HomeMy WebLinkAboutBuilding Permit # 9/7/2016 BUILDING PERMIT tyORYfy ^-
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ~ '°
Permit No#:_ Date Received
* �SSAC H�15E�
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION eK2c�- '
Print
PROPERTY OWNER 4 v o Q
Print 100 Year Structure yes no
MAP06r/ PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building x'One family
❑ Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
C3 Sept[c ®Well D,FloodplaiY[, ❑lllfefilands � U IIICatersl�ed D[str[ct
DESCRIPTION OF WORK TO BE PERFORMED:
� - (1�6 z
C E t_k
Identification- Please Type or Print Clearly
OWNER: Name: i` "�r �° � 'r3�J Phone:
Address: C
� ' �'� �
Contractor Name:
Email: v -
Address: - �s r.
P
Supervisor's Construction License: cy,� t ' Exp. Date:
Home Improvement License: 7 Exp. Date: t z Z. -2—
ARCH ITECT/EN G1 NEER
2-ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDINCY PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ CEJ 6 t Q ` FEE: $
Check No.: Receipt No.-.-
NOTE:
o.:NOTE: .Persons contracting with registered contractors do not have access to the guaranty fund
�()RTF{ 'q
Town of 2 ,, Isndover
No. �, a-tel � � ',iCA__ _ -� �.
oh ver, Mass,
1.
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD
_ Septic System
THIS CERTIFIES THAT .......... !!� ,... .....,. . . ..... ...... BUILDING INSPECTOR
has permission to erect .......................... buildings on ., �/... , .� .,`,, . . . .... ... . ..; Foundation
�. Rough
to be occupied as ....... ....... b ...... .. ..............Ta
. ....... Chimney
provided that the person acceptir this permit shall inevery re pect conform to the tern the apption
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 16 MONTHS ELECTRICAL INSPECTOR
UNLESS CONS TI T Rough
Service
... . .... .......... . ........ ........
Final
DING INSPE TOR
GAS INSPECTOR
Occupancy Permit Required t® 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.
•
i
Resdential & Commercial Roofing
C Iimneys All Types Of
iidiin CHIMNEYS POINTED-REBUILT-CAPPED
g Expert Masonry Work
Mass Toll Free 'Roof tears,Experts� Licensed & Insured
Locally Owned&Operated Sirce J976 +""'
1-800-WAIT-4-US00
924-8487") YKO�' Czee ' ozw ox,7ohv sLicense#
We Work Yearar Round
Proposal; To: Jim Groleau Date 8/24/2016
Street: 10 Copley Circle 978-681-9875
T. Andover, MA
Roof proposal jgroleau@verizon.net
Certainteed Landmark
1. Extra coution will be taken to protect house and 12. Removal of all work related debris. Planks will be
landscaping as best as possible. (tarps etc.) placed under dumpster to prevent any damage to
Magnets run at final clean up. driveway,
2. Remov3 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 under
Any compromised plywood will be replaced at an normal wind and rain conditions. lr
additio al cost of$65.00 per sheet of 112" CDX. Total roof cost: $1100.00
4. Install heavy gauge 8" aluminum drip edge to all g e: 1'000
eaves d rakes. White,brown or mill finish ra
5. Install' of Certainteed Winter Guard ice and Cll�mll@ cap: 0.00 1�!
watershield along all eaves and top to bottom in all
valleys, Install double coverage of ice and water (Stainless steel) /Z,
shield iZ rear valley"catch all" area. Skylight optio install{2) new Velux S06
\ 6. installertainteed Diamond Deck synthetic flied skylight d flashl g kits.$875.00
underlayment to remaining sheathing up to ridge.
7. Install 11 new pipe boots, additional cost p r unit nstall factory i stalled
light block blinds. 22 ,00 additional cost per
8. Install Certainteed starter shingles to all eaves. unit. Please be advi : Some minor cos otic
9. Install ertainteed Landmark Limited Lifetime interior finish trim be needed.
architectural shingles to entire house. 10 year Not included in pr osa
materiaMFG. warranty. (See extended warranty) (1) extra bundle of shingles included.
All shigles will be installed and fastened . All work to be completed within 1-3 days
accords ig to mfg. specs, weather permitting,
10. Install 4ew GAF Cobra ridge vent and cap with
color r4atched Certainteed Shadow hip and ridge
shingles. (MA code) Certainteed 3Star extended direct MFG warranty
11. Counte` flash chimney lead, wall connections and A fully transferable 100% coverage against
all roo#protrusions with ice and water shield, tie material defects for a fully non pro rated period of
into nes shingles and seal with clear Geo-Cel 20 years, Please refer to pamphlet left in estimate
sealant folder. Offered to our neighborhood referrals and
included in this proposal at no additional cost. W
*Note*: Please be advised if applicable, valuables in
the attic sh uld be moved or covered due to minor Balance due upon completion,no deposit reauired
References available u on re nest
debris, dust and asphalt particles that will accumulate Highly rated member of the accredited BBB and
during the tripping process. All Under One Roof not Annie's List
ist
for any damage or clean up that may occur Thank ois
in attic. ..-
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www mass gov/dia
Workers"Compensation Insurance Affidavit:Builders/Contractors/Electricians/('lumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Alrn6cant Information Please Print Legibly
Name(BusinesslOrganizatior individual): /tel/� 4
Address: -3'Z> t OA �-
City/State/Zip: Phone#:
Are you as employer?Check the appropriate box: Type of project(required):
I.El 1 am a employer with employees(full and/or part-time).* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required]
9. ❑Demolition
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
]0[] Building addition
4.O 1 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 11.❑Electrical repairs or additions
proprietors with no employees. 12.[]Plumbing repairs or additions
5011 am a general oontractor and f have hired the sub-contractors Iisted on the attached shot[. ]3,❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance-=
14.®Other
6.❑We are a corporation and its officers have cxcrcised their right of exemption per MGL c.
152,li 1(4),and we have no employees_[No workers'comp.insurance required.)
'My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy mformation.
r 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 subcontractors and slate wbether or not those entities have
employees. If the sub-comractors have employees,they must provide their workers'comp.policy number.
am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date-
Job
Job Site Address: O C' L �r`/2 CQ� City/State/Zip: A "
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 certify under the pa and pe aloes of perjury that the information provided above is true and correct
Si ature:
.r
Phone#:
Official use only. Do not write in this area,to be completed by city or town oriciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk Q.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
�e` ® CERTIF *ANCE DATE(MMIDDIYY )
. wy�E �� L A � �
06/28/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
BELOW. THIS CER77FICATEFOF INSURANCE DOES TIVELY OR ANOT CONSTITELY UTE A CONTRRACTTBETTHE
EN THE 18-SUINC3 AFFORDED
AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, ?
IMPORTANT,if the certificate holder Is an ADDITIONAL INSURED,the policypes) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsemept. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements}.
PRODUCER 02051.001 µCT Branch 2051-1
Perry Insurance Agency LLC622 �� o. (97e}695-7sso AX
North Andover,gMA 01846JUC.No„ 1578}t;e7-0349
INSURED A,1.M.Mutual Insurance Company
A11 Under one Root r - 33758
C/O John Lanzafame
30 Tempie privy INSURE z
Methuen, HA 01844
INSURCS
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
CERTIFICATENMAY BE5ISSUED ORNMAY EPP TAIN LATHE EINSURANCE AFFFORDEd Y THE POANY LICIES DESCRIBED HEREIN 19 SU JRESP
ECT TO ALL THEE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR TYPE OF IN8URAIJCE ,�qSP POLICY NUMBER M � " ..�t�i'��b7iri�r LIMITS
_ GENERAL LIABILITY
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABfLtTY —
mmus.mma [D OCCUR $
MED FJ(P(Any ane parson) $
PER80NAL6ADVINJURY $
EN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $
ORO• PRODUCTS-COMPIOPAOp 4
UCY OC
AUTOMOBILE LIABILITY
COMBINED-9INGEra LIMIT—
ANY AUTO r $
ALL OVM D Au oSULBO BODILY INJURY(Per person) s .�
NON OVVNEb BODILY INJURY(Per acatdent) $
HIOS
RED AUTOS AUTO$
S
UMBRELLA LIAR OCCUR
3
EACH OCCURRENCE g
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DED $
A9� 90NNSF' gAM x S 06TR•
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S
NIA AW0400-7009484-2016A 11/9/2016 11/912016 E.L.EACH ACCIDENT : 00000.00
(mandatory in NH)
E.L.DISEASE•EA EMPLOYEE $
a R lOt�4F IPERATIRNS below 1100,000-00
E.L.DISEASE-POLICY LFMrr S 600,000,00
DESCRIPTION OF OPERATiDN81 LDCATICNB!VEHICLES(Attach ACORD 101,Aaaitlonal RemtrRs Schedule,If more space Is required)
The workers Compensation policy does not provide coverage for John Lanzafame
CERTIFICATE HOLDER._ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
0 9$0.2010 AOORD CORPOR TION.A[ig to reserved.
3 registered marks of ACORD
From:Universal insurance To:19769750461 07115/2016 14:45 #715 P.(02/002
ACaRCERTIFICATE OF LIABILITY INSURANCE DATE( WMD"W)
07 I" 01 B
THIS CERTIFICATE€S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO 11R.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TH POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), A Mo
RIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certif icste holder is an ADDITIONAL INSURED,the policy(les)trust be endorsed. IF SUBROGATION IS WAIVED subject to
i the terms and condition:of the policy,certain policies may require an endorsement. A statement on this certificate doesnot sorter r hts to the
certificate holder In 1191: I:of such enderseman .
rRonucelr Leandro Guimaraes
UNIVERSAL INSURANCE AGENCY P "E , 5Q13 752.8333 F
leandro universallnsa en .cam
O BE STEER ST. INBURER a AFtORD1NOCOVERA08 "yQe
WORCESTER ___ MA 01804 MSURERA I ACADIA INS CO 31325
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MILFORD MA 01757 E s RFRF;
COVERAGE$ CERTIFICATE NUMBER: 89377 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUM"WITH RESPECT TO ICH THIS
t CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL E TERMS,
EXCLUSIONS AND CONOITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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DESCRIPTICNOFOPERATIONSrLOCATIONS tyCHICLES(ACORO141,AddlUonelRemarks SeMdule,rnayboousehedJim*"opacelaraaYtredl
Workers'Compensation benefits will be paid to Massachusetts emptayees only.Pursuant to Endorsement WC 20 03 08 8,no euthorizallpn is givel 110 pay
claims for benefits to employees in States other than Massachusetts if(he Insured hires,or has hired those employees outside of Massachusetts,
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ows the
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N Search tool at www.mass.govttwdlwnrkere-compensatlonllnvpeogatlonaL
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t CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DFSCRIDED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DCL ERI»D IN
ALL UNDER ONE ROOF ACCORpANCIWrrHTHEPOLICY PROVISIONS.
30 TEMPLE DR
AUTRaRIZEv RerReseRTATae
METHUEN MA 01844 Daniel M Gr
' Y,CPCU,Vice,President-Residual Market— RISMA
1988-201e ACORD CORPORATION. All rlghl s reserved.
ACORD 73(2014101) The ACORD name and logo are registered marks of ACORD
i
Massachusetts -Dei:irrrnwit or
Boort!of BLuiwing RoquixionI; 1.'•:i ;�:'.u';'.::;
oNtITCtiU1] .SLIPCITistlY
License: CS-069120
JOHN
W T 1*rr�y ♦ i. 1
30 TEMPLE DR : tl t,-9
MUMMA
C��I'imtssl]ilr 04/03/2017
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Click on the registration number to view complaint history, `fou can also view arbi#ration and Gu -ntY ELIOd
history
The list is current as of Wednesday, October 8, 2014,
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$®arch Results E
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REGISTRANT RESPOD II1 REGIS-MA-130-14 EXPIRATION
NAME IND1�tIDUALL Btttmeat DATE
ADDRESS STATUS
f
At.t.UNDERONE ROOF LANZOWAk4E, 137 L? 166 A MERRIMACK ST 10/02/2-016 &rrent
.JOHN MI;THEUN..MA 018"
02M Commonwealth of Massachusetts.
Msss.GoA is a registered service mark of the CommonwbW[h-of Massachuseft.
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