HomeMy WebLinkAboutBuilding Permit # 10/13/2016 No�rr�y
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: �� Date Received t
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Date Issued: i I f
IMPORTANT Applicant must complete all items on this page
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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
`�Se tic �Ulf;?lI, 'i=7 Flo�dplam ❑Wetfands r �q,iNaterstaed Uastifct ���
DESCRIPTIONOF WORK TO BE PERFORMED:-
:.. .F ,.
Identification- Please Type or Print Clearly
OWNER: Name: 044 OL�- r774 Phone: F
Address: 7-1
.. s ✓ kn n w r k ., ✓/ r ..........A�
Ercall f
Su�et��sor s�Canstructcor� Llcer�se � - ,
ARCHITECTIENGINEER 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.: Receipt No.:
NOTE: Persons contracting with u r gister contractors do not have acc s t guaran fund
ntlUwner nature of contract
Signature:of Ager' __g __
t%O Thi
Town of " s 6 ndover
No. 43
O 4AY(Q h ver, Mass,
all
2 CO_01c.twi[K
E0 AP4�,i5
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
HIS CERTIFIES THAT � #V..... �►. . ...ral A".�............... BUILDING INSPECTOR
las permission to erect ........... buildings on ri O R Foundation
. .!..e......Al........ ..................................................fO 0 Rough
o be occupied as ........ ........................... chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
►n file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and
.onstruction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
fIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION START Rough
......PQ.... .� .. ..................... Service
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy PermitRequiredt® OccypV B 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 Bet.
A
Ep
0
Chimneys Residential & Commercial RRoofing
Siding CHIMNEYS POINTED-REBUILT-CAPPED Jul Types Of
Mass Toll Free HOO:f Leaks;Experts Expert Masonry Work
1-800-WAIT-4-US Locally otvRvd o'perarod srne�76 •...... # Insured
(924-848?) IK00 ewee wo"" oZ ohw I�- License 034.200
We Work Year Round
Pr
IN I
Proposal To: New England Shed Date 10/22/2013
Street: 48 Campion Rd.
N.Andover, MA
'91RO Roof proposal
f2c Labor
1. Extra caution will be taken to protect house 12. Removal of all work related debris. Planks will be
exterior and landscaping as best as possible, placed under dumpster to prevent any damage to
(tarps etc.) Magnets run at final clean up. driveway.
2. Remove all layers of 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.
additional cost$55.00 per sheet of 1l2"cdx fir.
4. Install aluminum drip edge to all eaves and Total roof labor cost: 14�rJOQ.QQ
rakes. • This proposal includes all nails and fasteners
5. Install 6' of ice and water shield along all eaves needed.
and top to bottom in all valleys • All materials excluding nails and fasteners will
6. Install underlayment to remaining sheathing up to be supplied by homeowner.
ridge.
7. Install all new pipe boots. *Note*: Please be advised if applicable, valuables in
8. Install starter shingles to all eaves. the attic should be moved or covered due to minor
9. Install architectural shingles to entire main house. debris, dust and asphalt particles that will accumulate
All shingles will be installed and fastened during the stripping process. All Under One Roof not
according to mfg, specs. responsible for any damage or clean up that may
10. Counter-flash chimney lead with ice and water occur in attic.
shield, tie into new shingles and seal
11. Install ridge vent to entire ridge capped with col-
or matched hip and ridge cap shingles. Balance due upon completion
References available upon rec
guest
Highly rated member of the accredited BBB and
An ie's List
Thank nk you!
Acceptance of Proposal—The above prices, specific tions and conditions re satisfactory and are herby
accepted. You are authorized to do the work as specifi A. Payment wi ade s outlined above.
Date of Acceptance: r Signa
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass�goy/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Elect6ci2ns/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print L ib
Name(Business/Organization/Individual): lq4,L, Ute'-11 �
Address: v 1 Zvi" l ti- Mi.�
City/State/Zip: k Phone
Are you an cmptoyrr?Check tine appropriate box: Type of project(required):
1.0 1 am a employer with employers(full and/or part-time).* 7. ❑New construction
2L❑I 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
10E] Building addition
401 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will
ensure that all contraclors either have workers'compensation insurance or are sok 11.0 Electrical repairs or additions
proprietors with no employees. 12.Q Plumbing repairs or additions
5elam a general contractor and I have hired the sub-contraciors listed on the attached sheet. 13.❑Roof repairs
'These sub-contractors have employees and have workers'comp.insurance.t �}�err /J `�'/'/'
6.❑We are a corporation and its ofTces have exercised their right of exemption per MGL c. l 4.""' /
152,§1(41 and we have no employees.(No workers'comp_insurance required.)
•Any applicant that checks box HI must also fill out the section below showing their workers compensation policy information.
t Honwowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state wbctber or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'corp,policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.li: Expiration Date: '
Job Site Address: `�J / � a� 0, ! � 0 __City/State/Zip: I_
Attach a copy of the workers'compensation policy declaration page(&bowing 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify p sand realties of perjury that the information provided above is true and correct
Signature:
Phone
Qfftciat use only. Do not write in this area,to be completed by city or town official,
City or Town: PermittLicense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
From:Universal Insurance To:19169150461 07/15/2016 14:45 #715 P. 021002
O CERTIFICATE OF LIABILITY INSURANCE DATE UMDIYWY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT8 UPON THE CERTIFICATE Ii0 01
TIfj$
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY T149 POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE 0098 NOT CONSTITUTE A CONTRACT eLTWEEN THE ISSUING INSURERS$), At THORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
{ IMPORTANT; 1 the certificate fielder Is an ADDITIONAL INSURED,this Polfoy(las}must be endorsed. IF SUBROGATION IS WAIVED subject to
i the terms end conditions of the pelIcy,certain policies may requirs an endorsement. A statement on this certificate does not confer r hts to the
certificate holderIn lieu of such endarsernan s.
GONTA
FRcaueEx
Leandro Guimaraes
UNIVERSAL INSURANCE AGENCY PHONE (508L -9333
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3T4 6ELMONT ST. INAURERM AFFORDINOCOVERA08FLucs
WORCESTER MA 01804 msURER A, ACADIA INS CO 31325
INSURED
MGG CONSTRUCTION INC ANSR s
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MILFORD MA 01757 I RERFI
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P30EY PERIOD
INDICATED. NOTW€ NSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED Olt MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL I HE TERM
EXCLUSIONS AND CONDITIONS OFSUCH POLICIES.UMrr$SHOWN MAY HAVE 13EEN REDUCED BY PAID CLAIMS. _
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claims for beneflte to employees In states other than Massachusetts If the insured litres,or has hired those employees outside of Massachusetts.
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I This eertMcate of Insurance shows the policy k1 force on the date that We certificate was issued(unless the e%plrallon date on the strove poli
Issue date of this cedincate or insurance). The status of this coverage can be monitored daily by eaoes3ing the Proof of COverage-Coverage Ver€ Cation a
Search tool at www.mass.gavl€wd/workere-anmponeaVonRnvosUgetionef.
CERTIFICATE HOLDER CANCELLATION
{
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFLL1 D BEFORE
a THE EXPIRATION DATO THEREOF, NO.110E WILL 68 DEL VERSO IN
ALL UNDER ONE ROOF ACCORDANCE WITH THE POLICY PROVIBIONS,
30 TEMPLE OR
AUT�HOI.DZ�kD REPRlISlkTA71YE
3 METHUEN MA 07644 Danlei M,Cr y,CPCU,MOD president—Residual Market— RIBMA
®18a8-2011 ACO"CORPORATION, All rights reserved,
ACORD Z8 SZ014I4i} The ACORD name and foga ere registered marks of ACORD
A COR
CERTIF-1-CATE OF LIA131LITY INSURANCE (710OD7,
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rests CERTrFicATe 113I T AF AS A MATTER OF INI=oRMATION ONLY ANi} CGNFERS NO RIi3HT5 UPON THE CERTIFICA E HOLDER THIS
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the ferrl)t;and conditions of the policy,certain pollcll;s may require an endorseme�}t. A statement se Phis certiROG does not c afar ,subhts to the
certificate holder in Ileo Of such endorsement{$�,
PRODUCess 02051.009
Per Insurance Agency LLC
C sranch xoaY-�
622 Chickering Rd lo.Ext• {978)685-7890 l� .HD.: (978)687-0149
North Andover,MA 01896 .
INSURED A.I.M.Mutual Insurance Company j
All tinder ails Roof �
C/O "hn LanzaPame
30 Temgle DrLv4
Methuen, 1h 01844
COVERAGES CERTIFICATE NUMBER: REVISION NUMB
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER 000UMENT WETH RI;sAECT TO WHICH THIS
CERTIFICATE MAY BE 18SUET) OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALO THE TERMS,
EXCLUSIONS AND CONDITION OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
El r TYPE OR INSURANCEyP POLICY NUMBER ~^ � LIMl7 �—
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S.L.DISEASE-POLICY LIMIT 400,000.00
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The workers compensatlon policy does not provide coverage for John Lanzatame
CERTIFICATE BOLDER
.. CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE'. RELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTH01i REPRESENTATIVE
98 -fd0 COR ORPO O .A, g reaerYe
A registered marks of ACflRD
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,I�A�ssanhut+ettt.t]e;$rt►nett ar� . ..
Board of Building Regufarlana Ina 5;a,�,-313 .
conitru¢tilin Sttpcll'I�ui'
License: C3-069.20
JOHN W LAN %
30 TENP LE DR : .1• .. .
METHUE MA 01844
Osarnttitssf��lar »,.. '3: ,
04/t)31Zpg7
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Offce of Consumer Affairs and BusinessRe ulat•
10 Park Plaza - Suite 5 g ton
Boston 170
Home Improvement Co usetts 02116
ntractor Registration
Registration: 137057
ALL UND Type: DBA
OF =A.:` ..,i Expiration: 10/x/2018
JOHN LANZA AME Tr# 291333
166 A MERRIMACK ST 3 v< . : :'
METHEUN, MA 01844
,
SCA 1 r, 20M.05fsI Update Address and return card
[] Address .Mark reason for change,
_ Renewal ❑ Ernployrnent
r'�1ra»r�nniirn��r/f/ ❑ Lost Card
// rxr;ac/rrs�flr
Office
w of Consumer Affairs&7usi6ess Regulation
Registration valid for individual use only before t
►d HOME IMPROVEIIAENTCOIVTRAC70R
I •Registration: 137087 expiration date. If found ret he
Type: urn
Expiration: 10/21201$ Office of Consumer Affairs and Business Regulation
UN DBA 10 Park Plaza-Suite 5170
ALL UNDER QiVE ROOF
Boston,MA 02116
JOHN IANZAFAME
166 A MERRIMACK ST
MET1-IEUN,MA 01844
derserretary -----
Not valid without signature -
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