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HomeMy WebLinkAboutBuilding Permit #1155-2016 - 137 LANCASTER ROAD 5/16/2016 BUILDING PERMIT of NORTH{ q ��t�eo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION n0 ~ Ob Permit No#: Date Received gSSgA EO CH11`,���y 4 Date Issued: M ORTANT: Applicant must complete all items on this page LOCATION /3 _ Print PROPERTY OWNER 3A l4 Print 100 Year Structure yGno MAP PARCEL: ZONING DISTRICT: Historic District Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building t,4bne family ❑Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: s Identification- Please Ty a or Print Clearly OWNER: Name: 1'►M , s S'4 - -A , Phone: Address: 3rI h✓l SS/� Contractor Name: 6&�xv\- Phone: Email: 1510 81 Aa %osa 0—&" Address: 3 z, T-f--\a/-e— 1,74 K�0-r� oo'49-5 c Supervisor's Construction License: C) tZ-�E> Exp. Date: Home Improvement License: l s 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: $ a ®° FEE: $ �� Check No.: `Q y- 1 Receipt No.: ?)6 NOTE: Persons contracting with unregistered contractors do not have access t e gu Yanty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ 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 ConnectioniSignature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 ,,FIREDE3PAk yes Ino Osgood RTMENT TemDumpserronisity Nit di aDepart,rnenSi gnature/dafe� w4 G.OMMENTS', __ Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 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.$100-$1000 fine j • I NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department F 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 OTE: 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 46 Copy Of Contract Floor/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 2014 NORTH Town of Andover qn No. Z61 � t Z2' Y O IAKt h 1 ver, Mass, at, COC NIC Kl WICK � S V BOARD OF HEALTH Food/Kitchen R M T T L U Septic System THIS CERTIFIES THAT ....... 1 ....... .. BUILDING INSPECTOR ft Foundation has permission to erect .........&............... buil ings on ........ Rough 4:5 tobe occupied as .................�.. .......... ..... .... ........ ................................................................ Chimney provided that the person accepting this permit 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 CONSTRUCTION VARTS Rough 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. i, Chimneys Residential & Commercial Roofing All Types Of Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work Mass Toll Free r*Roof Leaks Experts Licensed & Insured Localiy Owned& Operated Sitzce 1976 1-800-WAIT-4-US .. License#034200 (924-8487) IKO® ez&' wozm oz john ' ` We Work Year Round .._._. _._. __ _ _ (�,f 1`l^:.7�`I�IV.wI lar=d �1`{Ll•�jfj�] Proposal To: Melissa Taylor Date 3/16/2016 Street: 137 Lancaster Rd. 978-375-1194 N.Andover, MA Roof proposal missle857@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. 13. Building permit included. 3. Inspect and re-nail any loose or lifted plywood. 14. Contractor workmanship warranty: 10 years Any compromised plywood will be replaced at an under normal wind and rain conditions. additional cost of$65.00 per sheet of 1/2" CDX fir. 4. Install heavy gauge 8"white aluminum drip edge Total roof cost: $ 21,600.00 to all eaves and rakes. • Option: Install (1) new stainless steel custom 5. Install 6' of IKO Armourguard ice and water chimney cap to rear chimney covering entire shield along all eaves and top to bottom in all top crown. $450.00 additional cost valleys. Front and Rear trouble areas: Remove existing siding, corner boards and any • IKO Shield Pro Plus Extended MFG warranty: compromised material as needed. Install new A-full 100% coverage on material, labor and sheathing as needed. Install full coverage and debris removal for a full non pro rated period counterflash entire wall with WR Grace of 20 years. Included to our local referrals (Industry best) ice an water shield and new (Marc Perry) and in this proposal at no aluminum step flashing. Not responsible for additional cost. re-installing siding or corner boards. 6. Install IKO roof guard synthetic underlayment to *Note*: Please be advised if applicable, valuables in remaining sheathing up to ridge. the attic should be moved or covered due to minor 7. Install all new pipe boots. debris, dust and asphalt particles that will accumulate 8. Install IKO Leading Edge starter shingles to all during the stripping process. All Under One Roof not eaves. responsible for any damage or clean up that may 9. Install IKO Cambridge Limited Lifetime occur in attic. architectural shingles to the entire house. 15 year non pro-rated warranty by mfg. (See warranty Balance due upon completion, no deposit required! info) All shingles will be installed and fastened according to mfg. specs. References available upon request 10. Install a new GAF Cobra ridge vent capped with color matched IKO hip and ridge shingles. Install Highly rated member of the accredited BBB and all new square static vents on rear main roof. Angie's List 11. Counter flash chimney lead, wall connections and skylight with ice and water shield. Seal with clear Thank you! Geo-Cel sealant. i The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mas&gov/dia Yorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ,,/J Please Print Leeibly Name (Business/OrganizationnMividual): A/ (fr vl� C Address: , City/State/Zip: &1-43 i%10 Phone#: '91Y "J'_ Are you an employer?Check the appropriate box: Type of project(required): 1.❑1 am a employer with employees(full and/or part-time).' 7. E]New construction 2.a 1 am a sole proprietor or partnership and have no employees working for the in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.0 1 am a homeowner doing all work myself.[No workers'comp.insurance required.)t 9. ❑Demolition 10 Q Building addition 4.E]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 arc sok 1 I.Q Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5J*a general contractor and 1 have hired the sub-contractors listed on the attached she". 13.E]Roof repairs 7lresc sub-contractors have employoes and have workers comp.insurance.[ 14.(]Other RiS�� 6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4X and we have no employees.[No workers'comp.insurance required.) •Any applicant that chocks 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 hue outside contractors must submit a new affidavit indicating such. :Contractors that check this box mast attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employocs,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.#: Expiration Date: Job Site Address: l V / / City/Statc/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 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 5250.00 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 u der thus penalties of perjury that the information provided /e ' blue/and correct Si afar : Dat : ✓` T Za� b Phone#• Official use only. Do not write in this area,to be completed by city or town offieiaL 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority" Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 Tel. #617-7274900 ext.7406 or 1-877-MASSAFE Fax #617-727-7749 Revised 02-23-15 www.mass.gov/dia CERMIFICATE OF LIABILITY' INSURANCE 17= �� 5 DORS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO?DER, THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR -NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES yLOV;, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(a'), AUTHORIZED :MESENTATIVE OR PRODUCER AND T14E CERTIFICATE HOLDER. t MPORTANT; If the CerttfiCBte holder IS an ADDI•F•IONAL INSURED,the poficy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the srss and conditions of the policy, certain Policies may require an endorsement A statement on this certificate does not confer rights to the eI icate holder In Ileu of such endoNement(s). l t13UCER — CONTACT NA-11B, Berkle Assigned Risk Services I?Ilve ai Insurance Agency Inc FANAx 74Umont St M.r3 . 804 534-4589 IAIC.Na). 856 215-8118 �aroester, MA 61604 �o IMSs: P0l=cys8f ;eS2berkla1rI-4i.com INSUXER FFOR LVQCOVERAGE NAI d Ir Lit 31325 v.riilrtc0 IAC Construction Inc LILRER e: Ik1;UR[R C: •%��ng7>esa$i: INSLG2EP,0 ., �6fo�rd, rY7A 097x7 �MIRER e. INSURER F: -S,VC-RAGES _ CERTIFCATE YUaISER: __ ___ F VISIQN itU'.1t3ER: f{8 {u FO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN lSSUEQ TO THE{t$1}RED NAPAED ABOb E FOR THE POLICY PERIOD NDICATEO. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH ^ THIS ERTtFtCATE MAY'8E ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS QF SUCH PQ CIEZ.,WAITS SHOWN MAY HAVE BEEN REDUCED BY PAID C LAIFAS. jR TYPE OF INSURANCE {NSR 1EIL Ub; POL{CYNUtd R OLIQ POLI.Y uT WAFTSRTl41DDlYYY kiJDDIYYYY +OF.NEFAL—LIABILITY AUTO I,OBILE UAIITUTY $ WORKERS COMPENSATION WC STATU• 0TH• AND EUPLOYERS'LIASILITY car 4 TORYLIr'lT5 ER ANY PROPRIETORIPARTNEfnQcCCUT(V9 f i,D00,000 �• OFt*ICERJ EFASER EXCLUDED? Q run Q IIVC-2a-20-tlt�s&6MO 0312012015 EL EACH ACCIDENT $ .,... iLmndatory In HN) II 40520/2016 Ii ye!•delt6be mdef 4 1 E.L OISEhSE-EA EA1P OYEE S 1,000,000 DEGCRIPTDN OF,OPERATIONSbote^j _ ,� ,• t!!!i .L ❑t AS _p0 IC !!K 1.�D�.Q�� 3—�R,pTtoN Of ortl7A.TIaNS F LGCAT tGt,1[:{V&HtLLE�1 Waxstl A.O$to tot.Addiu.ml ROI—hs Sshedntr,d hofe SAGO utsttustdr Coverage. lm Category Elect.Status Nems State(S) ( ) NI F1IdLs5 l.ntat#©rte_ ¢ZfTMcer Include Maria Gunman N1t 1`J1GG Construction Inc 83 congress St Milford,MA 01757 dtRI1FfGATE HOLDER CA14CELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPtRATiON DATE THEREOF, NOTICE WILL BE DELIVERED IN X11 Under One Roofing AUTHORIZED WITH.THE POUCX PROMNSIONS. U HO 12 NT ,IV ED Temple St ,*thuen, MA 01844 :QRQ 25(2010/051 WORKERS COMPENSATION ANO EMPLOY RS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insura ce Company 54 Third Avenue, Burlington, M ssachusetts 01803.0970 (800) 876-2 65 NCCI Na 28158 POLICY NO. AHC-400-7009484-2015A PRIOR NO. 'gWG400- 6 4U.R-- ITEM 1. The Insured: All Under One Root' DBA: Mailing address: C/O John Lanzafame 30 Temple Drive FEIN:•-*"8251 Methuen,MA 01844 Legal Entity Type: Sole Proprietor Other workplaces not shown above: See Location 2. The policy period is from 11/09/2015 to 11/09/2016 12:01 a.m.standard time at the insured'-$mailing address. 3. A. Workers Compensation Insurance:Part One of the policy Ippiies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applils to work In each state listed In Item 3.A. The limits or liability under Part Two are: Bodily Inju by Accident $ Bodily Inju by Disease g "---- 100,000 each accident Bodily Inju by Disease $ "" 500,000 policy limit ,�•„• 100,000 each employee C Other States Insurance: Coverage Replaced by Endorse ent WC 20 03 Ota B D. This Policy includes these Endorsements and SchedulesLSCHEDULE 4. The premium for this policy will be determined by our Manualsications,Rates and Rating Plans. All information required below is subject to verification and ch;; PremiRates ---- Code Estimat kd Per$100 �� No. Total An ual Of Estimated ~-- ----••-- Remunertltio Remuneration Annual """—'— -- Premium INTRA 174366 i i INTER i SEE;CLASS CODE SCHEDULE Minimum Premium mW - - To al Estimated Annual Premium GOV . GOV De osit Premium STATE CLASS MA 5474 S# to Assessments/Surcharges $1 .00 X 5 7)500% $1 This policy,including all endorsements, is hereby countersigned by --� uthorise signature ..10/05/201.5 Sate Service Office: 54 Third Avenue P rry Insurance Agency LLC Burlington MA 01803 5 2 Chickering Rd,Rt 125 N rth Andover,MA 01845 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on compensation Insurance, usod with Its permission. Massachusetts -Det:artrns,it or Board of Building Reguiatic^ ;;; Cun:tructiun supcl.0"411• , License: CS-069120 ' • ttt� , j %% JOHN W LANZA� `. 30 TEMPLE DRS til METHUEN MA 61844' �ainm;ssiot icy 04/03/2017 Click on the registration number to view complaint history.You can also view arbitratl4nand Ou�,ran y Fund his. tory. The list is current as of Wednesday, October 8, 2014, Search Results REGISTRANT RESPtitrtStE&E REiGISTRAZOIl t313RTc5S EXPIRATION QSTATUS NAME INDM.DUAL NtI81SEiR DATE ALLUNaERONE RooF LANZAFAtitlE. 137057 166 A MERRIMACK ST 10/02/2016 Current JOHN METHEUN,MA 01844 . 02012 Commonwealth of Massachusetts. Mass.Gov®lea registered servloe mark of the Commonwbalth o€Massachusetts;. ,nmrnnt,t Location No. i ` �}? 2 L) T Date `� / 1 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $------ TOTAL $ Check# � Building Inspector J aJ.J �i