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HomeMy WebLinkAboutBuilding Permit #320 - 58 OLD VILLAGE LANE 10/20/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION O`%.►ORT#y A0R16.6 Permit NO: ib Date Received + :T 4 1 � oDR,7�D � I•PP`y(y Date Issued:/ � � 9SSACHU`+E� IMPORTANT: Applicant must complete all items on this page LOCATION SSS QL n V L LLtq&,E I A,tIR Print PROPERTYOWNER —femNy e- (— Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ;K Repair, replacement ❑ Assessory Bldg ❑ Commercial Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF W RK TO BE PREFORMED <ffKi ge -le(1oF Identification Please Type or Print Clearly) OWNER: Name: Phone:q?8 69q QQQ�{ Address: g (DL.0 214A)1E CONTRACTOR Name: LAM(U 6. &E-1'N G Phone: U6 -317 y QD.)``l Address: Q6S Wt'i\"t- Sr : /�A1/4Y1,hi Cl 0/g30 '. Supervisor's Construction License: 07,9/ 3o Exp. Date: 610 16 Home Improvement License: Q�a 1 Exp. Date: ARCHITECT/ENGINEER Name: Phone: ;-Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATUP COST BASED ON$125.00 PER S.F. Total Project Cost :$ �, 600 00 FEE:$ Check No.: ! ReceiptNo.: Page Iof4 i TYPE OF SEWERAGE DISPOSALSwimming Pools ❑ Tanning/Massage/Body Art ❑ Public Sewer Tobacco Sales Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 r FIRE DEPARTMENT - Temp Dumpster on site yes �'' no Fire Department signature/date 6 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 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use Parc 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:131)FORM05 Created AMC.Jan 2006 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Rooting, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application o 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) o Mass check Energy Compliance Report (If Applicable) 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 o 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 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:INSPECrIONAI.SERVICES DEPARTMEN'rMFORM05 Page 4 of 4 NORTH Town 0 t 4 over 0 No. 3 _ ... LAKE over, Mass.,10 coc MIC NE WICK y^ 0 A T E D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 0 a feeBUILDING INSPECTOR THISCERTIFIES THAT ...................................................................... 4............................................ Foundation 0 has permission to erect........................................ buildings on -4.0....(00...........6..F*?..t Rough ...................................................................................... Chimney to be occupied as..... .. ti, 1!....Aksh ii "�. �i?jg provided that the personl acicil t s per in eve aspect conform to the terms of the application on file in Final Vi 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 O LOW- PERMITEXPIRES IN 6 MONTHS Final UNLESS CONSTRU S S ELECTRICAL INSPECTOR CF T4kTWWIW� Rough ........... ................................ .................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. Ein*51, T' PSON Mq f� MA Reg. H'ic#121981 singe 2`` ocyc MA Lic. #UCS 078130_ re Single-ply tic g 1711 T h t v�cvi2932 C-9 . 265 Winter Street,Haverhill;MA 01830: MEMBER We are: .✓ Licensed, ✓ Insured ✓'Factory.Trained ✓ Factory Certified1nsta1lers: u Dater Estimate fork. .4 r kr ' E me' c r. Telephone 1: �° 6 � Y Telephone 2 4 v ' ��i�x . Address:. L5 0 City/Town I t!, G �Z' �{�? Stater Zip r . b �3 Job Location: fe d � + City%Towo: State:.. ZipA L.R.C. agrees to commence described work on/or about T-6A and described work willbe completed in about working days. L:R.C. shall not be held liable for delays due to circumOcinces-beyond!out control. L.R.C. shall not-beliable for any damage to landscape,attics,-interior walls or ceilings and/or fixtures due to circum- stdnces beyond:`our control. L.R.C. cannot and will not be held liable for any`damage-to the.surface that the.disposal container is placed on.11.C. shall not'be Held liable for pre- existing conditions including bitnot'limifed fio mold and/o,rwood rot,defedive,.foo lty;rotted or worn building counterparts such as but not:limited to siding,gutters;masonry,plumb- ng,and windows that jeopardize the watertight integrity of:the building.and are not covered under the roofing warranty: The following work includerall permits,labor and materials needed to complete yourjob in a_professionol workmanshplike manner.' Stee Slope fiuickquote proposal to furnish and install the'following Approximate roof area_ New Roof ❑ ,Re=roof 0; Gutter: ❑ A Repair ' � entilation ,7�_ �Prepare for re-roofing liy ensuring:allsafety measures are taken in accordance to OSHA standard regulations and landscape is properly -prat dei , �''Removi existmg'layers:of roof material down to roof deck and inspect wood If upon inspection we discover any rotted wood,replacement will be performed at. $ per LF.'* If substanticiFdeck rot"is;discovered.re-sheathing,ofroof deck cambe:performed at $h -.per SF.* If wood is sound;we will nail any loose wood to rafters,sweep deck=and prepare for installu'tion. ; ®/Install 8"Drip edge ❑ Install"5"Dnp Edge ❑ Install Hug edge(Re roofs only) t� ' �''t t r ./r!, Color �AApply C619:water.shield(UNDERLAYMENT)as per manufacturers'specifications and or. C7 Ap ply= f #felt paper(UNDERLAYMENT)to the balance of the exposed;wood deck. 19°'Reflash 611:stack.pipes,tie-ins,chimneys and/or any coo enetrotions as required and dilated by good:roof practice to ensure water#ightness. Rpsealchimney base using cement fabric Re Lead ) ❑ Re point chimney ❑ Re-6u Id chimney $ � I stall u riew Year ❑ Traditional Architectural style shmgle'roof sysfern ;,Color 6 M �. `Mdnf.: ally 1, j 'E Fu nish':and install a new shingle over style:ridge Pent system, :' O-Soffit`iimll Own All debris generated by La,mbert Roohng;Co.,1nc. willbe cleaned up and disposed_of from the lob site Ina legal fashion. -Under no:circum"stances will the watertight integrity of the budding be compromised /} / Special Notes. `'r:. . �' ,r'' c 3 { t4'� �Z �t'at 'F'�LFi $!' .. ?�^".78f/-. '4•0,. Warranty options:, andard LRC Manufacturers Upgrade; $ aiwi ? ' ",benotes.addihondl costs ab-ove the total estimated peas. UPON COMPLETION AND PAYMENT IN,FULL,ROOF SHALL HAVE-two GUARANTEE FOR A PERIOD OFTEN:YEARS HONORED AND ISSUED BYTHE LAMBERT ROOFING COMPANY AND .:YEARS'HONORED A.ND ISSUED BY THE SHINGLE MANUFACTURER.:;; , This document can serve as a contrail,however if amore elaborate contrail is desired we will issue it6t the owners request. please sign and.return one copy'upon acceptance. NOTE-1f thts contrail is not accepted in l 5 days;it may be wthdrawdby LRC. NOTE:We accept major credit cards*_&financing is available *'A#finance charge of 1,5%per month(18b/o per year)willbe charged on past due accounts over 30 days Total Estimati of Acce te Price: $ f%. Daptance AAW Payment ta;be made as follows. �.'..to!/ . ..€�'r i1 (Home/Business owner) f igna re (LRC) t fzxgna ure Haverhill-ft 978 374.9224 Ldwrence.MA.978-687-7339 Atkinson NH 603-362-9 `-888-SOS-ROOF (767-76631 Fax: 978 521-5791 "Our Proof ison rour"Roof' A CORD DATE(MM/DD/YYYY) •+ TM. CERTIFICATE OF LIABILITY INSURANCE 10/16/2006 PRODUCER Phone: (781)933-3100 Fax: (781)933-9048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SALEM FIVE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOYLE INSURANCE SERVICES HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 445 MAIN ST BOX 606 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WOBURN MA 01801 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NAUTILIUS INSURANCE CO T G L R C INC INSURER B: COMMERCE INSURANCE COMPANY DBA LAMBERT ROOFING INSURER C: 265 WINTER ST HAVERHILL MA 01830 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSR DATE MM/DD/YY DATE MMIDD GENERAL LIABILITY NC 609679 10/12/06 10/12/07 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1,000,000 PREMISES(Ea oceurence) CLAIMS MADEa OCCUR MED.EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 1,000,000 - POLICYF—j PRO JECT LOC AUTOMOBILE LIABILITY ZT6915 07/16/06 07/16/07 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ 500,000 B X HIRED AUTOS BODILY INJURY $ 1,000,000 X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ 500,000 (Per accident) GARAGE LIABILITY $ AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 7 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION$ $ i WORKERS COMPENSATION AND WC STATu- OTHER EMPLOYERS'LIABILITY TORN LIMITS E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS WORK COMP CERTIFICATE WILL BE SENT DIRECT TO YOU FROM A.I.M.MUTUAL WORK COMP CERTIFICATE HAS BEEN REQUESTED. CERTIFICATE HOLDER CANCELLATION — – SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE jt;j� Attention: Gerard F Bo Jr ACORD 25(2001/08) Certificate# 6694 ©ACORD'CORPORATION 1988 CERTIFICATE OF INSURANCE ISSUE DATE(MM/DD/YY) 08/29/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Boyle Insurance Agency Inc DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 Box 606 Woburn, MA 01801 COMPANIES AFFORDING COVERAGE INSURED T G L R C Inc COMPANY A.I.M. Mutual Insurance Co dba Lambert Rooting Co. LETTER A 265 Winter Street Haverhill, MA 01830 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO: INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM! EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIOI, LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE S COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ ::::]CLAIMS MADE[:::JOCCUR PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) S 1 MED.EXPENSE(Anyone person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ MBRELLA FORM AGGREGATE $ THER THAN UMBRELLA FORM WORKER'S COMPENSATION AND Xj WC STATU- OTH- EMPLOYERS'LIABILITY R ITFR 6009966012006 08/28/2006 08/28/2007 EL EACH ACCIDENT $ A ITHE PROPRIETORi NEXCL INCL > PARTNERS/EXECUTIVE EL DISEASE--POLICY LIMIT 3 500,000 OFFICERS ARE: EL DISEASE--EA EMPLOYEE S OTHER SOO OOO DESCRIPTION OF OPERATIONS/LOCATIONS/VEIECLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE i ��e �arn�nwauaea�i o�✓�aaaczclzuaelr -------- i Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 149221 Board of Building Regulations and Standards Expiration- 12/6/2007 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 LAMBERT ROOFING 00 RICHARD LAMBERT 265 WINTER STREET HAVERHILL,MA 01830 Administrator Not valid without signature \ ` ne Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 149221 ? Type: Private Corporation Expiration: 12/6/2007 LAMBERT ROOFING CO RICHARD LAMBERT - 265 WINTER STREET HAVERHILL, MA 01830 - Update Address and return card.Mark reason for change. DPS-CAI 0 soM-o4/os-Pcess6 Address [] Renewal F� Employment Lost Card Board of Buildingg Regqulations One Ashburton Place, Ism 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Number: CS 078130Expires:06/02/2008 Birthdate: 06/02/1972 Restricted To: 00 RICHARD J LAMBERT 95 MAPLE AVE ATKINSON, NH 03811 Tr, no: 27100 DPS-CAI 0 50M-04/OS•PC8696 Keep top for receipt and change of address notification. Location wttgj,40—, l oyi-e_ No. y Date 0 " 4 6 4° i NQRTM 1 TOWN OF NORTH ANDOVER .f f: •. 1 '. • Q9 Certificate of Occupancy $ 1 ♦ p 4 a I �,sACMUStt� Building/Frame Permit Fee $ 7— !i Foundation Permit Fee $ jw li Other Permit Fee $ I TOTAL $ Check #3 19716 Building Inspector