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Home My WebLink AboutBuilding Permit #782 - 72 GREAT POND ROAD 5/30/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Issued: Date Received o DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: ST'rr-N c- N S s i�'T-c� Phone: Arliirocc- ARCHITECT/ENGINEER Phone: Address: 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: $ f- 0 v FEE: $ �d Check No.: -2(,0 Receipt No.:��, NOTE: Persons contracting with istered contractors do not have access to the�,�, �=,=� fund 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 FOLLOWIN�G.$ECTINS FOR OFFICE USE ONLY INTERDEPAITT IIIIE�I�f"ALA' IGK-O'FF = U -FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ ■El DATE REJECTED DATE APPROVED .DATE .REJECTED, DATE APPROVED ,e I .s i •-- tit --� � --C. � _.-.. HEALTH ❑ ❑ POMMENTS b Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Water & Sewer Connection/sem Located at 384 Osgood Street Comments Comments tE DEPARTMENTS%rtp D mpster,c��s>teye� �` nr" ated at 24 Main Street` x r PW Departi-"nt sighatareldate 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 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) o 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 -?a G � T Pte( A No. Date d� HQRTIy TOWN OF NORTH ANDOVER �AL .. 9 Certificate of Occupancy $ s' E<�' Building/Frame Permit Fee $ 30 s�cMus Foundation Permit Fee $ Other Permit Fee $ f— TOTAL $ Check # � T r 2024 Building Inspector a T.G.L.R.C. INC., DBA/LAMBERT ROOFING CO. In business since 1932 May 9, 2007 ATTN: MR. CARL WOKEL amber ,....- SUBJECT: FOR NEW ROOFING @ 72 GREAT POND ROAD NORTH ANDOVER, MA PHONE: (603) 635-3608 FAX: (603) 635-2604 WE PROPOSE: To the following Single -ply roof construction on the building @ the above address as per detailed description listed below. Approx. total roof area: 300 +or -SF." 1) Pre -pare for re -roofing by ensuring all safety measures are taken in accordance with OSHA standards and landscape is properly protected. 2) Remove all existing rubber and wet insulation and dispose of in a legal fashion. 3) Wood nailer around perimeter to be 1/2 Ply wood. 4) Mechanically anchor new 1/2" rigid POLYISOCYANURATE insulation using 3" plates & screws to fasten. 5) Furnish and install a new fully adhered roof system using .060 ml membrane. All the proper sealants and/or caulking will be performed to ensure secondary containment. 6) Perimeter edge will receive a "WHITE" aluminum drip edge style flashing as required. TWO SIXTY FIVE WINTER STREET HAVERHILL, MA. 01830 (978) 374-9224 (FAX) 521-5791 OR VIA E-MAIL LAMBERTROOFING@AOL.COM OR VISIT US ON THE WEB @ WWW.LAMBERTROOFING.NET EIN# 51-05033313 UCS# 078130 -2— MAY 9, 2007 7) Re -flash up under roof line above as required and dictated by good roof practice to ensure water tightness. All debris generated by the T.G.L.R.C., Inc. will be cleaned up and disposed of from the job site in a legal fashion. Under no circumstance will the watertight integrity of the building be compromised. NOTE: We understand this is not your average roofing project. Below find our pledge to ensure pre, work in progress and post construction is a safe, comfortable and speedy process. "All workmanship will be performed to the standards and expectations enforced by the 7h Edition Massachusetts Building Code. Unrestricted construction supervisor license #UCS 078130 will be on site and/or accessible diligently through out the project. We will discuss in detail the project agenda prior to starting and follow our commitment to the best of our ability. We recognize that you are running an important business and we will come to a consensus together on how best to plan this project with out interference." T.G.L.RC. INC. agrees to commence described work in the month of (MAY) and the described work will be completed in about (1) working days. T.G.L.RC. INC. shall not be held liable for delays due to circumstances beyond our control. T.GL.RC. INC. may not be held liable for any damages to landscape, attics and/or fixtures due to circumstances beyond our control. T.G.L.RC. INC. 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, plumbing, and windows that jeopardize the watertight integrity of the building are not covered under the roofing warranty. The following work includes all labor, materials and disposal needed to complete your job in a professional workmanship like manner. UPON COMPLETION AND PAYMENT IN FULL A 10 YEAR WARRANTY WILL BE HONERED AND ISSUED. -3 - The cost for all permits, warranty, labor & materials is *Payment Terms: No money down, upon completion payment in frill. Acceptance of proposa Signature Date 10.3 07 MAY 9, 2007 r Please sign and return re. ` L 11 one copy upon acceptance. NOTE: Due to volatile pricing on building products this proposal is void if not accepted within 15 days of reception. "Quality Workmanship You Can Trust" Our Proof is on Your Roofl President/Quality Control I National Roof Removal Specialist 338 Florence Road • Middletown, NJ 07748 1-866-GUILIANO (toll free) • guilianobrothers.com SHEET NO. OF CALCULATED BY DATE SCALE CA m m m CO) m CO) F, m —v, H CD C d d � O C2 Z y D gCO). Poo O d = y )Moto o m O v CD CD o CLQ CD CDo C O H� -• CD CL0 CO) co C v CO) O 'o Z CD � o � • CD O CCD cn Cn n O Fm �l 1 C C=Rao w �7 M o cr go S 0cm m N z �. Z �. C =d��• �► C ,. n o O G m04 $ ;m gym' m 0 > > C., 0 y a oZ O co a m aom o oa �Orn CLg0 CD O ID I d •� _ Q G to C C41 CR _ 'g m H y CA � m cc ao N mo COOa: m y o H d 2 Vim: ted. N CL-,% is w� � m 0. F . RE N C•) T n Fn - 0O2 -1 m Cn R Cn Z w �7 M n z �. id G r t7i M zrl W O G � d ppO ry\� Ci z 0 V r H 0 9 0 c The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 k s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �Ca Address: City/State/Zip: < �L Phone #: Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ff `l am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. f ship and have no employees These sub -contractors have working for the in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] 3�G� 9aa Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions I 1.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # I 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. TContractors 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: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: 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 Investigations of the DIA for insurance coverage verification. I do hereby(certify#r the 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 # �-73o—v 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 #: CERTIFICATE OF INSURANCE ISSUEDATE(MM/DD/YY) 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 dba Lambert Rooting Co. COMPANY A.I.M. Mutual Insurance 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 PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DD/YY) POLICY EXPIRATIO11 DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG. $ COMMERCIAL GENERAL LIABILITY LAIMS MADE=IOCCUR - PERSONAL & ADV. INJURY S EACH OCCURRENCE $ OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one lire) $ MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ MBRELLA FORM THER THAN UMBRELLA FORM i WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY X WC STATU- 0TH- T RY LIMIT $ 500,000 A !THE PROPRIETOR/ X INCL PARTNERS/EXECUTIVE 6009966012006 08/28/2006 08/28/2007 EL DISEASE--POLICY LIMIT $ 500,000 EL DISEASE--EA EMPLOYEE $ 500,000 OFFICERS ARE: EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEMCLES/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. r AUTHORIZED REPRESENTATIVE o� �`ie ioa�nmzonwea�/ o�✓�iiaao�iueel2a ------ ------- 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 CO RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Administrator Not valid without signature Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Can tractor 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-CA1 as 5OM-04/05-PC8698 [-] Address [:] Renewal F� Employment 7 Lost Card Board of Building Regulations One Ashburton Prace, Rm 130 Boston, Ma 02108-1618 1 License: CONSTRUCTION SUPERVISOR LICENSE Number: CS078130 Expires: 06/02/2008 Birthdate: 06/02/1972 Restricted To: 00 RICHARD J LAMBERT 95 MAPLE AVE ATKINSON, NH 03811 DPS -CAI 0 50M-04/05-PC8698 Tr, no: 27100 Keep top for receipt and change of address notification.