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HomeMy WebLinkAboutBuilding Permit #497-15 - 90 WINDSOR LANE 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 1 Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION: dam... _ �^ r PROPERTY OWNER / Print 100 YearOld Structure yes, no MAP NO: L d PARCEL: ZONING DISTRICT: .Historic District ye no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well 0 Floodplain 0 Wetlands ❑ Watershed District El Water/Sewer - DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Ty a or Print Clearly) OWNER: Name: �(� �G� Gi�a Phone: _ Address: P,J CONTRACTOR' Name: ✓1i'S %�_ _ _ _ Phone: Address: . Supervisor's Construction License: Exp. Date: Home Improvement License: _ _ _. __ __ _ _ 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: $ D FEE: $ � Check No.: (6 Z+ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signa ut re�of Agent/Owner�� 1�-�- Signature of contractor �, _ Plans Submitted 1] Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted-❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ .TYPE-ORSEWERAGEDiSPOSAL 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 Reviewed on Signature i COMMENTS HEALTH Reviewed on Signature r COMMENTS F Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments 5 I !Nater & Sevier ConnectioniSignature& Date Driveway Permit DPW Tuvv;. Engineer: Signature: Located 384 Osgood Street .FIRE DEPARTI!!I� NT =`Temp Dumpster on site yes no Located at I1 4,Mair,,Street Fire ®epartrnent signature/date " =s a- i •• y ., i i a COMMENTS `` - 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 de artment use i i B Notified for pickup - Date { Doc.Building Permit Revised 2010 f Building Department The folbwing is=a list of the retluired.forms to be filled out for the appropriate.permit to.be obtained. Roofirf g, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or G.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 apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm-tted with the building application Doc: Doc.Building Permit Revised 2012 . Location �✓ t�. Y Sr92 . No. 3 Date Zy o - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee 01--•CV Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#�` Building Inspector r 1 NORTH ve" ** o No. 49?e 4"h ver, Mass, 'Q toc"Ic"a WICK y�• S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System MIce�S THIS CERTIFIES THAT BUILDING INSPECTOR ...... .... .... .... . .. has permission to erect .................... buildings on 9.b l .l`. .cS�dR Foundation ...... ..... ...... .....................�............ Rough to be occupied as ....... ......................................................,,.... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Final PERMIT EXPIRES IN 6 MQNT S ELECTRICAL INSPECTOR • UNLESS CONSTRUCTION STA Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove, Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. T.G -: EIN#51-050-3313 Haverhill MA 978.374.9224._. MA Reg.HIC#149221 amber = Lawrence MA 978.687.7339_ '4E' MA Lic.UCS#78130 Hampton NH 603.929'9224 BBB. Single-Ply License#1711 Roofing. Hampstead NH 603.329.8200 SGvu`ei1932Toll Free 1.888.SOS.ROOF o,__ . 265 Winter Street Haverhill MA 01830 ensed *Insured *Factory Trained *Factory Certified Name: O'� L—di-Je Date: 67/7i 3 Telepho1ddre%ss:— W'% 22 l8Alt.Telephone: Email: Billing o fCity: A o GAJ State: Job Address: - City: State: n cj Scope of Work trip and Re-roof D Re-roof Approximate Roof Area: —�-- 1 ❑ Prepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected. ❑ 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 will performed at*$ ,�S per LF for roof.deck boards. If substantial deck rot is-discovered,re-sheathing of roof deck can be performed at*$ .Z.J per SF.If individual seets are found.to..b_e rotted/or de-laminated,removal,,disposal and replacement will be performed at*$ per sheet,If any trim boards are rotted, replacement will be performed at*$ �'}'per LF for new pre-primed pine.Inspect siding at roof ine and all flashing behind siding,if we'discover'any damaged flashing or siding at the roof line;replacement will be perforiiied of*$` $�" `-If wood deck;siding,and flashing-is sound,we will re=nail any loose wood to rafters, weep deck,and prepare for-roofing — - -❑ Install 8"drip edge to all rakes and eaves. Color , ❑ Apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or 1 T ❑ Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck. ❑ Re-flash all-plumbing stack pipes,-and any roof penetrations as required and dictated by good roof practice to ensure water tightness. ❑ If upon inspection;we discover chimney lead to be worn or deteriorateo, at C) replacement will be performed *.$ El Install a new: Year 0 Traditional kArchitectural ❑ Designer o or 'c � ❑ Fumish and Install a new shingle over style ridge vent system El Soffit vent system*$ S c1t (V 001) ❑ 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 waterti ht'integrity of the building be compromised. Special Notes 1 W - -- c — UPON MPLETION AND-PAYMENT IN FULL,ROOF`SHALL HAVE A.WORKMANSHIP GUARANTEE.FORA PERIOD OF - I. YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND/YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE *$ *Denotes potential additional costs above the total estimated price. TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE u zabove fo e total = The-Contractor agrees to pyerform the pwork-furnish the materials and labor specified sum of:$ (*) C^D M10)6-C9, onki .7 (Dollars) . ` Payment will be made according to the following work schedule:$_._deposit upon signing contract l � $ by or upon completion of $—.—upon completion of contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram or by delivery,not later than midnight of the . third business day following the signing of this agreement. See attached notice of cancellation for for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES Acceptance of the Contract Proposal Home Owner(s)Signature(s): �'� Date: It /Z I / Z© �1 v Contractor's Signature: Date: / Z www.la ert ing.com (Please see reverse side) Board of Building Rngulatienw °"taanda.ds . . CS478130 RICHARD J LAN OERT� 265 WOMR STMEiV _ Haverhill MA 01830 v9' - Y 062/2016 Office.of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ; Home Improvement Contractor Registration Registration 149221 : - TYpe Pd—fi Corporation ExpfraHon: 12/6/2015 Tr# 246813. T.G.L.R.0 dlia Lambert Roofing Company RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 - Update Address and return card.Mark reason for change. E] ❑Address Renewal Employmeent Lost Card ...,..- ..;...... ,....v.,o..n _v ft:..,'rv.+.a..n. .sti:gq •br ^?:+ A.m j..-...,sgq _ ..,-,. .--v"`2. .. :d xy. XrRV -. =SCAT fir, ►F LIABILITY tfit .�J to ICE wM� s• ��� 5wxELZTIFt l0.!rf Jm t l -,*4W t 'tNftORlf IO ONLY AND CONI=ER3 NQ Mi#1 T"i IiPOR M 1C7t�'F1dt:L R THIS �TIFXAIS DOES,*'",'!CFFMATIVEL:Y�R:iftErSAT EL-Y AWWQ EXTEND OR ALS E VE kms!~ Yk BY I ME.l�bL.IOIE ` 9ELAW:"=fiH18'CERTIFICATEOF`INWRANCE DOES:° MOT.-CONSTITUTE A CONTRAS EEN"1`�1E':iS�RIF[G ltjS): A.M' '01kIZE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. N SUBROGATION IS WAIVED subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer lights to the certificate holder In Neu of such endorsemen s. PRODLR= '� . Jerrold 8ameras ALLAN INSURANCE AOSNCY INC._--- -- _ _ .- _ _. PHONE (978) 745-5905 . FAX (978) 7%.3683 63 1/2 Jefferson Avenue 2nd Floor L .JerroldNalianinsuraaae.com P.O. SOX 511 WWRERNI AWORDINo NAILS SALEM MA 01$70.-0511-.:. :. ._. _ _ _ A'Assacirat4sd: ii'id; INseREu WSVRER9:0&fety Itrsuraace CO - TQL>tC _ = INSIrRr R F ataona3- Q4d hire ns:..Ca. dba:_ Zamb4srt oofiag Ca r - INSURERD;Ace AMIDtiaan''Tusurai�.da Co. . — .. 255,afinter Btrsst PRERJE:Aoe. rcatu,; cai,. o. .Salverhiil. _ aan eis30- _ - - _ COVERAGES .. RTIFICA--NUMBER. Ra=lrviSiCN Nt1MeER. . ► $L ='Tki!°� °_f'QlCtl _ ::111IFFJ° ![ E.1 iTED;SELf;lg4klE BEEN ISSUEt7 TO TM1E.iNG[IRD NAMi):A$OVE:I�Ctit. f71E., 1tiCY.PE�iit�.. l�`.'�NRffI.,0F'ANY CONTRACT OR:CQTHQ€4 (;IJIV�EI11 �1N.R�SPEC7.'iO WlilCll�H13:' _ _. 1N$tJ�tlFF3Ft>3D�R.B_Y_sk#E,.ffi�CfE€:i _G�J�F�?,)iEItE16l::�$..StiB,iECT TO::ALi..J.t�E:ZERMS �. J :•. ./�EXCEUSK)N&+ANLT;gON 10A�iS f]i=SUCH POL1pES.UtJITS Sfi01AM IIAdIY HA1fE BF i t2EDliCED S PAfa3 .LAu►45.= -- s�eF .A'xs�aio#POLicy N 9ER P.0 CJI R ,« X t OINAfERCIAL LiENERAI WABRi s# y� g 3 ! / ,:. / ! s 50 0 0. A S 9L'6€161� Y ,.aC. 1028029 1/12/Toi3 1l2/xar4 = •tOt d . .r. ..`., 1<w .. �.FO,dti , X Per Project Agg' a-U .�:w_ r; / / / / PERSUNAL:BAUvwIURY... '6. 7:G00.10,06 - i GEN'L AGGREGATE LIMIT APPLIES PER / / / J PRODUCTS-CbMPlOP AGG S 21-0001000 / ! i POLICY X �� LOC �...� .:,;.. ....,:;•-. .. ._ .. .: ....:. ... . ..,:. AUTOMOBILE LIAaIUTY - (ED jk=dwd _ $ ANY At1T0 AUTOS .AUTOS' n 203819 7/i6/2014 7/16/2015 13ODILYINJURY(P�eoradw:t);S' AL-LOVWWD :.'. :SBti69ULE9 -:... $ ;. ►NREALfTOS`.'X: -OS .L ^..:'. / ./ - :./' /. _ s•:. - X UMBRELLA UAB A occuR T .., .... _" ACFt t�CcuaR c> .T! s::. ...5.1'OOfl..aOp EXGESS.WA6`-. 8037731435 = 1/12/2013. 1/12/2.014;::` . C CIAIFdSMADE': ATE _ ".S : 3.i:'QOax.a'0.0 N Y Y I wolticaRs�.CIYIPTrNSJ►710Et / / ! / g ATU AND FMPLOYERS'LIA(AM ANY PROPRIETbRWARTNER"ECVTIVE N 'NLA ! !, /.: .. / E.L. EACNACCIDE�T}i, S 1 013-0r-060 _D, �� � F�( ►UDEO $ IIB-260987 214 MA, 1!3$/2014 3125/2b i5 E+ DISEASE PAEMWAvE s x 6:a� .000 ayare descihe under —_--- — - - eE�CRlP710NOFOPETtAT7ONShataw Y ! ! ELIHSE11> •POLICY La" 's : 1''Ob0 :000 �:;., . - S workers comp, &: employers. :. .- r ,, ! /, J I same o:,ds a:at 1';000,00'0 Liabili yy for NH B62UB7509031'3 „<' 2!2212013- 2/22/2014 - ��� - UOCRIPTiON OP.OPERATMS 1:L,OCAnONS 1 VENICUS(Attach AWRD 701.Add ftml Remarks Schedule.H more space Is required) _ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE I,ambe3zt Roofing CDnigaiay' THE EXPIRATION .DATE .THEREOF NOTICE WIU SE .;DELLVEItED.1N_:, ACCORDANCE WTrH'THE POLICY PROVISIONS 265 Winter_ Street _---- ::. AUTHORIZED -ESENTATIME. } : Haverhill MA 01>33.0. + 1 ACORD 25(2010/05}. ;k ®1988-2010 ACORD C ORATION All nghfs served __ i The Commonwealth of Massachusetts Department ofIndustrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/Organization/Individual): Address:—J e //i'�^ City/State/Zip: zgj�i ,GG /etz Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1m a employer with� 4. El am a general contractor and I ❑ ' 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet,# E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition p ' com •insurance. working forme in any capacity. workers9. ❑Building addition [No workers' comp.insurance 5. ElWe 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 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. 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.#: �a�, riJ� ��L- ���� Expiration Date:---2 j Job Site Address: �� �/%7 � _ 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 requiredunder 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 ofup 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 cert under thepains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: �( Phone#: 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: Informati®n and Instructs®ns 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 ofhire,- 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 adeceased 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-contractors)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 Massaftsetts Departaaent of Industdal.Accidents Office ofInvestigatlons 600 Washington Street Boston,MA 02111 Tel#61.7-727-4900 eyt 406 or 1-877:MASSAFE Revised 5-26-05 Fax,##617-727-7749 WWW-Mass.govfdia