The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #78 - 70 BUCKINGHAM ROAD 7/31/2007Location 0 &c k1�v No. _ Date Of , NORTH TOWN OF NORTH ANDOVER �••1D ��0 i • OL 9 , Certificate of Occupancy $ •:• '�b''••° �'��' Building/Frame Permit Fee $ ?/ ss�CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #1 ff55 ,` r �I 2U �u wilding Inspector 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 COMMENTS, CONSERVATION COMMENTS HEALTH COMMENTS FBI u DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED 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 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 No 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract o 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 Permi- Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses L3 Copy Of Contract } Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permi New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan v Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permi, 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 recordir must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 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: Reglstration: 149221 Board of Building Regulations and Standards E•xpifatlan: 1 -?V6/2007 One Ashburton Place Rm 1301 T..__. ,.______. __ Boston, Ma. 02108 '�' � � Ami !S••� "� ' 'p� D X 0 without signature :� �- •**d3�o Ions and Standards e -Room 13 01 usetts 02108 p lntractor Registration M c Registration: 149221 Z .�Type: Private Corpration YP P 0 i� Expiration: 12/6/2007 X o \ m b D ID z .� f Update Address and return card. Mark reason for chat O I Address [D Renewal 0 Employment [:) Lost OPS -CAI 0 SOM•04105•PC8698 I d eh a• a !F C4 t ajing Regulations z. a d oz. IF'DPlace R m 1301 02108-1618 C v Birthdate: 06/02/1972 E ti Restricted To: 00 Tr. no: 27100 Keep top for receipt and change of address notification. N. o 0 b (D .� N 0 .0. Q (DI' f D N +- 0 D a. � A� R. a. OPS -CAI 0 SOM•04105•PC8698 I d eh a• a !F C4 t ajing Regulations z. a d oz. IF'DPlace R m 1301 02108-1618 C v Birthdate: 06/02/1972 E ti Restricted To: 00 Tr. no: 27100 Keep top for receipt and change of address notification. CERTIFICATE OF INSURANCE ISSUE DATE(Miv(/DD/YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND PRODUCER 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. 06 POBox 606 COMPANIES AFFORDING COVERAGE Woburn, 01801 INSURED ' T G L R C Inc COMPANY A.I.M. Mutual Insurance Co A dba Lambert Roofing Co. LETTER 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 PEI INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH - CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIO LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) LIABILITY GENERAL AGGREGATE $ MMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGO. $ RGENERACIOL LAIMS MADE�CCUR PERSONAL & ADV. INJURY $ WNER'S &CONTRACTOR'S PROT. EACH OCCURRENCE S FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Anyone person) S AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT f ALL OWNED AUTOS BODILY INJURY CHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) S GARAGE LIABILITY PROPERTY DAMAGE j EXCESS LIABILITY EACH OCCURRENCE S MBRELLA FORM AGGREGATE S THER THAN UMBRELLA FORM WORKER'S COMPENSATION AND X WCSTATU- OTH- EMPLOYERS' LIABILITY TORYLIMITS A 6009966012006 08/28/2006 08/28/2007 S �Q� THE PARTNERS/EXECUTIVE NCL PROPRIETOR, MXCL DISEASE-POLICY L1MIT S 500,000 OFFICERS oTJ�R ARE: EL DISEASE—EA EMPLOYEE s 500, 000 OF OPERA ITEMS TE HOLDER CANCELLA', SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR T- MAIL10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION 0. LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS 01 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ��O www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Api licant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/zip:U°�J��, %% D/� Phone Are you an employer? Check the appropriate The Commonwealth of Massachusetts 1. a employer with � Department of Industrial Accidents - Office of Investigations i ii iqti i - 600 Washington Street ship and have no employees Boston, MA 02111 www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Api licant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/zip:U°�J��, %% D/� Phone Are you an employer? Check the appropriate box: 1. a employer with � 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself [No workers' comp. 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.❑ Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks boz # 1 must also fill out the section below showing their workers' compensation policy information. I 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. n I Insurance Company Name: Policy # or Self -ins. Lic. O �� (�� C ' 66 Expiration Date: Job Site Address: RD 18 i` Iiav c City/State/Zip: Itlo Attach a copy of the workers' compeqsation 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. I do hereby certif r-rrPM`e 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 11 Contact Person: Phone #: 11 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfonnance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give as a call. .The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.govldia Ein # 51-05033313 MA Reg. Hic # 121981 MA LiL # UCS 078130 Single -ply Lic. # 1711 Teamb ee Roofing GrcPiZ 932 265 Winter Street, Haverhill, MA 01830 We are: ✓ Licensed ✓ Insured Date:Jv Ly O Telephone 1:— '77 _6 �'2 ?0.3 (iq) Address:U uG� i►uG „� r►. �� Job Location: m ✓ Factory Trained ✓ Factory Certified Installers Estimate for: _33 QYA-J"i 0 0 Telephone 2: $'7 76 27 City/Town kORTtj 1gAJP0VErL . State: 6 Zip: Zip: MAss9 d BBB y N -7- MEMBER L.R.C.. agrees to commence described work on / or about W w 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 tiamage to landscape, attics, interior walls or ceilings and/or fixtures due to circum- 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 pre- 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, plumb- ing, and windowsthat 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. SteepAope Quick -quote proposal to furnish and install the following: Approximate roof area l ja0 :5Roof ❑ Re -roof ❑ Gutter ❑ Repair ❑ Ventilation ppare for:re-roofing by ensuring all safety measures are taken in accordance to OSHA standard regulations and landscape is properly protected. .� Rem v xisting layers of roof material down to roof deck and inspect wood. If upon in we discover any rotted wwoo, replacement will be performed at $.3�per LF. `. If substantial deck, rot is discovered, re -sheathing of roof deck.con be performed at $ o ` s per SE * If wood is sound, we will rad any loose wood to rafters, sweep deck and prepare.for installation. Lel In a118' Drip edge ❑ Install 5" Drip Edge ❑ Install Hug edge (Re400fs only) . A— '?,f Pd vt`/.61 6P- Color U%A irk 0 pply ice &.water shield (UNDERLAYMENT) as per manufacturers' specifications and or ;). COUtL s IFS IA -L .-90� r- /100/ 7-10 v/%4 ,t.t: 1/ALtEys` Er pply # felt paper (UN DERLAYMENT) to the balance of the ex sed wood deck.. l� Reflash all stack pipes, tie-ins, chimneys and/or anyrooff enetrations as required and dictated: by good roof practice to ensure water tightness: ❑ Re -seal chimney base using cement & fabric 03' Re -Lead ❑ Re -point chimney ❑ Re -build chimney $ IG? * ► QQv +E p Install a new O Year ❑ Traditional a"'Ar.diitectu al style shingle roof. system Color Monf. ❑ , Furnish and Install a new shingle over style ridge vent system ❑ . Soffit vent system $ 0 - 'All debris generated by Lambert Roofing Co., Inc. will be cleaned up and disposed of from -the iob,site in a legal fashion.. Under no circumstances will the watertight integrity of the building be compromised. Special Notes: U5 eEXl�! + li 4. 100 e•. VEx) i -r AGCcsr 41q Q .Z£ < 1 c c W + T --+-k iy E UJ 2,c�o�- VC�'S �. RQ � t~ .1P�►"C'" Qac.+ Warranty options: 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 36 YEARS HONORED AND IS 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 maybe withdrawn by LRC NOTE: We accept major credit cards* & financing is available! *Due to merchant related costs there will be a 2.3%service charge. ' A finance charge of 15% per nth (18% per year) will be charged on past due accounts over 30 days. Total Estimate Price: $" 0� ° / Date of Acceptance Payment to be made as follows: QdS + + +�-A��G (Home/Business owner)' Signature t D CUMPILC_ 7—/U n/ (LRC) Signature Haverhill MA 978.374-9224 • Lawrence MA 978-6874339 Atkinson NH 603-362-9500 • 1 -888 -SOS -ROOF (767-7663) - Fax: 978 521-579.1 "Our Proof is on Your Roof" www.Iambertroofing.net ON W W as o w2 a cin x w w° a°' c U m w x w a a w w W ^a a z o :w e\a v V C. \ O E Q m o C 0 CL � om � ° ES ZU �c \ ° \C)C CA O Hh t • r.�a CD zv a Z C y 4.4y CCU O •r.a :may m U a E :�o cc P-4 OD o cu c c O = m : mmA 3 t.- •fylJ W EV -0 CO3 y g g 7 C sa�m a C E Q Z y GO y E O C3 O a CA 0 V C46 c 0 ev C cc CL as CM C CD O D � c m H = 3 .a O LM L. ® Q CL 006 ca .O ZO CD CL CIO C LLI U) ujN 19 W W W U)