Loading...
HomeMy WebLinkAboutBuilding Permit # 5/16/2016 BUILDING PERMIT �� �ORv 6q� .q'44Eo Ini "�q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No : Gt i4o Date Received S C HU5 Date Issued: �;A'VIO—R:TANT: Applicant const complete all items on this page LOCATION ] Print PROPERTY OWNER 1"/ f /'�" Print 100 Year Structure yes no MAP PARCEL: � � ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential _ Non- Residential ❑ New Building ° ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other I,�„r, � « , , r,,� ;l r N /6/ 1 !!/r if / i 1... 94flInuHOilAlf tlaiiywr;➢�✓ / r 11�l.,, '�� DESCRIPTION OF WORK TO DE PERFORMED: Identification- Please'hype or Print Clearly OWNER: Name: v'' 1.. "` `...,-��,,.. Phone: " ... Address: <� Contractor Name " �„ ��� °,� � � J: ���r . - Phone. Email: Mf f. �� r r .. / ..� � ) o�,-,11 ,address: / "(Jj 4:-7. ..,` -C'T-tl 3 -po'l 1,14 Supervisor's Construction Licenser (-D �/2 0 Exp. Date: Horne Improvement License: Exp. Dater f 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. p Total Project Coat: $ / i st Cw FEE: $ 1 Check No.: Receipt No.: NOTE: Persons contracting with registered contractors do not have access to the guaranty fund i �/i rr sir/ r r„;,„ ;/ / r< ry ,.,q--' ✓ iS�_CL�L ire.Q 1 tAORTH Town of Andover 0 % LAK. ��Y°� Mas Hot, a CoCNICHC WIC1t U BOARD OF HEALTH PER Food/Kitchen Septic System s THIS CERTIFIES THAT .......... ..................... .. .. ....... BUILDING INSPECTOR has permission to erect ...... Foundation .......................... buildings on ..... .. ....... ... ® . ..... .... .. ...... Ic Rough tobe occupied as .................. ... ......... ... ... .. ............................................................ Chimney provided that the person accepting this p rmit 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS I TART Rough Service .............. ................. ... .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildink Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingr Dry Wall To Be Done FIRE DEPARTMENT 9 til Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. C mss/"11611_5 ra � ,��}�si� �¢�r�il �$( k� � k�l�&r���"��iP� �'�� �r�CY��,��r�"�t9r r � u,.�Yflt e€ A11 Types Of Epdert Masonry Work L_ie r,nsai & I1-1sured Mass 0111 Vreo n; Writ/P3 /Jri4t <I 3 Lice nse#034200 vWOO- Cara taad (924_848'() zf Proposal To: Tom Destifino Date 12/16/2015 Street: 356 Raleigh Tavern bane 978-682-5666 N. Andover, MA Roof proposal grinch2@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 up to (2) 13. Building permit included. layers. 14. Contractor workmanship warranty: 10 years 3. Inspect and re-nail any loose or lifted roof boards under normal wind and rain conditions. ` or plywood. Any compromised roof boards will be10,400.00 TOl��ll 1"40 C®St.. replaced at an additional cost of$3.00 per lineal foot of Ix8 Spruce. Any compromised plywood will be replaced at an additional cost of$65.00 per • IKO Shield Pro Plus Extended MFG warran sheet of 1/2" CDX fir. A full 100% coverage on material, labor and 4. Install heavy gauge 8" white aluminum drip edge debris removal for a full non pro rated period to all eaves and rakes. of 20 years. Included to our local referrals at no r~ 5. Install 6' of IKO Armourguard ice and water additional cost. shield along all eaves and top to bottom in all valleys. Install full coverage of WR.Grace ice and *Note*: Please be advised if applicable, valuables in water shield to entire rear low slope area. the attic should be moved or covered due to minor (Industry best defense against water infiltration debris, dust and asphalt particles that will accumulate from ice dams.) during the stripping process. All Under One Roof not 6. Install IKO roof guard synthetic underlayment to responsible for any damage or clean up that may remaining sheathing up to ridge. occur in attic. 7. Install all new pipe boots. 8. Install IKO Leading Edge starter shingles to all Balance due upon completion, no deposit required! eaves. 9. Install IKO Cambridge Limited Lifetime References available upon request architectural shingles to the entire house, 15 year non pro-rated warranty by mfg. (See warranty Highly rated member of the accredited BSB and info) All shingles will be installed and fastened An ie's LiQX " according to mfg, specs. 10. Counter flash chimney lead, skylights and all roof Thank you! protrusions with ice and water shield and seal. 11. Install a new GAF Cobra ridge vent capped with color matched IKO hip and ridge shingles. C\ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization4Mividual): ®�(� (J✓J� �1( i !I ' Address: � �) 2( t City/State/Zip: cti v;tw l") Phone#: Are you aB employer?Cheek the appropriate bort: Type of project(required): 1.0 1 am a employer with employees(full and/or part-time).* 7. [:]New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in $, E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.E]1 am a homeowner doing all work myself.[No workers'comp.insurance required_]1 10 Q Building addition- 4.01 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 sok 1 l.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5 [•i am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.DRoof repairs t "These sub-contmctors have employees and have workers'comp.instaanee.t 14.[:]Other 6_n 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#1 must also fill out the section below showing their workers'compensation policy information_ t 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 nnw attachod 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.It: Expiration Date: ` Job Site Address: 3-5-L f24L t (�/� /�J ��`'1 L/`� City/State/Zip: Zt� 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. I do hereby certify un ins a penalties of perjury that the information provided above is true and correct Si afore: Dat Phone 0fi7cial 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#: 11/18/2015 iVED 11:66 FAX 781 598 6430 DAVID ZELLER INSURANCE 0001/001 f i AG®R m CERTIFICATE ®F LIAEILITY INSURANCE bATE(MM,°°^�, , THIS OERTtFiCAT9 IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER8 N0 RIGHTS UPON THE CERTIFICATE HOLCER.1 HIS i CERTIFICATE DOES NOT AFFIRMATIVELY OR NEOATIVELY AMEND, EXTEND OR ALTER.THE COVERAGE AFFORDED By THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(%AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT; If the certltioate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. if SUBROGATION 19 WAIVED,subject to j. the terms and conditions of the policy,certain policies may reciulre an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such ondorsement(s). PRODUCER DAVID E,ZELLER INSURANCE AGENCY INC NAMED Ma allent3oodwin 1_�7512071No: 370 LYNNWAYdavidzelier,corn i _ ; NAIGN 1 LYNN MA 01801 INS ANt , ACE AMERICAN INSURANCE Oe INSURED 22657 j IND R B' BERRY FRANK&BERRY JAMES DBA FRANK&SONS INIURFAct, iI Neu 46 WINBROOK DRIVE INM EPPING NH 03042 INSURER F I i COVERAGES CERTIFICATE NUMBER: 13141 REVISION NUMBER: THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN IsSU@p TO THE IN9URE0 NAMED O ABOVE POR THE POLICY PERIOD INDICATED. N07WITHOTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT ABOVE WITRESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE H THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR nPHOFiHSURANCEADD SURR F P i COMMERCIAL GENERAL LIABILITY POUCYNUMBIR M IOU LIMITS EACH OCCURRENCE CLAIMS-MADE Q OCCURPREM1896.IEaeuoDeO S MfiDEXP(Aeroneeorsom s NIA PFR90NALtAOViNJURY i GENLAGOREGATELIM�IIT.APPLIES Per; OERSORANERAL LADVIGREGJU S POLICY JECT LOC PRODUOTS•COMPIOPA00 AUTOMOaILELI45I6iTY $ , ANYAUTO t) $ All OWNED SCH�DUIED BODILY INJURY(Perpereen) S AUroa A�OS NED NiA BODILY INJURY(Per erec tdenq S HIRED AVT08 S S 1 UM8RtLLAL1A6 OCCUR TDcaeaeLUeEACH OCCURRENCE MA ! LAiMSCE NIA w 0R 0 T s fi H WORKERS COMPENSATto ANDEMPLOYERWLTAEIUTY IN ANYPROPA1eTOWARTNERAfXECUTNE �^ A ImandeloryinOFFICENMEMEREXCLUOfiO? NIA IAA NIA 9SOZUB8988L43415 11!06/2015 11/06/2016 E'LPJICHACdOENT i 100,000 (fyot.d te4ba uH) E.L.018EASM- EMPLOYEE d 100 000 ' Ityoe,deecllbe undo '. DEeSCRI TION FOPERAT7 $ low B.LDISEASE.POUCYUMR $ $0()000 t NIA � OESCRIPTIONOFOPERATIONS ILOCATIONS IVEHICLES(ACORD101,Additional Remerkaaciledutr,mybeatuehsdlfinengeoeieroqullvd) Workers'Compensellon beneMs will be paid to Massachusetts employcam only.Pursuant to Endorsement WC 20 03 Oe 9,no euthorizalion is given to pay claims for benefils to employees In stated other lhan Massaohusatle if the Insured hires,or has hired those employees outside of Massachusetts. ThN certificate of Insurance shows the policy In force on the dale that this certificate wed AtaUad(untees the expiration dale on the above policy precedes the Issue data of this 1 certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at 1 www.mass.govAwdtworkers•oompensaUONinvediigaUonsL 1 No partners have elected coverage. t CERTIFICATE HOLDER CANCELLATION I �`�� �s• 0L/6� 1 ENDUED ANY OP THB AtiOVB DESCRIBED POLICIES BE CANCELLED BEFORE � THS EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ! ALL LINMIR ONE POOF ACCORDANCE WITH THB POLICYPROV1SioN3. 30 TEMPLE DRIVE ArUTT HORIZeDatipRESENTATIYE METHUEN MA 019440 n of M.Cr A CPCU,vice President—Residual Market-WCRIBMA 0 1988-20114 RD CORPORATION. All rignis reserved, ACORD 25 2014101 ) The ACORD name and logo are registered marks Of ACORD WORKERS COMPENSATION AND EMPLOY RS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insurat ce Company 54 Third Avenue, Burlington, Massachusetts 01803.0970 (800) $76-2765 NCCI NO 28158 POLICY NO. AWC-400-7009484-Z015A PRIOR NO. 'AWC-400.7009464-2014A ITEM r 1, The insured: All Under One Root DSA; Mailing address: C/O John Lonzetfame FEIN:**-*1.8251 30 Temple Drive Methuen,MA 01844 Legal Entity Type: Sole Proprietor Other workplaces not shown above: See Location 2. The policy period Is from 11/09/2015 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 applies to work in each state listed In Item 3.A. The limits of liability under Part Two are: Bodily Inju by Accident $ 100,000 each accident Bodily Inju by Disease * —" b00,00 policy limit Bodily Inju by Disease $ ;�'"` 100,000 each employee C Other States Insurance: Coverage Replaced by EndorserrentWo 20 03 oo B D. This Policy Includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals f Rules,Classifications,Rates and Rating Plans. All information required below is subject to verification and char ge by audit. Ciessificetims Coda Estimal id Per$100 Estimated No. Total Ant ual Of Annual Remuner tion Remuneration Premium INTRA 174$66 I ; i l i INTER SEi:%'6hQS CODE SCHEDULE Minimum Premium 9ftp To al Estimated Annual Premium GOV . GOV Deposit Premium STATE CLASS MA . 5474 S# to Assessments/Surcharges $1 .00 X 5 7500% $1 This policy,including all endorsements,Is hereby countersigned by 10/06/2015 ulhor 9ignelure -" bate Service Office; P rry Insurance Agency LLC B Third Avenueurlington MA 01803 5 2 Chickering Rd, Rt 126 BN rth Andover,MA 01846 WC 00 00 01 A(7-11) Includes copyrighted matarial of the National Council on compensation Insurance, used with its permission. Massachusetts -Department Board or Buiiding RegoiaYions an: Cufliti'tittiuil Suj'iCl'i'iNui - Licensot CS-069120 ,•t i� JOHN W I.ANZAI,kME 30 TEMPLE DR METHUEN MA 01844 t�.�,.. ,` i Commissioner 04/03/2017 Click on the registration number to view complaint history.Ybu M 01so vl�i� bit;�� and G„uamnty Fund history. The list is current as of Wednesday, October 8, 2014, $earch Results REGISTRANT RESg*©MMLE REMSTPAMOM ADDRESS -EXPIRATION STATUS NAME INDIVIDUAL Nt3MEMR DATE At.f.tfuaertot+e Roor- LANZA AME. D A7 O-Z 166 A MERRIMACK ST 10102/2016 Current .JOHN METHEUU,MA 01844 a201Z Commonwealth of MassachuSOtts. Mass.00vo is a registered service mark of the Commonweaith-of Massachusetts,