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HomeMy WebLinkAboutBuilding Permit #649 - 770 SOUTH BRADFORD STREET 4/26/2010BUILDING PERMIT NW" I" ,bgtio TOWN OF NORTH ANDOVER Fes,op APPLICATION FOR PLAN EXAMINATION -100 Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER i'i L Print MAP 210 { q dPARCEL: 5� ZONING DISTRICT: Historic District yes roo Machine Shop Village ves 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 1Jtbt;K1r 11UN OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: -f ,,/-Q )��6117–,o Phone: Address: CONTRACTOR Name:-42&2cr9,36'fy Phone; f; Address:GLl r -e7 leg 5Re-c7– Supervisor's e-7–Supervisor's Construction License: , 6) :Exp. Date:: 7�/6 Home Improvement License: c9 / Exp. Date. 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: $. /9S00 FEE: $ 3 Check No.: 1b 1 /) Receipt No.: • (C! NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner --signature of contractor 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 PLANNING & DEVELOPMENT COMMENTS DATE APPROVED CONSERVATION Reviewed on _ Signature COMMENTS HEALTH Reviewed on Signature CC)MMENTS .9 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT Temp Dumpster Located at 124 MainStreet Fire Department signature/date COMMENTS Located .384 Osgood Street site yes no 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 2010 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: Building Permit Revised 2008 Co r1 W M 5� F . C � CO C2 C � O N O v V c CD c r o . L. or Lo c CD . E c V4 :gym c' aCa N A mm N y ; 3ep co ; m J C _m Cc N W N l m m o aU O ; H • r O C3 N Z w: d O Q m C = O 'Cc p i— O O. O f . O 1— �... N W C W fl t LA- � •N �O.Z O G � w •r= ciLLI _v N CD V m 0-00.s ® CO y 0.+�.m E a OAP N N C O v cm m G: cm C m O cm C �G N CD Z O Z O O F. F-4 z IF co O co O v Z co CL O y G C C C C p� CO2 CD m m co 43 = O � 3� 4D e_Qv o a o- CM< ca 'fl c c CID .Q EL cl CD C co 0 CL C.3 y C R C' _cc Q. H 0 U) W W W CA °o w v Cf)w z a '� G o o ab U a w p a o a; g x O w o 2 cx � a u. m a C2 c w a G co z cn v Q v ° cn . C � CO C2 C � O N O v V c CD c r o . L. or Lo c CD . E c V4 :gym c' aCa N A mm N y ; 3ep co ; m J C _m Cc N W N l m m o aU O ; H • r O C3 N Z w: d O Q m C = O 'Cc p i— O O. O f . O 1— �... N W C W fl t LA- � •N �O.Z O G � w •r= ciLLI _v N CD V m 0-00.s ® CO y 0.+�.m E a OAP N N C O v cm m G: cm C m O cm C �G N CD Z O Z O O F. F-4 z IF co O co O v Z co CL O y G C C C C p� CO2 CD m m co 43 = O � 3� 4D e_Qv o a o- CM< ca 'fl c c CID .Q EL cl CD C co 0 CL C.3 y C R C' _cc Q. H 0 U) W W W CA :. DATE(MM;DDNY) `C'ER�-FIC. Am �cucr=R ill V Ota/31 /2009 i TO ALL THE TERMS, SUCH POLICIES. LIMBS 51iCWJN MAY HAVE BEEN REDUCED SY Pa1D CLAIhq$. - -t--- LT -YPE OF INSURANCE —' - - LTR POLICY NUOI�t POLICY FFFBCTIVE POLICY WRAWN S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ALLAN IRWRANCL AQWCY 3TC. GELIERAL LIABILITY FONiLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE 43 1/2 Jefferson hvOnue 2nd F P-0. Box 511 AF�i2, THIS CERTIFICATE DOE$ NdT AMEIJD, EXTEND OR ER THE COVERAGE AFFORDED BY THE pOLICIES BELOW. SALBM INA 01970-0$11 S 1— 000 40 �S - __ . -CO}UIPANIES AFFORDING COVERAGE X COMPREHENSIVE FORM SGL30G0422 COMPANY _..._.._... A Seneca Insurance Company TGLRC INC dbaL Xanbaaxt Rswiiug BODILVOLIURYOCC BODILY INJURY COMPANY g Ufsty Znsuratzce Group 265 'WINTER STRUT _,.... ._._.. ._...._._.. --- RnvERKLLLD9l D1S30- AGG --- --. COMPANY Lan4mark Insurance Company - - -•- . COMPANY AIG D COVERAGES TH'S i$ TO CERTIFY THAT THE POLICIES OF MURANCE LISTED BELLWNMAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATEO, NOTWIT116YANOING ANY REQUIREIV1 TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRk RESPECT TO WHICH THIS CER'nRCATE MAY BE ISSUE() OR MAY PF-RTAIN jjil INSURANCE AFFORDEC SY THE POLICiL=S 0E^sCRIBf=D HEREIN IT SUBJECT EXCLUSIONS ANO CONDCf10N5 Of i TO ALL THE TERMS, SUCH POLICIES. LIMBS 51iCWJN MAY HAVE BEEN REDUCED SY Pa1D CLAIhq$. - -t--- LT -YPE OF INSURANCE —' - - LTR POLICY NUOI�t POLICY FFFBCTIVE POLICY WRAWN DATE(MMIGGIYY) CATf (MWDDIYY) UNITS GELIERAL LIABILITY S 1— 000 40 �S X COMPREHENSIVE FORM SGL30G0422 13/12/2008 12/12/2009 BODILVOLIURYOCC BODILY INJURY A IC PAEM19ES10PERATKk13 AGG 2L000,OOO UNDERGROUND Ekpl OS10N s COLLAPSE HAZJ= / ! / / FROPERTYDAMAGEQCC E 2 0001000 X PROOUCTSICOMPLEI'MOPER PROPS TY DAMAGE AGG _ X CONTRACTUAL / / / / 818 PO COMBINED DCC g INDEPENDENT CONTRACTORS BI a PD COMBINED AGG d -- "" -• X BROAD FORM PROPERTY DAMAGE PERSONN.I. N,IURYAUG-.._ 000 X PERSONAL INJURY .2 -um t 5 000 c-.--- AUTOIAOBILE LIABILITY ANY AUTO BODILY INJURY-- H X ALL OWNED AuT08 (PAvatb Pme) 203819 IPer pewrn) - S RA�L OvwvNAUTO$ (Oe1et then 07/16/2009 07/1.6/2010 RT -_...-_.-••• fNM. PeBBBf } X HIREOAUT06 PoD.I.-y , $ X NON-ONNEDAUT'OS / / / / PROPERTYDAMAGf - _ WRA6E LIABIt.t'IY 5 PE DAMAGE 8DtCEbb _ L1A8RriY a' 1,000,000 11/12/2006 x1/7-2/2009 EAC OCCURRENCE AGGREWe '- -... S -5, 000`p0Q .b.. 5, 000, OOO C X UMBRELLA FORM OiHEitT•HANUMBRELLA FORM LEA046005 D vvoroc>:Rs evnr�sa�tola AIQP LOYER�uAstuTv09934145 08/28/2009 08/2812010 wcs a � x s-' . _ X INCL ER,,THS EL EA.CM ACCMENT — 5 l, (100, o o, n 0 OfFICERgARE;I EXCLI EL DISEASE-POLICYLIMR 3 1,000,000 OTitER EL DISEASE - EA Fugal nvFo c Y AAA n wo-- DMCRInQN OF OPFRAA=NSRACA'n ON51VEHICL MSpBr'ALrmn CERTIFICATE HOLDER (978) 521-5791 y TGLRC dbd Lambert R00fing 255 Winter Street Havehill NX 01030- 1 18301 $H04W ANY OF THE ABOVE GESCWBED POLICIES BE CANCELLHD BEFORE THE gMFATtON care THEROF, THE ISSUR G WNPANY WILL ENDEAVOR TO Mau• 30 PAYg N N"M To I CER}1FICATE HQLDER NAMED TO THE LEFT. BUT FARM TO MAIL SUCH NUMM SHALL iAPQSE ND OBLIGATION OR LIABRITV 4F KING UPON TTIE COMPANY, ITS OR REPRESENYAYWE& AUTHO REP OVE • AlrOR�CORAORATlON 7986. ,, Nlassuchuxeclt tts - Da �} Board of Building` Be Construction. Sup License: CS 78130 Restricted to: 00 RICHARD J LAMBERT 95 MAPLE AVE ATKINSON, NH 03811 ------------------- ( mllmiCcimler LAMBERT ROOFII RICHARD LAMBE 265 WINTER STIR HAVERHILL, MA ( S-CA1 is 5OM-04/04-G101216 i t�ncnt (,t P blic Ssfet, uPtions it d Standards visorI is nse lExpirati n, 6/2/2010 iI rt# 27762 of i COI sumer Affairs and usiness Regulation 0 Park Plaza - Suite 5170 ston, Massagiusetts 02116 )rovement tor Registration Registration: 149221 =_ Type: Private Corporation Expiration: 12/6/2011 Tr# 290268 Update Address and return card. Mark reason for change — Address [] Renewal [] Employment ❑ Lost Card The Commonwealth of Massachusetts Department o f Industrial Accidents Office Oflnvestigadons 600 9rashington Street Boston, 1i24 02111 U1 www m.ass-gorl&a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers m icant Information Name (Business/organizatim/lndividual): - 2 riease mint LeQibl. Dr3 Address: City/State/Zip: L /�3 G Phone #: Z Are you an employer? Check the appropriate boa: I • a employer with 4. ❑ I am a o contractor Type of project (required): . 2. ❑employees (full and/or part-time).* I am a sole general and I have hired the sub- contractors 6 ❑New construction proprietor or partner_ ship and have no employees listed on the attached sheet t 7• ❑ Remodeling working for me in any capacity. These sum contractors have workers Ominsurance. 8. Demolition [No workers' comp. insurance P. P 5. W. ❑ e are a corporation its 9. ❑ Building addition 3. ❑required.j I am a homeowner doing all and officers have exercised their 10 ❑ Electrical repairs or additions work myself. [No workers' comp. right of exemption per MGL c. 152, § 14 have 11.0 Plumbing repairs or additions in�ran ce required.] t to ees. [and no em [ P Y No workers, Roof repairs us POMP. insuranc 13.0 Other *Any appIicset that checks bm ial must also ilii out the secctaa e _%f U" t Idomeowners who submit —& 'Ill W Q5 " ``=� _ this affidavit indicatin they a.e -^ al, work and then hire outside conte tors must submit anew affidavit indicating such. `Contractors that chink, tbis box must attached an additional sheet showing the name of the sub con tactors and their workers' comp. policy information. infoo rmation. an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site Insurance Company Name: Policy # or Self -ins. Lie. #: Sob Site Address:-T— A A+4---1, _&7 Expiration Date: 0 — p a copy of the workers' coin ensa ' n Policy City/State/Zip: _ P sa p cy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL C. 152 c an lead fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in theform of a STOP WORK imposition of cRDER penaltiesof of 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. 1 ao hereby certify of perjury thrrt 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 6. Other Contact Person: -.1.Z 3. City/Town Clerk 4. Electrical Inspector 5. Plumbinb Inspector Phone #: Information an- d 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 apart>nents and who resides therein, or the occupant of the dwelling house of another who employs persons to do mainte3namce, 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 constrict 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 conraacting 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' comp creation 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 stun to sign and date the affidavit. The affidavit should be :turned to the city or town that the applicauon for the pernait 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 us a call. The Department's address, telephone and .fax.number- The Commonwt21th of luiassarhusetts. Department of Industrial Accidents Office of Inwest(agat ons 600 Washington Street Boston, MA 0.2111 Tel. # 617-727-4900 eaft406 or 1-977-MASSAFE Revised 5-26-05 Fax # 617-72.7-7749 WWW-mass..govtdia. n Cl -7,8 230 /597 T. �PSZERN MASsq 2V (�r 9Gr Ein # 51-05033313 amber 2i BBB MA Reg. Hic # 149221 �— MA Lic. # UCS 078130 �oot tng ,,�Z 932 Single -ply Lic. # 1711 MEMBER G_ 265 Winter Street, Haverhill, MA 01830 --� We are: ✓ Licensed ✓ Insured ✓ Factory Trained ✓ Factory Certified Installers Estimate for: fofn $ /�A-1 14Y ft=QLt'% Date: 7 AQy-tt- 2c91d Telephone 1: 67e(- 06959 E -Mail / Alt: Billing Address: Job Location: 770 S. )IZAPt=-ao City/Town State: Zip: City/Town: 4J,0tuO64,,i9n-- State:INZip; L.R.C. agrees to commence described work on / or about )-3 tv.�a and described work will be completed: in about 3 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 damage to landscape, attics, interior walls r ceilings and/or fixtures due to circumstances beyond our control. LXC. can notand will not bie held liable forany::damage to the surface that the disposal container is placed on. L.R.C. shall not hold liable for ice dam -development or damage caused by ice dams. 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 orworn building counterparts such as but not limited to siding, gutters, masonry, plumbing, and windows that jeopardize the watertight integrity ofthe building and are not covered under roofing warranty. The following work includes all permits, labor and materials needed to complete your lob in.a professional -workmanship like manner. Steep slope ,nick -quote proposal to furnish and install the following: Approximate roof area�62 $Q S X. 1� ew Roof Ll Re -roof ElGutter LIRepair LJVentilation l 0 epare for re -roofing by ensuring all safety measures are taken in.aciordance to OSHA standard regulations and landscape is properly protected. U� 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 S 39 s * per LF for roof deck boards: If substantial deckrotis discovered, re -sheathing of roof deck,can be performed at $ `ZIE' r *per SF. If individual sheets are found to be rotted and/or delaminated; removal, disposal and replacement will be performed at $,62.- *per sheet. If any -trim boards are rotted, replacement willbe performed: at $12 �" * per LF for new pre -primed pine: Inspect siding at roof line and allflashing behind siding, if we discoverany damaged flashing or siding at the roofline, replacement will be �erformed at $-r+vn * If wood deck, siding, and flashing is sound, we will re -nail any loose wood to rafters, sweep deck, and prepare for roofing. Def Install 8" Drip edge to all rakes and eaves. LIInstall Hug edge (Re -roofs only) to all rakes an eaves. Color:�J _W ti 1"i t pply ice & water shield (UNDERLAYMENT) as per manufacturers' specifications and/or A ply premium (UNDERLAYMENT) to the balance of the exposed wood deck. eflash all plumbing stock pipes, and any roof penetrations as required and dictated by good roof practice to ensure water tightness. Vupon inspection, we discover chimney lead to be worn or deteriorated, replacement will be performed at $ q8Q. install a new ,16 Year ❑ Traditional YArthitectural: style shingle roof system ❑ Designer Color t�,&tF-t-1a)L7r9.6 Manf. Ci=FZ.i - Furnish and Install a new shingle over style ridge vent system ❑ Soffit vent system S ❑ All debris generated by Lambert Roofing Co., Inc. will be cleaned up and disposed of from the job site in legal fashion. Under no circumstances' will the watertight integrity of the building be compromised. Special Notes: Sc�, i s cic c{ R&O F Ago- r A i c.4Lu t, E a. Warranty options: V'Siondard LRC ❑ Manufacturers Upgrade $ UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF 2 YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND .3a. YEARS HONOREDAND 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. Denotes potential additional costs above the totalestimated price. 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: $)= ©O . Date of Acceptance //% Payment to be made as follows: V,311) ENZ cT . i3AZ_A"C� (Home/Business owner) _ 4aw L"' -- f"c.r(; (� Signature [p CCrvt?L�TrOr`/ (LRC) Signature Haverhill MA 978.374.9224 • Lawrence MA 978.687.7339 • Hampstead NH 603.329.8200 • 1.888.50S.ROOF (767.7663) • Fax: 978.521.5791 "Our Proof is on Your Roof" www.lambertroofing.com Location 1�41W -1d No. Date TOWN OF NORTH ANDOVER 0 0. - Certificate of Occupancy $ Building/Frame Permit Fee $ 0-V CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 25 6 6 Building Inspector