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HomeMy WebLinkAboutBuilding Permit # 7/14/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Received Date Issued: � IMPORTANT:PORTANT: Applicant must complete all items on this page PROPERTY OWNER t 100 Year Oltl Structure yes no I'r�nf ;qtr MAP NO PARCEL_ ZONING DISTRICT Historic Dtstnct yes no rfMachine Shop'Village `:yes :` no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 00ne family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑S,eptic p Well Floodplain Wetlands = ❑ Watershed District . 01Nater/Sewer v . DESCRIPTION OF WORK TO BE PERFORMED: Ski() n_nA �a I a� Identification Please Type or Print Clearly) OWNER: Name: 1 Phone: �, ° r740 w Address: CONTRACTOR Name ;Phone. Address 7/ I Supervisor's Construction License Exp Date_� t Home Improvement-Licens( 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acc t gu and Signature of Agent/Owner Sicinature of contr Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ FORTH Anutiver ' irown of ® No. 26 �T - __ � ..-y V6'I' SSS c' 9 9 0� LAKE COCHICNf WICK y1. Q0RAT E D `S U BOARD OF HEALTH Food/Kitchen ERMIT T Lu Septic System BUILDING INSPECTOR THIS CERTIFIES THAT . ,• .. .......................... ......................................... Foundation ' has permission to erect buildings on ..n.1........ �• •• ••• •••••�•• •••• p .......................... Rough to be occupied as .... ....�....... .. .......................................................... Chimney provided that the person§acVceptithis permit shall in every resile onform to the terms of the application Final e on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT E I ® THS ELECTRICAL INSPECTOR LESS C T I ST Rough Service ............ ..... ........ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy ButldiRough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Insecte an rove y the Building Inspector. Burner Street No. Smoke Det. T.G EIN#51-050-3313 Haverhill MA 978.374.9224 MA Reg.HIC#149221 ambe Lawrence MA 978.687.7339 MA Lic.UCS#78130 Single-Ply License#1711 Hampton NH 603.929.9224 �o ® HamP stead NH 603.329.8200 -' S64,v�19.32 O- Toll Free 1.888.S0S.R100F 265 Winter Street Haverhill MA 01830 ( =Licensed Insured ::Factory Trained ;Factory Certified Name: t�l`�Gs r4 Date: !/ Telephoneg78 7��J `��}� Alt.Telephone: Email: Billing Address: (J!ill uir 1� a,eh T)r-. City: /''j✓I OOAK State: Md- Job Address: City: State: Scope of Work y 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 'ob site. ❑ Inspect wood deck,if we discover any rotted wood,replacement will will performed at*$M • Is per LF for roof deck boards.If substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$ / ZP per SF.If individual sheets are found to be rotted/or de-laminated,removal,disposal anLd replacement will be performed at*$ per sheet. If any trim boards are rotted, replacement will be performed at*$ _per LF for new pre-primed pine.Inspect siding at roof l�jne 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. ❑ Install 8"drip edge to all rakes and eaves.Color 7 h ElApply 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*$ 41-X,5 ❑ Install a new: Year ElTraditional ,PI(Architectural ElDesigner 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 inte it of the buildi g be compromised. Special Notes ISI o i1 ea .( t el t, trS-� 1 11 cg E,!-i 4o_e ! , Q> a Ali It l-i -•Pi �fi 1� �b �� l 1 !�S t� 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 40_YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE *$ � ��00 *Denotes potential additional costs above the total estimated price. > TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE ' Y r. The Contractor agrees to perform the work, furnish the materials and labor specified above for the total sum of: $ ry (*) (Dollars) Payment will be made according to the following work schedule: $ deposit upon signing contract $ 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: 7/ 7 / ,2'd Contractor's Signature: "`i` Date: 7/ 7 / 0 4 ®li�e7 Mhavt'ifnafina ram tPloncp CPP 1'PVPYCP CIrlP1 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 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: 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 Business Regul -aVd the consumer sh 11 be required to submit to such arbitration as provided in MGL c 142A. Owner: e s`X� J Date: Ar Or Contractor: r— V-� - 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 ConsumerAffairs 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. e�f• X INITIALS The Commonwealth ofliMassachusetts Department of lndustrud Accidents Office of Investigations 600 Washington. Street Boston,MA.02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizatiorAndividual): �- Address: J► n City/State/Zip: y` �o Phony#: q1 Are you an employer?Chett�e appropriate box: Type of project(required): 1 am a employer with 4. El am a general contractor and 1 6. EJ Now construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7 E]Remodelling ship and'have no employees These sub-contractors have 8. El Demolition working for me in any capacity. workers'comp.insurance. y 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.❑ I am a homeowner,doing all work right of exemption per MGL ILEI Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.QRoofrepairs 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. T Homeowners who submit this affidavit indicating they Aire doing all work and then hire outside contractors must submit a new 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 1s providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. INEQ r_�f CDP Policy#or S elf-ins.Lie.#: �~ ®o� 1?)- Q 9-11 c,� 9-I y Expiration Date: Job Site Address: Lo1 o &R-P->n py— 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 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of 'Investigations of the DIA-for insurance coverage verification. Ido hereby cert19 under rn �Z e niti fperjury that the information providecd above is true and correct. Si ature: Date: Phone# Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 6.Other - - TL.......1.f. DATE(MMIDDfYYYYI CbRe CERTIFICATE OF UABUTY oNSU NCE 04/07/2015 tm� THIS CERTIFICATASMEOR NEGADIVELYI AAAEND, EXTEND OR ALTER TRMATON ONLY AND CONFERS NO IHE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. fMPORTAhiT: If the certificate holder is an ADDITIONAL iPISUREO,the poiicy(ies} must be endorsed. if SUBROGATION IS WAIVED,gubjeet to the terms and conditions c the policy,certain policies may requirs an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). cDNTA T Jerrold Xsslerae ,RODUCER RHOS, _ PRONE (g78) 7.;15-590$ FAX o•{970) 745-5483 4Y,LAN INSURANCE AGENCY NC. C-MAIL ,,Te(978) 745-59naurance.eora 53 1/2 Jefferson Avenue 2nd Floor n NAIC0 P.O. BOX S 11 INSURERS AFFORDING COVERAGE P.O. mA 019`70-0511 INSURERA:Assoicated Ind Ins Co insurance insurnce CO INSURED INSUREDINSURERC.National union Fire Ins CO. TGLRC dba: y,aanibE+rt Roofing Co. INSURERD:Ace American insurance CO. 265 Winter StreetRoofing INSURERE:Ace American. ingur =6 C-0-tEEI HaverYli11 MA 01.830- INSURERF COVERAGES CERTIFICATE NUMBER: REVISION THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDED ABOVE FOR THE POLICY PERIOD NUMBER: INDICATED NOTWITHSTANDING ANY REQUIREMENT•TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTATHE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, IN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. X POLr[NS,R S POLICY NUMBER i m no ro MMID Y UfAlT3 TYPE OF INSURANCE 110001000 EACH OCCURRENCE 8 GENERAL LIABILITY O A O D 50,000 octr rrence 5 X COMMERCIAL GENERAL LIABILITY 1/12/2014 11/12/2015 1,000 CLAIMS MADE a OCCUR 51028024 MED EXP{An one prison) 5 PERSONAL a ADV INJURY S 1,000,000 X Per Project An / / / 2,000,000 GENERAL AGGREGATE 3 PROdUGTS-COMP-PAGE 3 2,000,000 GENT.AGGREGATE LIMIT APPLIES PER �[ PRO• LOC / / / i COMBINED SINGLE L1PAli ll s 1 000 000 5;AL,,1094F-D E LIABILITY I % / L;ODILY INJURY iPcr Person) S TO `MED X SCttEDULEO 6203819 / / BODILY INJURY{P accident) S AUTOS 37/16/2014 07/16 f 2415 PROPERTY DAMAGE $ AUTOS AUTOS / / Pe; ant ELLA LIAB X 8113 530331 % EACHOCGURRENCk 5,000,000 OCCUR 11/12/2014 11/12/2015 AGGREGATE 5 3r 000,000 S LIAR CLAMAS-IAr1DERETENTIONE WC S rATU• DTH- RKERS COMPENSATION X EMPLOYERS'LIABILITY YIN / / / EL EACII ACCIDENT S 1 0001000 ANY PROPRIETORIPARTNERIEXECUTIVE❑ OFFICERIMEMBER EXCLUDED^ NIA S62UB-21309875-2-1$ LSA 3:25/2015 03/25/Z016 EL DISF-ASE-EA EMPLOYE S 1,000,000 D {hlanAalory In NH) I % / / If yyos descnbe under F.L DISEASE-POLICY LRAM S 1,000,000 DE3GRIP)tON Of OPCRATIONS hul.'w W Worker's Compenstaion LVH 16S62UB-81381311-6-1a NIL 2/22/201•! 12/22/2015 same tmAsas 1,000,000 aC]vt 1,000,000 DESCRIPTION OF OPERATIONSI LOCATIONS VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CEFITIFICATE I'ni nr-R CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TGLRC dba Lambert Roofing THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE 6NITH THE POLICY PROVISIONS, 265 Winter Street: AUTHORI(E REPRE.IENTATIVE �G o- r� a ',I 7 •'J v Ii81r2rhi1.1 NA 01830- rt�w€"•,�v� - w� l��t�y°`��.�`i�'";tv�`� ©9988-2010 ACORd CORPORATION. All rights reserved. A10062D 25(2010/06) INS026(20{0&'.)1 Os The ACORD name and logo are registered marks of ACORD 0 Ce-078130w 2q RT UF 2®5VAWnR STMET $ Haverhm MA o1 s Office-of Consumer Affairs and Business Regulation 10 Park Plaza o Suite 5170 Boston, Massachusetts 02116 Home Emprovement Contractor Registration Registration: 449224 Tyw. Private Corporation T.G.L.R.0 dba Lambert Roofing Company E*IraWn: 42/ O15 TrA 24Wt3 RICHARD LAMBERT 265 WINTER STREET HAVEHILL, MA 01830 Update Addrew a®d return card,lark reawn for Cham 0 Addrr ewal (� Employment ® Lut Card