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HomeMy WebLinkAboutBuilding Permit # 5/1/2015 " TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ) Date Received Date Issued: I PORTANT:Applicant must complete all items on this page LOCATION f PROPERTYOWNERirnt ,. Pnnt'r 100 Year Old Structure yes no MAPNO ��� PARCEL��'�ZONING DISTRICT � istor�c is roc yes no Machine,ShopVillage "; yes �no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building WOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic- ❑Well 0'Floodplain;a . 0 Wetlands :, t]aWatershed District, Ii Waster/Sewer ; DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: alt" r2�1�L , Phone: '�L Address:_'�c -1 r CONTRACTOR e Nam : ' aF?fione.> '? ; 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: $ , 0 00 FEE: $ 1 �_ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t my f Signature of Agent/Owner Sig-nature of contractor Plans Submitted D Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ORTH town of Andover No. h T Z , L.Kc h ver, `ass, CONI C HI W,CK ��• ®S 4ATED PI? %_�� UMIT BOARD OF HEALTH Food/Kitchen T L mU PER-- Septic System THIS CERTIFIES THAT 4 .4 BUILDING INSPECTOR has permission to erect.......................... buildings on ....30....Daum....... ......................... Foundation Rough g tobe occupied as ........... ....... ....... ..... ...... .. ........................................ Chimney provided that the person accepting this mit shall in every respect con for o 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 n� Final OPERMIT EIR I 6 MONT ELECTRICAL INSPECTOR LESS CONSTRUCTIO A S 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. EIN#51-05033313 ai b r MA Reg. HIC#121981 0 MA Lic.#UCS 078130 •° b fi Single-Ply Lic.#1711BBB CO. Ron We are: ATIcensed )+Insured Factory Trained ArFactory )tCerdfied Installers April 26, 2015 Mr. & Mrz. Szelest 30 Davis Street North Andover, MA 01845 New Steep Slope Roofing System Proposal Approx. 2,700 SF Main House and Shed TGLRC Inc. dba Lambert Roofing Company will provide certificate of insurances demonstrating that we are fully insured for workers compensation, general liability, automobile liability and a $5,000,000.00 umbrella policy. This documentation will be sent through the US mail or VIA E- MAIL/FAX to the above named party if not already provided. Upon completion of the roof and final payment, a shingle manufacturers warranty"5-Star"and our executed two (2)year workmanship warranty will be sent to the named party. Work to be Performed And Materials to be Utilized Conditions: • A Standard two (2) year workmanship warranty applies in addition to a"5-Star" manufacturer's warranty. • Under no circumstance will the watertight integrity of the building be in any way compromised. • All work will be performed to the standards and expectations dictated by the 7th edition building code and proper roofing practices founded in NRCA roof covering and waterproofing manual and manufacturers specifications. 1) A pre-roof walk around will be executed to observe and document any pre-existing conditions and or any special considerations. 2) Ensure landscaping and dwelling is and will remain properly protected. Please take special note that during demo of the existing roof system all valuables non- fastened are subject to falling during demo and debris will fall in the attic so preparing for this will avoid an inconvenient clean up. Lambert Roofing will not be responsible for the above-mentioned preparation. Page 1 3) Prepare for re-roofing by ensuring all safety measures are taken in accordance with OSHA and CMR Standards. 4) Remove existing layers of shingles down to the wood roof decking and properly dispose of debris from the jobsite. T.G.L.R.C., INC. will arrange for disposal. 5) Inspect wood roof decking, if we discover any rotted wood, removal and replacement will be performed at an additional cost of- * £• $3.95 per foot for rough pine removed and replaced. • $50.00 per sheet of CDX Plywood removed and replaced. • Any Carpentry or extra work desired aside of what is being contracted for in this contract will be charged at$65.00 an hour,per man,plus materials upon approval and change order from owner. If we discover any pre existing conditions we will notify owner for approval. No work will be started without notification and owner approval. If wood roof decking and trim is sound, we will re-attach any loose wood to the rafters,sweep deck and prepare for installation. 6) Attach aluminum F8 drip edge to all leading edges. Color(Bvo )((V k I r�� 1 7) Apply a premium ice and water shield to the leading edges 6' up and around any penetrations including Chimney. Cover the balance of the roof deck with synthetic felt paper. We use, as our standard, a hurricane nailing system recommended in northeast regions. This means, we install six (6) nails per shingle to reduce the risk of shingles being damaged by high winds and the weather changes we encounter. 8) Install a new Certainteed Landmark Standard limited lifetime architectural style shingle roof system. Color: ��: �(-�tE f U _Certainteed Swift start and Shadow ridge over Shingle vent II ridge vents is also included in this scope of work. 9) Re-flash Chimney with new lead. 10) All debris generated by TGLRC Inc. dba Lambert Roofing Company will be cleaned up on a daily basis and properly disposed of from the jobsite. Roofing Warranties: UPON COMPLETION AND PAYMENT IN FULL A MANUFACTURERS 25 YEAR WORKMANSHIP WILL BE HONERED AND ISSUED BY"CERTAINTEED". A FIFTY YEAR NON PRO-RATED WARRANTY WILL BE ISSUED ON ALL MATERIALS, LABOR, TEAR OFF AND DISPOSAL BY MANUFACTURER. NOTE: No generic roofing materials are being utilized on this project. "All" Approved Certainteed materials are to be used on this project. Page 2 TGLRC Inc. dba Lambert Roofing Company agrees to: • Commence the described work on or about MAY 2015 • The described work will be completed in about(1-3) working days • Shall not be held liable for delays due to circumstances beyond our control • Shall not be held liable for any damages to landscape, attics and or fixtures due to circumstances beyond our control • Shall not be held liable and roofs are not covered under the workmanship warranty, for pre-existing conditions including but not limited to: o Mold and or wood rot o Defective, faulty,rotted or worn building counterparts such as, but not limited to: siding, gutters,masonry,plumbing and windows, all of which may jeopardize the watertight integrity of the structure if not in sound condition • Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence Required Permits A building and dumpster permit may be required to remove and replace your roof It is our obligation to secure these permits if required as the homeowner's agent. Note:Homeowners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A Additional Attached Documents, Agreements or Provisions • Insurance Documentation if not already provided • Arbitration Agreement • Contractor Registration Information • Notice of Cancellation Form This contract is the complete contract unless a signed Change Order has been executed between TGLRC Inc.dba Lambert Roofing Company and the Homeowner Page 3 Contract Price and Customer Obligations The total cost for all permits, warranty, labor and materials is: ( $109174A, �OO Ten Thousand S ` fty--------- 11 Payment Terms: a deposit of 1/3 is due with the signing of contract • Balance due upon completion. • A finance charge of 1.5 %per month(18%per year) will be added to all invoices on the 31 day. All legal and or collection fees will be paid by the binding holder of this contract • The law requires that any deposit or down payment required by TGLRC Inc. dba Lambert Roofing Company before the work begins may not exceed the greater of. 0 1/3 of the total contract price or: o The actual cost of Special or Custom made materials which must be special ordered in advance to meet the completion schedule Acceptance of the Contract Proposal: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES OR ANY UNRESOLVED ITEMS NOTE: Due to volatile pricing on building products,this contract is valid for 15 days of receipt. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be the main office or branch thereof,provided you notify the seller in writing at the main office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement. Because of the three (3) day Notice of Cancellation, work may not commence for a minimum of seven (7) days after we receive this signed contract unless the contract is signed at our office. Signatures Xi Date: ® /'' , Please sign, keep a copy and return one copy upon acceptance. "Quality Workmanship You Can Trust" Very Truly Yo _e.W Ri eft b Preside alC of Lambe i ompany Page 4 The Commonwealth of Massachusetts - Department of IndustrialAccidiiits Office of Investigations 600 Washington Street Boston,MA.02111 UV www.rnass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leuibly Name(Business/Organization/Individual): 1- POD G,y 1 Address: acos t, 1 City/State/Zip: 00\)Q �'ii � 0, 1 ( Phone Are you an employer?Check the appropriate box: Type of project(required): I.W am a employer with aO 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El 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. q ❑wilding addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] 10.F1 Electrical repairs or additions officers have exercised their j 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance �uired.req employees.[No workers' ❑ i 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 a're 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. lam an employer that isproviding workers'coin ensation insuranceformy employees. Below isthepolley and1ob site information. Insurance Company Name:__ Policy#or Self-ins.Lie.#:(_05 Loa( )e)"r 09&1 )`-' Expiration Date: Id' Job Site Address: `r`+ City/State/Zip: P, P (QA/Q- 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I Ido hereby certify un th pains and enalties ofperjury that the information provided above is true and correct. - Signature: Date: t Phone#: -11 q -tea 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: C8478130 ®r, RICHARD J JAWERT s 26SWr=RSTMET Haverhill MA 01930 Office.of Consumer Affairs and Business Regulation 10 Park Plaza o Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 Type: Private Corporation Expiration: 12/6/2015 Tr# 248813 T.G.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT 265 WINTER STREET HAVRHILL, MA 01630 Update Address and return card.Mark reason for change. Address F-� Renewal C] Employment F] most Card �� QA DATE(MMfDD/YYYY) CERTIFICATE LIABILITY INSURANCE 04/01/2015 TFIIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jerrold Yameras NAME: ALLAN INSURANCE AGENCY INC. PHONE . (978) 745-5905 FAC (978) 745-5483 63 1/2 Jefferson Avenue 2nd Floor E-MA[LSS.Jerroldeallaninsurance.com P.O. BOX 511. INSURERS AFFORDING COVERAGE NAIC N SALEM MA 01970-0511 INSURERA:Asisoicated Ind Ins Co INSURED INSURERB.SafetY Insurance Co TGLRC INSURERC:Nati.onal Union Fire Ins Co. dba: Lambert Roofing Co. INSURERD.Ace American Insurance Co. 265 Winter Street INSURERE:Ace American Insurance Co. Haverhill DIA 01830- 1 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR ADDL 5 BR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER mI oDIYYYY MfAIDD YY LIMITS '... GENERAL LIABILITY / / / / EACH OCCURRENCE S 1,000,000 ----i -13AMAGE 10 RENTED X COMMERCIAt.GENERAL LIABILITY J J J J PREMISES(Eaoccurmnre) S _.._ 50,000 A CLAVAS-RIADE FOOCCUR ABS1028029 11/12/2014 11/12/2015 PAEO EXP(Any one person) S 11000 kGEI'L Per Project Agg J J / J PERSONAL BADV INJURY $ 11000,000 J J J J GENERAL AGGREGATE 2,000,000 AGGREGATE LIMIT APPLIES PER J / J PRODUCTS-COMPIOP AGG 5 2,000,000 POLICYFX PRO El LOC J / / $ AUTOMOBILE LIABILITY / / J J COtAU(NED SINGLE LIMIT Eaacc-der," 11000,000 ANY AUTO BODILY INJURY(Per porsen) $ B ALL OWNED X SCHEDULED 6203 819 / / J J BODILY INJURY(Per accidw) S AUTOS AUTOS XI X NON-OVINED 07/16/201407/16/2015 PROPERTYDAh1AGE 3 HIRED AUTOS AUTOS Per ar,,,donT X UMBRELLA LIAB X OCCUR E10430331 J / / J EACH OCCURRENCE $ 5,000,000 O EXCESS LIAB CLAIMS-MADE 11/12/2014 11/12/2015 AGGREGATE 51000,000 DED RETENTION WORKERS COMPENSATION X VJC STATU- OTli- '... AND EMPLOYERS'LIABILITY YIN --- ANY PROPRIETORIPARTNERIEXECUTIVT EL EACH ACCIDENT _ 3 1,000 000 OFFICERIMEMBEREXCLUDED? ® NIA 6362U8-2E09875-2-14 Afk 2/22/2019 12/22/2015 D (Mandatory in NH) E.LDISEASE-EA EMPLOYEE "a 1,000,000 If yes,describe Under '.. DESCRIPTION OF OPERATIONS bwnw J J J J E.L DISEASE•POLICY LIMIT $ 1,000,000 W Worker's Compenstaion NH 6S62UB-9D81311-6-14 ±,W 12/22/201412/22/2015 sLmel:mRsas 1,000,000 p Icy above 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION TGLRC Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. dba Lambert Roofing 265 Winter street AUTHOR15 REPRESENTATIVE Haverhill MA 01830- 4 , s ACORD 25(2090105) t ©9988-2010 ACORL, ORPORATION. All rights reserved. INS025(2a1e05101 The ACORD name and logo are registered mar6.s of ACORD