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HomeMy WebLinkAboutBuilding Permit #490-2011 - 126 LACY STREET 12/17/2010 � _ _ � BUILDING PERMIT pR7y - Of ��teD ,b�ti TOWN OF NORTH ANDOVER o- APPLICATION FOR PLAN EXAMINATION `K Permit NO: 7 d—,2 /�- ��i /0 Date Received •� DR-%rt D Date Issued: SsacHUSE� IMPORTANT:Applicant must complete all items on this page ay - ..� n d 4 7�'�ppfi r a r r �bbj }����t y,i r - y-+ 7 h 1� .i� E.R rV..ri�'1 '4 L >t. C.r72 -a `J�' iq •'Ytr i)'-1r �k 'Yi .r '. YT/.f(�� T 'laehiiecpi+�fag�r ':mss no 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 SP.id ,_ dell t -7 F�D #p7a3rt, laads 3aers �zas#r� t, A, Pr DESCRIPTION OF WORK TO BE PREFORMED: IlrrwloVc 4 Qr/%(t PaoiCi',LC z- � Identification lease Type or Print Clearly) OWNER: Name: efM C lef� Phone: - Address: L f_ til - 1/ d ♦♦ ����+�[� L + ..r �• J jy`aT r i 'jy�F� J'�yw,, 4 Y, t �.(///� �+.T y ��`S T ���eW+0. �1[.i7'a 7e ,�%r i�y`•Lr r5. t $- _k s i7 �-!i�'e h E t r .i s : `� f r. €J r,Y,}. . c`- I '7 r L•� � � -i 1' �, v� i ryl r� '61r ry �4 yc. V� � � # /�/yj ■y/ p Pj"'9 ? .sl �� �r�, :. �y SSS-Pr�ras�r'ststru� o oetase -` exp ..yip a14A717l'G H. 1 T 7 7�J�fl ent. - ARCHITECT/ENGINEER Phone: Address: Reg, No. FEE SCHEDULE:$ULD/NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 5125.00 PER S.F. Total Project Cost: $ '7 - FEE: $ Check No.: 3x62- Receipt No.:a 3-?S5"- NOTE: Persons contracting w'th unrea' ere ontractors do not have access to the guaranty fund Signature_of Agent/OwnerL4�ignatwr6:of contractor ti Plans Submitted Plans Waived Certified Plot Plan Stamped Pians TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well i Tobacco Sales Food Packaging/Sales Private(septic tank,etc. I Permanent Dampster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on-,-- Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature &Date Driveway Permit DPW.Town Engineer: Signature: Located 384 Osgood iireet ARE DERTIE+NT. Temp Dump sterJoni#e yes p `Located�at;,7 Z4�Nair�'.:St�set' fire 'Da' it-ra�eaatsignat*reldat COMMENTS 02 � Dimension otal square feet of floor area, based on Exterior dimensions. Number of Stories:��T Total land area;sq. ft.: -. kc:� ' ° ' ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 Location No. z S L�-� b/i Date NOATM TOWN OF NORTH ANDOVER F R 9 Certificate of Occupancy $ s;AcM,s t� Building/Frame Permit Fee $ �_'' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ' 2 23755 B ilding Inspector I ORTIy Town of � _ • Andover 0 dower, Mass., LAKE �. COC MICKEWICK V A0RATED `s BOARD OF HEALTH Food/Kitchen PERM IT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT............... ...�.�F.... .`.{............................................................................................... Foundation has permission to erect........................................ buildings on .... ............................................... Rough to be occupied as..................... .................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUCTIO STARTS Rough G u'J ��1,. Service BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. ORTM ToVM Qf- And over 0 _o lover, IVMass., L IK WICK 7�S ` RATE D � BOARD OF HEALTH Food/Kitchen PERM IT T D Septic System BUILDING INSPECTOR G THIS CERTIFIES THAT.............. l�si .f..... ..`..% ..../."' ............................................................................................... Foundation has permission to erect........................................ buildings on.....�96..... � ........ Rough - to be occupied as `S "� �... ..... c/J ''`` - '••\ Chimney ......................... .. .................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUCTIO STARTS Rough ........".......:.1.. .............................:.......................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. NEW ENGLAND CUSTOM DESIGN, INC. 226 LOWELL STREET WILMINGTON,MA 01887 #978-658-0881 Home Improvement Contract Registration No. 102467 ROOFING AND SIDING AGREEMENT This is a legally binding contract.Make sure you read this Agreement and understand it before signing it.Do not sign this contract if there are any blank spaces. NOTICE:All home improvement contractors and subcontractors,unless specifically exempted by Massachusetts law,must be registered with the Commonwealth of Massachusetts.All inquiries about registration should be directed to: DIRECTOR-HOME IMPROVEMENT CONTRACTOR REGISTRATION One Ashburton Place,Room 1301 Boston,Massachusetts 02108 Telephone:#617 727-8598 3is Agreementis on / 20, by and between New England Custom Design,Inc.(hereinafter,"Contractor') id owner� V e // r,& G9 (hereinafter,"Owner"),of ty/Town ,4Oy-T t'I Jgx-.0 a r/-/z State ao Zip 01 t%S (H)Phone ��� 1/ j b Address("The Premises") 42(,_ 44 C S-L (W)Phone i ew England Custom Design,Inc.SMesperson Roofing will be applied only on slope//roof surfaces below,over present roofing shingles unless specified under REMARKS. W0MATERIAL 7e(, �/4!�I Lo?7 cI c� � Color go Main Roof CS Bay Windows Ilaw-r Extensions (413 a Porches:Front bl/rtP Side L4.la,�P Rear Other Roofs A/�Y NOTE:Roof board replacement cost per foot OR V3.5" O d per 4'x 8'sheet of 3AC inch CDX plywood. tar MRARKS/�EXTRAS:Missing or defective lumber is not included in any category of work unless specified here. A viPlMvl/2 Sriv�r 1Gv,K Or= /4s,-hf94r S61%t.p�Irf SIo%���l�f(/rm%vcic2s /C?�� t f sz D - / 7. -0evne) c1 ( ✓ y7n9/vVo�E7'• CcJ�" The Contractoragmestoperforminagood and workmanlikemannerall work detailed above. CASH PRICE$ :2/ko• C>G DOWN PAYMENT$ f9 • C, Notes All Roofing Customers " r PAYABLE ON START OF WORK$��C G/d v d New England Custom De's�ga Inc:will not be held responsible for dust-and debris falltng m PAYABLE $ 2 attio;areasduiingroofing,install on Please PAYABLE ON COMPLETION$ -(6• t niv..Ts remove or cover valuables DATE: 20 RIGHT TO CANCEL Che Owner may cancel this agreement if it has been signed by the Owner at a place other than the address of the Contractor,which may be his main office or branch thereof,provided that the Owner iotifies the Contractor in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this Agree- nent.See attached Notice of Cancellation.A cancellation fee representing 30%of the contract price will be in effect if cancellation is requested after the legally allotted time has elapsed. rhe Owner hereby certifies that he has read this Agreement,that the terms and conditions and the meaning thereof have been explained to him,and that he fully understands them and that there is no mderstanding between the parties,verbal or otherwise,than that which is contained in this Agreement,and agrees that the said Contractor is not responsible nor bound by any representations not con- ained in this Agreement,made by any of its agents,unless the same be reduced to writing and signed by the Con 9 ON HOME R T SIGN THIS CONTRACT IF THERE ARE ANY B SPACES to �ah))aalo Iz a Owners Signature Date Ne ngland Custom Design,in Date Owners Signature Date ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID KC DATE(MMIDDmYY) NEWEN-1 03/22/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kilgore Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ' 5 Centennial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Peabody MA 01960 Phone: 978-531-6550_ Pax:978-531-9442 INSURERS AFFORDING COVERAGE NAIC INSURED INSURER A: western world Insurance compan New England Custom Design INSURERB: Safety Insurance Company 39454 Incorported Ron Weinberg & Val Lanza INSURER C: 'travelers Prperty a Casualty 226 Lowell Street / Unit B4'-A INSURER D: Wilmington MA 01887 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN-MAY HAVE.@EEN REDUCED BY PAID CLAIMS. INSK LTR NSR POLICY EFFECTIVE POLICYEXPIRATIN TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY NPP1203241 03/;14/10 03/14/11 PREMISESEaMrrence $ 50000 CLAIMS MADE OCCUR MED EXP(Any one person) $2500 PERSONAL S ADV INJURY $1.000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1000000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ) ANY AUTO ` 0062853 04/05/09 04/05/10 (Ea accident) $ ALL OWNED AUTOS POLICY RENEWS 04/05/10 04/05/11 BODILY INJURY $250000 X SCHEDULED AUTOS (Per person) HIRED AUTOS ' BODILY INJURY $ 500000 NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $100000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 01.CLAIMSMADE,. . AGGREGATE $ DEDUCTIBLE ., $ RETENTION $ $ WORKERS COMPENSATION ANDX TOTATULIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE B ANYYERS'LIABILITY 7PJUB0239N232-10 03/14/10 03/14/11 E.L.EACH ACCIDENT $100000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-F IfA EMPLOYE $.100000 yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE,EANCEL. F�D BEFORE THE.EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE'HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, ' - AUTHORI SENTATIVE 1 ACORD 25(2001/08) ©ACORD CITPORATION 1988 .� f�re�a�Jh�co�u��ea�� a�,i`taaoac�Zuael� Office of Consumer Affairs&Business Regulation a. HOME IMPROVEMENT CONTRACTOR Registration: 102467 Type: Expiration:- 712/2012 Private Corporatioi NEW ENGLAND CUSTOM DESIGN,INC. Val Lanza 226 LOWELL ST. WILMINGTON,MA 01887 Undersecretary 'l:ltivicliu�e##�- Depa'tnicnt :if Puhlic `+ufe"' , 11 i34i:trtl cif Building Rec_'Ulatimis Mitt �+tueiuctz c?� Construction Suter is=arm ce??>. License: CS 8828 Restricted to: 00 VAL J LANZA 34 BIXBY ST REVERE, MA 02151 z Expiration: 4/20/2012 �'•,nintit••i„n:•s- i r: 20843 1I 1 I License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10,Park?laza•-Suite 5170- Boston,MA 02116 1 1 Not valid withou nature i. Restricted to: 00 00- Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/YDPS