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Home My WebLink AboutBuilding Permit #104 - 873 CHESTNUT STREET 8/9/2007 BUILDING PERMIT ° �t``° ' do �° ° TOWN OF NORTH ANDOVER F i APPLICATION FOR PLAN EXAMINATION CO- Permit N0: 0 Date Received 3 "°JV4 �SSACHUS�� Date Issued �0 IMPORTANT Applicant must complete all items on this page CAT,ON3 k ............ W E � '% TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition [I Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p 41" n,s, I ters( �1rJ� trl }� .. All Or DESCRIPTION OF WORK TO BE PREFORMED: S' -17<` 1.w(f� "' Identification Please Type or Print Clearly) OWNER: Name: h �� v4a Phone: Address• 923 6�6s%�1 ",U y Q OMIT CT R NSlot s M "$ , gNP, Aallress� �, �+ � i 777 pare 'A, s cans yr nn:.. se �� Expo t3ate . ate`n � � ARCHITECT/ENGINEER Phone: Re No. Address: 9• FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASE ON$125.00 PER S.F. Total Project Cost: $ FEE: $ 0 qi Check No.. •�r,;L.`� Receipt No.: L NOTE. Persons contracting with unregistered contractors do not have access to the guaranty fund Signattare of Agent/Owner 4 Y = , S�gnatur o contractor ,..,., Location 'Y q,3 C �"fi,✓T r,,— No. Date ` v MORTh TOWN OF NORTH ANDOVER t a Certificate of Occupancy $ �'�s'•••°U Etn cMus Building/Frame Permit Fee $ 7 '' s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # q a T 2 U t: 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION DATE REJECTED DATE APPROVED ❑ ❑ COMMENTS HEALTH DATE REJECTED DATE APPROVED ❑ ❑ COMMEI'4TS 4 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Coldnection/Si nature& Date Located at 384 Osgood Strut Drivewav Permit FR � pARTMEN ' Temp Dt�rnpstet�an site Located a 1Z4 Ma+n street >, yes- . _ftb re3eparrret-srgiature'4late W sZ r 11.5' Lam" z 4 OTM y[ 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: Revised 2.2007 NORTIy own of 0 1" /D 0 of , over, Mass., , J - O LAKE COC H1,HE WICK \ RATE D C5 TE 1 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System *.IfflO. BUILDING INSPECTOR THISCERTIFIES THAT............. .. ......46no....... ! ........................ ............... ........................................ FoundationBUIL has permission to erect........................................ buildings on 3 �► s'� II Rough to be occupied as S �....... Chimney 0 . . . .. ........... . ................................................. .... .... ..... . provided that the person accepting this ermit shall in every respect conf o the terms of the application on file in Final 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR. UNLESS CONS TRU19T�TS. Rough .... ............................................ Service ..... ....... BUILDING INSPECTO Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumer Street No. SEE REVERSE SIDE Smoke Det. �iGe �osvnanu�eall� o�✓�aaoac/ucae(.Io '-•--•- ---.._.— Board of Building Regulations and Standards License or registration valid for lndiv(dul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 148221 One Ashburton Place Rm 1301 E•xpiriitidn; 1`jV012007 Boston,Ma.02108 Type: Private Corporation LAMBERT ROOPING= RICHARD LAMBERT 265 WINTER STREET r4- HAVERHILL,MA 01830 Administrator Not valid without signature O e &ommowo" Board of Building Regula ions and Standards One Ashburton Place - Room 13 01 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 cha OPS-CAI 0 5OM•04/05•PCO698 Address (] Renewal CD Employment [D Lost Board o Buildin Regqulations One Ashburton Pace, Fpm 1301 u,p Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 06/02/1972 Number: CS 078130 Expires: 06/02/2008 Restricted To: 00 RICHARD J LAMBERT 95-MAPLE AVE ATKINSON, NH 03811 Tr. no: 27100 Keep top for receipt and change of address notification. OPS-CAI 0 SOM-04/05-PC8698 ISSUE DATE(MM/DD/YY) CERTIFICATE OF INSURANCE 29 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND PRODUCER CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Boyle Insurance Agency Inc POLICIES BELOW. P 0 Box 606 COMPANIES AFFORDING COVERAGE Woburn, MA 01801 INSURED TG LR C Inc COMPANY LETTER A A.I.M. Mutual Insurance Co dba Lambert Roofing Co. 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 PE INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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 TE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIO LIMITS LTR TYPE OF INSURANCE DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PROD UCTS•COMP/OPAGG. S LAIMS MADE[�CCUR PERSONAL&ADV.INJURY S OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE S FIRE DAMAGE(Any one rire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ LIMIT ANY AUTO ALL OWNED AUTOS BODILY INJURY S CHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE S MBRELLA FORM AGGREGATE $ THER THAN UMBRELLA FORM WORKER'S COMPENSATION AND X WC ST IMTU�S O R EMPLOYERS'LIABILITY —'- 6009966012006 08/28/2006 08/28/2007 EL EACH ACCIDENTf :IUU,UUL A THE PROPRIETOR, X INCL DIE E— IC LIMIT S 500,000 PARTNERS/EXECUTIVE OFFICERS ARE: L EL DISEASE—EA EMPLOYEE s 500,00 OTHER DESCRIPTJON OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRMED POLICIES BE CANCELLED BEFORE TI EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR ' MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TI LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION l LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS REPRESENTATIVES. AUTHORIZED REPRESENTATIVE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street `tl M p Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Q ti Address: C9ds— City/State/Zip:_ Z— oie"3G Phone #: '2 �c� Are you an employer?Check the appropriate box: Type of project(required): a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks boz#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. :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. _ Insurance Company Name: Policy#or Self-ins. Lic.#: Z�dQ�9 IaO6 Expiration Date: Job Site Address: 6 73 64s/-I411� 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 cern er a pains and penalties of perjury that the information provided above is true and correct Si ature: oDate: /12 Phone#: 6 3 7� Oda 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 Contact Person: Phone#: 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 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 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, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFB Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia T. SjERN M ty Ein#51-05033313 s� MA Reg. Hic#12198109. Licensed ambert S • c'yG MA Lic #UCS 078130 aan� Q1t 5BBB gSingle-ply Lic #1711 C.%C .1932 �'G. Q265 Winter Street,Haverhill,MA 01830MEMBER ✓ Insured ✓ Factory Trained ✓ FactoryCertified Installers Date: r�' Estimate for• 4,<,4 Af ln,lAa,41 70 Telephone 1: p/ / 1 ,,t Telephone 2: Address: , ,7,3 (f�'� 77/7 U . 1 ! City/Town: ®0 ve- Stater Zip:�1 Job Location: City/Town: State: Zip: L.R.C. agrees to commence described work on/or about .TOAJ C and described work will be completed in about 0 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,interi r 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 windows that 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. 0 Steep s Quick-quote proposal to furnish and install the following: Approximate roof area Q� ew Ro ❑ Re-roof El Gutter C3 Repair El Ventilation -Prepare for re-roofing by ensuring all safety measures are taken in accordance to OSHA standard regulations and landscape is properly protected: I 'Remove existin layers of roof material down to roof deck and inspect wood. If upon inspection we discover any rotted wood,replacement will be performed at $ 7S' Per LF.• If substantial deck rot is discovered,re-sheathing of roof deck can be performed at $ . —"'"T per SF.• If wood is sound,we will re-nail any loose wood to rafters,sweep deck and prepare for installation. e ( -7%stall 8•Drip edge ❑ Install 5"Drip Edge ❑ Install Hug edge(Re-roofs only) Color J�" Zf-Apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and or Apply L7.0 #felt paper(UNDERLAYMENT)to the balance of the exposed wood deck. ;e-Reflash all stack pipes,tie-ins,chimneys and/or any roof penetrationsos required and dictated by good roof practice to ensure water tightness. ❑ Re-seal chimney base using cement&fabric -0-Re- ad ❑ Re-point chimney ❑ Re-build chimney -0-Install a new Year ' TradiMMI Architectural i��yle shingle roof system Color Monf. l f - #urnish and Install a new shingle over style ridge vent system ❑ Soffit vent system ---.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. 041 L Special Notes: f9r.�fl�Q Gr'� OZ3 l�B v of %� �. 7J (f e ��• / Dry Warranty options: XStandard LRC ❑ Manufacturers Upgrade $ •Denotes additional costs above the total estimated price. UPON COMPLETION AND PAYM T IN FULL,ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF TEN YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND 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. 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 13%per month(18%per year)will be charged on past due aaou. over 30 do _ Total Estimate Price: S / 1 -7 5w �SO Date of'Aoep once Payment to be made as follows: / ,3 / v (Home/Business owner) ignotur {� "'� N � jv� LRC � 4`4- ' [ ��v �� 3 j Signature Haverhill MA 978 374-9224 • Lawrence MA 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.lambertroofing.net