HomeMy WebLinkAboutBuilding Permit # 2/11/2016 0oRT#1
BUILDING PERMIT
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received 'S.
C US
Date Issued: IMPORTANT: Applicant must complete all items on this page
/ / 6-2 -Y,,i�j 'e - I
LOCATION / 7'
Print
PROPERTY OWNER
Print 100 Year Structure yes no
ZONING DISTRICT: Historic District yes no
MAP PARCEL: -) Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
I] New Building ,,V'bne family
11 Addition 11 Two or more family [I Industrial
f--J Alteration No. of units: [I Commercial
WIRepair, replacement [I Assessory Bldg Li Others:
11 Demolition 11 Other
DESCRIPTION OF WORK TO BE PERFORMED:
V Aln, ( -
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Identification- Please Type or Print Clearly
OWNER: Name. Phone: -i", , '
Address: 0Z
Contractor NamePhone::
Email:
Address: �IJ t,4,
Supervisor's Construction License: -Exp. Date:
F.
Exp. Date:. I
Home Improvement License:
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.
/ 1 C) .> 'e) ,
Total Project Cost: $ " FEE: $ 1�?�
1/-" Z-2
Check No.: Receipt No.:
12
NOTE: Persons contracting ivith unregistered contractors do not have access to,the, guaranty fund
Sign-at uLe--Q f-c ont r a cto
V/
Andover
Town of
® ® —
C, h Ver, lass, A,
O� COCNtG(WICK y�•
J�AD4ATED
`s 11 BOARD OF HEALTH
Food/Kitchen
Pm= R 1 � T LD Septic System
/ BUILDING INSPECTOR
THISCERTIFIES THAT .........�`/,/.I..... ..C. .,��...............................................................................
/� y Foundation
has permission to erect buildings on .,//....5. . c .G:!.`s ::/•.• :.............................
.......................... Rough
to be occupied as ......................
Cn'MO :I.................................................................................... Chimney
provided that the person accepting this 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 PLUMBING INSPECTOR
Construction of Buildings in the Town of North Andover.
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Final
PERMITI E ®NTS ELECTRICAL INSPECTOR
UNLESS CONSTRUC ION STARTS Rough
Service
..... :.... .... .................................................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Bualdan Rough
Displayin a Conspicuous Place on the Premises — Do Not Remove Final
LathingNo or all To Be Done FIRE DEPARTMENT
Until Inspected and Approvedy the Building Inspector. Burner
Street No.
Smoke Det.
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es
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Mass �"t"uii ,f'er, ExpertMasonry ��Ic
Licelised & Insured
S r.. o,k wd x, , It,!,1 x "'1, � s; License##034200
We Woirgr Year Houndh
Proposal To: Phil and Marilyn Doyle Date 1/3/16
Street: 111 Glencrest 978-687-2989
N. Andover, MA 978-948-7383
Basement Remodel
Finished area
1. Remove existing flooring 14. Install (4)new vinyl Paradigm Energy Star rated
2. Remove existing wall around boiler insulated glass gliding basement windows.
3. Seal all foundation walls 15. Install all new electrical plugs, switches and
4. Insulate all foundation walls with rigid insulation recessed lighting to code.
board to code. Insulate all interior walls and 16. Sink area: Remove existing sink. Install new cus-
ceiling to code. tomer supplied sink and cabinet. All plumbing
5. Frame new perimeter and interior walls to all areas included.
discussed during estimate meeting. Frame in new 17. Laundry area: Install all new drywall, tape, sand,
closet. prime and paint.
6. Install new walls and ceiling: Blueboard, plaster 18. Stairs: Remove one wall on one side. Install new
and paint. wood railing and balusters to code.
7. Install all new finish trim 19. All permits included
8. Re-locate hot water tank. 20. Removal of all work related debris.
9. Install all new baseboard heating 21. contractor workmanship warranty: 10 years
10. Remove existing support column.
11. Per structural engineer report: Install whatever Total Cost: $22, 500d00
needed to existing house support beam to comply
with code and maintain structural integrity to
remove support column.
12. Install all new customer supplied tile flooring to
entire area.
13. Remove (1) existing basement window on front
foundation wall. Frame in.
Acceptance of Proposal—The above prices, specifications and conditions are satisfactory and are herby
accepted. You are authorized to do the work as specified, Payment will be made as outlined above.
Date of Acceptance:`° Signatur :
Signature:
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NOTE CAREFULLY:
SHOULD CONDITIONS OR DIMENSIONS
AS DEPICTED ON DRAWINGS BE
DIFFERENT THAN SHOWN OR'
F�0 SHOULD ANY UNFORSEEN LATENT
CONDITIONS BE UNCOVERED DURING
THE COURSE OF CONSTRUCTION THAT
APPEAR QUESTIONABLE OR ARE NOT
I IN COMPLIANCE WITH THE BUILDING
CODE,OR DRAWINGS
THE CONTRACTOR IS TO NOTIFY THE
-f-r r ^ ENGINEER FOR REMEDIAL
o e. CORRECTION DETAILS
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pXT epw LAWRENCE H,OGDEN.P.E.
198 EAST MAIN STREET
GEORGETOWN,MA.01833
978-352-8318,cell 978-502-5921
The Commonwealth of Massachusetts
Department of industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
www.mas&govldia
Ut \Workers,Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print LUibil
A Leant Information
Name (Business/Organization/Individual):
Address:_
City/State/Zip:— LyMfl Phone#:
Are you an employer'?Check the appropriate to:: Type of project(required):
/1 7. []New construction
1Q,I am a employer with —ploy.(full and/or part-time).`
2.®1 am a sole proprietor or partnership and have nocmployees working for mcin 8. O'Remodeling
any capacity.[No workers'comp.insurance required.] 9. ❑Demolition
am a homeowner doing all work myself.[No workers*comp.insurance required.]t 10 Building addition
am a homeowner and will be hiring contractors to conduct all work On my PmPcrly. 1 will I I.[]Electrical repairs or additions
ensure that all contractors either have workers'compensation insurance Or are sole
proprietors with no employcM 12.[]Plumbing repairs or additions
5C)I am a general contractor and I have hired the sub-contractors listed on the attached shat, 13.oRoof repairs
These sub-contractors have employees and have workers'comp.insurance.t 14.®Other
6.D We are a corporation and its officers have exercised their right of exemption Per MGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
Any applicant that checks box N I must also fill Out the section below showing their workers'compensation policy
infonnation'affidavit indicating such_liomoowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors mussubmitnew 3
I s box must attached an additional shod showing the name of the sub-connactors and state whether or not those entities have
,Contractors that check this tractors have employees,they must provide their workers'comp.policy number.
employees. If the sub-con -employes, compensation insurance my emplayees. Below is thepolicy and jab site
I am an employer that is providing workers'
information.
Insurance Company Name:
Policy H or Self-ins.Lic.#: 2cW'I Expiration Date:_
Job Site Address; (� �City/state/zip: lhqn ,q,",J 11/�
Attach a copy of thew orkers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL C. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification. ofperjury that the information provided above is true and correct.
I do hereby cerAY5,under fains andpenalties
the z
Signature:
Phone#:
oricial 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
ctor
6.Other Phone#:
Contact Person:
WORKERS COMPENSATION AND EMPLOY RS LIABILITY INSURANCE POLICY
INFORMATION PAGE
XII.M. Mutual Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(600) 876.2 65 NCCI NO 26158
POLICY NO. �AVVC-400-70_09484-2015A
PRIOR N0, AWC-400.7009464-2014A
ITEM
1. The Insured: All Under One Roof
DBA;
Mailing address; C/O John Lanzafame FEIN:** °""8251
30 Temple Drive
Methuen, MA 01844
Legal Entity Type: Sale Proprietor
Other workplaces not shown above: See Location
2. The policy period is from 11/09/2-015 to 11/09/2016_ 12:01 a.m.standard time at the insured's mailing address.
3. A. Workers Compensation Insurance; Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers'Liability Insurance; Part Two of the policy appli s to work in each state listed in item 3,A.
The limits of liability under Part Two are: Bodily Injury by Accident $ _100,000 each accident
Bodily Injury by Disease $ ___ 500,000 policy limit
Bodily Injur by Disease $ _ 100,000 each employee
C Other States Insurance: Coverage Replaced by Endorserr ant WC 20 03 06 B
D, This Policy Includes these Endorsements and Schedules: EE SCHEDULE
4, The premium for this policy will be determined by our Manualsf Rules,Classifications,Rates and Rating Plans.
All information required below is subject to verification and cha ge by audit,
Classifrcetions Premiu Basis Rates
Code Estimat d Per$100 Estimated
No. Total Ani ual Of Annual
-� Remuner tion Remuneration Premium
INTRA 174365
INTER 5EE!CLASS CODE SCHEDULE
Minimum Premium OW Tolal Estimated Annual Premium t
GOV GOV Deposit Premium
STATE CLASS
MA . 5474 St to Assessments/Surcharges
$1 ,00 x 5 7500%v $1
This policy,including all endorsements, is hereby countersigned by �' "'�� fr'_ct 10/05/2015 ..
-Authorfred Sic�nelure Oate
Service Office: PrryInsurance Agency LLC
54 Third Avenue
5 2 ChickeringRd, Rt 125
Burlington MA 01803 N rth Andover,MA 01845
WC 00 00 01 A(7-11)
Includes copyrighted material of the National councll on compensation Insurance,
used with Its permission,
assad'T1usetts its ,'c71n.i1r Nuj"1
o..._
C II 11111 UL11111i .)tl ll C'111Y) ^�
License: C"69120
JOHN W LANZAF,IME
30 TEMPLE DR :
MM EN MA b1844
�1
itli lissacl , 04/03/2017
Click on the registration number to view complaint history. You can also ute;w,9rbitr-atioxl and C`auar$nt fund
history.
The list is current as of Wednesday, October 8, 2014,
$earth Results
REGISTRANT ANT RE pO StBLE REGISTRATION ADDRESSEXPIRATION STATUS E INDIVIDUAL NUMBER DATE
NAM
At.t_UMER ONE ROOF LANZiAFAME. t � ? 166 A MERRImACK ST 10/02/2016 Current
JOHN f`<PIETHEUN, A 01
Q2Q12 commonwealth of Massachusah.
Mass.Gov,D is a registered service mark of the CommonweWtll'of Massachusetts.