HomeMy WebLinkAboutBuilding Permit #627 - 58 MILK STREET 4/24/2008Permit N0: &�2�
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
Date Issued: d o --%"-'
IMPORTANT: Applicant must complete all items on this nate
LOCATION '5 �ic,
Print
PROPERTY OWNER '" d - V. If ✓.Yy�2.��
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Others:
Repair, replacement
Assessory Bldg
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: Phone: �?'2ep
Address: S ll
.-- 4���� r fL /)� S ericr
Supervisor's Construction License: dj Exp. Date:' +�
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER
Address:
Phone:
Reg. No
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $16 `j 6 FEE: $
Check No.: 7 99 � Receipt No.: Q %lo;
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner , Signature of contractor r
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)
❑ 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 2.2008
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
. IL`[cl.IN11:0 Ito]04411111 r
COMMENTS
CONSERVATION Reviewed on Siqnature
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 Con nection/Sinnature & Date Driveway Permit
DPW Town Engineer: Signature:
l_ocatea 364 U
FIRE DEPARTMENT - Temp Dumpster on site yes no_
Located at 124 Main Street
Fire Department signatureldate
COMMENTS
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 2008
Location
No Date
TOWN OF NORTH ANDOVER
S
Certificate of Occupancy $
Building/Frame Permit Fee $ Y
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Z6-1 ',In --�'
Check# z 7 7ell-
Building Inspector
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The Commonwealth of Massachusetts
Department of Industrial Accidents
z Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please .Print Legibly
� A
Name (Business/organization/Individual): r�
Address:
City/State/Zip:��, /� l�/eta Phone.#:
Are you an employer? Check the appropriate box:
1. (-I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part -tune). *
have hired the sub -contractors
2. ❑ I am 4 -sole proprietor of partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
employees and have workers'
working for me in any capacity.
comp. insurance.$
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their
myself [No workers comp.
right of exemption per MGL
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp, insurance required.]
Type of project (required):
6, ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
'9. ❑ Building addition
10.7 Electrical repairs or additions
11. ❑ .Plumbing repairs or additions
12. E] Roof repairs
13.0 Other_
"Any applicant that checks box 41 must also fill out the section below showing their workers' eQmpensation 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: �✓✓? �11%L.��
Policy # or Self -ins. Lic. #: /� �(�G0 Expiration Date: F--w-04F
Job Site Address: /% City/State/Zip:"44t--vow
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 venficat on.
Ido hereby certify uerfd,X pains and penalties of perjury that the information provided above is true and correct.
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 #:
RUG -31-2001 FRI 0851 "Ij BRSSOCIRIED 1NSURRNC
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Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 149221
Expiration: 12/6/2009 Tr# 262486
Type: Private Corporation
LAMBERT ROOFING CO
RICHARD LAMBERT
265 WINTER STREET
HAVERHILL, MA 01830 Administrator
License or registration valid for individ I use only
before the expiration date. If found retirn to:
Board of Building Regulations and Stat dards
One Ashburton Place Rm 1301
Boston, Ma. 02108
Not va r without signature
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(U11c .ashburtace - Rooi
1301
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Boston. Massachusetts 02108
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Home Improvenle; t Contractor Registration
Registration: 149221
Type: Private Cor
Expiration: 12/6/2009
LAMBERT ROOFING CO
RICHARD LAMBERT
265 WINTER STREET
HAVERHILL, MA 01830
OpS.CA, i, 50M07/07-PC8490
015 U•
ition
Tr# 262486
Update Address and return card. Ma reason for change.
El Address El Renewal [] Empl
me ❑ Lost Card
Board cif Building Re.qulations
One As".---'rten Pace m ' 301
�,4a 021 G8-1618
Llcenso CoI)STRUCTIO,`,,' SUPER:'!SOR _ 'crvSE Blrthdato 06/0?,'197?
Number CS 078130 Expires 06' uJB Restricted To 00
RICHARD 1 LAMBERT
g5jMAPLE AVE
ATKINSON, NN 0331 I
Tr. no 27100
Koap lop for roc9ipt and cha I. of aocrass nonncar,c
• Jr'p �._;t,. fes: i
Ein # 51-05033313 T.G. �P5,t?.N M,4Sp
MA Reg. Hic # 149221 ii,
rt
MA Lic. #UCS 018130 V " oting BBB
Single -ply Lic. # 1711 , eL � 193. T.
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265 Winter Street, Haverhill, MA 01830 MEMBER
A
We are: ✓ Licensed ✓ Insured ✓ Factory Trained ✓ Factory Certified Installers
Date: :t ! ('i'.; y'J . c Estimate for: i ?"X, °•;',i ; �.:
Telephone 1: Telephone 2:
c
Address: City/Town:./t / I=`� : ''4!i` State:r'�.i Zip:
Job Location: City/Town: State: Zip:
L.R.C. agrees to commence described work on / or about i ~<.":`> and described work will be completed in about , -':'. working days. L.R.C. shall not be hel
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 circun
stances beyond our control. L.R.C. can not and will not be held liable for any damage to the surface that the disposal container is placed on. L.R.C. shall not be held liable for pr(
existing conditions including but not limited to mold and/or wood rot, defective, faulty, rotted or worn building counterparts such as but not limited to siding, gutters, masonry, pluml
ing, and windows that jeopardize the watertight integrity of the building and are not covered under the roofing warranty.
The following work includes all permits, labor and materials needed to complete your job in a professional workmanship like manner.
Steep slope Quick -quote proposal to furnish and install the following: Approximate roof area %;z::' •,."
❑ �Iew Roof i' R -roof ❑ Gutter ❑ Repair ❑ Ventilation
Ell 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 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 $* per LF for roof deck boards. If substantial deck rot is discovered, re -sheathing of roof deck can be performed al
$ * per SF. If individualsheets are found to be rotted and/or delaminated, removal, disposal and replacement will be performed at S y
per sheet. If any trim boards are rotted, replacement will be performed at $ * per LF for new pre -primed pine (not to exceed 1" x 8"). If wood is
sound, we will re -nail any loose wood to rafters, sweep deck and prepare for roofing.
❑ Install 8" Drip edge ❑ Install 5" Drip Edge nstall Hug edge (Re -roofs only) itY.P i r,.; :, ; . Color kj_;, -
❑ Apply ice & water shield (UNDERLAYMENT) as per manufacturers' specifications and or
❑ Apply -# felt paper (UNDERLAYMENT) to the balance of the exposed wood deck.
Ei Reflash all stack pipes, tie-ins, chimneys and/or any roof penetrations as required and dictated by good roof practice to ensure water tightness.
❑ If upon inspection, we discover chimney to be worn or deteriorated, replacement will be performed at $ * per chimney for single flue and
$ * per chimney for multiple flues.
Of Install a new '-. Year L] Traditional W Architectural style shingle roof system Color r'f .`; f',1' R Monf.
❑ Furnish and Install a new shingle over style ridge vent system ❑ Soffit vent system $
�—X'AII debris 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: f� }� 1 �: r t i5 A C 1' /=t
Warranty options: 0' Standard LRC ❑ Manufacturers Upgrade $
* Denotes additional costs above the total estimated price.
UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF TEN YEARS HONORED AND ISSUED BY THE LAMBERT
ROOFING COMPANY AND ='>� YEARS HONORED AND ISSUED BY THE 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
A finance charge of 1.5% per month (18% per year) will be charged on past due accounts over 30 days.
Total Estimate Price: $ Date of Acceptance ••{ ;: r
Payment to be made as follows: .r'r' i -j- (Home/Business owner)
Signature
'; ..c. (LRC) t:
Signature
Haverhill MA 978 374.9224 • Lawrence MA 978-687-7339 - Atkinson NH 603-362-9500 - 1 -888 -SOS -ROOF (767-7663) - Fax: 978 521-579
"Our Proof is on Your Roof"
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