HomeMy WebLinkAboutBuilding Permit # 5/16/2016 OORTH
BUILDING PERMIT ,,ED 16"6
TOWN OF NORTHANDOVER C)
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received ap Pv
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Date Issued: M t -
TANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER 14 'i i ', ,'3A J-z� ---71,0000'
Print 100 Year Structure yl,-,s no
MAP PARCEL:P7- ZONING DISTRICT:__ Historic District y s no
Machine Shop Village ye no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building , One family
L-1 Addition El Two or more family El Industrial
El Alteration No. of units: ri Commercial
El Repair, replacement EI Assessory Bldg [I Others:
0 Demolition 0 Other
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P,1 ❑ " 11 " �l"/",/"/,�Ill","�',�,/�',�ll,� !"I , .�;,Iuwe land'
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DESCRIPTION OF WORK TO BE PERFORMED:
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Identification- Please T�!Te or Print Clearly
OWNER: Name: T
- A Phone:
Address:
Contractor Name: (3
Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
Home improvement License:
l
Exp. Date: c;>
ARCH ITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:B UL DIN G PERMIT:$12.00 PER$1000.00 OF THE TOTAL ES TIMA TED COST BA SED ON$125.00 PER S.F.
Total Project Cost: $ cr FEE: --7
Check No.: Receipt No.:
DOTE: Pei-sons contracting with unregistered contractors do not have access e gu rantyfund
Signaturp of %Ainizr —Si
& tkOR'i'ps
Town of Andover
0 "A
261
: 9- ver, Mass,
LAKE
CoCNICM@WICK
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BOARD OF HEALTH
Food/Kitchen
PERM T T LD Septic System
40113011113M, loe
THIS CERTIFIES THAT ....... BUILDING INSPECTOR
. .............. .... ........ ...... ......... ........... ......................................................
has permission t0 erect ......... g Foundation
....0.......... buil in son .......................................................:..............@..:;:.
Rough
0F
tobe occupied as .................. ...... ............. ..... .... ............................................................................ 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
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION TARTS Rough
........... ... . .y ..................................... Service
" ' " 'v�'`� '"`°`�� Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® Occupy Buildina Rough
Display in a CoS is S Place on the Premises — Do Not Remove Final
Lathingr Dry Wall a ®rte FIRE DEPARTMENT
Until Inspected and Approvede Building Inspector. Burner
Street No.
Smoke Det.
A
LL
Chimneys Residential & Commercial hoofing All Types Of
Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work
Mass Toll Free �- Roaf aks Experts Licensed & Insured
Locally Owned& Operated Since 1976
1-800-WAIT-4-US ® g License#034200
(924-8487') IKO G?izee 'hozW or 90hn We Work Year Round
- - - KAMM,-
Proposal To: Melissa Taylor Date 3/16/2016
Street: 137 Lancaster Rd. 978-375-1194
N. Andover, MA
Roof proposal missle857@comcast.net
IKO Cambridge
1. Extra caution will be taken to protect building 12. Removal of all work related debris. Planks will be
exterior and landscaping as best as possible. (tarps placed under dumpster to prevent any damage to
etc.)Magnets run at final clean up. driveway.
2. Remove all shingles from entire house. 13. Building permit included.
3. Inspect and re-nail any loose or lifted plywood. 14. Contractor workmanship warranty: 10 years
Any compromised plywood will be replaced at an under normal wind and rain conditions.
additional cost of$65.00 per sheet of 1/2" CDX
fir.
4. Install heavy gauge 8" white aluminum drip edge Total roof cost: $ 21,600.00
to all eaves and rakes. • Option: Install(1) new stainless steel custom
5. Install 6' of IKO Armourguard ice and water chimney cap to rear chimney covering entire
shield along all eaves and top to bottom in all top crown. $450.00 additional cost
valleys. Front and Rear trouble areas: Remove
existing siding, corner boards and any • IKO Shield Pro Plus Extended MFG warranty:
compromised material as needed. Install new A full 100% coverage on material, labor and
sheathing as needed. Install full coverage and debris removal for a full non pro rated period
counterflash entire wall with WR Grace of 20 years. Included to our local referrals
(Industry best) ice an water shield and new (Marc Perry) and in this proposal at no
aluminum step flashing. Not responsible for additional cost.
re-installing siding or corner boards.
6. Install IKO roof guard synthetic underlayment to *Note*: Please be advised if applicable, valuables in
remaining sheathing up to ridge. the attic should be moved or covered due to minor
7. Install all new pipe boots. debris, dust and asphalt particles that will accumulate
8. Install IKO Leading Edge starter shingles to all during the stripping process. All Under One Roof not
eaves. responsible for any damage or clean up that may
9. Install IKO Cambridge Limited Lifetime occur in attic.
architectural shingles to the entire house. 15 year
non pro-rated warranty by mfg. (See warranty Balance due upon completion, no deposit required!
info)All shingles will be installed and fastened
according to mfg. specs. References available upon request
10. Install a new GAF Cobra ridge vent capped with
color matched IKO hip and ridge shingles. Install Highly rated member of the accredited BBB and
all new square static vents on rear main roof. Angie's List
11. Counter flash chimney lead, wall connections and
skylight with ice and water shield. Seal with clear Thank you!
Geo-Cel sealant.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-20-17
www mas&gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information ,✓� Please Print Legibly
Name (Business/Organization/Individual): t•fi<I Ult-_�2 54 04 -
Address: Oc
City/State/Zip: �m A 4-0 Phone#: `�y
Are you as employer?Check the approprbte box: Type of project(required):
L❑I am a employer with employees(full and/or part-time).* 7. ❑New construction
2.D 1 am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling
any capacity.[No workers'comp.insurance required.)
9. El Demolition
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10[]Building addition
4.[:]]am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions
proprietors with no employees. 12.Q Plumbing repairs or additions
5 �._
a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs
sub-contractors have employees and have workers'comp.insurance.' r
6_0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.00thel
152,§1(4),and we have no employees.[No workers'comp.insurance required.)
*Any applicant that chocks box 4 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they arc 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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number_
I am an employer that is providing workers'eompensadon insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
„l
Job Site Address: 1 31) L ��sj�� 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 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.
1 do hereby certify7;�
a penalties of perjury that the informadon provided a e ” due and correct
Si atwe: Date:
Phone#: %y
0
Qfikial 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
Contact Person: Phone#:
CER.TIFICAT OF LIABILITY INSURANCE FDA`fE01I.J1DDNYYI)
`S C 5/2(3!2015
t�i5 CERTIFICATE IS ISSUED AS A MA"ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE !'Q!-.DER, THIS
•ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY A14END, EXTEND OR ALTER THE COVERAG-E AFFORDED BY THE POLICIES
'--LDV, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(41), AUTHORIZED
:EPRESENTATIViE OR PRODUCER AND THE CERTIFICATE HOLDER.
PIFORTANT: If the certfficate holder Is an ADDIFIONAL INSURED;the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to,the
:3=5 and conditions of the policy, certzin policies may require an endorsement. A statement on this certificate does not confer rights to the
E,Zificate holdcrin lieu oTsuchendoNement(s). _
VZA1uceN C Wiley Assigned Risk Services
Irlc 6=1 Insurance Agency Inc PIQUEAx
!&-q.r5 . 840 634-4589 !Arc.Ira: 866 21 S-8118
74 SMtnont St F-4 SSS: Pot;c) n°oes�bsrkt2yTisls.com
I�e+Ycoster, MA 01G04 IN,URER oR N61 COVERAGE NAICn
'v�fiED Ir Lit
MC3 Construction Inc MMLAM e;
IM.UlkCA d..
G.�r►a�r�ss Si 00 LA ER L<
r;€KOrd, M.A 01757 I1-13URER E
INsutatt F; •
s3 Jr=RAGES GERT(FICATE NUMBER: _ _ F�VISfQN!dU 98ER:
SffS 183 To CERTIr Y_THAT THE POLICIES OF INSURANCE LISTEDf3ELOW FiA1IF BEEhF ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
,NDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
'ERTIFtCATE MAY SE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
itCLtl5lOtd5 AND COM1IQCCiQiS OF SIJCi{PC!!G[F-+S,(,MIT$SHQWN MAY HAVE BEEN REDUCED 9Y PAID C LA1MS.
TYPE OF INSURANCE UPOLI vY_r POLICY
(3 CNEFAL LIABILITY GK
_ INSR YND FOLICYNUt18 !T I.ILflDD1YYY L!AkAT YYY LIMBS
AUTO a0011£LIABILITY $ „
WORKERS COMPENSATION I 1 1yC ST AT U. pTH.
AVO EAfPLOYERV UABILM Y/N (t it TORY L1A1T8 ER _
ANY PROPRIETORIPARTuerri AEr,UTNB $ t,a00,0Do
+�• O FF(CER.l E1.13ER EXCLUDED? �1 NIA VtfC-20-204t10565MD 05/20/2015 �o5P2Of2016 EL EACH ACCIDENT
if
Ln NH)
If yds,ddseriba no,, E.L piSEASE•EA EAIP OYES § 1,000,000 ..
D'c5CRIPT ON OF,OPEi2ATtOflS beton,.,_• E.L DI A4E_poLiCY Lits tY 1,DDp,DDD
�?'��Rtf'YtON OF 07EflA.T10NS rL6CAY SONS lVEHtCfE sl ftitve:nA:_orLD tOl,lv.'Eiltattnl Rafxnc�SahoE_b,Qrte apasc t:requstdp
Coverage.
-rim)Category Elect,Status Nerve State(s) NI Erlti�es LacafiDris
officer Include Maria Gunman MA (`dGG Construction Inc
83 congress St r-litfortl,VA 01757
dtKIIFIGATE HOLDER CASICEI.LATiOid
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPI'RAT10N DATE THEREOF, NOTIdE WILL BE DELIVERED IN
�I! Under One Roofing ACCORDANCE WITH.T.HB POLICY PROVISIONS.
UTHOR17ED REFR99FUrATIVr
F2 Temple St
4 Chuen, MA 01844 '
,lWu.;,,,••.Y` if ;?:{�•'—,C.,��,r,,,.,,.
Signatures E .,,,.,
:CARD 25(2010/05)
WORKERS COMPENSATION AND EMPLOY RS LIABILITY INSURANCE POLICY
INFORMATION PAGE
A.I.M. Mutual Insura ce Company
54 Third Avenue, Burlington, M esachusetts 01803.0970
(800) 876-2 65 Nccl Na 2815e
POLICY NO. --- �•--
AV�1C:-400-7009464-2015A
PRIOR IVO. ''AN/x:400-7009464-2014A
ITEM
1, The Insured: All Under One Foot
DBA:
Mailing address: C/O John Lenzafame
30 Temple Drive FEIN:**-***8251
Methuen,MA 01844
Legal Entity Type: Sole Proprietor
Other workplaces not shown above: See Location
2. The policy period is from 11/09/2016 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 Ipplies 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 Inju by Accident $
Bodily Inju by Disease $ ---~— 100,000 each accident
Bodily Inju by Disease $ '� `---—500,000 policy Iimlt
,� ,.. 100,000 each employee
C Other States Insurance: Coverage Replaced by Endorse ent WC 20 03 0t3 B
D. This Policy Includes these Endorsements and Schedules: EE SCHEDULE
4. The premium for this policy will be determined by our Manuals f Rules,Classifications, Rates and Rating Pians.
All information required below is subject to verifleation and cha ge by audit,
_Classifications Premfu Basis
. _—
Code Estlmal d Per$100
No. Total An ual 01 Estimated
---- —••-- Remuner tiol Of
Annual ;
Premium
INTRA 174366 •�--i
INTER
SEE;CLASS CODE SCHEDULE
Minimum PremiumTO
Deal Estimated Annual Premium
GOV GOV De osit Prentrum
STATE CLASS
MA 5474 St to Assessments/Surcharges
$1 .00 xx 6 7500% $1
This policy,including all endorsements, is hereby countersigned by """ ��--'� 7
uthor 10/05/2015
ive Signature Date
Service Office:
54 Third Avenue P rry Insurance Agency LLC
Burlington MA 01803 5 2 Chickering Rd,Rt 125
N rth Andover, MA 01845
WC 00 00 01 A(7-11)
Includes copyrightedmatariai of the National council on compensation insurance,
used with its permission.
Massachusetts -De).art;ne,it or PLIIaI;1:
i
Board of Building Kcguiaticno sI 5;-,;
Cun:h•uctlun SUPCITi,ut•
License: CS-069120
,`N'I I
JOHN W LANZAV"
30 TEMPLE DRS
METRUEN MA 01844
�ainrn;ssio i Ir,r 04/03/2017
Click on the registration numlaer to view complaint history,You can also view.-arb-dation and Guaranty Fund
hi2ma-
The list is current as of Wednesday, October 8, 2014,
$earch Results
REGISTRANT RESPO!`4MI[B E REGISTRATION EXPIRATION
NAME tNDnnDUAL HurASER ADDRESSEXPIRATIONSTATUE
ALL UNDER*NE ROOF L,ANZAFAME, 1137057 166 A MERRIMACK ST 10/02/2016 Current
.JOHN METHEUN, MA 01844
02012 Commonweaitn of Massachusetts,
Mass.Gov®is a.registered servios mark of the Commomv8e11h of MassochusettA,