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HomeMy WebLinkAboutBuilding Permit #635-2017 - 17 QUAIL RUN LANE 12/13/2016N.otbBUILDING PERMIT oo ow o TOWN OF NORTH ANDOVER o� h' - APPLICATION FOR PLAN EXAMINATION Permit No#: (03' °�° ! Date Received Date Issued: ! }/l3 IMPORTANT: Applicant must complete all items on this page I A` LOCATION�(� -Print. PROPERTY OWNER Print 100 Year Structure yes no MAP JQ,PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building LPOne 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: Identification - Please Type or Print Clearly OWNER: Name: IZ►�T�: /42 SJ , Phone: Address: ( `1 ©- L ���-- 1 :� !�A Contractor Names Phone: Email: '. GL AI LJA/7� 011, 111/2641-- . �J)- Address: Z> -e,� 01 19?z A -tXU3 '-',n on,4ss Supervisor's Construction License: -001 2, Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ /f /, 6 C" 6 , C (—,. FEE: $ 13 7/ Check No.: (0 Y-5 :7 Receipt No.: 313-11 NOTE: Persons cont acting with L uregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor ' •R 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 PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature_ CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 0 Planning Board Decision: Comments Conservation Decision: Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on, site yes no z -- Located at 124 Main Street Fire Department 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 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 NU I t5 and UA I A — (For department use ❑ Notified for pickup Call Email Date Time Doc.Building Pennit Revised 2014 Contact Name 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 u Building Permit Application u Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract o Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application u Certified Surveyed Plot Plan u Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) u 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) u Building Permit Application o Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract u Mass check Energy Compliance Report u 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: Building Permit Revised 2014 Location 17 OoAiL 2tjy%j No. -(o 35'- A 01 -7 Check # V3 -7 Date I -> - / 3 -�-v/ 6 TOWN OF NORTH ANDOVER Certificate of Occupancy $- 1--� Building/Frame Permit Fee $-L3? Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector y 0 Z �p O Qr C -a O 00 CD CL �5 Cr CD 0 =o (D CL CO CD LWT 0 O N 10. 0 CO) CD CD a CO) U) O Z 0 CD Z m cn O cn x a 55 C v z Z co): m O 0 0° �r y= -<m m �c CL C)- CD n `�° n z o ?tea N 0 5 U a; �• o. -n rt 0 0 •� Q O T CD 0 CD N W CD "VCD N CD 2 3 co C to 0- C1 W_, O =��law CCD D o 0 co MAW CDO vi ?4 to -h cn O O ''• a- ••� O DO = N. O C CO O O � _ y O 7 CD Q _ �'.� �•C@•� CD LU O rt CD 0 BL o co rt CD D O .-r co N - C TON 0 as 0 o CL Ln W T x T V7 W T .Z7 T n X T N T Co fD O N G d N N = 00 � d0 :3Q r rt m S n S 7" 7 S D- A \ z ( oi Ln 0 m oi N n m M s •n m C W 3 ro 3 C O 7o G) N '° G o n z D H r O -�I M m M m O m m m z 2 0 O y 0 8 4( "" CD � Z CD O Cr C '� CQ O 00 CD C� Cr CD o oco ou CL O . CD CQ N O Lw� a O U) a r_ c N CD CD CD CD I O Z CCD O CD r-11 Z mcn O V+ C= q m z .a < O 0'a Osv = O N_ S CD CO) N C I = _� CD � CD n 0 O0 Q-0 � � Z 0 _==-a v; y O O NOi �p rtr* Q 0 Fri'O" O N N s. 0 '0 CO) cC 2 Cl) -% O Q 2) @ CD O C 0 CL (m O rt O. 3 CD low C N 0o co 00N:4 c M U .Q N N n(92 O C Q. O 0 CL N (D N �D 7 N CLCD WC@D CD 3 C0 N *** c rt @ C o � C04 O 0 x CD CD CD � N O Ci O rt O O :� CL VI Ln co T 7J T N 3 O CD O rOr N OZ C .A mH a m 3' N O . C. S N m 0 x 3 d O < O C S m m n Z m m j 0) O C S C W H D m j pu 3 3 OG O C S O C O_ fu C z cl 0 fD "a f1 L N 3 O O \ '+ rDS 3 W > 7° m x 0 I qo;u 10 Chimneys Siding Mass Toll Free 1 -800 -WAIT -4 -US (924-8487) ALL UNDER "ONION ONE ROOF Residential & Commercial Roofing All Types Of CHIMNEYS POINTED -REBUILT -CAPPED Expert Masonry Work * Roof Leaks Experts Licensed & Insured Locally Owned & Operated Since 1976 `- License #034200 IKO® G'aee WVZM oe nohn -%e` �i We Work Year Round Proposal To: Kate Bargnesi Date 10/10/2016 Street: 17 Quail Run Rd. 617-877-7312 N. Andover, MA 01845 Replacement Window proposal 1. Carefully remove and dispose of existing storm windows. 2. Carefully remove existing sashes and interior tracks. 3. Prep and insulate all rough openings. 4. Install (21) new white vinyl Paradigm premium double hung Tapestry replacement windows. Low E/ Argon gas insulated Energy Star rated glass package. 8 over 0 GBG's (grids between glass). Top sash only. Glass package will meet Mass Save requirements. 5. Windows will be tilt -wash, have double locks and full screens. 6. All windows will be sealed with paintable silicone to code. 7. Removal of all work related debris. 8. No painting or staining included. 9. Limited Lifetime warranty direct from MFG. (Paradigm) 10. Contractor workmanship warranty: 5 years Acceptance of Proposal—The above prices, specif accepted. You are authorized to do the work as spec Date of Acceptance: j ('' I 76(c Kate.bargnesi@gmail.com Total window cost: $ 11,600.00 Payment schedule: • Balance due upon completion Thank you! is and conditions are Payment witl bq mac and are herby I above. The Common -wealth of plass ch 'efts ..... Department off-ndustrialAccidents x _ I Congress meet, Suite 100 Boston, HA 02114-2017 7 iY7?2GI�`.S.gopIdia > Znsux .A�davii$uiXderslCoatxaciors/�eeixzciannslPl-ma�bexs. WoIkers Coxnpens—M ante TO BB Q WfH ME I" R RTDNG AU'MORM. ApRh ant Wormy -.on Please Print ieg1y Name (Businesdividual): kJ 411-64 Ad&ass: Gty/state/zip:. Phone. .Axe you an employer? L'Iieekss se, ap4opxiaie box: 1.211 am a employerv& _employees (fall and/orpatffime).* 2.� I am a sole proprietor orparinership andhave no employees working forme in any capacity. [No Wolk",' comp. insurance required l 3F-lIamahomeownerdoiagallworkmyself INoworkers' comp. insmancengaired.]t 4.0 lam a homeownmandwM behidng contractors to conduct aIt work onmypropaty. I WM ensnre thaw alI coniracrors eitherhave workers' compensation insnranee or are sole propixetors w .no m6 pIgYees. 3.❑ lam ageneral conractor and Ihavehiredthe sub-confrantorslisted onthe aftachedsheet. nes, snb-contraciorshave employees andhaveworkme comp_ fi trance.; 6. ] We are acorpm-dti m?ndts O:Ecmhave exercised thelefight of CxemptionperNlGL c. 152,andwe]iaveno.,empiAiyees. jNoworkerscomp. in=aworaq reALJ Type of project (regmred): 7.. [] Now codst ction 8. [] Remodeling 9. El Demolition 10 Q Building addition Il:E] Electrical repairs or additions I!. [] Plumbing repairs or additions 13.[�Rooirepairs *Any appHcaotthatchvalubcx�Rmrikalsofaoutthasectionbelowshavagthen-workers'cnmpensadonpolicyilft) anon i Homeowners -who ffdli iiiit� ai�davith hGa m9they are doing all sv ukand ;henlm e outside contractors roust submit anew EdHdaviL mdicatmg such ?Contractors fat check 7Liq bcmu mt-atiagbed an additional sheet showing the name of the sub-couaadurs and state whether orpo lhcse entities have employees. Ifthesub-c�haororsEa�ee�ployees, ieymasiprosidetheswork(is'come.pollcymmmber. I awn aTz ertipZoyeT MZ 4t zs Yor�ioc'irig-Yvo kers' conz�ensadon insurance for rriy e yTIZ yees.' Beloi�u is thepoZicy andjob site info��iatior�. _ Insurance CompanyYc-me:— Polio#orSelf-ins. Iia.#: IC, 0 1 D ira'donDate: lob Site Address: %o r4 t`Z � a N City/statemp: Attach, a copy oftheT7o�kers' compensationpoUcy declaration. page (show - nu ng the and expirati= date). Failure to secure coverage as required un.derMOL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one year imprisoxin.ert as welt as c&A penalties in. the foim of a STOP WORK ORDER anal a Tine of up to $250.00 a day against the -violator. A, copy of fbis statement may be forwarded to 'Jae OMou ofInvestigations of the DIA for insurance coverage veriftoation- dohereby certify the arl penatde�s of Perj �y tryst the z�cforrnaiio�t p�ovao'ed a7�o've is �fue c co�� -act Signature: Date: f Z /L7-4 6 Phone#: D ff ezaZ Usle onrj�. JI o not -w,, to in this arecy to lie completed by city or toY�r� official City or Town: PermitlLicense Issuiazg AV iori;ty- (Circle One): i I. Board of)ffealtla 2. BvffdingDepartuent 3. City/Tovm Clerk 4. 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Sue xo `.44ua Ie.�Iel zaT-o xo uo4u.iodtoo `do;4--ezo osse `cTT mupmd `Iimppupux tze„ ss paur�ag st �arfozduxa t� cc-ugRya zo lexo `pazldtux zo ssezdxa `oxrggo 1p-B4aoo Sup xapun migoue do ootazas o -4 i4 uosxad dxaAo---„ se pat[rgap sr ao fozdula ue `a�.v.�-�ers srr o� �uensxna "So ado d&t �za xo UO-.4Esaadtaoo sza .zom a w-ozd o sxado clnzia . saxmbaz agcle MB xaua s sa o-ess . I � �� � P �- I IN ZSX � 'IIS J � tI Iq suox� uilsul -put U011 -U ri0 juI AcoR& CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDONM) Illtl-� 11108/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 02051-001 ERAJACT Branch 2051-1 Perry Insurance Agency LLC 622 Chickering Rd I�i c.Exl: (978)685-7690 AlC.No; (978)687-0149 �'�Ess: North Andover, MA 01846 INSURED INSURER(S) AFFORDING COVERAGE INSURER A • A,I,M, Mutual Insurance Company All Under One ROOF INSURER B: INSURER C, C/O John Lanzafame INSURER D, 30 Temple Drive Methuen, NA 01944-0000 INSURER INSURER F, COVERAGES KCv151V1VNUMUER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED PAID CLAIMS. c yBY IL TYPE OF INSURANCE 11M POUCYNUMBER MMIDO/Y MMI�DY/YYYY LIMITS pp GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAUL TO RENTED CLAIMS MADE 7 OCCUR P S MED EXP (Any one person) $ PERSONAL&ACV INJURY S GENERAL AGGREGATE S EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG S O LICY OC AUTOMOBILE LIABILITY CO ' DSING MIT S fEar ANY AUTO AAIUlT� ED LED BODILY INJURY (Per person) S AUTOSCHES HIRED AUTOS DIED BODILY INJURY (Per accident) S PROPERTYDANWG S AUTos AOS ' UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS MADE — _.___.._.__.. AGGREGATE S DED RETENTION $ S yy�RKERg cp�tpENNggppnn NN AND EMPLOYERS LIA 6Pf yy� gTTpp77uu TH X TORY LIMITS : OER A Y f N (Mandatory In NH) �'�i`f�tITIVE�Y NH) NIA AWC-400-7009494-2016A 11/9/2016 11/9/2017 _ E.L. EACH ACCIDENT s -1,000,000,00 E.L. DISEASE • EA EMPLOYEE S '(rMand�atory�in DCRIfO� �F �PERATION56obw E.L. DISEASE - POLICY LIMIT S 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) PROOF OF COVERAGE The workers compensation policy does not provide coverage for John Lanzafame CERTIFICATF lane nro All Under One Roof 30 Temple Dr Methuen, MA 01844 ACORD 26 (20101091 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ��.^'.'�"-`� •— ••-•••- --'-Uy a,c 1114FR3 of AI.VKU Masiatohu>setts . Department or aual,o a,t•+t; BoRrd Of Building Roguladone arw Starts ar Cundruedun Superrhur License: C84 20 JOBN W��. 30TEBMBDR S t. . MBTSUENMA D1844'�" o or Commssalorla� 04/6it017 I ❑ Office of Consumer Affairs »d g mess Rem 10 Park Plaza - Suite 5170 gelation Boston, Massachusetts 02116 Dome Improvement C©tractor Registration Registration: 187057 ALL UNDER R OOF r - " . : �'m• DBA Expiration: JOHN LAIVZAFA 1 _ • , . ;. • _ �" :. lorzi2ols Tr# 291333 166 A MERRIM ME -;: •�� ' �, :� ;.', . METHEUN, MA 01844T= ` ._• f scA t 4 zoM oyrr ;; . , Update Address and return card. Mgrk reason for • [] Address change. 0 RenewalEm l ❑ P oymeut (I LOSt Card 0lnceorConeamerAfiaits Busifiess Ruar/iafrQl „ IHOME IMPROVEMENT CO ' -i;Hoa Reg"tradop valid for individual use only before the RegisdaHoq: 137057 i'nRACTOR expiration date. If found return to: � i Expiration: tom2018 DBA Types Office of Consumer Affairs and Business Regulation 10 Pat$ plaza . suite 5170 ALL UNDER ONE ROOF Boston, MA 02116 JOHN LANZAFAME 1613 A MERRIMACK ST MMEUN, MA 01844 denecretary Not validwithout alguature