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HomeMy WebLinkAboutMiscellaneous - 405 WINTER STREET 4/30/2018N i Plans Submitted -11 Plans -Waived -0 Certified Plot Plan ❑ Stamped Plans ❑ - TYPE ORSEWERAGE-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 Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS L !s 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 " DPW To` o. Engineer: Signature: Located 384 Osgood Street FIRE DEPARTIlflr AT 'Temp Dumpster on site yes no Locafed at 124sMair Street. - ```1 Fire Dep5rtme1jtsig4ature/date ' COMMENTS `t 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 EJ Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The fdowing is ---a- list of the required -forms to be filled out for the appropriate -permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits o Bailding 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 cas" 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 submAted with the building application Doc: Doc.Building Permit Revised 2012 Location 6o k,A� s< - No. Date 14 go Check # A(0© 27160 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector •f IDd rA rA A ,n W MEN -M O J LU L d' O m O Nm U Y \ O LL N >.2 N U O. (%j d ? Z O C "6 7 LLL r O W ? N C E7 U LL W d Z Z m J d t ix LL ° Z U W J W t O' U N LL O a N Q S 7 d' LL z WCC G G W W LL y CO O Z +� CU 41 V1 0 N O N C 10 a �o L Q, 4) � Q O i+ y V Q. L y d d 0 � E C V L " 3 C L , � C L =N y G� O = d G 0 0 C s V Q U) d FM O - -f_o Z �rw s c o y O �• 3 o0 L Qi •y +' o c c F- O y Q. v •n co m. m W = -.0+r O O ui ce. 0'y ,A y C Q t O v w = 0 L V a� 0-0 cn C• am j :� c CO) mo o H s � CL o 0 0 LU Z Z In `i r H O E CL Z U y W w/ 0 v, = X Z 4) u c W J a z_ m L O c N t O Z 0 dOMM/ O �l •N a E 0 0 Z N A, I c M MM •� W W a o s_ 0 �+ in 0 cc O a CL � Q 's v_ J cc .CL 0 r,A0 CL W V CL W !D vI H W W 19 W EIN # 51-050-3313 MA Reg. HIC # 149221 T MA Lic. UCS # 78130 BBB. Single -Ply License# 1711 L T. aMber' RO!fing swu4ei1932 CO._ 265 Winter Street Haverhill MA 978.374.9224 Lawrence MA 978.687.7339 r Hampton NLS 603.929.9224 Hampstead NH 603.329.8200 Toll Free 1.888.SOS.ROOF Haverhill MA 01830 t, *Licensed *Insured *Factory Trained *Factory Certified Name: 6b►11zo Dater 16/3 Telephone: _4P2 Alt. Telephone: Email: t '' c�� ,, `� Billing Address:; l3 P.;�' Jt . ---City: � !'IrU01AW State: f ` (A i Job Address: City: State: Scope of Work YStrip and Re -roof ❑ Re -roof Approximate Roof Area: ❑ 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 . 9 '_5 per LF for roof deck boards. If substantial deck rot is discovered, re -sheathing of roof deck can be performed at *$ 1.20 per SF.:If individual sheets are found to be rotted/or de -laminated, removal, disposal and replacement will be performed at *$ .�Sy °' per sheet. If any trim boards are rotted, replacement will be performed at *$ 1 '--_ per LF for new pre -primed pine. Inspect siding at roof l Re and all flashing behind siding, if we discover any damaged flashing or siding at the roof line, replacement will be performed at *$ 1 C If wood deck, siding, and flashing is sound, we will re -nail any loose wood to rafters, sweep deck, -and prepare for roofing. ❑ Install 8" drip edge to all rakes and eaves. Color VVI c I ( / y ❑ Apply ice & water shield (UNDERLAYMENT) as per manufacturers' specifications and/or '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 deteriorated, replacement will be performed at *$ , j C Install a new: Year ❑ Traditional ❑ Architectural ❑ Designer Color YYYb i 2 e lo)G . El Furnish 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 irate rity of the building be ompromised. ,,/ j Special Notes r' i roo / �/ ("�� o f ' 'c'% 1 tri0,,c' '�,` e o GeiMg 70 �✓ �` `� C a — G a'iC� i a b�'18 ( x ) t f , % UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF 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 /0 The Contractor agrees to perform the work, furnish the materials and labor specified above for the total sum of: $ 5 0� (*) Payment will be made according to the following work schedule: $ deposit upon signing contract /_3 $ by _/_/_ or upon completion of upon completion of contract. (Law forbids demanding full payment until contract is completed to both parry'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 expl*anation of this right. Home Owner(s) Signature(s): DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES Acceptance of the Contract Proposal l?^'v Date: /off l l 13 Date: Contractor's Signature: / t �i`�rJY��"' _/ The Commonwealth of Massachusetts Department of IndustrialAccidents 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 Lepitbly Name (Business/Organi'zation/ludividual): City/State/Zip: 66 L Phone #: l' 32 ��2 - / Are you an employer? Chec the appropriate box: - Typo of project (required): 1. am a employer with 4• El am a general contractor and 1 6. El Now construction 7 employees (full and/or part-time,).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor orpartner- listed on the attached sheet, t �• El Remodeling ship and'have no employees These sub -contractors have 8. El Demolition working for mein. any capacity. workers' comp. insurance. g, [] Building addition [No workers' comp. insurance 5. El We are a corporation and its 1011 Electrical repairs or additions required.] officers have exercised their 3. El 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.] employees. [No workers' " 13.0 other comp. insurance required.] Mny applicant that checks box Bf must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that checkthis 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. „ „ n Insurance Company Policy # or Self -ins. Lie. Expiration Date: Job Site Address-. �l� %�� S 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 of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office sof :Investigations of the DIA for insurance coverage verification. I do hereby certoT under the pains andpenalties ofperjury that the information provided above is rue a d correct. Date: �7;/� 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 Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Phnn,.#f• ��r �9s�a 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 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 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 Weal 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 tivith the insurance coverage required " Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth.nor any ofits 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 elate the affidavit. The affidavit should be retumed 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 5_ 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 an any given year, need only. submit one aff davit indicating current Policy information (ifnecessary) 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 ormarked 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 orpermit to burn leaves etc) said person is NOTrequired 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 togive us a call. The Department's address, telephone and fax number: The Commomeafth of Massa.,cl�v.:sPtiS Depaftexit of faftbial .Accidents OfAce ofIuyedtigatiom 60Q waswngtou Stent Boston, MA 021 X 1 Tel, # 617-727=4900 W. 406- or 1-S77�MA.SS.AFF, Revised 5-26-05 Fay ,# 617-727-7749 C-0 Y Ownl n -- Office of Consumer Affairs and Yusiness Regulation. 10 Park Plaza - Suite 5170 Boston, MassadhU setts 02116 Home Improvement Contractor Registration Z RKeMstration: 1421 Type: Private corwation Expiration: .,11216/2-013 Tr# 218746 I G.L.R.0 dba Lambert Roofing Cofripany RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Update Address and return card. Mark reason for change. Address —i Renewal —1 Employment F Lost Care, -DATE (MMIDDryyyyI CERTIFICATE OF LIASILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INF 'D9/19/2�013 CERTIFICATE DOES NOT AFFIRMATIVELY OR N N ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS . EGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED I REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. It the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed- If SUSROGATION 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 rights to the Certificate holder in lieu of such endorsernent(s). PRODUCER CONTACT ALLAN INSURANCE AGENCy INC, NAME: Jerrold xameras 63 1/2 Jefferson ,Avenue 2nd Floor PIO- BOX 511 SALIDIMA 01970-0511 INGCOVMGE NAI irqsuRrERA:.Firtlit MercAr ENSURED _. I Insurance Co TGLRC Inc. INSURERB:Safety insurance g9m �Ap py JNSUR9RC:C,4artJS Insurance CCM an dba Lambert Roofing Company INSURtR.D.Ace American Xnsurance 265 Winter Street Co. I NBORERF.Ace.Arftarican insuranceI Co Haverhill MA 01830- __... THIS IS TO CERTIFY THAT THE POLICIES Or WSW INDICATED. NOTWITHSTANDING ANY RE'QUIREME CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, IN'S LTR TYPE OF INSURANCE AM SUBIR GENERAL LIABILITY X CO�MMER(-IALGEt"ERJiLLIABtLITY A a CLAIf,4S-WAJ)E I X� OCCUR LEN'L AGGREGJVTI; I 1W t' APPLIES PER1 " UMBRELLA LIAa 11 )J: OCCUR I C [ �EXC SS UAB I CLAIMS iCt LI$TEDBELOW HAVE BEEN TERM Olt, 91 ISSUED 0 THE tNSURED.NAMEO ABOVE FOR THE POLICY PERIOD CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS L INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL. THE TERMS, NITS SHOWN. MAY HAYE.BEEN REDUCER BYPAIbCLAIMS. POLICY NUMBER F0—UCYEfv POO-C—YEXP LIMITS tEACH OCCURRENCE 6 11000,000 —07IXAMT. N GENII_ 0100 -CaL000000656-01 11/12/2012 11/1212013 EDEXP(Aryonapers-on) $ 1,000 PERSONAL & AVV INJURY 11000,000 GFNERAL AGGREGATE 2,000,000 PRODUCTS . c2mpfop AqG 2,000,000 $ BODILY INJURY 'Per pamon) 5 03819 BODILY iN,;LfRy PROPERTY -DAMAGE EACH OCCURRENCE S. 037721464 11/21/2012 11/12/2013 i WORKERS COMPENSATION AND.EMPLOYERS' LIABILITY —T-VRC-8-f-A—TU--T ANY PROPRIETC-.RfPARTNER''XIEC',JTNF-. YIN I TORY I, IMITS I OfFIGERAAEmBER EXCLV-XL�7 I`7$'N,f A EL EACHACCIOEN (Mandatory in NH) 58562781 08/28/2013 08/28/2014 — If yes, descxbo under i, E,L, DISEASE - FA E DESCRIPTION OF OPERATIONS i,,,I,, -7 21 Workers comp EmployerS 11 , F��- DISEASE -POI. S452tUMB B75090312 12/22/2012 12/22/2013 Liability foN r H a6ove DESCRIPTION OF OPERATIONS : LOCATIONS I VEHICLES (Attach ACORD 10`1, Additional Remarks schedule, if more spa cc Is required) 51 000, 0001 5,000,06 0i 1,000,000 1,000.000 %oMI-AVCLL-4A I ttJTY (978) 373-6944 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE. THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROvItioNS, AUT14ORIZED REPRESENTATIVE ACORD 25 (2010105) X31988-2016 ACORD GbR RA [ON. All rights reserved. INS026(2010005).01 The ACORD name and logo are40�sired marks of ACORI'l AUTOMOBILE LIABILITY B ANYAUTO ALLO'MIED I X] SCHEDULED AJT 0, AU70S 'X4 ,--4 X NON-O%�NED HIRIDAU10S n AUTOS " UMBRELLA LIAa 11 )J: OCCUR I C [ �EXC SS UAB I CLAIMS iCt LI$TEDBELOW HAVE BEEN TERM Olt, 91 ISSUED 0 THE tNSURED.NAMEO ABOVE FOR THE POLICY PERIOD CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS L INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL. THE TERMS, NITS SHOWN. MAY HAYE.BEEN REDUCER BYPAIbCLAIMS. POLICY NUMBER F0—UCYEfv POO-C—YEXP LIMITS tEACH OCCURRENCE 6 11000,000 —07IXAMT. N GENII_ 0100 -CaL000000656-01 11/12/2012 11/1212013 EDEXP(Aryonapers-on) $ 1,000 PERSONAL & AVV INJURY 11000,000 GFNERAL AGGREGATE 2,000,000 PRODUCTS . c2mpfop AqG 2,000,000 $ BODILY INJURY 'Per pamon) 5 03819 BODILY iN,;LfRy PROPERTY -DAMAGE EACH OCCURRENCE S. 037721464 11/21/2012 11/12/2013 i WORKERS COMPENSATION AND.EMPLOYERS' LIABILITY —T-VRC-8-f-A—TU--T ANY PROPRIETC-.RfPARTNER''XIEC',JTNF-. YIN I TORY I, IMITS I OfFIGERAAEmBER EXCLV-XL�7 I`7$'N,f A EL EACHACCIOEN (Mandatory in NH) 58562781 08/28/2013 08/28/2014 — If yes, descxbo under i, E,L, DISEASE - FA E DESCRIPTION OF OPERATIONS i,,,I,, -7 21 Workers comp EmployerS 11 , F��- DISEASE -POI. S452tUMB B75090312 12/22/2012 12/22/2013 Liability foN r H a6ove DESCRIPTION OF OPERATIONS : LOCATIONS I VEHICLES (Attach ACORD 10`1, Additional Remarks schedule, if more spa cc Is required) 51 000, 0001 5,000,06 0i 1,000,000 1,000.000 %oMI-AVCLL-4A I ttJTY (978) 373-6944 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE. THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROvItioNS, AUT14ORIZED REPRESENTATIVE ACORD 25 (2010105) X31988-2016 ACORD GbR RA [ON. All rights reserved. INS026(2010005).01 The ACORD name and logo are40�sired marks of ACORI'l