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HomeMy WebLinkAboutBuilding Permit # 6/29/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: W2 Date Received Date Issued: `� -1 IMPORTANT: Applicant must complete all items on this page LOCATION ma Pnnt PROPERTY OWNER Pfinf r 00 Year Old Structure; yes o MAP NO PARCEL :ZONING DISTRICT Historic Dtstnct yes no no .. . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ` ❑Well ❑ Flog-dplain ❑Wetlands ,❑ ;Watershed Ristrict D Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name Phone: Phone: ) Address: ` CONTRACTOR Name .` Phone Address 1 �..... r Su errnsoF,s Construction License Bc Date p �, Home ImprovementLicense - Exp Date: 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: $ ��, GD FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access arant�.fi—nd Signature of Agent/Owner Signature of'contracto _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ t%O R TH na d o v le r Town of 0 No. W2,.. 201� 2615 7n� h s� O LAKE it ver' [A.SS�...� aim, COCKICKEWICK 1I °RATIT E D A ,�C:) ` U BOARD OF HEALTH Food/Kitchen P RM MIT T %A; U Septic System THIS CERTIFIES THAT BUILDING INSPECTOR .............. . ............................ ......... ............... .............. ...... .... . ...... . .. ...... has permission to erect g ,,, ,.,, ,,. �., Foundation .... ..................... buildings .... ..... ... . .. ......... . "accept�in ...... `` ........................................ Rough to be occupied as ...... ...... .... . V. ................................ Chimney provided that the persthis permit shall in every respect 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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESSCTI T RTS Rough Service ..............a:..... . .,,.-.............. ............................ Final BUILDING INSPECTOR GAS INSPECTOR ccupancy 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. 4 EIN#51-050-3313 Haverhill MA 978.374.9224 be Lawrence MA 978.687.7339 MA Reg.HIC#149221 MA Lic.UCS#78130 Hampton NH 603.929.9224 RO0fin Hampstead NH 603.329.8200 Single-Ply License#1711 s�1932 O. Toll Free 1.888,SOS.ROOF 265 Winter Street Haverhill MA 01830 cLicensed -%-Insured *Factory Trained ::Factory Certified 9 Date: Name: Telephone: Alt.Telephone: Email: =� Cit : G`- , 1"I DID) \/lr State: tY)t Billing Address: � 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. ElInspect 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*$ ;—' 2 per SE If individual sheets are found to be rotted/or de-laminated,removal,disposal and replacement will be performed at "' er sheet. If an trim boards are rotted, *$ 5n- p Y replacement will be performed at*$ 1 per LF for new pre-primed pine.Inspect siding at rood line 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,sweep deck,and prepare for roofing. r ❑ Install 8"drip edge to all rakes and eaves. Color ❑ 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*$ ElInstall a new: ! Year ❑ Traditional `�Architectural ❑ Designer Color ❑ Furnish and Install a new shingle over style ridge vent system El Soffit vent system*$ . oti\ ❑ 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 Pad 4 z� C 1e , r ��.�_.� ( SffJ6,iCd� jaE: Cl� �cstt;�h,�� a lY.�4( nf'; E4r ( 1=n21 }4 {7lLrC1� 1� ';"G- th �7z � a t 1. ,t [ l p%r! -, UPO COMPLETION AND PAYMENT IN FULL,ROO SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF_,/tet 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 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 schedule: i` _ $ deposit upon signing contract f "' $ 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 Acceptance of the Contract Proposal / Home Owner(s)Signature(s): Date: l 2_1_03/ Contractor's Signature: Date: 6 / L3 /_L5 -A Jambertr®ofingocom (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!Companagrees 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 worn 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 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 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. 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 Business Re lation and th consumer shall be required to submit to such arbitration as provided in MGL c 142A. Owner: Date: Contractor: t 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 in writing at the main office by ordinary mail posted,by telegram sent or by delivery,no later than that midnight of the third business day following the signing of the agreement I ITIALS The Commonwealth of Massachusetts - Department oflndustriglAceWhts 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/OrganizatiorAndividual): Address: `1�1 � - City/State/Zip: ,Q CjaPhane Are you an employer?Check the appropriate box: Type of project(required): 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(fall and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor orpartner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. workers'comp.insurance. g• E]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑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,❑Roofrepairs insurance required.] employees.[No workers' q ] � 13.0Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they 2•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. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy and f ob site information. Insurance Company Name: Policy#or S elf-ins.Lic.#:(r� 0 _� ^� _' Enation Date: c�^ a, �j " �� Job Site Address: rKl ,,`J City/State/Zip: \D Aftach 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 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. Do advised that a copy of this statement may be forwarded to the Office of Investigations of the AIA.for insurance coverage verification. Ido hereby cert under thep ' p altie Wry that the information provided above is true and correct. Signature: Date: /;�t k PhoneIt: `���� 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.EIectrical Inspector 5.PIumbing Inspector 6.Other - 1rn"fA1,f PP.YSnn_• _ Phone 9: ®® OATE(MM001YY 04/07/2Q15 CERTIFICATE OF LIABUY INSURANCE NFERS, NO ON AND CO THIS CERTIFICATE IS ISSUED AS A MATTER OF NEGATIVELY AMEND, EXTEND OR ALTER RIGHTS COVERAGE AFFORDED UE BY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR N BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING DUCER,AND THE CE if SUBOGATIN lb VVAIV REPRESENTATIVE OR PRO RTIFICATE HOLDER. iMpORTANT: If th®certificate hthe POI!cY lie older is ntaADDI ION may quire. ui eNMD�an endorsement. A statement ant his certificcate do®s not cconferDr�ights to the the terms and conditions of the p Y, Certificate holder in lieu of Such endorsement(5}. coNTACT Jerrold ilamerae NAME: ,(978) 745-5483 'RODUCER PHONE (978} 7�s-5905 Fa/C �I,I,AY�T IY38URANC� AGRY3CY SIdC• E-MAIL s•Jerroldaallaninauraace.com 53 1/2 Jegforson Avenue 2nd door NAIC0 lN5URER 5 AFFOAOtNG COVERAGE p.O. BOX 511 SALEMNA01970-0511 INsuREra:Rssoicated Tnd Ins Co INSURER 13:SafGtVTr1SLbr�T1Ce CO INSURED INSURERC.National Union Fire IIIS C'O. TGLRC INSURERD:RCE' American insurance: CO. dba: Lambert Roofing Co. INSURERE:ACa Ame£1.Can 11 1II8 265 Winter $iGreetraY1C� CO. L. 01830- INSURER F HaverhillREVISION NUMBER: COVERAGES CERTIFICATE NUMBER: THE IN THIS IS TO CERTINFnYTHSTANDING POLICIES IREQUIREh ENT,TERM ORil DCOND TION OFH ME OANY CONTRACEEN ISSUED T OR OTHER DOCUMENT WITH RESPECT CT TOLIWHICHTIHIS INDICATED NO CERTIFICATEMAYBE ISSUED OF S CH POLICIESTHE INSURA .LIMITS SHO NCE b9AYFHAVE BEEN REDUCED IY PAID CLAIMS D HEREIN IS SUBJECT TO ALL THE TERM EXCLUSIONS S B POLICY EFF POLICY EXP 1 LIMITS POLICY NUMBER n+M�nD/vvr tdMtDD Y 11000,000 I SR TYPE OF INSURANCE / / / f TR F11Ct1 OCCURRENCE °� _ GENERAL LIABILITY / / / / D O 2. •D 50,000 N ED P(Aane'Person) S XCOMMERCIAL GENERAL LIAl11LITY 1l 12/2013 11/12/2015 EXny S 1,000 A CLAIMS MADE Fil OCCUR 51028029 1,000,000 PERSONAL v AOV INJURY s X Per PrOjeCt Agg / / 1 GENERAL AGGREGATE S 2,000,000 PROD UCTS-COPAPIOPAGG S 2,00 1000 GENT AGGREGATE LIMIT APPLIES PER , / / ( S , PRO- LOG COM6INED SINGLE LIMIT 1 000 000 POLICY / / / / a am'de t AUTOMOBILE LIABILITY I / / / / BODILY INJURY tPer pesen) $ B ANY AUTO UOUILY INJURY(Per accident) S ALL OVMF� SCHEDULED 6203819 AUTOS X AUTOS 07/16/201: 07/16/2015 PROPERTYOAtAGE 5 NON•OV,tiVEO Per amds:nt- X HIRED AUTOS X AUTOS I / / / EACH OCCURRENCE S 5,000,000 X UMBRELLA UAS X OCCUR E18a30331 5,000,000 11/12/2014 11/12/2015 AGGREGATE 5 C EXCESS LIAB CLAIMS-MADE / / / / $ OED RETENTION S / / / / X WC STATU- OTH- WOR KERS COMPENSATION I / / I AND EMPLOYERS'LIABILITY EL FJ�Ct1ACCIDENT 8 1 000 000 ANY PROPRIETORlPARTNERIEXECUTIVE YIN a ' 3/25/2015 03/25/2016 FL DISEASE_EA EMPLOYE S 1 000 000 CFFICERIMEMBER EXCLUI)fO^ 6S62UB-2E09875-2--1- NA D (Mandatory In NH) J / / f F.L DISEASE-POLICY LNdT 5 1 000 000 If yyas.describe under DE$CRIPIION O! OPERATIONS t Cl w 1,000 r 000 2/22/2013 12l2212015 same tm:tsaa W Worker's Compenstaion NH '6S62tTe-SD81311-6-1a NR / / / / P,I,'yacove 1,000,000 DESCRIPTION Of OPERATIONS I LOCATIONS)VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if mors space is required) CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TGLRC dba Lambert Roofing THE ACCORDANCEIW THDTI POLICY PROVISIONATE THEREOF, S. WILL BE DELIVERED IN 265 Winger Street AUTHORISE REPRESENTATNE 3 r ' Haverhill MA 01830- �'•`-",�-*. °+-• `' � ©1988-2010 ACORIJ CORPORATION. All rights reserved. ACORD 25(2010105) INS025(20=5101 The ACORD name and logo are registered marks of ACORD CS-078130 _. RT $ 265 WEMR SI=ET Haverhill MA 01930 10 Office.of Consumer Affairs and Business Regulation 10 Park Plaza ® Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149229 Type: Private Corporation Expiration: 92/6/2o95 Tr# 245843 T.C.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01630 Update Address and return card.Mark reason for change. E] Address [] Renewal [] Employment M Lost Card