER / f / / PRODUCTS-COMP/OP AGG S 2,000,000 POLICY PRO- LOC / / / f $ AUTOMOBILE LIABILITY f COl'BINED SINGLE LIMIT a agent ,$ _ 1,000,000 ANY AUTO / / / / BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 6203819 7/16/2015 7/16/2016 AUTOS X AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED / / / / PROPERTY DAMAGE $ HIRED AUTOS AUTOS we,ac"entt X UMBRELLA LIAS X OCCUR / / / / EACH OCCURRENCE S 5,000,000 C EXCESS LIAB CLAIMS-MADE E018335635 11/12/2015 11/12/2016 AGGREGATE $ 5,000,000 DED RETENTIONS / / / / $ WORKERS COMPENSATION / / / / X WC STATU- OTH. AND EMPLOYERS'LIABILITY :NYPP.OPRIETOR/PARTNERIEXECUTIVEY/N S62UB-2E09875-2-16 MA 3/25/2016 3/25/2017 1 FR EL EACH ACCIDENT $ 1,000,000 D OFFICERlMEMBER EXCLUDED? FRI NIA / / / / (Mandatory in NH) E L DISEASE-EA EMPLOYE $ 1 000 000 If yes describe under DESCRIPTION OF OPERATIONS below F L DISEASE-POLICY LIMIT I S 1,000,000 E worker's Compensation NH / / / / same IMISas 1,000,000 S62UB-8D81311-16-15 NH 12/22/2015 12/22/2016 po,cyabove 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space is required) CERTIFICATE HOLDER CANCELLATION TGLRC dba: Lambert Roofing SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 265 Winter Street AUTHORI REPRE NTATIVE Haverhill MA 01830- ACORD 25(2010/05) C 1988-2010 ACORD CORPORATION. All rights reserved. INS025t7otoo5)oi The ACORD name and logo are regisi Bred marks of ACORD CS-078130 ow M RICHARD 1 LAM ORT r 265 WINTER STREET Haverhill MA 01830 06102!2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 Type: Private Corporation Expiration: 12/6/2017 Tr# 273093 T.G.L.R.0 dba Lambert Roofing Company _ RICHARD LAMBERT 265 WINTER STREET --- HAVERHILL, MA 01830 Update Address and return card.Mark reason for change. (_f Address F] Renewal n Employment F Lost Card