The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #760 - 163 OLD FARM ROAD 5/18/2007 vt0RT#y BUILDING PERMIT TOWN OF NORTH ANDOVER ?tb:y''. Z. APPLICATION FOR PLAN EXAMINATION10 4 Permit NO: �i- Date Received Date Issued: 6�a 9SSACHus�� IMPORTANT: Applicant must complete all items on this page L0`0 '166 l , 1' x PRC3 'EYOWN -� MA1 �C PARA L: lNG p t„TROTS M: Ht C DIST q a no ::u'f TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building A One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Sttp ".0 Well fX C�td dpin ��etlnds 1tVters€ I tstrict �,WatrlSewer x �� a r / a F, DESCRIPTION OF WORK TO BE PREFORMED: dentifi cationle ase Type or rant Clearly) OWNER: Name: 7ay C[--, Jy Z- Phone:13 V Address: OLS 9 .o%W1P-1 CIS / �CCNTE +CTtJR Nar Ad"doss gpl tt ert S U; - r l.tJ•' t� l e��J�i.s.. .: k- ac t�. Hame 1'nip-:,V ent .. !ase �t � ` �' Ex ate ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COS�TBASED ON$125.00 PER S.F. Total Project Cost: $ �S , o�b�- O FEE: $ 1 1 9 Check No.: S-f Receipt No.: CQ O NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Slgnattare of. Agent/Owr�er S�9naturntr, e of coactor. µ. E Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street no FIR��t�EPART�UI�NT� Tel�lp � �npster�n site �Cai4 a MdII SS, r40" Fire D �� rtm t sllgnatVitro, �E CbMMENTS ti 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 ................. .....................................................................................................................- ............................................................ Doe.Building Permit Revised 2007 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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 AC RSD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 1 P"Q0"`'E" 11 io9/2006 lntemet In3urance Agenco y CERTIFICATE ISSUED AS A MATTER OF INFORMATION 522 Chickering Rnad INSuRM Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEIt North Andover. MA 01845 R THE COWRAGE AFFORDED BYCERTIFICATE DOES TTHEEPO�ICIES BELOW. INSURED RS.AFFORDING COVERAGE _ NAIC It JOHN LANZAFAME A- NORFOLK A DEDHAM INS —NSE COI,4PANY DSA ALL UNDER ONE RO%)F e: AIM30 TEMPLE OR - --- METHUEN. MA 01$44 NSLIREP._D_ — COVERAGE! �NSUi PER E ---_—.—_ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT DR OTHER DOCUMENT WITH ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES OESCRISED HEREIN I..SUBJECT TO SPECT TO WHICH THIS O SFICATE MAYBE ISSUED MAY POLICIES.AGGREGATE i.:MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH LTR OM TYPE OF BISURAMM A GpIQAt LaMurr POLICY 201550636 6/3/2006 Ways COMMERCIAL GENERAL uASILIT? I I 6/3/2007 EACH OCCURRENCE _ I.000.000.00 D CLAIMS MADE Z OCCUR ' P0,0C - MED EYP(any one pe sari— f 5.0G0 W - .................................. 1 PERSONAL&A INJURY S I,000.QOC GG GEN'L AOOREGArE LIMITAPPLIcS PER. GENERAL AGGREGATE _ !.r0,OQ0.00 POLICY PROJECT LOC PRODUCTS-COMP/OPAGG S 2.000.040.00 AUTOMOdLL°LIAIBITry -- AMYAUTO I COM8INEDSIKiLI LIMIT ALL OWNED AUTOS ( I (Es a�eadenq f SCHEDULED AUTOS BUOLLYINJURY HIRED AUTOS (Per AMsmn l ! NON-OWNEDAUTOS BODILY INJURY - /Per axiden;) S _ PROPERTY DAMAGE GARAGE L&*AkM (Per&Woerd) L I ANY AUTO AUTO ONLY.EA ACCIDENT t OiH�R THAN EA ACC IMESBlUMBRBLLA IJA&LtTy AUTO ONL Y. OCCUR CLAIMS MAOE� EACH OCCURR�AGG S. S I AGGREGATE DEDUCTIBLE + r RETEMION �"_^- f ��p�� _ !< 11i UA �TIONAND AW C7009464012003 11/19/2006 11/912007 S ANyPR0PR1ETowPAHrNERfEXECUTR;t To YLIMI B nFF'CER/AIEMRER L•XCLt+0ED9 ER MYss�iIOsunOsr• E.L EACr,q�IOENT S 1Q0,000 GJ SPECtAt>'ROV181ONSGsww OrSD$lf:: EAEIIPLOY t f IOQ,000.L'0 OTWA _ E L DISEASE.POLICY LIMI- f 5Dt.y00 OG rnFICATE BOLDER CANCeLLRTION SHOULD ANY OF TME ABOVE DADBSCRRIED POLICES BE CANCELLED BEiJRE THE hof,THE B18LANG Nrs vLMRAnoN URBR YY{LL ENDEAI►OR TO MAIL 30 DAYS""TEN NOTICE TO Tm CBRflFICATE HOLDER NAMW TO THE LER,AUT FAtlyf TTO DO BO lNALy qH ON LtABILITy OF ANY"a Lou,TIE INSURER.ITS AGENT!OR AUTHORIND REpftSENrATi11E .. ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UIP. 600 Washington Street Boston,MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information t \ Please Print Legibly Name(Business/Organization/Individual): Gart2/a�/a�� Address: 8 .C� City/State/Zip: Phone#: Are employer?Check the 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.t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp,insurance. 9. ❑Building addition [No workers'comp,insurance 5. [1 We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL i l.❑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' comp.insurance required.] 13.[:]Other *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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site information. Insurance Company Name: -r-m /'t U TS 4 1 Policy#or Self-ins. Lic.#: C- 6 b C� Expiration Date: Job Site Address: 6 8l'Q ��>� �. City/State/Zip: /v A 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 the airs and p nalties of perjury that the information provided above is true and correct. Sip,nature: Q9VDate: -s- / 0 `7 Phone#: / °� - - Official use only. Do not write in this area,to be completed by city or town officiai 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#• RTH Town 0 sM, 4 over No. M0 L ICHEW1 Cass,s— COCH ?* dover., 7,9 PS` 04ATED A5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System PTW. C BUILDING INSPECTOR THIS CERTIFIES THAT........ 06ow 0?6(4 .............................................................. .... . . ... ...... Foundation has permission to erect............... buildiggs on ... ........04....... F.0%.......Re(....... Rough 2 Chimney to be occupied as........... .Etl . . ...... ...........1�..0.. ................................ .....ti AA 0 provided that the person acceptin 'this: p�rm s all in every resp I onform to the aI t h e a ppI I catI on'*o*on le-in so 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 q V UNLESS CONSTRUCTION AR ELECTRICAL INSPECTOR ON TAR Rough ..... iuj�ii .................. .... ....................... ....... Service d' i6R 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. 0 q 3 Sam— A AIM p Chimneys Residential & Commercial Roofing Siding CHIMNEYS POINTED-REBUILT-CAPPED All Types Of Expert Masonry Work Mass Toll Free 'I'Roof Leaks L`xe� �' Licensed&Insured�� 1-800-WAIT-4-U$ Locally Owned&Operated Since J 976 �" IKO0 sS License#034200 (924-8487) `-��e yloxm O �ajlif bM� We Work.Year Round Proposal Submitted To— Phone C/ Date Street Job Name 8 /?,1 City,State&Zip Code �o Job Location /7 J!-� �A 01JP S Job Phone We Propose hereby to furnish and labor in accordance with specifications below,for the sum of- L42a'l OM G- 4/ LWO 07 �6"'" L�J.gf N Dollars (S �d6 16 0 j 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 pr may be or delays beyond our control,Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within '-days. We hereby submit specifications and estimates for: Al acar stall 3 feet of special "Save Seal" ice and water barrier protection along all bottom edges of roof and top to bottom in each valley.&roof is Stripped, we will apply conventional ice and water �.,, _ p Y a er 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 (ST. per sheet of plywood. C/0 k, Q'Install heavy gauge aluminum drip edges along every edge surface of each roofline. 9-' MCover entire roof (s)wit s, premium grade shingles (Color of choice). �- CCJG��=Sa .t't a s _ ) �"C. .btu ,3�� G�vwr. Q-Ae lace all i Ali��L�C;� p pipe boots where possible. 4Seal all flashings with clear Geo-Cel sealant. No black tar unless previously applied. U(Remove all work-related debris. Contractor warrants roof against all leaks due to defects in his workmanship for 92 years under normal circumstances. E(Local current references and proof of workman's compensation insurance gladly given. idRemarks: -aT TPI s MI Gam/" C a a11ia t) oc- Tc o -To S-A(r Cds�'nft C�'t 8`'f P��jCr� `S'at l'i'ao f" t/eN 7– Acceptance 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 Date of Acceptance: above.7, Signature: �� B(oa�ui ing egul ions an# rniaddWargSO4' One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Construction Supervisor License License CS: 69120 Restriction: 00 Birthdate: 4/311959 Tr# 11855 Expiration: 41312009 JOHN W LANZAFAME 30 TEMPLE DR METHUEN, MA 01844 Update Address and return card.Mark reason for change. Address ' : Renewal Lost Card ✓a o t mg` egu}a+t{us tan and Construction supervisor License License: CS 69120 Birthdate 4/3/1959 Earprfabtsn - 1312009 Tr# 11855 -' "�� fEestticbpn 00 JOHN W LANZAfA[itE �.•G - —y�`� 30 TEMPLE DR METHUEN,MA 01844 Commissioner LLocation No. Date �oRTM TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s,+cMust 9 r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #��S 20226 Building Inspector