Loading...
HomeMy WebLinkAboutBuilding Permit #196-14 - 164 MILL ROAD 9/3/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �A Date Received Date Issued: / IMPORTANT: Applicant must complete all items on this page / LOCATION Pn PROPERTY OWNER_ _.. I`�I_ �f"Aeg4- J$g - Pring 100 Year.Old Structure,% yes., no . MAP NO'111�7PARCEL:._ .. ZONING DISTRICT:. Historic,bistrietiyes no -. Machine:S.ho:pYillage. 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 ❑ Septic ❑Well, ElFloodplain 11 Wetlands, ❑ Watershed8istrict9 . Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTORName - � J,��J Z� ,TPhone:_ 'Address-,' :J� - •d+ lft Su ervisor°s, Construction License: `Ze`j)` p C �2 Exp , Date: - Home Improvement'License: s Exp. Date:' ,:t Z ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ /0 ;7,©O Check No.: 166 2— Receipt No.: -2 r-570'�) NOTE: Persons contracting with unregistered contractors do not have access to e guara ry fund Signature.of Agent/Owner Signature�of�contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 11 amped laps ❑ 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 o Building Permit Application o Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application u Certified Surveyed Plot Plan Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable)- o 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) Li Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract o Mass check Energy Compliance Report o 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: Doc.Building Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ElTanning/MassageBody Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ f THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on _ Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlrecei t submitted yes —Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town ]Engineer: Signature: Located 384 Os ood Street FIRE DEPARTMENT = Temp Dumpster on site yes no Located at 124 Main�Strdet Fire Depa'rtment-signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Motor 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.$10041000 fine NOTES and DATA— (For department use ® Notified for pickup - Date € f Doe.Building Permit Revised 2010 Location No. o f y Date o - TOWN OF NORTH ANDOVER �,. .. Certificate of Occupancy $ Building/Frame Permit Fee $ �IXJ >r r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 26800 ilding Inspector t%ORTH own of u ndover 0 o �AKf h , ver, Mass, coc"Ic„ewocw '►. 0, �TED ►`PP`��y U BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System �� Z Cjr THIS CERTIFIES THAT .. . :... ..........Q...Y.....................,. ,,,,,,,,,,,,,,.,,,,,,,,,,,,,,.,,,. BUILDING INSPECTOR ................................. has permission to erect ,,./ � ,� � Foundation .......................... buildings on ...... ...��.': ................. .................................... Rough to be occupied as ......... � ...7�:.. &.14 ............. ................................................................... Chimney provided that the person accepting thispermit 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 Final 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 TARTS Rough Service BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. IFSEE REVERSE SIDE Smoke Det. =»kr r ZA Residential J otri Roofing All Types Of 1. CHIMNEYS PONT OD REBUILT-CAPPED Siding ,xpei-t Masonry Work Mass Toll Free * ' . Licer)se;d & insured 'I-800-VVAI,-_4-1, r.,<, rJla c�;vnf�� : r�, i,rc cr.Sr ... .i i76 c License#034200 ir, °, ex � � Ursa � = sd (a24 848�� �-"'�`•.�,.m.,,,,0 We. Wcnrlc '9'eas ]Round C . �g�.';r�'�.�'•�.�` s �"�""` y"' y� .r� s `�'� �'at � }„ 'eta ie� � 4"`` �,: n � � � "� �� r� E°tifr ��� °� y "Ikvt1� r � ,�4,sr� � "� '� � x a �s b .�".�" '� 1,.s�,„r 3 "d'' - �•�2x. � 3 ; „« f Proposal To: Bob Moore Date 7/15/2013 Marianne Langston Street: 164 Mill Rd. 508-509-9440 N.Andover, MA 978-852-3843 Roof proposal bobmoore01845@verizon.net 1. Extra caution will be taken to protect house 12. Removal of all work related debris. Planks will be exterior and landscaping as best as possible. placed under dumpster to prevent any damage to (tarps 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 under 4. Any compromised plywood will be replaced at normal wind and rain conditions. an additional cost of$55.00 per sheet of 1/2"cdx. 5. Install heavy gauge 8" white aluminum drip edge Total cost: $ 8,900.00 to all eaves and rakes. 6. Install 6' of IKO Armourguard ice and water *Note*: Please be advised, valuables in the attic shield along all eaves. should be moved or covered due to minor debris, dust 7. Install IKO roof guard synthetic underlayment to and asphalt particles that will accumulate during the remaining sheathing up to ridge. stripping process. All Under One Roof not responsible 8. Install all new pipe boots. for any damage or clean up that may occur in attic. 9. Install IKO Leading Edge starter shingles to all eaves and rakes. Balance due upon completion 10. Install IKO Cambridge ARLimited Lifetime architectural shingles to all roof lines of entire References available upon request house. 15 year non pro-rated warranty by mfg. All shingles will be installed and fastened Highly rated member of the accredited BBB and according to mfg.specs. 11. Counter-flash existing chimney lead and skylight Angie's List flashing with ice and water shield,tie into new Thank you! shingles and seal. 12. Install a new GAF Cobra ridge vent capped with color matched IKO hip and ridge shingles. Acceptance of Proposal—The above prices, specificz tions and conditions tisfactory and are herby accepted. You are author i ed: do the work as specifi d. Payment wi be m d as out ' ed bove. Date of Acceptance: a Signatur . . Signature: AC40RDI' CERTIFICATE OF LIABILITY INSURANCEDZi( 10104/2012 F52NWOrth DucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION tty Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Andover,MA 01845 2 Chickering Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC t INSURED IN$URERA- ATLANTIC CASUALTY INSURANCE JOHN LANZAFAME INSURE e: AIM DBA ALL UNDER ONE ROOF INSURER a 30 TEMPLE DR INSURER D; METHUEN, MA 01844 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED SELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING CO (M ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE(MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. AMM eISRO TYPE OF WSURANCE POLICY MUMBER wimimmmLumn A GENERAL LIABILITY L118000227 911112012 911112013 EACH OCCURRENCE s 3W.000OD ✓ COMMERCIAL GENERAL LIABILITY PREMISES Ea axurence $5a ow OD CLAIMS MADE � OCCUR _ MED EXP(Any one person) g 2.50000 PERSONAL&ADV INJURY S 3W.000.OD GENERAL AGGREGATE b W0.00D00 GEN'L AGGREGATE UPAITAPPLIES PER: PRODUCTS-COMPIOP AG--GS 00 POLICY PROJECT LOC AUYORKNRLE LIABO nY ANY AUTO (E COMBINED SINGLE LOW $ a acdden ALL OWNED AUTOS -- SCHEOULED AUTOS BODILY INJURY $ (Per person] HIRED AU'T'OS NON,OWNED AU TOSBODILY INJU 'VIRY S (Per aaAtl PROPERTY DAMAGE $ (Por.dw) GARAGE LIABILITY ANY AUTO AUTO ONLY-EAACCIDENT S 71 OTHER THAN EAACC S AUTO ONLY AGG $_�— EXCIESSnalIBRELLA L IABUTy OCCUR Q CLAIMS MADE EACH OCCURRENCE AGGREGATE S DEDUCTIBLE ' RETENTION 3 $ B WORKERS COAAPENSATgN AND S EMPIOYetSLTABILITY AWC70Q946441201Q 11109/2012 11/092013 ✓ TORY LIZ' ER ANY PROPRIET TNER1EXECVnVE OFFICEREL EACHACCtDENT S Imo. : A�fEMBER EXCLUDIEDj _ E-L DISEASE- A EMPLOYEE $ too.0000D `� srvl�'�`DN$sero» _._.. OTHER E.L.DISEASE-POLICY LIMIT S 500.t]Of1 o CERTIFICATE HOLDER CANCELLATION SSD ANY OF THE AS7VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OATE THEREDF THE ISSUING INSURER VOLL ENDEAVOR TO MAIL 10 DAYS WRITTCN NOT'CE To THE CERTMICATE HOLDER NAMED TO THE LEFT,BUT FAILUr TO DO SO$HALL IMPOSE NO OBL.IGATWN OR L1ABp17Y OF ANY KIND UPON THE IN ITS AGENTS OR lTATtUES. AUTHORIZED REMMSENTATIVE C7—7--- ACOM 25 f=l=) IIICC T 1 t t,nSurttc,! \I*Iajf-� & Business RC2UIatxui - Mass tin\ .. �. r e Official website o±ine Tice of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation {� ,rtaa .., ,„r,rr r1r -- Ir7tprovB/Hent COntractinp Home Improvenaent Contractor Registration Lookup You can search;filte the registration lift by any of the criteria below. Search by Registration Number 1137057 Search} Search by Registrant Name Search by City ! Zip Code — Search Registrants '.kk on the reglstran:m number to view complaint history. You can also view arbitration and C,cjarar,ty Funu nt ry The list is curre)t oi, of Thursday, September 20, 2012. Search Results REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION ADDRESS STATUS NAME INDIVIDUAL NUMBER DATE Al; !iNDER ONE POOf (_ANZAFAME. 137057 166 A FINACHARO 10102,2C 14 Current IOHN BUILDING METHEUN, MA 01844 2012 Gornrnonwi-a;vi t;: massacriusem / p @Q}� 7���pp/� Mass Gov?;is a reomtereu serviCe Mark el tho COMIT10AW@®11h of MAISA 906 � 1 Massachusetts 'tom=>arinient of Pui311c Satety , Board of Building Reauiatlons and Standards r +?T+ii"ti,o,-n 1{njwrx i-ir +cense C&069420 JOHN W LANZA 30 TEMPLE DR NMTHiiEN MA 81944,, The Commonwealth ofMassachusetts - Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/clia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Pit V Y16Le/1 d 1 -(-- ! a Address: ,L City/State/Zip: �'l�'lJ"t"'� tWIZf Phone#: L 70 �� J /. Are you an employer?Check the appropriate box: Type of project(required): I. a employer with 4. ❑ 1 am a general contractor and I 6 ` employees(full and/or part-time).* have Hired the sub-contractors . E]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. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [N-oworkers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurance required.]i employees.[No workers' comp.insurance required.] 13.0 other *Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they 3're doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showingthe name of the sub-contractors and their workers'comp.policy information. I am an employer that 1sproviding workers'compensation insurance for my employees. .Below is thepolicy andjob site information. Insurance Company Name:. ( hm /;p UTW Policy 4 or Self-ins.Lic./ ionDate: Job Site Address:— / b t 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 requiredunder 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$250.0 0 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 cer•ti nde tae pains 7 ndpenalties ofperjuiy that the information provided above is true and�correct, - Sinature: q Date: 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): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.EIectrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: 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 ofhire,• express or implied,oral or written." An employeY is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a j oint 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 ofpublic 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 cheoking the boxes that apply to your situation and,if necessary,supply sub-contractors)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 au LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 andprinted legibly: The D epartirient fias provided a space afi the bo Loin 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 permithicense 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 maybe 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 burn 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: Tho CQmmonwea>tf�o Tassa.,rhusefts Dep.artmeut of fadustdal.A,ccidelit, Moe oifJ"eWgat io.xts 6,Q 0 Wmhiugtot�S txeet Bos#on}SIA.Q�X x� `QL#617-727-4900 eYd 406 ox 1-8,77-MASSA F- F, Revised 5-26-05 FaX 4 617^72,7-7749