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Home My WebLink AboutBuilding Permit #797 - 92 MEADOW LANE 6/4/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO. Date Received Date Issued: * --11_ - e DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: &,R cxa,0.4 Phone: 273 �� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT:: $$12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BA SED ON $125.00 PER S.F. Total Project Cost: $� ! FEE: $ Check No.: &'- Receipt No.: NOTE: Persons contracting with unregistered contractors 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS ■❑ DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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) Li 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 Locatio No. Date 0 , TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ q Foundation Permit Fee $ Other Permit Fee $ { TOTAL $ e Check # V43 S"" 2046 63 _ Building Inspector E w O O F=4 U �Ia 0 w T 0*4 CN E I c v c E M3 t O y c cmm CM ac c m 0 c 0 t_ 0 Z cm O 0 w a O a �91' U O 4..t+ .,.a c Z s CL V CO) O C C c CLCOD 0 W 0 LLI U) 19 W uj 19 W N w c1 a w° a U w a w x w a x w a ca w � a ra 0 z W 0 cn 0*4 CN E I c v c E M3 t O y c cmm CM ac c m 0 c 0 t_ 0 Z cm O 0 w a O a �91' U O 4..t+ .,.a c Z s CL V CO) O C C c CLCOD 0 W 0 LLI U) 19 W uj 19 W N CERTIFICATE OF INSURANCE ISSUE ATE(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 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE BE PDOES OLICIES ND, P O Box 606 Woburn, MA 01801 COMPANIES AFFORDING COVERAGE INSURED T G L R C Inc COMPANY A,I.M. Mutual Insurance Co A dba Lambert Roofing Co. LETTER 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 PERK INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH TII' CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBERPOLICY EFFECTIVE POLICY EXPIRATIO LIMITS DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ MMERCIAL GENERAL LIABILITY ��LAIMS PRODUCTS-COMP/OP AGO. $ MADE[:::)OCCUR PERSONAL & ADV. INJURY $ OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE (Any one tire) S MED. EXPENSE (Anyone person) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ RMBRELLA FORM AGGREGATE $ THER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS' X WC STATU- OTH- i LIABILITY R X LIMITS A ITHE 6009966012006 08/28/2006 08/28/2007 EACH ArC1DFNT $ PROPRIETORi INCL PARTNERS/EXECUTIVE NEXCL EL DISEASE—POLICY LIMIT $ 500,000 OFFICERS ARE: _ OTHER EL DISEASE—EA EMPLOYEE S 500,000 OF OPERATIONS/LOCATIONS/VEInCLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE it EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL*ENDEAVOR TO 1' MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE i' 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 ACORN v TM. CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY) 10/16/2006 PRODUCER Phone: (781)933.3100 Fax: (781)933.9048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SALEM FIVE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOYLE INSURANCE SERVICES 445 MAIN ST BOX 606 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. A ITS AGENTS OR REPRESENTATIVES. WOBURN MA 01801 INC 609679 INSURERS AFFORDING COVERAGE NAIC # INSURED T G L R C INC INSURER A: NAUTILIUS INSURANCE CO MED. EXP (Any one person) $ 5,000 INSURER B: COMMERCE INSURANCE COMPANY INSURER C: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT DBA LAMBERT ROOFING 265 WINTER ST HAVERHILL MA 01830 INSURER D: INSURER E: LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS ZT6915 rnvcoer_Fc 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 RESPECT TO 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE iMMIDDAn POLICY EXPIRATION DATE MM/DD LIMITS A ITS AGENTS OR REPRESENTATIVES. GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADEa OCCUR INC 609679 10/12/06 10/12/07 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea ocarence) $ 1,000,000 MED. EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT PRODUCTS-COMP/OP AGG. $ 1,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS ZT6915 07/16/06 07/16/07 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ 500,000 X X BODILY INJURY $ 1,000,000 (Per accident) X PROPERTY tDAMAGE $ 500,000 (Per acciden) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG E EXCESS / UMBRELLA LIABILITY OCCUR El CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ S $ t WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? It yaa, daacribr under SPECIAL PROVISIONS below TOWCSTA TU- RY LS OTHER IMIT E.L. EACH ACCIDENT E E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMB E OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS WORK COMP CERTIFICATE WILL BE SENT DIRECT TO YOU FROM A.I.M. MUTUAL WORK COMP CERTIFICATE HAS BEEN REQUESTED. CERTIFICATE HOLDER CANCELLATION -- — — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Attention: AUTHORIZED REPRESENTATIVE A _ 6 Gerard F BO Jr ACORD 25 (2001/08) Certificate # 6694 ® ACORD CORPORATION 1983 Ein # 51-05033313 MA Reg. Hic # 149221 MA Lic. # UCS 078130 Single -ply Lic. # 1711 T. ie—g �AiiliilLr�ty Z 932C. 265 Winter Street, Haverhill, MA 01830 We are: ✓ Licensed ✓ Insured Date:% Telephone l: -- `i gtE0.N MASS 1 Esc K BBB -1 MEMBER ✓ Factory Trained ✓ Factory Certified Installers i J Estimate for: ..: Telephone 2: Address:_' /tr Y `' % G. % t. City/Town:_/ . i'.+t'c: -' State: hVK� Zip: Job Location City/Town: State:—Zip: L.R.C. agrees to commence described work on / or about l —Z, �. +'r and described work will be completed in about 4, 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 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. Steep slope Quick -quote proposal to furnish and install the following: Approximate roof area 3 = L;: --T, t". Q` ',New Roof ❑ Re -roof ❑ Gutter ❑ Repair ❑ Ventilation p'rPrepare for re -roofing by ensuring all safety measures are taken in accordance to OSHA standard regulations and landscape is properly protected. Cr7 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 ' per LF for roof deck boards. If substantial deck rot is discovered, re -sheathing of roof deck can be performed at $ 1 ' per SF. If individualsheets are found to be rotted and/or delaminated, removal, disposal and replacement will be performed at $- per sheet. If any trim boards are rotted, replacement will be performed at S 6'-2,'` per LF for new pre -primed pine (not to exceed 1" x 8"). If wood is sound, we will re -nail any loose wood to rafters, sweep deck and prepare for roofing. Cld'lfnstall 8" Drip edge ❑ Install 5" Drip Ede Ll Hu edge Re -roofs only) %-,,r c:' ;r"''. P 9 P 9 9 9( y) Color VEf'A ly ice & water shield (UNDERLAYMENT) as per manufacturers' specifications and or r> pply r`:' # felt paper (UNDERLAYMENT) to the balance of the exposed wood deck. �/Reflash all stack pipes, tie-ins, chimneys and/or any roof penetrations as required and dictated by good roof practice to ensure water tightness. If upon inspection, we discover chimney to be worn or deteriorated, replacement will be performed at $ per chimney for single flue and ,$^w< ` ' per chimney for multiple flues. V, t, Eurnish nstall a new .'mac) Year C3Traditional Architectural style shingle roof system Color > ....fMonf. and Install a new shingle over style ridge vent system ❑ Soffit vent system $ 0 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. SpedalNotes: i,i- ; •`< r- �i`... :1 C�� "?++,, '' c< �_'" i-r"�; 5 �r.: 'r i. r^ r; G ti. Warranty options: CStanddrd LRC ❑ Manufacturers Upgrade $ * Denotes additional costs above the total estimated price. UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF TEN YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND 2>' - 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 may be 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: $ Date of Acceptance Payment to be made as follows: (Home/Business owner) ~`� f ` t • •..w _ Signature (LRC) 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 Roofn w Inmh&rfrnniinn nat Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 149221 Expiratlnn: 1V612007 Type: Private Corporation LAMBERT ROOFING. CO RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma, 02108 Not valid without signature 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 Ca SOM-04/05-PC8698 Registration: 149221 Type: Private Corporation Expiration: 12/6/2007 Update Address and return card. Mark reason for change. Address [] Renewal F-1 Employment R Lost Card Board of Buildingg Regqulations One Ashburton Place, Ism 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 DPS-CA1 0 SOM-04/05-PC8698 Tr, no: 27100 Keep top for receipt and change of address notification. The Commonwealth of Massachusetts IR Department of Industrial Accidents Office of Investigations 600 Washington Street UIP Boston, MA 02111 r Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers u des/Cont anlicant Information ractors/Electricians/Plumbers Name (Business/Organization/Individual): City/State/Zip: Are you an employer? Check the appropriate box: L ❑ 1 am a employer with 4. _ employees (full and/or p .* 2. ❑ 1 am a sole proprietor or I am a general orctor anda aha a hired the sub -contractors partner- ship and have no employees listed on the attached sheet t These sub -contractors have working for me in any capacity. [No workers' comp, insurance workers' comp, insurance. 5• ❑ We are a corporation 3.[1required.] I am a homeowner doing all and its officers have exercised their work myself. [No workers' comp, right of exemption per MGL c. 152 10), and we have insurance required.] t no employees, ees m loy . [No workers' P Y [ comp ins 3,2r9�;2,-) 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 urance required.] I 13 ❑ Other c *Any applicant that hecks box #I must also fill out the section ow 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. �Contmctors that check this box must attached an additional sheet showing the name of the sub-contrwtf a,,.4 I am - - _ ^.,.wosa wmp. poetry mtormation. information. an emp oyer that is providing workers' compensation insurance for my employees. Below is the policy andjob site Insurance Company Name: ` Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/S Attach a copy of the workers' compensation policy declaration Page (showingthePolicynumber and Failure to secure coverage as required under Section 25A of MGL o 52 can lead to the imposition of criminal genion datea fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties of a of up to $250.00 a day against the violator. Be advised that a copy of this statement may be f forwarded o a STOP WORK he Office of d a fine Investigations of the DIA for insurance coverage verification s and penalties of perjury that the information provided above is true and correct enahirP• ( Oficial use only. Do not write in this area, to be completed by city or town oJ)icias: Mr City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4 6. Other . Electrical Inspector S. Plumbing Inspector Contact Person: Phone #: