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Home My WebLink AboutBuilding Permit #275 - 93 ELM STREET 10/12/2007 ,AORTH BUILDING PERMIT %'a9.D D .2% -6 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Arap �SSA46�__ �_0 C Date Issue IMPORTANT:Applicant must complete all items on this page q p R LOGATfON L F,7n 7 PROPERTY,OVVNER": 'Pn t MAP NO t PARCEL 0: C" District-;0N DI ` a IVlactaire Shop Village ryes ono 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 sqPt1"q, ell �'FJob p a' Wetlands aers e� d' IS r1C 1Na77, `2 ' e tbris"er, DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: Gfl ` 0'7tr4`i"�_; 3 NT TPORName - FF .Address. Supervisor's ConstructionL�cense' /'' Exp 7 2- i 2 TZ 7,7 7 7, Improvement Home License '-Ex H vem6ht e,L Lib e::L ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $e 36 Check No.: -5 7v�� 1. , Receipt No.: 0?0 NOTE: Persons contracting with unregistered contractors dv,not have access to the guaranty fund ----------- .......... Signature of # 'Ad 6n wher 0 pcontractor gure o...-.� .. .... . Location,&-') / No. : Date �aRTh TOWN OF NORTH ANDOVER + Certificate of Occupancy $ Building/Frame Permit Fee $ s�cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20663 Building 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS 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 f IRE DEPARTMENT 7emp'Dumpster on sitex yes Located`at 124.Vl6tn Street Fire Department s�'na#urdldate ''COMMENTSn - 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 o 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 Page 1 of 1 Leathe, Brian From: Brown, Gerald Sent: Monday, July 13, 2009 4:05 PM To: Leathe, Brian Subject: FW:-93 Elm Street From: Liz Fennessy [mailto:lizettafennessy@yahoo.com] Sent: Monday, July 13, 2009 4:02 PM To: Brown, Gerald Subject: 93 Elm Street Gerry, This house has a few signs in front of it advertising a roofing job. Have they applied for a permit,because that is a house that the MSV commission would have something to say about regarding the type of roof Liz 7/13/2009 1ne commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): ��" Address: �`S a c /Ce S City/State/Zip: L_{_...&e k,G - Are you an employer? Check the appropriate box: Type of project(required): 1.V–r—am a employer with_9d 4. ❑ I 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 working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 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' l3.❑ 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. :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. Lie. #' ��C' / 6 6 6/ lld Expiration Date: Job Site Address: ZCity/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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under t ains and penalties of perjury that the information provided above is true and correct. Si nature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town officiar' City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: FAX N0. 7819339U4U r ulil - AUG-31-2007 FRI 0851 AM BOYLE INS,SSOCI rED INSURANCE N0. 6909- K 1/1 AUG. 30. 2001 6;08P �S 08/30/2Pu7 ATIOPRODUCEONLY A74D R OAM C N R�oH7 s vpaNDTAS�iD c N'XTTER OF T ATT 10{.A THIS CERTIIgCATE CONS q14 Umutmes AVACY I= DODS NOT AMEND,EXTEND OR AMR Tu>r covl�RA4B nfFORDED BY TH p sox 6a6 POLICIP9 BELOW, Boy 06 01801 COMPANIES AFFORDING COVE�tAGE obM,sVM Q L R O Ino COMPANY A A.I.M.Mutual Iusutuncc Co b8 Lambw XDotrnB CO. LBTTSR S Winter Strw ;pvWhill,MA 0100 WITH RESPECT THIS 15 70 CY C�R'[7P T THAT T$tT ANDINO AN$REQt11AEMBNT,TTERM OR CONDITION OF ANY CONTRACT OR OTHER DOC OUMi� A T►TB POLI PERIOD INDICATED,NOTWIT 70 WHICH THIS CSRTiFICATF.MAYOBz C4NDITOIONS OF SLICK ppl 1ciss.LIM MS Ho OM Y HA RD By�5N REDUCED CIM DESCRIBED YYPtiID CLLAAiMS.IN Is su91 TOALLTHUTCRMS I�1 rouL11LT►6Cr11 rop; LxKxxnon Urdrri cc TYreorINSOPAH r ►OUCYNVNAACR 'T,t= OAYO044pwm QOH9RM.AgORaG�TII CZN=RALUA!MM 00 SPI ►usoNAL«ADY,Oi1UItY QCON11>IxgALGlNC7IAL W BILt11 a.Awl,,,�,�I►(�occalR eACI+occrlaaB+cl �0 nlsw�?1AG6(AAY�I++d COwoA7ID I� AUTOMp01ii{i�iIYTY L17�tt AjiYAUTO OR�o UQV ALLOW=ADIOS aq�y AuuLY gNOOVI.W At= Vre.cdJu� gpya=w 110NOOM AUr9S ►ao)ea'N wmAGo y&p kCaU ASMr(V IAd{Qce "CCU LL+IWTY ArlsawTY LowAMAATOPM e m"m Lu LLAwom ATCTPDRY llMTrs DTHER WOAKlOt!�MpgN$ATLON AND X eMPLowjw LUBILI'PY SI.EACH dCCiDSt17 500.000 ALI cmAI6009966012007 08/Z8/20D7 08/2mrm8/2008 SDI 'OUcyU� 500,000 Mflis�g EnCH 500,000 CODggC�ilP7rlON OF OpEHAT ONS OR LOGTIONSc ATA SHOULD MEnAN Ir TIM NG OO ANY �HtdD�P�1VORTOMJ�g1IS �1�WAfTT�B}IN07fC97G�T}►EAJ ICIII�DT7PICAT OWN OF WINCFMS7'ER OLpU N� To THE Lwr.SUT PAjUM TO MAIL SUCHNOTME SHALL W.PoSP NO OIIUQATION R LIA$ILITY OP ANY KIND UPON THE COFiPAw,TTS AQENTS OR REPI.ES@ TA?rm' I MOUt4'i'YERNON ST C�STEIt,MA G189V °f/H T00lJN196fi.lGV�F�i• 4�✓�li6CGG� `4 � � -- •.•. Board of Building Regulatlons and Standards License or registration valid for Indivldul use only HOME IMPROVEMENT CONTRACTOR before the Bo rd of B 1 dingexpiratlon date. If found return to; Regulations and Standards Registration: 149221 One Asbburton Place Rm 1301 Ezpiritlont 1.2(¢/2007 Boston,Ma. 02108 T.y{re: Frivate Corporation LAMBERT ROOFIt4G:CO RICHARD LAMBERT 265 WINTER STREET �.., .amu✓ HAVERHILL,MA 01830 Administrator Not valid without signature f . Board of Building Regula ions and Standards One Ashburton Place - Room 13 01 Boston. Massachusetts'02108 Home Improvement jContractor 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 ror chs OPS-CAI n soM04/Os•Pc119e D Addrus [D Renewgl 0 Employment Los OEM Board ofBUilding Regulations One Ashburton Prace, fpm 1301 UIR 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 ATKTNSON, NH 03811 Tr. no: 27100 Keep top for receipt and change of address notification. OPS-CAI n SOM•OWSPC1090 FROM :LANDERS FAX NO. :9786822212 Oct. 06 2007 09:10AN P1 02/20/2016 18;35 FkX 1�002/002 our Prot 1§ oriYour R22ft Subject: Scope of Work to be performed yet: 93 Elm St North Andover Ma.01845 Sutimitted To: Vincent Landers 40 court St. N.Andover OiM We propose 1.)ERentovo existing built up roof to expose wood deck,Any wood replaosment to be done at an additional chane. 2.)Install 112" polyisosyanurate Insulation to entire roof area. 3.) Install now gPDM rubber roof systern, 4.)Install new rnml.drip edge to perimeter edges. 5.)Pmpats and flash back wall per manufacters specifications and details. 6.)Remove all trash and debris. Work to be performed in•workmanship like manor for the sum of: 1400.00 OneThousand Four Hundred.............w................ ...................w......001100 please Note:If existing tar and gravel to remain the cost of tho now roof is less $W.00 Total post of go over is$1000.00 payment terms: 113 Deposit Balsoas duty upon oompletion Feel free to contact me with any questions or concems, Jim Rousseau Field Supervisor, T.G.L.R.C.,Inc. dba Lambert Roofing Company V n n