HomeMy WebLinkAboutBuilding Permit #835 - 743 WINTER STREET 6/19/2007BUILDING PERMIT 0* "UI q�
"90 e ti
TOWN OF NORTH ANDOVER c
APPLICATION FOR PLAN EXAMINATION
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Permit NO:
Date Received
Argo f
[JESURiPTiON OF WORK TO BE PREFORMED:
i3O f Re RGU/=
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
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: $0' FEE: $ ] Z J
Check No.: �` Receipt No.: e90
NOTE: Persons contracting with unre iste do not have access to the guaranty 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 FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
IN
DATE REJECTED DATE APPROVED
DATE REJECTED DATE APPROVED
U
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
f
COMMENTS
�r`
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
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 2.2007
0 MnA J/—
Location 7
N no. —CfJ S Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
1�-, Other Permit Fee $
TOTAL $
e,)
Check #4401�
203 1 4 B =16ing �Inspect�or�
NQ FD 5 314
. . ... � h1q 7 .......
TOWN OF NORTH ANDOVER
RECEIPT
/Iit'C 10 /,C A M;-f� ids
This certifies that ............................................
� 0- CK. -
has paid ........... 5
f,r ..... P
PAV,%4-;'-f
......................................................................................
Receivedby .... ................................................................
Department....... tj.��� ....................................................................
WHITE: Applicant CANARY: Department PINK: Treasurer
The Commonwealth of Massachusetts
Department of Fire Servic*es
Office of the State Fire Marshal.
SL te Ro d, Stow, NIA 01775
Box 10b ai
PERMIT 4//I/D 7
Date:
North Andover
-Permit No
(City of Town) (If Applicable) Dig Safe
Eii accordance with the provisions of M. G.L.1 4 8. Chapter as provided in section
—U-2—C.MR 34
Suirt Date
7.1 -,,.-This-Perinit is�granted to:
Full nam6 ofperson, Firm or Corporation
p6m:iission to locate d.ump.s t e r for con.stru'ction/renovation/demolition of building
Corr"nents: dUMps.ter mus t be
25' from structure if unable to Place wi�h required
Restrictions:
clearaace du pster must be covered with 1 wood or tar end of work day
Lf 72
.at �7 0%v�i-e-r St
to provicd adequate identification of location
Give location by street and no., or describe in such manner as L
FecPaidS 50.00
bi Fire Chief
TIiis Permitwill expire- -7 Of offical granting permit Title
signatue 9--t-9 5=it
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
t Boston, MA 02111
',H 5www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
nnlicant Information Please Print LeAbl:
(Business/Organization/Individual):_
62 6 s
Phone.#:
you an employer? Check -the appropriate box:
1. I am a employer with 4. E]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. employees and have workers'
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its
3. ❑ I am a homeowner doing all work officers have exercised. their
myself. [No workers' comp. right of exemption per MGL
insurance required.] t c. 152, § 1(4), and we have no
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
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13. ❑ Other
*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:// �..� 61 UlG
Policy # or Self -ins. Lic. #:_ i6 DOD la (6 /o9 OQ Expiration Date: Q — a F 6 z
Job Site Address: 3 60i
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 performance 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 cityor 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. Anew 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 us 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, NIA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 11-22-06 Fax # 617-727-7749
www.mass.gov/dia
I OM 7 / C :C ,amu A3 7 /
T. S"ON Moss
-05033313 'c,
MA Reg. Hic # 149221 robe i tiN
MA Lic. # UCS 078130 uon„9 y $$B y
Single -ply Lic. #1711 cwoPiZ932 ��- h
MEMBER
,265 Winter Street, Haverhill, MA 018.30
We are: ✓ Licensed ✓ Insured ✓ Factory Trained ✓ Factory Certified Installers
Date: 1 Ll � (Ung E 2L1� 7 Estimate for: / J I or _r_ 4 rJ cn F_c. �
Telephone I:— `1�� ��� �i.,�` Telephone 2:
ll� I tJ 1 CSL. -, City/Town:
Address• %�i�. �J. % NrkyG&- State: 4 Zip:
Job Location: SRM F City/Town: State: Zip.:
L.R.C. agrees to commencedescribed work on / or about 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. shalf not be liable for any damage to landscape, attics, interior wolls 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 windows that jeopardize the watertight integrity of the building and are not covered under the roofing warranty.
The following work.indudes all'permits, labor and materials needed to complete your ob in a professional workmanship like manner.
Steep slope Quick -quote proposal to furnish and install the following: Approximate roof area 2. Ivo S �-
1 ew Roof L2 Re -roof ❑ Gutter ❑ Repair ❑ Ventilation
repare for re -roofing by ensuring all safety measures are taken in accordance to OSHA standard regulations and landscape is properly protected.
t� 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 $�— t per LF for roof deck boards. If substantial deck rot is discovered, re -sheathing of roof deck can be performed at
$�_' por. SF. If individualsheets are found to be rotted -and/or delaminated; removal, disposal and replacement will be performed at.$'l7.
per sheet. If any trim boards are rotted, replacement will be performedot S.2s ' per LF for new pre -primed pine (trot to exceed 1" x 8A).• If wood is
,A
ound, we will re' .nail any loose wood to rafters, sweep deck and prepare for raofing. .
}�sta118" Drip edge Q Install 5 Drip Edge E l Install Hug edge (Re roofs.only) 4" Pe'2tr�-�� "E�. Color W H i i k
O' Apply icb_&_w ter shield. UNUERIAYM'ENT as er ma cturetx' s ecifuations and ar Go 2s,5C
IY pply J # felt paper. (UN DERLAYMENT) to the balance of the exposed wood deck.
Ur eflash allstack pipes; tie-ins, chimneys and/or any roof penetrations as.requir'ed and dir<a.te.d:-bygood roof practice to.ensu:re�.water.ti,ghtness. .
3 If upon inspection, we:discoverchimney to be -worn or deteriorated; replacement wilt be.performed at:$. d • ' p.er chimney for single flue and
$ 2J ' * per chimney`for multiple flues: ••p-tqut., r;
Install a.new Year C3 traditional ❑ Architectural style shingle roof system Color c'�RC� Manf. �mwc, �aQ
❑ Furnish and Install. a new shingle over style ridge vent system ❑ Soffit vent system $
EY
All 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: .0.32
r�
Warranty. options: ❑ Standard URC _' E
❑ Manufacturers. Upgrade $ -
* Denotes additional costs above the total estimated price.
UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A. WORKMANSHIP GUARANTEE FORA PERIOD OF TEN YEARS HONORED AND ISSUED BY THE LAMBERT
ROOFING COMPANY AND q6. 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 maybe 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: $C1 y� • ��� ' �' d .I �� " Date of Acceptance (� ' ' �F 4'a �7
Payment to be made as follows: /
%CEJ fir» _ •
(Home/Business owner) I''1 l
Signature
(LRC) l '
Signature
Haverhill NIA 978 374.9224 • Lawrence NIA 978.687.7339 • Atkinson NH 603-362-9500 • 1 -888 -SOS -ROOF (767.7663). Fax: 978 521-5791
"Our Proof is on Your Roof
www. lnmhartrnnfina.nat
��
Board of Bu(iding 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: 1?16/2007 One Ashburton Place Rm 1301
Type: Private Corporation Boston, Ma. 02108
LAMBERT ROOFING -GO
RICHARD LAMBERT
265 WINTER STREET'S
HAVERHILL, MA 01830 Administrator Not valid without signature
n 01
Board of Building Regula ions and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
LAMBERT ROOFING CO
RICHARD LAMBERT
265 WINTER STREET
HAVERHILL, MA 01830
0PS-CA1 0 5OM-04/05-PC8698
Registration: 149221
Type: Private Corporation
Expiration: 12/6/2007
Update Address and return card. Mark reason for change
E) Address [:] Renewal r'� Employment [:] Lost Ca
Board of Buildingg Regulations
One Ashburton Place, Rm 130
Boston, Ma 02108-1618 1
License: CONSTRUCTION SUPERVISOR LICENSE
Number: CS 078130 Expires: 06/02/2008 Birthdate: 06/02/1972
Restricted To: 00
RICHARD J LAMBERT
95 MAPLE AVE
ATKINSON, NH 03811
OPS -CAI 0 50M-04/05-PC8698
Tr. no: 27100
Keep top for receipt and change of address notification.
CERTIFICATE OF INSURANCEISSUE
-1
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.
COMPANIES AFFORDING COVERAGE
POBox 606
Woburn, 06 01801
INSURED
T G L R C Inc
dba Lambert Roofing 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 PERP
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH TI
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER2
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 EXPIRATIO
DATE(MM/DD/YY)
LIMITS
GENERAL LIABILITY
GENERAL AGGREGATE
$
PRODUCTS-COMP/OP AGG.
$
COMMERCIAL GENERAL LIABILITY
LAIMS MADE�OCCUR
PERSONAL & ADV. INJURY
$
EACH OCCURRENCE
$
OWNER'S & CONTRACTOR'S PROT.
FIRE DAMAGE (Any one lire)
S
MED. EXPENSE (Anyone person)
$
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE
LIMIT
S
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
S
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY
(Per accident)
$
GARAGE LIABILITY
PROPERTY DAMAGE
S
EXCESS LIABILITY
EACH OCCURRENCE
$
MBRELLAFORM
AGGREGATE
$
THER THAN UMBRELLA FORM
WORKER'S COMPENSATION ANDWC
EMPLOYERS' LIABILITY
STATU• OTH-
R I
A
6009966012006 08/28/2006
08/28/2007
$ ,
THE PROPRIETORi INCL
PARTNERS/EXECUTIVE
NEXCL_
EL DISEASE—POLICY LIMIT
$ 500,000
EL DISEASE—EA EMPLOYEE
S 500,000
OFFICERS ARE:
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TC
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