Loading...
HomeMy WebLinkAboutBuilding Permit # 5/6/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ®� Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION chi t l Print PROPERTY OWNER -t � ��( Pnnf 100 Year Old Strucfure , ;> yes no MAP NO PARCEL: ZONING DISTRICT Historic District< yes no,: ; ""'Machine',,Shop Village yes no, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building YOne family ❑Addition ❑Two or more family ❑ Industrial ''Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑Floodplain; ❑Wetlands ❑ Watershed District ❑Water/Sewer i DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: t'�> .� �1 14 01010 Phone: 1`,7)- Address: CONTRACTOR:NameC�t i��C� l1r Phone: 2;` f �_ Address: �ttI�1 '..` �'� ' ;; Su ervisor's Construction" License: p . Exp :Date: Home Improvement License Exp. Dater 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: $ ) 4 ,c)CC O FEE: $ ,L3 e) _ ! Check No.: � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to anty fund Signature`ofAgent/Owner Signature of contractor,- - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 0 Stamped Plans El ttORTH Town of yx_ nclover 0 0% , ® ' •T• • Pr a7� �v C% LAKE h y VVa' LdSS9 COCKICMEWICK �1. A. S ll BOARD OF HEALTH Food/Kitchen mM It T LD Septic System THIS CERTIFIES THAT ..................... �L 1,`l ............................... BUILDING INSPECTOR ................... . . . ..... .. has permission to erect buildings on .. Foundation ..................... � . .. ............ ... ..�: .......o............... Rough to be occupied as ............ f . ....... ....... . .. ....... ....0... ....................................... Chimney provided that the person acceptin this permit shall in every resp conform to 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 Final PERMIT EXPIRE THS ELECTRICAL INSPECTOR S UNLESS CONSTL-%- I Rough Service ........ :............................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. T.a EIN#51-050-3313 Haverhill MA 978.374.9224 MA Reg.HIC#149221 No Lawrence MA 978.687.7339 MA Lic.UCS#78130 Hampton NH 603.929.9224 Single-Ply License#1711 ®fang Hampstead NH 603.329.8200 S .2932O, Toll Free 1.888.S0S.R60F 265 Winter Street Haverhill MA 01830 �Licensed -rInsured .,.,Factory Trained >c Factory Certified Name: "/t�oLG7G �,tJl�' anf Date: y l r' Telephone-71S' _9L) : Alt.Telephone: Email: Billing Address: f 1S41I'ts City: tk da'a)Wr State: Job Address: City: State: Scope of Work Strip 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 per LF for roof deck boards. If substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$ J . b per SF.If individual sheets are found to be rottedlor de-laminated,removal,disposal and replacement will be performed at*$ L;(�� per sheet.If any trim boards are rotted, replacement will be performed at*$ 1 —tUper LF for new pre-primed pine.Inspect siding at roof Iiie and all flashing behind siding,if we discover any damaged flashing or siding at the roof line,replacement will be performed at*$ If wood deck, siding,and flashing is sound,we will re-nail any loose wood to rafters,seep deck,and prepare for roofing. ElInstall 8"drip edge to all rakes and eaves. Color LJkr -c, / ❑ Apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or ❑ 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*$ mot/ El Install a new: Year El Traditional Architectural El Designer Color ❑ 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 integrity of the building be compromised. Special Notes ', '� , vc, 61 C44 14 S'&21 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 '7Y)YEARS HONORED AND ISSUED BY SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE *$ J10,�O CZ) S *Denotes potential additional costs above the total estimated price.TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE 4A) The Contractor agrees to perform the work,furnish the materials and labor specified above for the total sum of:$ (*) (Dollars) Payment will be made according to the following work schodule: $ 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 party'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 explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES Ac ceptance of the Contract Proposal Home Owner(s)Signature(s): Date: 5- / 2 Contractor's Signature: :10r Date: !/ 0 alb rtroOfingxo 111'I (Please see reverse side) Company Insurances TGLRC Inc.DBA Lambert Roofing Company will provide certification of insurances,demonstrating that we are fully insured for worker's compensations, general liability,automobile liability and an umbrella policy.This documentation will be sent through the US mail to the above named party if not already provided. TGLRC Inc.dba Lambert.Roofing Company agrees to: Commence the described work on or about Complete the described work in approximately days. Not be held liable for delays due to circumstances beyond our control. Not be held liable for any damages to landscape and or fixtures due to circumstances beyond our control. Not be held liable and not covered under the workmanship warranty,for pre-existing conditions including but not limited to: • Mold and or wood rot,defective,faulty,rotted or wom building counterparts such as,but no limited to:siding,roofing,masonry, plumbing and windows,all of which may jeopardize the watertight integrity of the structure. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. • This contract is the complete contract unless a signed Change Order has been executed between TGLRC Inc.DBA Lambert Roofing Company and the Homeowner/Business Owner or Agent. Permits A building permit may be required to remove and replace your roof.It is our obligation to secure these permits if required as the home owner'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. Accelerated Payment A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Payment Terms A finance charge of 1.5%a month(18%per year)will be added to all invoices on the 315`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 work begins may not exceed the greater of- 0 1/3 of the total contract price or: 0 The actual cost of Special or Custom made materials which must be special ordered in advance to meet the completion schedule. Arbitration The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and BusinessReguiatio the consumer shall be required to submit to such arbitration as provided in MGL c MA. Owner: Date: ��Z/ �/� Contractor: �� (` ,.. » Date: Contractor Registration All home improvement contractors and subcontractors must be registered,any inquiries about a contractor or subcontractor relating to a registration should be directed to: Contractor Registration: Director of Home Improvement Contractor Registration Board of Building Regulations and Standards One Ashburton Place,Rm. 1301 Boston,MA 02108 (617)727-3200 Home Improvement Contractor Law: Consumer Information Hotline Commonwealth of Massachusetts Office of Consumer Affairs and Business Regulations 10 Park Plaza,Rm.5170 Boston,MA 02116 (617)973-8787 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 Cancellation 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 in the main office or branch thereof,provided you notify the seller inwriting at the main office by ordinary mail posted,by telegram sent or by delivery,no later than that midnig}jt o the third business day following the signing of the agreement. INITIALS The Commonwealth of IiPassachusetts ANN Department oflndustrliilAccrcients Office of Investigations 600 Washington.Street Boston,MA.02111 www.massgov/dia Workeris' Compensation Insurance Affidavit:Buil.dens/Contractors/Electricians/Plumlbers Applicant Information Please Print Le�ib� Name(Business/Organizationlfndividual): rn po3 Address• City/State/Zip• t- y �l�I ��.� C, i Phone Are you an employer?Check tk appropriate box: Type of project(required): L R I am a employer with c 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have Hired the sub-contractors 7. []Remodeling 2.[l I am a sole proprietor or partner- listed on the attached sheet.I ship and'have no employees These sub-contractors have S. El Demolition working for me in any capacity. workers' comp.insurance. 9. []Building addition [No workers'comp.insurance 5. 0 We are a corporation and its 10.F1 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner.doing all work right of exemption per MGL I LF1 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' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill outthe section below showingtheir workers'compensation policy information. T Homeowners who submit this affidavit indicating they go doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors 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 joh site information. Insurance Company Name: Policy#or S elf ins.Lic.M j� )1Ll 2 C Q 9�/ Ern anon Date: - ' Job Site Address: '"1 �(�(V�1�,5 hL�C_ ! A City/State/Zip:t� �' 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 o. 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 eerfijyj un s and lties ofperjury that the information provided above is true and correct. - 4 Signafore• ' ' "e` Date• Phone 9: �'1 �1 Official use only. Do not write in this area,to he completed by city or town offzcial. City or Town: Permit/License 0 Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other ph nn t�tE• CERTIFICATE LIABILITY INSURANCE DATE(MtdIOD(YYYY) 04/01/2015 THIS 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(ies) 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 NAMJerrold Kameras ALLAN INSURANCE AGENCY INC, PHONE (978) 745-5905 FAG (978) 745-5483 UQ 63 1/2 Jefferson Avenue 2nd Floor E.h1AIL -JerroldGallaninsurance.com P.O. BOX 511 INSURER(S)AFFORDING COVERAGE NAIC 0 SALEM MA 01970-0511 INSURERA:Assoicated Ind Ins Co INSURED INSURER B:Safet Insurance Co TGLRC INSURER C:Natlona.l Union Fire Ins Co. dba: Lambert hoofing Co. INSURERD:Ace American Insurance Co. 265 Winter Street: INSURERE:Ace American Insurance Co. Haverhill MA 01830- 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSURR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER IIM(DDIYYYY inVOD YY LIMITS GENERAL LIABILITY / / / / EACH OCCURRENCE_ S 1,000,000 - R X COPA!AERCIAL GENERAL LIABILITYU,1h A TTY / / / / PREMISES Eaecrurren;.e S 50,000 A CLAIMS-MADE 51OCCUR ABS1028029 11/12/201411/12/2015 MED EXP(Any one person) S 11000 X Per ProjeCt Agg / / / y PE14SONALEADV INJURY S 11000,000 GENERAL AGGREGATE S 2,000,000 �IENT.AGGREGATE LIMIT APPLIES PER / / / / PRODUCTS-COMPIOP AGG $ 2,000,000 '.. POLICY X 2,0- LOC / / / / 8 AUTOMOBILE LIABILITY / / / / C0IABINED SINGLE LIMIT Esacciderd 1,000,000 ANY AUTO / / / / BODILY INJURY(Per person) $ I3 I ALL OWNEDX SCHEDULED 6203819 / / / % BODILY INJURY(Peracciden!) $ tAUTOS AUTOS '.. X HIRED AUTOS X NON-OIMNED 07,116/2014 7/16/2015 PROPERTY DAMAGE AUTOS - Per arndent $ X I UMBRELLA LIABX OCCUR E18430331 / / / f EACH OCCURRENCE S 5,000,000 C EXCESS LIAR CLAVAS-MADE 11/12/201411/12/2015 AGGREGATE $ 5,000,000 DED RETENTION S / / / / S WORKERS COMPENSATION / / ! / X VJC STATU- OTH- AND EMPLOYERS'LIABILITY StUSLIMIT.S ' A14Y PROPRIETOWPARTNERIEXECUTIVE YIN / / / / L.L EACH ACCIDENT S 1,000,000 D (Mandatory EREXCWDE07 ® NIA 6S62UB-2E09875-2-14 hSA 2/22/201x} 12/22/2015 ( ryinNH) E.LDISEASE-EAEMPLOYE $ 1,000,000 If yes,descrba under DESCRIPTION OF OPERATIONS ba!aw / / / / E.L DISEASE-POLICY LIMIT $ 1,000,000 W worker's Compenstaion NFf 262UB-BD81311-6-14 ?df? 12/22/201412/22/2015 sam.kmitsas 11000,000 pal:cyabove 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 AUTHORI� REPRESENTATIVE Haverhill MA 01830- "' - y`5y1 f. `i"A c ACORD 25(2010105) ! ©1988-2010 ACORDAll rights reserved. INS025 QCIC05)01 The ACORD name and logo are registered marks of ACORD CS-0781130 RICHARD J RT 265 VVEMR STMXZT 4 Haverhill MA 01930 � 212016 Office.of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 Type: Private corporation Expiration: 12/612015 Tr# 246813 T.G.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT 255 WINTER STREET HAVERHILL, MA 01530 Update Address and return card.Mark reason for change. Address Renewal Employment M Lost Card