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HomeMy WebLinkAboutBuilding Permit #387-11 - 1560 SALEM STREET 11/2/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER �}i2 a�'1-e l Unit# Print MAP NO:LL� PARCEL: , ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes 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 0 Septic ®Well OiFloodpla�ii 4��Wetlands 'Watershed Distri �t -= s t ,I Ct DESCRIPTION OF WORK TO BE PERFORMED: s I/? (Identification Please Type or Print Clearly) OWNER: Name: a16d/I-,(( Phone: q 1r, Address: CONTRACTOR Name: c ��n Lam/-t'�I� ,'� �' Phone: I Address: �� TC'^ (t 0a Supervisor's Construction License: 0(-,9 f 2 :� Exp. Date: f Z 0 l� Home Improvement License: ... /,3/7 © Exp. Date: 2 Z- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.,$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: FEE: Check No.: r� 3 2Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the g ranty fund Si nature iof/A ent/Owner" `' _Signatu[e ofcontractor 3' - i - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/massage/BodyArt ElSwimming Pools 0 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR'OFFICE USE ONLY, .> , INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS j 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 Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date II COMMENTS 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 NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi a 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 i ❑ 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 1 Addition or Decks i ❑ 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 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 I Doc: Doc.Building Permit Revised 2008mi Locationl No. 139 Date �oRTM TOWN OF NORTH ANDOVER P i Certificate of Occupancy $ CMUsE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ y TOTAL $ �33 2- Check # r Building Inspector NORTH 01" otidover �`MM �� to , dover, Mass., Y Q - LAKE COC RICHE WICK V 7�S RATED PPy U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System v K BUILDING INSPECTOR THIS CERTIFIES THAT..........................ok............................ . .......................... .. .................................. .... Foundation has permission to erect........................................ buildings on .......I.�6i............ ��/� !...... ... .........�... Rough � - I to be occupied as.......8 Chimney"' � � the terms of the application on file in that the arson acceP ng hs ermit shall in everN res ecnfoo 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 ( . PERMIT EXPIRES IN 6 MONTHS Final TT TV A ELECTRICAL INSPECTOR UNLESS V LESS CONSC T 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. " ya„ ZFxA, � Residential & Commercial Roofing gAll Types Of CHOM. NEYS POIN E nr=oustT-CAPPED Expert Masonry VVocrk Mass �lT�not1 r�rF, Licensed 8. i,,, r.i 8LQ vYYF� �t j t << !/4' 6), zt 1 ci Plli rt•! tl 1 r J7 i L #0342 (924-848T) W �.PLrsrtrs�xssz �� s�• r" YA7� Year License 00 1 ✓0..`t b i y F;u_ - { �.: ,9 �,,auk .-� r Work r H<>Und 57 r' x s K"` • - .,, - '',��1,it. _-�'t:.';s..,�.� .-.: Y..T :::_: W, Proposal i- Proposal To: Carol Carbonell Date 5/2/2011 Street: 1560 Salem St. 978-688-8147 1 N. Andover, MA Roofro osal { P P caroicarboneli@gmaii.com 'a 1. Protect house exterior and landscaping as best as possible. (tarps etc.) Total COSI: TIE2 2. Strip all shingles from entire roof.3. Inspect and re—nail any loose or lifted plywood.4. Any compromised plywood will be replaced at an Options:additional cost of$50.00 per sheet of 1/2"cdx fir ' Upgrade to 6ble 5. Install heavy gauge 8"aluminum drip edge to all against severe ice dams) ice and water shield. $ eaves and rakes. 200.00 additional cost. 6. Install 6' of IKO Armourguard ice and water • Drill and install round soffit vents with screens shield along all eaves, wall connections and top to in rafter bays of main house and addition for bottom in all valleys. 6'MA state code . added attic ventilation. $400.00 additional cost 7. Install all new pipe boots. 8. Above the ice and water, install 30Ib felt underlay- ment base sheet to remaining sheathing. (not thin 151b) 9. Install IKO Leading Edge starter shingles Balance due upon completion 10. Install IKO Cambridge AR 30 architectural shin- gles to entire roof. Referrals available upon request 11. Install new GAF Cobra ridge vents. 12. Counter-flash chimney with ice and water shield Highly rated member of the accredited BBB and and re-seal. Angies' List 13. Building permit included. 14. Removal of all work related debris. Thank you! 15. Shingles are covered by the manufacturer up to '� s � 30yrs.(Pro-rated after 5 years.) 1" 16. Contractor workmanship warranty=10 years un- der normal wind and rain conditions. cceptance of Proposal--The above prices, sp ifications and conditions are satisfactory and are erby accepted. You are authorized to do the work as sp cified. Payment will be made as outlined above. ate of Acceptance: �� Signature,� Si gn»mrP /� ACC?R0- CERTIFICATE OF LIABILITY INSURANCE70T911/071201i PRODUCER THIS CERTIFICATE IS ISSMD AS A(MATTER OF INFORMATION Perry Insurance Agency ONLY AND CONFERS NO RICi M UPON THE CERTIFICATE 522 Chickering Roel (HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORD BY TME POLICIES BELOW. NOnh Andover.MA 01845 INSURERS AFFORDING COVERAGE MAIC p oavRERA: ATLANTIC CASUALTY INSURANCE JOHN CAN?.AFAME MOURER e. ALAI DBA ALL UNDER ONE ROOF tNSURERc 30 TEMPLE OR METHUEN,MA 01844 INSURER E: COVERAGE$ THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOIAREMENT.TERMS OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SLIS.IECT TO ALL.THE TERMS.EXCLUSIONS AND COND[ *NS OF SUCH POLOES.AGGREGATE LIMIITS SHOWN MAY HAVE BEIM REDUCED BY PAD CLAII01S. T alm YPEOF POLICY!mm* A GENERALLUBMM L1180D0227 9111/2011 9111/2012 EACHoccuFam CE t inn. a0 COWERCIALSAI.LIABILITY �._ Sso.000.00 MADE OCCUR ammazz(-AERP(Anyons Mean} t 2.900.00 PERSONAL A ADV tKNAY S 300 .00 GsENERALAGGR£CiATE 000.000.00 GF-WAGGREGATE ItI+B't APPLIES PER: PRODUCTS.OOMPfOP AGG t 009.000.00 POLICY MPROJLCT LOC AUTOMOBILE LIABILITY C� ANYAUTO (Sa s SMAE LIMIT $ ALL OWNED AUTOS fLMLE SCHEDULED/WTO& (P80Oer peYrson)NRY HIREDAUTOS NON-OWNEDAUTOSay r 1RY t PRO��OIA0.b�flE g GARAGE LIASWTY AUTO OI&Y.EAACCOENT S ' ANY AUTO mum EAACC S AUTYS QNLY AOGa s EII0E8OKMABREL.LA LtAWLITY EACH OCCURMI"Ice OCCUR Q CLAWS MADE AGGREGATE t DEDUCTIBLE E RETENTK)" $ 9 B Ew a TION AND AWC70MM64012010 11/09/2E111 11109/2012 TOR1rLaSIss ER AW EfcCLUOM CUTIvE E L.EACH ACCIDENT $MAW= dy CetsriDeunOar EL 13WASE-EAEAtPLOYEE „S 100,000.00 Sp CU1l PRDV45tON3 oerow E.L.OISEASE.POLICY LANT .S 5000[10.04 _, OTHER CERTIFICATE HOLDER CANCEL"TION SHOULD ANY OF TME ABOVE DESCRIBED POLICTEE BE CANCELLED BEFORE Tie EIdPIWATI DA►e thea THE:A�u»RI�It vntt EI�EAvoTi ra wvt i Q DAYS rtaetTtl?t tA/CS`T NCW t2!10V RAA A 1 tbrS NOTICE TO THE CERTWICATE HOLDERMWED TO TME LEFT BUT FAILURE TO 00 90 Smth. tr�iti L Page 1 of 1 8/2612011 1239:38PM I �I.r,,.r.hu,rll, l)c)rdrfur�•rt! ��! hulrlr� gal;t �- Board of t3uildin'-, and "taudaro, Construction Suoervrsor ;_rcens= License' CS 69120 JOHN W LANZAFAME 30 TEMPLE 1R METHUEN, MJF 01644 -� EAprrateon.. 41W2013 i Tfp# 14108 vZa O )ice of Consumer Affairs and �usiness Regulation 1 Q Park P) aza - Suite 5170 Boston. Massachusetts 021 16 1.1onle 1nTrovement Contractor Registration Reaistration. 13706 r ;vpe DBA ALL UNDER DNF- ROOF Expiration 10/212012 fro 204,12: JOHN LANZAFAME 166 A MERRMACK ST. METHEUN. MA 01844 Update Address and return cara. :Mark reason for r hnnLc. Address Renewal l,mptnvment l.0+r f crrd f The Commonwealth ofMassachusetts Department of IndustrialAccidents Office of Investigations, I Congress Street,,Suite 100 Boston,MA 02114-2017 www.mass.gov1dia Workers? Compensation Insurance Affidavit:.Builders/Contractors/Electricians/Plumbers A�Iplicant Inf®rmation Please Print I�e�ibly Name(Businessiorganization/Individual): Address: Ci /State/Zi c�12vJ C-1 Phone t5' p Are you an employer?Check th appropriate box: Type of project(required): 1. I 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 g. (]Demolition working for me in any capacity. employees and have workers'comp. EJ Building addition [No-workers' comp.insurance comp•insurance 5. ❑ Ade are a corporation and its 10.❑Electrical repairs or additions required.) . officers have exercised their 3.® I am a homeowner doing all work 11.E]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repair insurance re aired. t c. 152, §I(4),and.we have no q } employees. [No workers' 13„�Other U 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. TContraetors 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. -1 am an employer that isprovidin.9 workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: — �atr/� Policy#or Self-ins.Lic.#: /1`^S C 0414 Zit" Expiration Date: Job Site Address: S"C S/Yl Sri City/State/Zip: O1 r SLS 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 risonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine fine up to$1,500.00 and/or one-year imp 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. Ido hereby cerinfy under the ai s acid enaldes of e 'ur-y that the in orma ion provided above is true and correct Si ature: –77 - --- –-- -.113a S -- ----� Phone#: 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): 1e Board of Health 2.Building Depa ent 3.City/'I'own Clerk* 4.Electrical Inspector 5.Plumbing Inspector 6.®that Contact Person• Phone#•