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HomeMy WebLinkAboutMiscellaneous - 250 BEAR HILL ROAD 4/30/2018 (2)f I Wte.. e ..... r TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..0 I.f. 4" /l� .... J) 'r. P. t ) ................. has permission for gas installation ........... in the buildings of 9 -. -7. fl ............................ at . . �. )—P. 13 r/'!, (. /.(. � ...... North Andover, Mass. Fee.,?.��7.. Lic. No.. S- 3 ... ... GAS INSPECTOR Check u MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING r7z-- (Print or Type) r~• `` 14 w7- /7 Mass. Date G9 ®6 Permit # Building Location O <<`xC, Owner's Name vg /-/c-, Type of Occupancy 6�g��.j �� y G �-? T-6 New ❑ Renovation p ,. Replacement Z Plans Submitted: Yes❑ No o CLIMATE DESIGN HEATING and AIR CONDITIONING, LLC Installing 5 South Summer Street Address Bradford, MA 01835 978-372-9999 (phone) 978-372-0882 (fax) Check one: Certificate 'Corporation.® Partnership Business Telephone t-ic. Plumber: To ti P. Harjo-CluA - Firm/Co. Name of Licensed. Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ID No ❑ If you have checked ye, please Indicate the type coverage by checking the appropriate box. A liability insurance policy Z Other type of indemnity ❑ Bond ❑' OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage. required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the per it issued for this application will be in compliance with all pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 of t e General La By T)i of Ucense: Plumber gnature oTLje6nkd Plun0far or Gas Fitter TitleGasfitter Master Ucense Number Gty/Town journeyman I APPROVED (OFFICE USF ONLY) ¢ h W N N Cr N C 40 > of 2 f. W � N: W O U m = n V Q z z O r x z a u a ¢. o M v a ¢ m N W r 6 y W F- n > d J O Z V W = in Z Q 2 O W W W C7 J f• t✓ } N O > Z LL O F- Z J O F. OA W I 2 Z Q Q W W > 2 Q W C m O O W O 44 F ¢• 2. C 2 L6 3 O O J U C > O SUB--aSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR _ I 4THFLOOR I STH FLOOR 6TH FLOOR 7TH FLOOR CLIMATE DESIGN HEATING and AIR CONDITIONING, LLC Installing 5 South Summer Street Address Bradford, MA 01835 978-372-9999 (phone) 978-372-0882 (fax) Check one: Certificate 'Corporation.® Partnership Business Telephone t-ic. Plumber: To ti P. Harjo-CluA - Firm/Co. Name of Licensed. Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ID No ❑ If you have checked ye, please Indicate the type coverage by checking the appropriate box. A liability insurance policy Z Other type of indemnity ❑ Bond ❑' OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage. required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the per it issued for this application will be in compliance with all pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 of t e General La By T)i of Ucense: Plumber gnature oTLje6nkd Plun0far or Gas Fitter TitleGasfitter Master Ucense Number Gty/Town journeyman I APPROVED (OFFICE USF ONLY) Date.. ......................... O TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .. ' �-° .............,................................................................ �. has permission to perform ..........:....................................... wiringin the bu' ding of ................................................................................ at ... ....!...........................................� ........... , ort Andover, Mass. Fee ... !ado. '.,.... Lic. No A..... j .... ..... ............,- --r! ....................... �'—�ELECTRIC�AL k`a15F MR Check # ?(3& � V 5510 THE COADIOATRE,ALTHOFAM SMCHUSETTS Office Use only DEPARTNMVT0FPUBL1CS4FETY Permit No. BOARDOFFIREPREVEMONREGULAHONS527CMRI2.•OO �/ Occupancy & Fees Checked AFS APPLICA TION FOR PERMIT TO PERFORMEXECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACZw. AL CODE, S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date_ Town of North Andover To the Inspector of Wire The undersigned applies for a permit to perform the electrical work described Location (Street & Number) Z50 Owner or Tenant Dou5 ff f J Owner's Address Is this permit in conjunction with a building permit: Yes M No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Underground No. of Meters New Service Amps Volts Overhead Underground r --J No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work IV I PUP No. of Lighting Outlets No. of Hot Tubs No. of Lighting Fixtures Swimming Pool Above round No. of Receptacle Outlets No. of Oil Burners No. of Switch Outlets No. of Gas Burners wo: of Ranges ( No. of Air Cond. Total Tons No. of Disposals h No. of Heat Pumps Total Tons No. of Dishwashers Space Area Heating No. of Dryers Heating Devices No. of Water Heaters KW No. of Signs No. of Bailasis No. Hydro Massage Tubs No. of Motors Total HP THER- umtceCovaage Putsuarlttodlewgtri emffltsof Cenffa aveacuunp labl7ity Policyinchx;QigComp Q awsubmitledvalid fofsametotheOffica YES 3cking the x SURAN(MBOND r7 O H. M r7 xktoStattDateRNuest nedurdlernRrAesof J I ��Gfi�`/ '.MNA1vlE� j� ' l -nava . ST P 40 k4o. 1A L) gionahm NT,'S INS7 FA17E WAIVER; I am a that theliccnse-doesnothave thatmy signahueon thispeurntapphmfton waives this rquaernent, :ase check one) Owner ® Agent Signature oT Owner or Agent i,o. or iransrormers Generators No. of Emergency Lighting Battery Units FIRE ALARMS Total No. of Detection and KW Initiating Devices KW NQ, of Sounding Devices Na--.6iSelf Contained Detection/Sounding Devices 'Total KVA KVA No. of Zones KW I Loca'IF1 Municipal � Other —+I Connections substarMaluimlent ffyou ©u� IZI3'1IU Estimated Value of F,echical Worl{ , q FIA JA) LiomseNo. LicamiNo tw .i Tel. No. Telephone No. PERMIT FEE The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #: Insurance. Co. Policv # Company name: pl Address 1.., City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as welLas_civil.Renaltiesinlhelnrmjofa_STOP WORK ORDER.and aline.of_(.$100.00)_ajdayagainst_me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ! do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required Licensing Board Selectman's Office Contact person: Phone #: ❑ Health Department m Other N° 464 Date/-.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... F ... .5;Vx! i /"'o ! G ............. has permission to perform ...D �........................... plumbing in the buildings of ..................... .......North Andover, Mass. Fee. a. ' .. Lic. No. .. ..... ...`�.......... PLUMBING INSPECTOR Check # �� � -, WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION (Print or Type) D 06-7," Mass. Date De Building New ❑ Renovation ❑ FOR PERMIT TO DO PLUMBING Permit # Owner's Name/.//_r_1 Type of Occupancy Replacement 2' Plans FIXTURES \ / DEU ti AL_ Yes ❑ No ❑ Installing Company Name 2ot,�Ee7 Q - AMMATAeQ Check one: Certificate Address 7�(`) C04(l4Mt4n) y -A) ❑ Corporation /r E! N r' FA) - l t A U ❑ Partnership Business Telephone 7 1 2-Arm/Co Name of Licensed Plumber f'r3 F,P T til - A,NI.VI rq rro_Oe- INSURANCE COVERAGE: I have a current Ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Q' No ❑ If you have checked yes, please /indicate the type coverage by checking the appropriate box. A liability insurance policy ld Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sinnatnra of rluiner •--- . Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations p0ormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum " g oode and (N)apte?l of the eral Laws. Title re of Lice, u, , jLmF Type of License: Master Joumeymah J—]City/Town _ MPRONED OFFICE US ONL License Number �_3 5 NMI Installing Company Name 2ot,�Ee7 Q - AMMATAeQ Check one: Certificate Address 7�(`) C04(l4Mt4n) y -A) ❑ Corporation /r E! N r' FA) - l t A U ❑ Partnership Business Telephone 7 1 2-Arm/Co Name of Licensed Plumber f'r3 F,P T til - A,NI.VI rq rro_Oe- INSURANCE COVERAGE: I have a current Ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Q' No ❑ If you have checked yes, please /indicate the type coverage by checking the appropriate box. A liability insurance policy ld Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sinnatnra of rluiner •--- . Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations p0ormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum " g oode and (N)apte?l of the eral Laws. Title re of Lice, u, , jLmF Type of License: Master Joumeymah J—]City/Town _ MPRONED OFFICE US ONL License Number �_3 5 N z Q Z N V m A O m � m .r A 0 Z O � Z m O S • O O r e O Z Q Date/"F-.'?7. 4'4`' 3952 "O °7 :1�o TOWN OF NORTH ANDOVER PERMIT FOR P"&SWIG CHUS This certifies that .. .. ............ .............. . has permission to perform...................... g plumbing in th buildin s oY ................... , at .. ��............ i��' ,Norti Andover, Mass. Feel". c .....Lic. No..a. ....�`� PLUMBING S ECTOR 02/23/99 10:55 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) City, Town r' AT: Building Location_ WZ) New Plans Submitted Renovation ❑ Yes F-1 No X 1,4!111111 H Owner's Name---. // Type of Occupancy: o C) Replacement 11 Check One: Certificate Installing Company Name, 24. Corp. Address El Partnership 14 0 Firm,Company u B siness Telephone -9� f�— 7 , Y -Z - me of Licensed Plumber or Gasfitter I hereby certify that all of the details and illfo; oIa I joij I have knowledge and that all plumbing work and installations pc "ll)"lilled (or entered) in above application arc true and accurate to the best of my performed under 1'erinit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas codc and ctiapic, 142 of the Gcji,r,j I :, ,s I have informed the owner or his agent that I do not ha hahilil\ insurance i"ClUdillY, completed operations coverage. Sig -1 11r,, of Owl—/ Ag, ni I have a current liability insu r*a rice policy to include Ills By Title rt; 'tityjown APPROVED (OFFICE USE ONLY) HoB8s&WAAArzN.IMC. j989 x TYPE LICENSE: ❑ Plumber ❑ Gasfitter El Master R Journeyman ���ig< e of Lice .-,:,Signatu o Lice Plumber or Gasfitter' :> License Number /Is-, u- -, -11 111111 Kjj1j:=:J-j,T,h NONE MEN on OMNI MEN 0 0 mom IN OMNI VIT NTW NMI NMI NE -91.01-T. M; 0 NMI NMI 0 NONNI NMI �GTC on MCMIMMMMMMMMM1 Check One: Certificate Installing Company Name, 24. Corp. Address El Partnership 14 0 Firm,Company u B siness Telephone -9� f�— 7 , Y -Z - me of Licensed Plumber or Gasfitter I hereby certify that all of the details and illfo; oIa I joij I have knowledge and that all plumbing work and installations pc "ll)"lilled (or entered) in above application arc true and accurate to the best of my performed under 1'erinit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas codc and ctiapic, 142 of the Gcji,r,j I :, ,s I have informed the owner or his agent that I do not ha hahilil\ insurance i"ClUdillY, completed operations coverage. Sig -1 11r,, of Owl—/ Ag, ni I have a current liability insu r*a rice policy to include Ills By Title rt; 'tityjown APPROVED (OFFICE USE ONLY) HoB8s&WAAArzN.IMC. j989 x TYPE LICENSE: ❑ Plumber ❑ Gasfitter El Master R Journeyman ���ig< e of Lice .-,:,Signatu o Lice Plumber or Gasfitter' :> License Number /Is-, u- -, -11 31 18 Dates...`. ............. HONTM TOWN OF NORTH ANDOVER Ob.,,o ,e�tiOL p PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation ..................... in the buildings of....'. ':.. " ... ? . �........................ . at .. ... . rte :. .............. North Andover, Mass. Feet a. ".. Lic. No. �/'��'; 15:G0..�p [[j� ......... .... 03/09/99 12.14 S�iNSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 10 MASSACHUSETTS UNIFORM APPLICATION FOR PFRMIT TO 17 G (Print or Type) %50tAO 6 V �%L Mass. Date 19 � Permit # O GASFITTI ...... .. Building Location Owner's Name d 0,g 1U Z.4 (?2 c•YD &EA1Z /7i LZ- 1 )cD Type of Occupancy New ❑ Renovation ❑ Replacement Zf/ Plans Submitted: Yes ❑ No C/ FIXTURES Installing Company Name /AII "I A QES2611 SY$1Ec4 3' Che one: Certificate Address 9 S4,& t�A 2l �d 2 i_� ¢' Corporation Z 6&tJF- fc./•f ia— /-- ASS• 0/ ❑ Partnership Business Telephone q Ti- 3 -2 Z - C) 9C)9 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter M1 C I,i A E ( rl ii 0 uS C INSURANCE COVERAGE: I have a cur ren lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ( No ❑ if you have checked yes, please indicate the type coverage by checking the appropriate box A liability insurance policy Rr" Other type of indemnity ❑ Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Tygqee of License: By 13'Plumber &LLW �OO ❑,�7[-,a-sfitter Title aster Signatur of Licensed Plumber or Cas itkr journeyman / City/Town License Number APPROVED (OFFICE USE ONLY) ■■■■■■■■■■■■■■■■■■■■■■■■■ or M, 11MOTOT, a ErMwere M. orm, MOTES Installing Company Name /AII "I A QES2611 SY$1Ec4 3' Che one: Certificate Address 9 S4,& t�A 2l �d 2 i_� ¢' Corporation Z 6&tJF- fc./•f ia— /-- ASS• 0/ ❑ Partnership Business Telephone q Ti- 3 -2 Z - C) 9C)9 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter M1 C I,i A E ( rl ii 0 uS C INSURANCE COVERAGE: I have a cur ren lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ( No ❑ if you have checked yes, please indicate the type coverage by checking the appropriate box A liability insurance policy Rr" Other type of indemnity ❑ Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Tygqee of License: By 13'Plumber &LLW �OO ❑,�7[-,a-sfitter Title aster Signatur of Licensed Plumber or Cas itkr journeyman / City/Town License Number APPROVED (OFFICE USE ONLY) H z 0 V W a H z H V1 W U 0 a W u W. (40 ad 66 0 0 0 W m W W u. H z 0! V W d N z Q z W U z_ H Q U 0 0 0 F i 6W a Z � 0 W z 0 Q V a CL Q U z m 660 i W Q z cc O y Q U 0 ae me C CL O z V m Location c� C� ��f�61 t C e o( ' No. + Date (- O TOWN OF NORTH ANDOVER Certificate of Occupancy $ �It Hut <� Building/Frame Permit Fee $ � a Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ Check # 92%4 (2--,, Building Inspector oa Nora a try 49SSwcHusE TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION PermitNO: Date Issued: Date Received: :2 3 / nO� I IMPORTANT: ADDlicant must complete all items on this pave I LOCATION 2-6-0 -ECCAL A(-- 2z:' Print PROPERTY OWNER �Ou G ��uz 4 N Print MAP NO.: PARCEL: TYPE AND USE OF BUILDING ZONING DISTRICT: HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ A eration ❑ One family ❑ Two or more family No. of units: ❑ Industrial epair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED �CMc�vC I✓x�s' n.J ce S t -!r rt.JCoL�.s' ��n� �� i�rvn 1 ruST"i9 � t� c. � NC -cu A1?14AuLr Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: �14mf3�s�� jZc,nFti,� Phone:�i7Fr 37y �2zy Address: S�A�IivC'�It- c�� ►`��vEtzI�tc c ,Ing • Supervisor's Construction License: Exp. Date: Home Improvement License: i 9 �2 ( Exp. Date: (2-16L67 ARCHITECT/ENGINEER Address: Name: Phone: Reg. No. FEE SCHEDULE: BULDING PERMIT. $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED QN _$125.00 PER S.F. Total Project Cost :$ 131000. -- x10.00=FEE:$ Check No.:A2Y3 Receipt No.: Page I of 4 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks o Building Permit Application ❑ 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) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o 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 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:RPFORM05 Page 4 of 4 TYPE OF SEWARGE DISPOSAL Art ❑ wmmn i SiPools El g Public Sewer Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private F1 Permanent Permanent Dumpster on Site ❑ (septic tank, etc. Meter location to project 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION11 COMMENTS t� HEALTH COMMENTS DATE REJECTED 0 ❑ Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other ■l DATE REJECTED DATE REJECTED Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments 701 101 DATE APPROVED DATE APPROVED DATE APPROVED Water & Sewer connection signature & date l Temp Dumpster on site yes ,'no_ Fire Department signature/date G�it�`co•»ry �—,T/ -,Tl—o6- Building Permit Approved and Issued by: Page 2 of 4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total land area, sq. ft.: IV1,)1b5anaUAIA-1t,or Page 3 of 4 Doc INSPE.CTInNAI. SFRVI Created JMC. Jan.2006 Total square feet of floor area, based on Exterior dimensions. 0 0 z 4 rA W R.` A � v u� o w° 6 cu a cin ° w A � � w° � r2 � U is w ° Q. � O ab , is p iw a W W O rx w a 00 u: G ii A C CR z cn . i O cn ui am O m C O O � O H C O ca C-3 CS C O A C s :om E :Ea � D40 o sE m IL ♦ N C l� 0.0 mcL C � .gym Np H ti 13 0, m H Cc :•r: H O O Go o -v m : go o� c�a c o y •_ : m p m %0 d' o c Z Imcc` o cm ac Q :cmc .o = m :,—o N y r M CDs � LU Ma ILS O Z W E ca�oy o C.3 a 5 s W a G cm z Sam ZI 0 T. 0 O L O Z CD C. O h D C O Om CA C 'O y O O m m CL 3.0 0 0 L O a CL cma c t�pp O C. O CD C Z 4D �..± y O C C •� C h AC .................................... PRODUCER INSURED BOYLE INS AGENCY INC 445 MAIN STREET WOBURN MA 01801 LAMBERT ROOFING CO T G L R C INC D/B/A 265 WINTER ST HAVERHILL MA 01830 ...................:::::....::.:::>; TEM .. DA M!DDNY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A NAUTILIUS INSURANCE CO COMPANY B COMMERCE INSURANCE COMPANY COMPANY C COMPANY D THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DDNY) LIMITS GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR OWNER'S & CONTRACTOR'S PROT ] C 3 7 4 9 5 7 10/12_/_05 10/12/06 GENERAL AGGREGATE s2, 000, 000 PRODUCTS - COMP/OP AGG $1 000, 000 BODILY person)INJURY $ 500,000 PERSONAL 6 ADV INJURY $1 000, 000 EACH OCCURRENCE $1 000 000 FIRE DAMAGE (Any one fire) $1, 000, 000 NON -OWNED AUTOS MED EXP (Any one penton) $ 5, 000 AUTOMOBILE LIABILITY ANYAUTO Z T 6 915 7/16/05 7/16/06-- /16 06ANY COMBINED SINGLE LIMIT $ IDESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECUIL ITEMS WORK COMP CERTIFICATE WILL BE SENT FROM A.I.M. MUTUAL INS PER WC BUREAU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E�XlP1IRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTIC T E CERTIFICATE HOLIER NAMED TO THE LEFT, BUT FAILURE TO MAIJC$UCH OTIC 8 IMP E NO OBLIGATION OR LIABILITYOF ANY KIND UGH� Y NTS OR REPRESENTATIVES. AUTHORIZED REPR A E Gerard.,.. FF A ALL OWNED AUTOS X X SCHEDULED AUTOS HIRED AUTOS BODILY person)INJURY $ 500,000 X NON -OWNED AUTOS BODILY INJURY (Per accident) $1 0 0 0 0 0.0 PROPERTY DAMAGE $ 500,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ 11 EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE UMBRELLA FORM $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER - EL EACH ACCIDENT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EL DISEASE -POLICY LIMIT $ EL DISEASE -EA EMPLOYEE $ OFFICERS ARE: EXCL OTHER IDESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECUIL ITEMS WORK COMP CERTIFICATE WILL BE SENT FROM A.I.M. MUTUAL INS PER WC BUREAU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E�XlP1IRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTIC T E CERTIFICATE HOLIER NAMED TO THE LEFT, BUT FAILURE TO MAIJC$UCH OTIC 8 IMP E NO OBLIGATION OR LIABILITYOF ANY KIND UGH� Y NTS OR REPRESENTATIVES. AUTHORIZED REPR A E Gerard.,.. FF A CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) 09/02/2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Boyle Insurance Agency Inc CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P 0 Box 606 POLICIES BELOW. Woburn, MA 01801 COMPANIES AFFORDING COVERAGE INSURED T G L R C Inc COMPANY A.I.M. Mutual Insurance Co LETTER A dba Lambert Roofing Co. 37 Stevens 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 PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIO DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY LAIMS MADEE DCCUR PRODUCTS-COMP/OP AGG. $ PERSONAL & ADV. INJURY $ OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE S FIRE DAMAGE (Any one fire) S EXPENSE (Anyone person) $ AUTOMOBILE LIABILITYMED. ANY AUTO COMBINED SINGLE $ LIMIT ALL OWNED AUTOS JURY $ SCHEDULED AUTOS HIRED AUTOS EBODILY JURY $NON-0WNED ) AUTOS GARAGE LIABILITY PROPERTY DAMAGE S EXCESS LIA ILITY EACH OCCURRENCE $ MBRELLA FORM AGGREGATE $ THER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS'LIABILITY X 6009966012005 A IiE PROPRIETOR/ X INCL 08/28/2005 08/28/2006 EL EACH ACCIDENT s 500,000 ARTNERS/EXECUTIVE EL f)ISEASE--POLICY LIMIT $ 500 000 FFICERS ARE: EXCL OTHER EL DISEASE --EACH EMPLOYEE $500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEIUCLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEI EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDMAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMLEFT', BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIG LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE y c=_= � RT Boy �rnnueal� �. of Buitdiu g Re ulatioi11 and Staodard, HOME = ; Imp ROV MT. E . N Cq,% Registr . f 4CTOR Expi49221 ration 12/5/2007 TYd%e: Sur t . . LAMBS pemea 1, C. M ROOFING CO G. THOMAS pROPHET 265 WINTER STREET HAVERHILL. MA 01830 G -Y r us Admioistrntor Ein # 51-05033313 TG S�ERN ms MA Reg. Hic # 121981 ambe ? cy MA Lic. # UCS 078130 Bacon d B T Single ply Lic. # 1711 c.•, i 932 9 � �— a� 265 Winter Street, Haverhill, MA MEMBER We are: ✓ Licensed ✓ Insured ✓ Factory Trained ✓ Factory Certified Installers Date: I LA C Z00 G Estimate for: 1 J OU (�, Hy Z A R.. Telephone 1: q78- 86 Z - S9 9' Telephone 2: 9 % 8 " 2 � 8- Z y � d f:A 6 y� Address: 2 0 ?)CA R. I uL, �C) City/Town: � A Ai �oyE 2. State: y1 A Zip: Job Location: S 4 M E City/Town: State: Zip: L.R.C. agrees to commence described work on / or about L 3 W lC and described work will be completed in about l - y 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 fallowing work includes all permits, labor and materials needed to complete your job in a professional workmanship like manner. 7lope Quick -quote proposal to furnish and install the following: Approximate roof area 3 600 w Roof Ll Re -roof C3 Gutter ❑ Repair C3_ Ventilation 0� Prepare for re -roofing by ensuring all safety measures are taken in accordance to OSHA standard regulations and landscape is properly protected. ❑ Remove existing layers of roof material down to roof deck and inspect wood. If upon inspection we discover any rotted wood, replacement will be performed at $ per LF. * If substantial deck rot is discovered, re -sheathing of roof deck can be performed at $ per SF. * If wood is sound, we will ire -nail any loose wood to rafters, sweep deck and prepare for installation. O',�Install 8" Drip edge El Install 5" Drip Edge C3 Install Hug edge (Re -rook only) Color W H ►TF_ Oct AAply ice & water shield (UNDERLAYMENT) as per manufacturers' specifications and or Z Gouri.S ES 0 ply 1, # felt paper (UNDERLAYMENT) to the balance of the exposed wood deck. RReflash all stack pipes, tie-ins, chimneys and/or any rooff netrations as required and dictated by good roof practice to ensure water tightness. ❑ Re -seal chimney base using cement & fabric. ; Re -Lead ❑ Re -point chimney ❑ Re -build chimney $ ❑ 1 stall anew �O Year ❑ Traditional Architectural style shingle roof system Color�..Uf3Q��/%C Monf. G •� 1 • �-• ly nish and Install a new shingle over style ridge vent system ❑ Soffit vent system $ C� 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. Special Notes: �E-StAC--A, ii EO I IZE k4 of W/ V GD.X IZE-SE. i A"D )ui,-D uf' 3 S V- LIT 1W 1{ -r N- . 2 C -LC A1D A? a F F C m C- a"-svI.-- 1CoN� 1 WIT SHOP FraQi?1C.AT[r� MAS iLIA` . MALL. EJL AL �S QN �-r1� t�orLn-�rrLs ovcl� �AtzA�E taaE�1: SuR�-$TAR►"- w�anE,�-��+ ... _... Warranty options: �tundard LRC ❑ Manufacturers Upgrade $ * Dentes addiHona) 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 _'56 YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. ^� - This document can serve as a contract, however if a more elaborate contrail 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 1.5% per month (18% per year) will be charged on past due accounts^over 30 days. Total Estimate Price: $ 0oo r 1 Payment to be made as follows: J D E P'O S 17 0 13,4 L 14 0 C £ G� �__Ow1i'LEira►J (027 Date of Acceptance --7/2-1 /(, (Home/Business owner) Q Signature (LRC) gnature 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'