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Home My WebLink AboutBuilding Permit #393 - 56 ELM STREET 11/4/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION b � t%G J A e e r Print PROPERTY OWNER / Unit# Print MAP NO: PARCEL: ZONING DISTRICT: Historic District Ifio Machine Shop Villag ye 100 year-old structure e 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 D Other aseptic 0 Well d Floodplaiin M Wetlands d Watershed District ©Water/S ewer DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: C Phone: Address: `5e'Zj�G.� S '' CONTRACTOR Name: Z4,19e_,,W_ AE,:,.t Phone: Address: 04i�%C,? Supervisor's Construction License: Q-1-7eFI36 Exp. Date: �p / Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. �� _. Total Project Cost: $ � FEE: $ 1.5 Y_ Check No.: I Z / � Receipt No.: ormpf— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .Signature bf Aaent/Owner__ Signature of contactor:. _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Location .15-Ko No. 3-4� Date N a T1y TOWN OF NORTH ANDOVER ►O. 9 Certificate of Occupancy $ sACMUs�'�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 1 TOTAL $ r Check # �3g� 2 { i ding Inspector AORTH TO" Of 2 `` " Andover .. 0 No. - 343 ,20.�. . / CN o. , dover, Mass., V` Q - LAKE COCHICHEWICK 7�AQRATED P' �� S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........D*v;..j.............i4t r ............................................ ................................... Foundation has permission to erect.............. ....................... buildings on ......5� Rough • Chimney to be occupied as.......... ........ ........�. . ..1�..w...........�....�!`�M!5.................................................... Ch' e provided that the person acce ing this permit I 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-taws 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 N)!j XTSRough ............. ...................................................................... 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 FIR_ E-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. T EIN#51-050-3313 Haverhill MA 978.374.9224 MA Reg.HIC#149221 amber Lawrence MA 978.687.7339 � MA Lic.UCS#78130 Hampton NH 603.929.9224 BBB. Single-Ply License#1711ao#in9 041-14-1114 Hampstead NH 603.329.8200 _ S+wu Pi1932 CO- Toll Free 1.888.SOS.ROOF 265 Winter Street Haverhill MA 01830 e s ,Insured ti;Factory Trained Factory Certified Name. Date: QX Telephone:_ 9 It TeCIAM9Wddress, h ----� E-Mail: Billing Address: ,,�,+** • Scopeof Work �,[�5trip and Re-roof ❑Re-roof Approximate Roof Area:_ .cL .', ❑,Prepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and qlandscape i roperly protected. 1Remove existing layers of shingles down to roof deck and dispose of in a legal fashion fromWO-1, Inspect wood deck, if we discover any rotted wood, replacement will will performed t* er LF for roof deck boards. If substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$ per S . If individual sheets are found to be rotted/or de-laminated,removal,disposal d r lacement will be performed at*$ ''" per sheet. If any trim boards are rotted, replacement will be performed at*$1�Per LF for new pre-primed pine.Inspect siding at roof line and all flashing behind siding,if we discover any damaged flashing or siding at the roof line,replacement will be performed at*$ If wood deck,siding,and fl hing is sound,we will�e-nail any loose wood tor ftersheeet4kck,and prepare for roofing. Install 8"drip edge to all rakes and eaves.Color - pply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck. SDIe-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to errgure water tigh ess. upon inspection,we discover chimney lead to be worn or deteriorated,re lacement will be performed at*$�C I tall a new: Year El Traditional architectural ❑ Designer Furnish and Install a new shingle over style ridge vent system ❑�11 debris generated by Lambert Roofing Co.,Inc.will.be cleaned up and disposed of from the job site in a.legal fashion.Under no V circumstances will the watertight integrity of the building be compromiis�ed. Special Notes ` -' ,I QI- �j'.`[' C;. 11 f_: 93 _ UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE A WORKMA V P GUARANTEE FOR A PERIOD OF -CZ YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE *$ *Denotes potential additional costs above the total estimated price. TO - CONTRACT PRICE AND PAYMENT SCHEDULE j�/ The Co tra for agree t, perform the work, rnis the serials and labor spe d ove�br the to al sum of: $ ! 'y ( ) ��> (Dollars) Paymeftt will be made according to the following work schedule: $ � 'f 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 the third business day following the signing of this agreement: See attached notice of cancellation for for an explanation of this right. D T SIGN THIS CONTRACT IF THERE ANY BLANK SPACES Acceptance�e, a Contract Proposal Home Owner(s) Signa,re(s): Date: _/ Contractor's Signature: Date: 1ATI nu lamhnrtrnnfinn rnm /-I_ OCT-12-2010 TUE 10:59 AM ALLAN INS AGNCY FAX NO. 978+745+5483 P. Ul DATE(MMDrrry RJ�� ERTI'FIC 1 t7F L IBILIT '�INS`U' NCE 10/12/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ALLAN INSQRANC9 AGENCY INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 63 1/2 Jefforoon Avenue 2nd 7 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. BOX 511 COMPANIES AFFORDING,COVERAGE SALEM MA 01970-0511 COMPANY A Seneca Insurance Company INSURED COMPANY TGLRC INC dba Lambert Roofing Safety Insurance Group 265 WINTER STREET COMPANY C Landmark Insurance Company HAVERHILL C OMPANY NY YNational Union 'ira Insurance > COVERA0129 THIS 1S 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 THEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF-SUCH POLICIES. LIMITS SHOWN,MAY HAVE BEEN,REDUCED BY PAID CLAIMS, CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS (TR DATE(MMtDD" DATE(MMIDOYYY) GENERAL LIABILITY BODILY INJURY OCC—y $ • 1,0001000 GT.30D0422 ! / I I _ __ X COMPREHENSIVE FO.<:.w BODILY INJURY AGG E _.__2,000,0�0 X PREMISESIOPERATIONS PROPERTY DAMAGE OCC_ $ 2,000,000 A UNDERGROUND 11/11/2009 11/12/2010 pROPERYYDAMACAGG_• B -_• 2,,000,OQO EXPLOSION&COLLAPSE HA7ARD Bf 8 PO COMBINED OCC S X PRODUCT61COMPLETEDOPER / / / / BI&PO COMBINED AGG X CONTRACTUAL . .. INDEPENDENT CONTRACTORS F_ERSONAI;�N A1RY AGG ....5-1.00-01-000, X BROAD FORM PROPERTY DAMAGE / / / / Medical Payment _ _ 5 000 X PERSONAL INJURY AUTOMOBILELIABILITY (FDILLYYINJURY ; ANY AUTO X ALL OWNED AUTOS(Prrvaw Pasd) 6203819 / / / / BODILY INJURY b $ qq0y LLLL ;Otherth�n R HIREOAUTOS 07/16/2010 07/16/2011 PROPERTY DAMAGE $ 7C NDN-OWNED AUTOS I— GARAGE LIABILITY BODILY INJURY& PROPERTY DAMAGE S 11000,000 COMBINED excE55 LIABILITY FAcri 000URRENCE Q O C x UMBRELLA FORM L%046005 11/12/2009 11/12/2010 AGGREGATE .... •„_---, 9 ._ 5 OC D,00a OTHER THAN UMBRELLA FORM —$ WORKERS COMPENSATION AND 5TLM A X Oh H D eMPLOYER3 uABILIYY 009934145 1,000,000 EL EACH kggIDENT •_. 6._.__._.. . ._ THE PROPRIETOW INCL EL DISEASE POLICY LIMIT i 1,000,000 PARTNERS[EXECUTNE: - 2fH 08/28/2010 08/28/2011 ... —_.. OFFICE ARE: EXCL EL DISEASE.EAEMPLOYEE 1 000 000 OTHER DESCRIPTION OF OPERATIONSILOCATWNSNRSCLESISPECIAL ITEMS , . -CERTIFICATE HOLDER ( ) - (97 B) 521.4131 SHOULD ANY 4F THE ABOVE DESCRIED POUVES BE CANCELLED BEFORE THE Galinsky Plumbing & Heating EXPIRATION DATE THE?ROF,THE IUU1NGCOMPANY WILL ENDEAVOR TOMAI L 30 DAYS WRITTEN NOTICE TO iHe CERTIFICATE HOLDER NAMED TO THE LEFT, PO Sox 1701 BUT FAILURE YO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGAT10N OR LIABILITY OFA N PON THE COMPANY,ITS AGENT4PRIREPRESENTA71VES. Iiaverhill MA 01830- AU47H Pik •. ACPRD 26,N.(1185} ACORO;CORPORATIOtt 1,088.• Nlassachmsetts - SIC +�ii"�Ttiiaii s;F llhfi1_' 2 `� Boal-d of Building Re<-talattioris a111t, Sta,r?claa°il> Construction Supervisor License _- jLicense: CS 78130 ' RICHARD J LAMBERT 94 PICADILLY RD HAMPSTEAD, NH 03841 cam_ _y� c Expsraton: 6/2/2012 30062 11'e eOOmwu»aulea e 01✓Ga 0aC4''6-A Office of Consumer Affairs&Business Regulation HOME IMP ROIEMENT CONTRACTOR Reglstratioij:1.4-49221 ExpiratrN :;2.20- 11 Tr# 290268 Type: F3itiipat tion LAMBERT ROOT RICHARD LAMB T 7 265 WINTER STREET .g HAVERHILL,MA 01830". `"'' Undersecretary The Commonwealth of Massachusetts 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 Leizibly Name (Business/Organization/Individual): �" ��1� Address: City/State/Zip: a Phone#: Are you an employer?Check the appropriate box: Type of project(required): 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 [2.0 I am a sole proprietor or partner- listed on the attached sh%et. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]Building addition [No workers' comp.insurance 5. ElWe are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.0 Other *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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Alh.Z4 _6 641-w tic Policy#or Self-ins.Lic. Expiration Date J7 �- Job Site Address;ff L�G�r T% City/State/Zip: f ,� �,�,"% Attach 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$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. Ido hereby certify under th ains d penalties of perjury that the information provided above is true and correct. Simature- Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Per # 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#: