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Home My WebLink AboutBuilding Permit #14 - 58 HOLLY RIDGE ROAD 7/8/2008 R BUILDING PERMIT o�"°o" '+ti TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION . b. Permit NO: Date Received '•o ACHUS Date Issued: O IMPORTANT: Applicant must complete all items on this page s..iicc n > yxk ,,.. AMNMI 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 DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Cleanly) Phone: OWNER: Name: 46�z R ! �� YY�,2'_4 �ccr J� l,� Address: , e�/y�✓ -� . w 5 p . 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: $ � �d �— Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyJ,und - .. .^✓..br+Y:.^ 'rx3,x,.?sx .. Ne+v " sM. 1$.x<x,e .�..rAfi.K�'Fa3xe.-�..m.-`x.. 4a. 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 ❑ i 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS F 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 Located at 384 Osgood Street 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 _ 4 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) o 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 2.2007 Location 7 .� ��'l-✓"'� ' No. � Date -77 0 NORTh TOWN OF NORTH ANDOVER GAL � 9 i Certificate of Occupancy $ �b'••°•'<� Building/Frame Permit Fee $ ssA04 S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 304 Building Inspector ` NORTH 0" 0 T f ? Andover 0 .-..... -No. A K E o dover, Mass., O COCHICHEWICK ��• RATED PPa��y E BOARD OF HEALTH Food/Kitchen PERMIT T D - Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... a ............... .................,......................... ...... . ..... ..... .............. ..... Foundation has permission to erect.................................... uildings on ..... ......�. � �.......... Rough SONNNOW t0 be Occupied as........ #, Chimney r vided that the erson acce m this ermd shel� e #resp-ect conform to the ms of thea licationon file inp 0 p g pryPP 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 EXPIRESIN 6 MONTHS - . ELECTRICAL INSPECTOR. UNLESS CONS U O STARTS Rough Service BUILDING CTOR - 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 SIDE Smoke Det. 8o#5l-050333l3 T.G. ^�~w MA Reg. Hk# 149221 arnbert , kAUc #UCS 00l30ifflo-fing `=�" � �oD|�p�Uc # l7}l 617 / L/ ' / a=~ % MEMBE0 265Winter Street,Haverhill,MA0l830 � We are: V Licensed V Insured w/ FoctoryTroinod V Factory Certified Installers - � Dnm. [stimumfo,. /�� /�� oel: ^ ^^~ "� `~ Telephone 2: �l Address: /"U� �� [kv9owo �/��/ �um Zip�_______ Job Location: ": City/Town: 5mte.______Zip: ______ L.R.C. agrees to commence described work on/or about 1-3 U-iX and described work will be completed in about working days. L.R.C. shall not be held liable for delays due to circumstances beyond our control. L.R.C. shall not be liable for any damage to landscape,attics,interior walls or ceilings and/or fixtures due to(ircum- uvoo^vqmoovv,mm/v/. L.^.C. mx/m.m."=.,".""""."""".".".""/"""."»"="=^"""ce"=.."".^r"".~...... ~'..~..... ^^`^ ^..11..,.,,.~...~,.~ '.. mistingoonditionsimluding but not limited mmold and/or wood rot,defective,faulty,rotted orworn building counterparts such mbut not limited to siding,gutters,masonry,plumb- ing,and windows lomb-iog,uodviodons that impordizothe watertight integrity of the building and are not covered oodorthomoin0*mnnoty. The following work includes all permits,labor and materials needed mcomplete your job innprofessional workmanship like manner. Steep slope Quick-quote proposal to furnish and install the following: Approximate roof area ! Cq ANew Roof [] Ko'mof [] 8o8o/ [] Repair 0 Ventilation /Prepare for re-roofing by ensuring all safety measures are taken in accordance to OSHA standard regulations and landscape is properly protected. Remove existing layers ofshingles down roof deck nnddisymoofino)e0u|huhionhomdmiobdte.|n9octnooddockif*odbmvornoyrottedwood, � replacement willhoperformed ut per LF for roof deck boards.If substantial deck rot is discovered,re-sheathing of roof deck can be.performedut ! *per 5[|f indiv)'----------found tohorotted and/or do|ominntod,mmovu[disposal and my|ommont wiUhopor�rmodot � per . any�imboards umm�od,mp|ommon[wiUhopodormodot /� ~porLFforoonpm'primodpino(oot toexceed l"x0").|fwood is sound,we*iU re-nail onyloose wood n/rafters,sweep deck and prepare for roofing. d"Install B"Drip edge CJ Install 5"Drip Edge 0 Install Hug edge(Re-roofs only) Color _ (�Apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications a n d a r L'5, Apply #felt paper(UNDERLAYMENT)to the balance of the exposed wood deck. ,,Nflash all stock pipes,tie-ins,chimneys and/or any roof penetrations as required and dictated by good roof practice to ensure water tightness. L'—of If upon inspection,v4discover chimney to be worn or deteriorated,replacement will be performed at S-2> 0 per chimney for single flue and per chimney for multiple flues. 8f Install a new Year 0 Traditional Architectural style shingle roof system Color Manf. 26urnish and Install a new ~=�^ b0onom�d|wLom shingle All debris Roofing��Inc. will he cleaned upand disposed offrom the job site ioolegal fashion. Uncle- nocircumstances will the watertight integrity ofthe building ho 5pvdn Nvm, ' � | ^ � Warranty options: 0 Standard LR( 0 Manufacturers Upgrade * Denotes additional costs above the total estimated price. UPON COMPLETION ANDPAYM[NT|NFULLKOOFSMALLH4VEA WORKMANSHIP GUARANTEE FOR 4PERIOD 0FTEN YEARS HONORED AND ISSUED 8YTHE LAMBERT ROOFING COMPANY AND YEARS HONORED AND ISSUED DYTHE SHINGLE MANUFACTURER. This document can serve as a contract, however if a more elaborate contract is desired we will issue it at the owners request. Please sign and return one copy upon acceptance. NOTE.if this contract is not accepted in days, it may be withdrawn by LRC Financing is available Afinance charge ofl.596per month(l096per year)will kocharged oopost due accounts over 30days. Total Estimate Price: Date of Acceptance � Payment m6vmade us follows: (Mome/8miomam,00 —' oiSoamm (LRC!) Signature � Haverhill 8&4978 �74~�224 ° Lawrence ° Atkinson NH 603'362-95U0 ° l-888-SO8-QOUF (767'7663) ^ Fox: 978 521-5791 � ` ^��v� �°v^�.� ^_ �� Your Proof' � vmwvv |mm6ertromfioB'net The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street .` Boston,MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letzibly NaMe (Business/Organization/Individual): . en.—,l eta+ Address �,y��rlsLJ j City/State/Zip: ��` _&E39 Ph.one Are you an employer?Check the appropriate bog: Type of project(required): 1 XI am a 4. I am a general contractor and I ' employer with �� ❑ � 6. ❑New construction• employees(full and/or part-time).* have hired the sub-contractors 2.El 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' 9. F]Building addition comp.insurance.$ [No workers' comp.insurance required.] 5. We are a corporation and its 10.E]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised.their 11.❑Phunbing repairs or additions myself [No workers' comp. right of exemption per,MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we ave 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. . 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;T7'L� Policy#or Self-ins.Lic..#: too f d 0 Expiration Date:t_&9X d Job Site Address: e City/State/Zip: 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 Investiizations of the DIA for insurance coverage verification. I do hereby certify under the pains and 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 )JU k A NC I)('hy I Ll _,�RTIFICATP IS 15SUP-D F�_R,T H rhjS ,tiS C Ll�TL_F C()NFER3 No K T R C) R' r)o D 5 1-tO T P,r F N D,E-X tQrznc,3 k90':N In, FOLfCISS BELO'wV, -—--------- c r Dox 606 _mt�� A C,C) 0 RJ' 1 Y TF, 317� j:04Gily {_l 6 3 Y-'M(Or SST f I t3 I I H` 0 1 TN E�I S rD.,v S u E3 D T, -1 LA, 'ST-F)[3ELj T T !J 3Y'T rc,CEPI T� L) U TE f Y"') oc CIA O 4,C Qwr-"C-T U Aj U_ry pc)pfr.y LI.)Vd -in 0 1 gpI;,LVjf:V A ujzj MT-) LL-L-'n OTXZA TK-L."4 LP T IONrcw 5 0 0, L I-P UJ T-Y CH A.Cc I C)a?rr ;15 OOG Fl,DjaA&b,_?o)ucT UNIT 5QQ,OOQ ,v=xscvnvj 600996601x.lr . O8n&/NQ7 0 n00 Nct L3 W P OY B T I ON LOn OF OFEJ7 : j,,,LLN T-,z)D CP IPTIQN V;F wur Ez;- ZAVC)k"ro H/jl._i5 D4 k T11. e t r,�[)s f.;,j 7: HP_u,-�Y,VO 1,UL)INQ C�-�4"-NY P.,,jLLrP-E TO�31_SIIICI�NO r!CF S�'�L t L' r 76 I III L L_LFr.13 UT D}4 THS C toc"I 11 U LrNT ON 5 T NI-EN c /� / Board o Building Regulat ons an =anc6aras�� = J One Ashburton Place - Room 1301 o Boston. Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 149221 Type: Private Corporation Expiration: 12/6/2009 TO 262486 LAMBERT ROOFING CO --__..___-- ------- --------__._ RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 -----.._ ___ -----_ Update Address and return card. Mark reason f'or change. i—i Address F-1 Renewal Employment Lost Card OPS-CA! tii 5OM-07/07 PC8490 Board uF Buildin Kc_ui,iii n. ;incl ',i;w(kil tk Construction Super: sor License License: CS 78130 Restricted to: 00 RICHARD J LAMBERT ' 95 MAPLE AVE ATKINSON, NH 03811 i t,p,ration. 6/2/2010 �niini„i••iivr Tr= 27762