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HomeMy WebLinkAboutBuilding Permit #226 - 15 MEADOWVIEW ROAD 9/25/2006 TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMIINATION • �O A Permit NO: 'Z2,6 Date Received ° # Date Issued:_ 7 ¢rlia-1 ,SSACHIJS�t IMPORTANT: i plicant mus c 11 ete all items on this page PROPERTY OVl'NER LOCATION— Pr l I f M 1( Print ! IAP N(1.-6J PARCEL: ZONING DISTRICT: TYPE AND USE OF-BUILDING . HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building - ne family Addition Two or more family = Industrial L Alteration No. of units: Repair, replacement Assessory Bldg Commercial Demolition Moving(relocation) L Other Others: Foundation Only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: f �G��® Phone: ` IY 6YZ�� Address: f,s /-I CONTRACTOR Name: 6 6\4-1"VN I/A0 ✓i�i%� '/G� Phone: 91 9�6-fd 51 Address: a i '�► �� � j�c.�z"7 ` � S� L '1 SuZ-03 Supervisor's Construction License: ��`� � O Exp. Date: l I IUI17e Illlprw UnlCllt LlCetlSc;:�^� � � � Exp. Date: Z. ARCI-111ECT. ENGINEER Numc: Phone: ,-`address: Rcg. No. FEE SCHEDULE:BULDING PERMIT:510.00 PER,51200.00 OF THE TOTAL EST/11ATED COST BASED On ,5125.00 PER S.F. Total Project Cost S OL:.% x12.00=FEE:$ Check No.: /fd �6l � Receipt N f o. � 5 P.ue l of-! TYPE OF SEWERAGE DISPOSAL _ Tanning-Massage;Body Art Swimming Pools Public Sewer — Tobacco Sales Food PackagingiSales Well - _ Permanent Dumpster on Site Private(septic tank.etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty salt/ Signature of Agent/Owner Signature of contracto Plans Submitted Plans Waived i! Certified Plot Plan ❑ tamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED -DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ J COMMENTS r a Zoning Board of Appeals: Variance. Petition No: Zoninu Decision:receipt submitted }us Planning Board Decision: Comments Conservation Decision: Comments 1\atcr&, Sewer connection.Signature& Date Driveway Permit Temp Dumpster on site yes_no_V Fire Department signature:date Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Re aired Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NO'rGS and DATA—j For department use) I P;t.;r,o1-1 Gi:i:!":VIII C'l;(1.`:,\I.S1=P",ICL:i!)LPAR I MI-N 1'.1 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 Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit o 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) 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 ❑ : -lass check Energy Compliance Report 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 INSP:C IONAL Sr;kvu LS DH:PAR FsuE.v r:a3rrolt1ws �. ..j ��t•7 vet rr.�• _ Location �� - - �-- aq-226vDate r/,* No. � NaRT� TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ �i, J+•.a U MU Eta' Building/Frame Permit Fee $ � ACS Foundation Permit Fee $ Other Permit Fee $ , TOTAL $ Check # ON41 19615 X/1-1 dbii`ding Inspector �A CS M 'u Com , o I JAI r TM 1 Fly •. - - �r xscry; a r at c r o ML 8 `I -�iraFa The Commonwealth of Massachusetts` Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):: y�'^ b--1�12s'�/(/! Address: -d City/State/Zip: j-(-��-i� l'y✓1 ) Phone #: 9�� �c�f Are you an employer? Check the appropriate box: Type of project(required): 1_ am a employer with 4. ❑ I am 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 mein any capacity. workers' comp. insurance. 9. ❑ Building addition o workers'comp. insurance 5. ❑ We are a corporation and its [N P� 101-1 Electrical repairs or additions required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other 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_ lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site information- In surance nformation.Insurance Company Name: /✓l Q Policy#or Self-ins. Lic_ #: r1LJ C ExpirationDate: 1 \ f job Site Address: C':n-o `' OJI C:ty/State/dip: 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 cover;ag�verification. I do hereby cep ify under the Oins and enalties of perjury that the information provided above is true and correct. Signature: Date.- O Phone#: I^ C? S �� 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/Tovvn Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 1 ' 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 conunonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable e *dence 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-contractor(s)name(s), address(es) and phone number(s) along with their certificate(s) 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. Re advised thatthis 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 perrritJlicense 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-NMSSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia 3. aL� MaC�C G� CEQ)CD IF r Chimneys Residential & Commercial Roofing All Types Of Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work I i!-Roof L alts Experts *1 Licensed & Insured ' Mass Toll Free Locally Owned!&Operated Since.1976 =''- License#034200 1-800-WAIT-4-US - V/ (924-8481) IKO® C7& ?Zoon oz�`ohv We Work Year Round Proposal Submitted To Phone Date "-I 4=S � � �Z X 23 8��2� I` ) Streetl Job Name City,State&Zip Code Job Location Job Phone We Propose hereby to furnish and labor in accordance with specifications below, for the sum of: C;✓1 t Jpa c> Dollars ($ 12 6 ). C � All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized ( manner according to standard practices.Any alteration or deviation from specifications be- Signature: low involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents NOTE:This proal may be or delays beyond our control, Owner to carry fire,tornado and other necessary insurance. y withdrawn b us if not accepted within days. .� Our workers are fully covered by Workmen's Compensation Insurance. y We hereby submit specifications and estimates for: ❑ Install 3 feet of special "Eave Seal" ice and water barrier protection along all bottom edges of roof and top to bottom in each valley. If roof is stripped, we will apply conventional ice and water shield ( ) ft. high in the same locations previously described and tar paper will cover the remaining bare wood. Any rotted or damaged boards will be replaced at ( ) per linear ft. or ( ) per sheet of plywood. dInstall heavy gauge aluminum drip edges along every edge surface of each roofline.,?- ❑ Cover entire roof (s) withJE 2- year a It;-eer fibergIass, premium grade shingles (Color of choice). 30 2(( o 041—!7R10(�c= fl,c'cl rzc:7t/n( S�a�,u� Replace all pipe boots where possible. U]Seal all flashings with clear Geo-Cel sealant.No black tar unless previously applied. LJ/Remove all work-related debris. Contractor warrants roof against all leaks due to defects in his workmanship for 12 years under normal circumstances. J"Local current references and proof of workman's compensation insurance gladly given. ❑ Remarks: 151-r4 4 Acceptance of Proposal- The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment Signature: will be made as outlined above. U U r Date of Acceptance: a / Signatu ! -— --..�_-�:- .+=�o ruuea+l� r�4✓r�ia•.�ac�uaef' Kcg::la:iuns aml Standards HOME IMPROVEMENT CONTRA,:.TOR Registratiol:,137057 Expiration: 10/2/2006 Type.. .DBA ALL UNDER R07F JOHN LANZAr ' 166 A NMERRI?,RACK ST. - ..:._-- ✓lie Vr a��vrreoozurea,�� o�.�aaa¢e�zuaeda BOARD OF BUILDING REGULATIONS -W License: CONSTRUCTION SUPERVISOR Number: CS 069120 i ,yygv Birthdate: 04103M959 Expires: 04/03/2067 Tr. no: 10500 J Restricted:-00 JOHN W LANZAFAME f 30 TEMPLE M G— METHUEN, MA 01844 Commissioner NORT1y T0VM Of = : 4 over Z Z� No. z- = o dover, Mass., 2 ' 2 Y 0 LA E GOC MIC ME WICK ADf?ATED IT BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT 414.......���.6 ....VIEW ..�.......... Foundation *............. r has permission to erect........................................ buildings a�.`.......... .... T........ .. ..�.. 1. �. ....... Rough to be occupied as........STMe / .... Chimney provided that the person acceptithis permit shall in a respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-La s 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 940000, PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU TS Rough 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.