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HomeMy WebLinkAboutBuilding Permit # 9/9/2015 BUILDINGIT �,oRrw O�K.T L.�� /6•q�O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o 4 Permit No#: o Date Received �RA�RAATEU 9SSACyUS Date Issued: cE IMPORTANT: Applicant must complete all items on this page LOCATION ��QSA Pant , PROPERTY OWNER "W Paint 100 Year Structurees y no MAP PARCEL: ZONING DISTRICT: Historic District µ no Machine Shop Village s nod _mow TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building °One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other % r aii r.,,.,� Ji / //r,,,r r ,Ir r /.,, � ,, ❑,,Waters r h J , �� „ r ❑ r r, r rr / ri r r // r r �%/� r� 1 , �� DESCRI TION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: 1�1► (�C)f" X"l`"l l '.�'"" Phone: I n ` � �• Cir Address: Contractor Name: = Phone: C ~ Email: 1 v ,Y-. r, w . Address: L Supervisor's Construction License: C-5- C)"13 I� Exp. Date: Home Improvement License:_AL-k ` ,(4N Exp, Date: �e ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: Check No. wf) Receipt No. NOTE: Persons contracting with unregistered contractors do not have access to th ty fund F FORTTo' H A*wn of E }' ndover ® �o� _24j - o K h ver, ass, COCHICHl WICK ®S RATED 1 V BOARD OF HEALTH Food/Kitchen PERMIT T LU Septic System ITHIS CERTIFIES THAT ............................... BUILDING INSPECTOR . rGG Foundation has permission to erect .......................... buildings on f 1O 1. �' a.�(�!► .... .. .. .... ... ............ .................. Rough tobe occupied as ..... .. ..... ..... ... ............... ..... .......Ak......�L ®.................. Chimney provided that the person acc in this permit shall in eve espect 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 FRIT EXPIRESI MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T Rough LI. 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•G EIN#51-050-3313 Haverhill MA 978.374.9224 MA Reg.HIC#149221 mbe Lawrence MA 978.687.7339 MA Lic.UCS#78130 Hampton NH 603.929.9224 WE Single-Ply License#1711 �®firtg Hampstead NH 603.329.8200 SCvvc-e-1932 CO- Toll Free 1.888.SOS.ROOF 265 Winter Street Haverhill MA 01830 Licens d :Insured :;Factory Trained :Factory Certified /E Name: ''CIA �-�(�C-' o�,( Date: Telephone:/I C-11,/,/,(,Alt.Telephone: Email: Billing Address: a 'c r`7�In:, City: If )r1c r3 t,�\/ti,4'" State: c� _ Job Address: City: State: Scope of Work d tStrip 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 *$37,-�, per LF for roof deck boards. If substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$ Z per SF.If individual sheets are found to be rotted/or de-laminated, removal,disposal and 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 line and all flashing behind siding,if we discover any damaged flashing or siding at the roof line,replacement will be performed at*$__ bz If wood deck,siding,and flashing is sound,we will re-nail any loose wood to rafters, sweep deck,and prepare for roofing. ❑ Install 8"drip edge to all rakes and eaves.Color 4. ) L )11, — C r ) ❑ Apply ice&water shield(UNDERLAYMENT)as per manufacturers' specifications and/or ❑ Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck. - ❑ Re-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness. ❑ If upon inspection,we discover chimney lead to be worn or deteriorated,replacement will be performed at*$ ❑ Install a new: Year ❑ Traditional Architectural ❑ 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 compromise Special Notes�� i, r cam jr,, vim, sJ � � ��d Ar {{ j 1 [7f �26 I'/1+ J �a` �S�P�a t �1Ag !G / i i fs' 124)° ' �' ' 7- UPON COMPLETION AND PAYMENTYN FULL,ROOF SHALL HAVE A WORKMANSHIP CA JARANTEE FOR A RIOD 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. I� 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:$ t (*) (Dollars) Payment will be made according to the following work schedule: c > $ 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):.;' L`'` Date: Contractor's Signature: 4 -� — Date: .Iamb,orti oofingxom (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, brella policy.This documentation will be sent through the US mail to the above named party if not already general liability,automobile liability and an um provided. TGLRC Inc dba Lambert Roofing COmpanV aerees to: f Commence the described work on or about Complete the described work in approximately ,- W 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. nge Order has been executed between TGLRC Inc.DBA Lambert Roofing This contract is the complete contract unless a signed Cha Company and the Homeowner/Business Owner or Agent. Permits Abuilding 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: gistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. Homeowners who secure their own permits or deal with unre 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. o 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 f eguIA n and the c sumer shall be required to submit to such arbitration as provided in MGL c 142A. t .� ;i Date: f . Owner: r Date: J'- 15 Contractor: 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. INITIALS The Commonwealth of Massachusetts -- Department of Industrial Accidents m Office of Investigations w== 600 Washington Street Boston,MA 02111 ov/dia www.inass. g Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatiot>/Individual): + -,�o An c Address: t City/State/Zip: `JY'Y ► 1 'hone #: � c � Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer withI am a general contractor and I 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. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,X1(4),and we have no 12.E]Roof repairs insurance required.] f employees. [No workers' camp. insurance required.] 13T] Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'come.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. (tea Insurance Company Name:----- Ate- Q__ Policy#or Self-ins.Lic. #: ( ", )V) L( - Expiration Date: r S-I(o Job Site Address: fCcy .r "1- City/State/Zip . - � � q 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 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 of Investigations of the DIA for insurance coverage verification. I do hereby certify and pa' aWl-pewdlAm,of periuiy that the information provided above �is,true and correct. Signature: Date: ' l� 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 Cleric 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE LIABILITY DATE(MMIDDYYYY) 08/13/2015 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 Jerrold 1Cameras NAME: ALLAN INSURANCE AGENCY INC. PHONE (97II) 74545-5905 IC Pto: 197(11 7ss-5•t©1 63 1/2 Jefferson Avenue 2nd Floor EMAIL .Jerrold@allaninsurance.com P.O. BOX 511 ___, INSURER(S)AFFORDING COVERAGE MAIC N SALEM _._. _ -----... MA 01970-0511 INSURER ::Associated Ind Ins Co ----- - — INSURED INSURERB:Safety Insurance Co — — T LRC _..- INSURERC:National UnionFire Ins Co. a: Lambert Roofing Co. ------ INSURERD:ACE: American Insurance Co. 5 Winter Street ---- INSUREFtE;ACe American Insurance Co. Haverhill ---.. ...- —..-- --- -- - -- MA 01830- INsuaeRF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 1-0 CERTIFY THAT THE POLICIES OF INSURANCE LIS FED BELOW HAVE BEEN ISSUED 10 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED N01WINTSFANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUPAENT WITH RESPECT 10 NAIICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 10 ALL T"HE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADDI$UBR ---�-- _ _ ITR TYPE OF INSURANCE LICY EXP POLICY NUMBER MWDD/YYYY tMLICY EFT— M DO YYYY LIMITS — GENERAL LIABILITY / / / / kA('i-I OCCURRE=NCEX ET- A 000,OOO i C O tF FRCIAL GENERAL LIABILITY l / / / DAPIAC'ETORENTEDI 50,000 1— (LA1,M MADE ExIOCCUR Y ES1028029 11/12/201411/12/2015 1,000 X Per Project Agg PERSONAL&ADV INJCIRY 1,000,000 GENE PALAOGREGATF — s 2,000,000 C;F NI AG(MI GATE LIMIT APPLIES PER / / Ph1 RODUCTS-COPlOP AGG 2,000,000 PRn- — POLICY X--1 J- ---- AUTOMOBILE LIABILITY ';IN(-,LF LIMIT -- -[!-a---tcnt. c 11 000,000 ANY AUTO -- 13 BODILY INJURY(Per p.rsQn At OWNED X SCI-iEDUL[U 6203819 07 — - - - ---- UT?S AT] 0" Y /16/201507/16/2016 HOnI�Y IN.iC1RY(P-ac �ltnt) 3 _x I HIRED AOTOS X AUTO V1NE0 f f f f PROF F RtY DAMAGE '--- -1 {F -1-Ildew X :UMBRELL-A LIAR X OCCUR Y E18430331 11/12/201411/12/2015 EACH OCCURRENCE g 5,000,000 ESS LIAR aAInS-r-MnDE f f f f AGGREGAIf 5,000,000 RLTEN"ON.a --- WORKERS COMPENSATION 3 AND EMPLOYERS LIABILITY YIN I Y' L Y�Etd1T.5. !l l tOI FttE fORFAkINERIr. I!vL. D oriRIPIEFHER XCLtIDEJ ® N!A Et.EAGN A(CIDEtJT _ 1,000 000 (Mandatory—cQn,,H) 6S62UB-2.509875-2-14 MA 03/25/2015 03/25/2016 E L DISI EAEMPLOY[=1 1 000,000 X 1 1 5 d s r b�u on n — -_ �. llt SCFtif NON OF OPFfdATIONS EL DI EASE POLICY LIMIT " 1,000,000 W Worker's Compenstaion NH 6S62UB-BD81311-6-14 NH 17/27/2014 12/22/2015 ,,,E I„ _ 1,000,000 puLcy ab�we 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedulo,it 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 dba: Lambert Roofing ACCORDANCE WITH THE POLICY PROVISIONS. 265 Winter St. AUTHORIZE0�6PRESENTATIVE 11 r Haverhill MA 01830- - j, :CORD 25(2010/05) C�1988-2010 ACORD C, INS025 RPORATION. All rights reserved. ro The ACORD name and logo are registered rnarks of ACORD CERTIFICATE OF LIABILITY DA /0D/YYYY) 06116/2015 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(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 00571-004 N24ILACT D Francis Murphy Insurance Agency Inc 02No.Ext): (508)422-9277 No: (508)422-9914 200 Main Street EMAIL Marlborough,MA 01752 ADDRESS: lb[SURER(S)APEORDINGCOVERA NAIC INSURED -INSURER - A.I.M.Mutual Insurance Company 33758 Golf Construction Inc IN5VRERB• 63 Depot Street SE Milford, MA 01757 IN u E D• INSURER I 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. Ij(rS�t TYPE OF INSURANCE It�SQR POLICY NUMBER POOLC F POLICY EXP LIMITS MMl�D MM/OD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ M ES Ea o rre ce CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ OLICY ERO' CT OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ac dent ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE era et $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ DEO RETENTION_ $ WORKERS COMPENSA N y� g q-U - TH $ ANyD EMpPpL�OYERS' SABI TY X TORY LIMITS OER /� OFFICERUgETOR/EXCLUDED?ECUTIVE,�Y/�N� 1MandE 1n NH) l 1 N/A AWC-400-7032568-2015A 613!2015 6/3/2016 E.L.EACH ACCIDENT $ 500,000.0-0 YYQQ �de�PERATIONS below E.L.DISEASE-EA EMPLOYEE $ 500,000.00 DESeCRIPTI�N�F OE.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION LRC 265 Winter Street Haverhill,MA 01630 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HaTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 2010105 ©1988.2010 ACORD CORPORATION.All rights reserved. ( ) The ACORD name and logo are registered marks of ACORD CS478130 OCKARD J LWSiff "� a 265 VMMR STMEET 1•laverh1H MA 01930 16 Office.of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 612116 Home Improvement Contractor Registration Registration: 949229 'type: Private Corporation Expiration: 92/9/2095 Tr# 24013 T.C.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT 265 WINTER STREET HAV HILL, MA 01830 Update Address and return card.Mark reason for change. ❑ address ❑ Renewal ❑ Employment ® Lost Card