HomeMy WebLinkAboutBuilding Permit #762 - 131 GRANVILLE LANE 4/29/2014 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
Va Y/
I P RTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER ^
,�f�
PrintL 100 Year 01d Structure yes no
MAP NO / Q RCEL:_5bONING DISTRICT s... Historic District yes no
Machine Shop Village yes no,
.TYPE OF IMPROVEMENT. PROPOSED USE
Residential Non- Residential
❑ New Building ne family
0 Addition ❑Two or more family 0 Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
0 Demolition 0 Other
0 Septic ❑Wel[ i. 0 Floodplain p Wetlands ❑ Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
S17P
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: �� h �, L: Phone:
Address: fit-"°`
Supervisor's Construction License: Q�9 Exp. Date: L612"/3-
Home Improvement License: .. 1�/ t7 Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ Z ° FEE: $ -�
Check No.: � Receipt No.:
cess to th uara and
- NOTE: Persons contractin with unregistered contractors do not have ac g ty f
g g
�Signature�ofAgent/Owner Signature of�.contractor
Plans Submitted �.� ()IaUns aived ❑ Certified Plot Plan 11 tamped lans ❑
Location
No. Date
. - TOWN OF NORTH ANDOVER
. Certificate of Occupancy
` Building/Frame Permit Fee
Foundation Permit Fee �
Other Permit Fee $
TOTAL $
Check# !
4 / 507
Building Inspector
Plans Submitted ❑ Plans Waived1l; `.-Certified Plot Plan ❑ Stamped Plans ❑
TYPE OSEWERACED3SPOSAL-
Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑
Well ❑ Tobacco.Sales -Food Packaging/Sales ❑
Private,(septic tank,etc:_ - El
Piunpster ori=Site
------------------
THE.fOLLOWING SECTIONS FOR-OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF U FORM
_ 2 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 Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: :Comments ~
Water & Sewer Connection/Signature&Date Driveway Permit
DPW TowX-! Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMr NT - Temp Dumpster on site . yes, no
Located at124AMair, Street
"Fire . -,, '
Departme►�t signat(jiWddte
COMMENTS
e o Stories: Totals square feet of floor area based o
Number f n Exterior
dimensions.
q � _
_Total land-area; sq. ft.:
ELECTRICAL.:-Movement of.Meter.location-, mast or service drop requires approval of
Electrical Inspector Yes No
DANGERZONE LITERATURE: Yes No
MGL-.Chapter 166.Section.21A--F and G min.$10041000.fine
NOTES and DATA— For department use
® Notified for pickup - Date
S
Doc.Building Permit Revised 201.0
i
Building Department
i
= The foi`3w ng1s'a list of the requited-forms to be.-filled out for the appropriate-permit to.be obtained.
Roofing, Siding, Interior Rehabilitation Permits
aRuilding Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract s
❑ 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
❑ 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 apwr al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.BuiHing Permit Revised 2012 .
NORT11
Town of . s _ : 1. Andover
ozam0
No. — �y
TZ
o h ver, Mass,
A.
COCKICKl WICK *_
'11,9 A°RATED �P�,��(5
`S U BOARD OF HEALTH
PERMIT . T
Food/Kitchen
LD Septic System
THIS CERTIFIES THAT .. ���� ��'� N BUILDING INSPECTOR
................................................. ...........................
/� ' Foundation
has permission to erect .......................... buildings on ... !..... ....4 .....................................•
.............•..
Rough
tobe occupied as .. .. ...... ............................................................................ ............. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO'IST T' Rough
® r .
Service
..............................................
.............. ........................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to 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.
' ,.-Y—" h- v-_ --i -§f, �+'`i, M -- .. "y` w�-�'. -p 3 f•--c s " = -cam..
_,FAR'
�
e r,
-.- _
ChimneysResidential & Commercial Roofing
lTypes �
;.
SidCHIMNEYS POONITED9 >�ERUIL T-CAPPED I✓�pertMasongyIJtlark
.�
-' f Lid &
h.:.�
Mass Ta`i Free _*- ..� �g censeInsured
;
°"�• l.,:txGt/v l.livrted i C3��er<.tre! Sr...c.e: 1076
1-800-WAIT-4-US License#034200
(924-8487) ����, ee wozw ae,,qV
We 1'sATtsrlk Year Hound
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Proposal To: John King Date 3/25/2013
c` Street: 131 Granville Lane 617-982-6285
N.Andover
- Roof proposal jking@wsi.com
TKO Cambridge/Certainteed Landmark
1. Extra caution will be taken to protect house 13. Building permit included.
exterior and landscaping as best as possible. 14. Contractor workmanship warranty: 10 years under
(tarps etc.)Magnets run at final clean up. normal wind and rain conditions.
2. Remove all shingles from entire house. Total roof COSI: $ $,200.00 1�
3. Inspect and re-nail any loose or lifted plywood. (Angie's List discount applied and included)
C� Any compromised plywood will be replaced at . Option: Upgrade to WR Grace ice and water
an additional cost of$55.00 per sheet of 1/2" shield. $280.00 additional cost.
CDX fir.
,'j 4. Install heavy gauge 8"white aluminum drip Option: Install(1) Broan exhaust vent and
,• edge to all eaves and rakes. connect to bath exhaust. $75.00 additional cost.
• Option: Install (1)GAF Pro2 1600cfm power
5. Install 6' of IKO Armourguard ice and water
vent with thermostat controller. Basic hook up b
.� as
�- shield along all eaves. y
6. Install IKO roof guard synthetic underlayment to licensed electrician included, $400.00 additional
remaining sheathing up to ridge. cost.
7. Install all new pipe boots.
• Both IKO and Certainteed direct extended non
8. Install IKO Leading Edge starter shingles to all pro rated 20 year fully transferable warranties
included in this proposal. Please refer to
eaves. pamphlets in estimate package. Offered and
9. Install IKO Cambridge Limited Lifetime included in this proposal to our Homeshow
architectural shingles to entire house. 15 year referrals at no additional cost.
non pro-rated warranty by mfg. 10 year if If Certainteed MFG. is chosen then all
Certainteed is chosen. All shingles will be
accessory material will be Certainteed.
installed and fastened according to mfg. specs. *Note*:
Existingrubber roof on rear addition in good
Please be advised if applicable,valuables in
condition. New shingles will be tied into rubber
the attic should s be moved or covered due to minor
debris,dust and asphalt particles that will accumulate
and sealed. during the stripping process. All Under One Roof not
10. Counter-flash existing chimney lead with ice responsible for any damage or clean up that may
and water shield and tie into new shingles and
occur in attic.
seal. Balance due upon completion
11. Install a new GAF Cobra ridge vent capped with
References available upon request
color matched IKO hi and ride shingles. pg
p g . g Hi hl rated
12. Removal of all work related debris. Planks will - y member of the accredited BBB and
be placed u Annie's List under dumpster to prevent any damage to Thank you!
driveway. (,4A (�
ltd r
- i
„ . „ll�ut,tt \lfulr� c'C }3usmt-ss Kcgulatioll Mass-�ctt�
�n,u Jdeos,re u'me ,ncce of Consumer Atfatrs&business Regulation(OcABR)
Consumer Affairs and Business Regulation _
.....1.; Nr, improvement Coniracling
Home Improvement Contractor Registration Lookup
you can searchi'llltc the registration fist by any of the criteria below.
Search by Registration Number 37057 Semi
Search by Registrant Name
Se.arcv. by City ! Zip Code j
'Dearch ReglstrantS
rk r!n Mt. fe(ats r to view complaint history You can also view 41 f ( t Q a 0—( rS!r (;
he list is curre It of Thursday, September 20, 2012.
Search Results
REGISTRANT RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS
NAME
INDIVIDUAL NUMBER ),ATE
tNn.a ONE r Ot3r t ANZAF AME 13705:
166 A FINACHARO 1(1/0214
iOHN BUILDING
METHEUN. MA 01844
,, t�anurninwe r�lt, r�ssaUtusBtG `6y (( pIM/!lplg��,�gg`n f�tt1
':�rt}v�i K 8 iAq slel a+.l C@fVlt'.'4!111918��IIIQ t'{ALR1Allil�AA,t I!t� ��
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( u;3�9 t'iii f3+,17 +1Ur+t't�t�+t 1
L,cense. CS-069120
JOHN w LANZAFAM ..
_.•.....pmt v nio
CERTIFICATE OF UASIUTY II URANCE DATE(MlwDD►°tYrn
TIFtCATE 15 ISSUED AS A MATTER OF INFO 77 M ONLY AND CONFERS NO RIGHTS UPON THE CERTtFICA O
CERTIFICATE DOES NOT AFFtRtt41}.T(VEL OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Y
°fHfa CERTIFICATE OF INSURANCE DOES NOT CONSTTTLITEA CON
TRACT BETWEEN
THE ISSUING 011SUREWS).ALtTHOR ED
S tlT TLV R O U AND L
IMPORTANT:If the certificate holder Is an ADDMNAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED.subject to
"that terms and conditions of the policy.certain Policies may require and endorsement. A statement an this certificate does not confer rights to
Aha certificate holder in lieu of such endorsemen s.
CONTACT
PRODUCER NAIVE.
f A!'Ii:s 'E:-:_rk [Nc ae.;�.•- PHONE FAX
ti..1'N�s�fT.��A'i
LAIC,No,Fid):Fid):70 AtC,No}:
E4VIAIk
Y NN„ ;tA 01 rata I ADORESS:
2�Z'Aiii INStIRFR(S)AFFO�WI G C7WPV-,.GE MAIC Af
INSURED INSURER A: ACE A AERICAND&"ANCE CC�NWAJ-Y
I RRY 1,RANK &?,HR2Y, JAJ�AFS DBA FRANK&SUNS RMRER B:
INSURER C:
-11, WINDBROtOK I.)R INSURER E:
hPI"W". SIH 03(42 INSUR8tP
COVERAGES CERTIFICATE NUR REVISTOtR Nt)MBi :
-- TRE TO RACED THE POLICYPE N A EO. r
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PMYAN-TNEMISURANCE AFFORDED BY TNEPOUCIES ED"Ott 1SSUBSBCT TO ALL uW TOWAS.0=11IS10M AND CaN 110II1S OF fitrGH�"OLIGES.Leer SPA MAY ..
HAVE BEEN REDUC®B Y PAX)CLAIMS.
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EhPLOYETYSI-MiLITY YIN L*3.409P893-13 0722120`13 07Mf0 G Laa;;= _
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DESCRiPTIONOF OPERAMNS&OCATiONSAIS*CLESME'STMC'"DNSfSPECtAL t7F1Yt5
THISR.FK..Ar;E;ANY fP.IOP. ERI1RCATEISSUED TOTPECERTtFiCATIE HOLDER A.LIECTFNO WORKERSrOwP-,0VF A0F
*F:;}'AkTNY_R4 AeF t't;VF.Rk3>i=�'TN P WORKERS CON71iN:tATION F'OLICY
CERTIFICATE HOLDER CANCELLATION
!_UNDER ONE RC}C F SHOULD ANY OF THE AROW DESCF48M PoUCIeS BE CANCELLED
HE
BEFORE TEXPIRATION DATE THEREOF,NOTICE WILL B D
:aTT1v hIc7RIv4AN IG}iT: INACCORDANCE WITH THEPOLILYP
:k(?,l- vNJFLt:DRIVE A1ITHOR9-,EO Rt3�A"IE
NIIFTIVA-iN'•INA OI S44
AC6025(201 ) The ACORD name and logo are registered marks o ACORD 11W20101 CORDES ig sSairVQ
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ate` l/LC VV//L//EVIL►YCULL/L VJ L►l LLJJKI./LLLJCLLJ
Department of IndustrialAccidents
u a Office of Investigations
w
1 Congress Street, Suite 100
,= Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): ✓t( J✓lo--A Gau, f
Address: 3 ' --c--01 t 02
City/State/Zip: �-k — w-/.1-5 1 Phone#:
Are you an employer?Check the appropriate box• Type of project(required):
1.[1I am a employer with 4. a general contractor and I 6. New construction
employees (full and/or part-time).* have hired the sub-contractors ❑
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees . These sub-contractors have
8. ❑ Demolition
working for me in any capacity. employees and have workers'
insurance.:
9. ❑ Building addition
comp.[No workers' comp. insurance P•
required.] 5. E] We are a corporation and its 10.El Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13 Z�'bther 2b-
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 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'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: / Expiration Date:
Job Site Address: ( ��/Z✓� l'�1 Z_� 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under i pe pain and penalties of perjury that the information provided above is true and correct.
S4,nature: �GQ�• Q/ 6� "r,� Dat e: '4������
Phone#: °I d °L3�-,75-j 1
Official 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#: