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HomeMy WebLinkAboutBuilding Permit #130 - 187 WINTER STREET 8/20/2007 BUILDING PERMIT t401 of Th r 46ts r,.+q6+y � TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received gq^TED Date Issued: d D� �SsgcHusE� IMPORTANT: Applicant must complete all items on this page r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: - ❑ Demolition ❑ Other c 4 v vla DESCRIPTION OF WORK TO BE PREFORMED: %nom -ye Identification Please Type or Print Clearly) OWNER: Name: A&":q-17 ,6,46 Z7 S 1< Phone: Address: I �''l �� '�T�l S} /Q A yy , 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.BA Total Project Cost: $ 6. 6�,a a� FEE: $ 6 0 Check No.:- ?� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 1 , THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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 ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments 1 Water & Sewer Connection/Signature& Date Driveway Permit Located at 384 Osgood Street �Qhn �� �� �1��� " � � . c ' �&gyo- fr .: '�' r�� "x r `"2 r ,3'x a„. ,y 5•”. ,..��..- r:`�'.,,�^;�y x:, � ." ..< ,�`,_�rz <,nf .. ?.t�.«� ��,.Yu's..-�a >e.•i � `H-ns�' `" 3 �' �� a^ Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i Total land area, sq. ft.: i 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 i NOTES and DATA— For department use i li I - I I r ❑ Notified for pickup - Date 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 o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products Addition Or Decks ❑ Building Permit Application o Certified 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) o Engineering Affidavits for Engineered products New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o 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) 4 o Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 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 Location��� No. Date NORTH 1TOWN OF NORTH ANDOVER. Of�t�•o • .t.O f 9 # Certificate of Occupancy $ cMusEtt'� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2Q %5Q5 r �/` Building Inspector �Y } � -d�ge u 2ti san andar F . Canstruction Supervisor License License: CS 69120 x Birthdate: 4/3!1959 Expiration 4/3/2009 Tr# 11855 166060 JOHN W LANZAOA 30 TEMPLE DR METHUEN,MA 01844 Commiarse�* cr Board of Building Regulations and Standards a One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 137057 Type: DBA Expiration: 10/2!2008 Tr# 128146 ALL UNDER ONE ROOF JOHN LANZAFAME 166 A MERRIMACK ST. METHEUN, MA 01844 Update Address and return card.Mark reason for change. 0 s0M•05/06•pC8190 [] Address n Renewal D Employment ❑ Lost Card ."��� 1��rrrnr���urrt�x�/f vf,-:lj�aarrcfit�aelld _ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Y_ Registration: 137057 Board of Building Regulations and Standards Expiration: 10!212008 Tr# 128146 One Ashburton Place Rm 1301 Type: DBA Boston,Ma.02108 ALL UNDER ONE ROOF JOHN LANZAFAME 166 A MERRIMACK ST. ,1,� a,�,,, , METHEUN,MA 01XV Administrator t valid out slgna -° Jul fax:9786810149 , RNE1 INS" �� i N t E ;r 4 �I�..IINS 07 241208? cob _ TE t3�i6DEa AS A Pl1CIfER OR two !►TF .' �IE ar tt+N:Pot met 11mirw ce)kfpncY MAIC ►.2 Chic ketiog Road ►GE azth Andove,,MA 01845: tMFatas D�EOkAM tJGM M3t1RAt�5E CpNtPAM' AIM a� EggpAhtE_ c DBA -UNDER Oka ROS ALL 30 TEWLE OR e UEN,MA 01644 t 1CY p�p(pD DgTEO-�'�yTFISTAND1Nfi E umD ►anv� w w'm"m Cc r��> 70 �a� S o�sucM'v st GTO UXT.TMD ccneD ay To Pmos new sy no ctMS a�A"M_� ,tE rtes WANHAVE� `ung+,o�.aoo.oa void wuaY X20031° +,00a,oaa o0 a0g01433A s ".-Vt A ML LWMOV Slay N Uwf Doccu, q z.aoo.aaa.oa,; . PRA g:.a000ao.aa..' i ppm LWO APFUN PW �tD E c,�mT o roc --�------- AW AUTO ALL pv-GD AUT08 sra+e�•�Aurtos MW40iLMS � o ,wTp OtD.Y-EA ACCIOWT a SA ACC d v AUTO E�eCM OCA $ l�ItGREqATE $ OCCUR DEDUMBLEt 11Gi2�7 T6 $+ao,0oa.aa AWC7g06484012flfl3 — A g�oese 6►+E 3 +aooaa oa 8 600.00-00 +pyFFt�_ �iJiNE ff4.O�E�-COtS�t�T S e'�{.t A7tQ11 �py6i�8 10comuimwave TME Exp", nuT�T �@UT idtLe�TO oa s0 6NAlr tTa sem 1 t1D�,tiNT�OR - �ODLDAT�OR L ar AMr ItBCD gm y"pttlipm AT6YE ^ The Commonwealth of Massachusetts Department of Industrial Accidents RSI Office of Investigations . �! d 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): / L m Address: Ci /State/ZipL� L� /�'d� Phone #: iY :—,- Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. F1 am 6. ❑I a general contractor and I New construction .� full and/or part-time).* have hired the sub-contractors employees ( p ) listed on the attached sheet. 7. ❑ Remodeling 2.❑ 1 am a sole proprietor or partner- . These sub-contractors have 8. ❑ Demolition ship and have no employees working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have.exercised their ired.] in airs or additions 3. ❑ I arequm a homeowner doing all work right of exemption per MGL 11.❑ Plumbing rep myself. [No workers' comp. c. 152,§1(4), and we have no 12. Roof repairs t employees. [No workers' insurance required.] 13.0 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 (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 employees. Below is the.policy and job site information TV Insurance Company Name: F'1 v � Policy#or Self-ins. C 6b c.'�C, U` 2OZ3 Expiration Date: I z A -J Lic #: Job Site Address: 10Q. q &_d,rkG'_, (� ,�/ City/State/Zip: % r� 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 he cel ify nder ie pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: 9y1 `i 7 J 7J�3� 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/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: L 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 legalentity, employing employees. However the owner of a dwelling house having not morethanthree 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 of public 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 checking 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 an LLC or LLP does have employees, a policy is 'required. .Be advised that this 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 511 out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perrut/license number which will be used as a reference number. In addition, an applicant that must submit multiple pernut/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 may be provided to the applicant as proof that a valid affidavit is on file for future pemuts 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. is address The Department's 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-MASSAFE Fax # 617-727-7749 Revised 5-26-05 w�rpr.maSS.gov/dia ac�a �c�ca�r� GD MEE C)him>ne•ys Residential & Co\421 al Roofing All Types Of Sidling CFi1M1N1 YS POINTED-REBUILT-CAPPED Expert Masonry Work Mass Toll Free Roof Lebk)s Experts * Licensed & Insured 1-800-WAIT-4-US Locatty Owned& Operated Since 1976 License#034200 ® G�aeB wozm oz oliia (924-8487) aK0 � .� We Work Year Round Proposal Submitted To Phone Date -�2 1- Al F r��1 S 1��= l°7� - - '� '1 { t I v Street t Job Name City,State&Zi Code Job Location Y P ,-� Job Phone We Propose hereby to furnish and labor in accordance with specifications below, for the sum of: ._l ;iii G ! t� �017 t� 7`f'y,(,) Dollars 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: C 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 proposal may be or delays beyond our control, Owner to carry fire, tornado and other necessary insurance. Our workers are full covered b Workmen's Compensation Insurance. withdrawn b us if not accepted within f'a O y y p Y p days. We hereby submit specifications and estimates for: /?& Yinstall 3 feet of special "Eave Seal" ice and water barrier protection along all bottom edges of roof and top to bottom in each valley. f# roof is stripped, we will apply conventional ice and water shield ( ) ft. high in the same locations prev~ iously described and tar paper will cover the remaining bare wood. Any rotted or damaged boards will be replaced at ( ) per linear ft. or ( ,j'���� ) per sheet of plywood r t' Install heavy gauge aluminum drip edges along every edge surface of each roofline. ' i Cover entire roof (s) with IK'0--2S_ _ear all asphalt, non-fiberglass, premium grade shingles (Color of choice). Cif- j- ' t.;4-)i '����� ;t?c,,, j0 St ^iA �- U Replace all pipe boots where possible. or dSeal all flashings with clear Geo-Cel sealant. No black tar unless previously applied. i Remove all work-related debris. A Contractor warrants roof against all leaks due to defects in his workmanship for 12 years under normal circumstances. E Local current references and proof of workman's compensation insurance gladly given. Remarks: ! ) 17Lol rSJ..s '_9 ✓tS �;i1 Lfj�: �:G r11I-1 S ✓>: .+ ut J k ji J�+ tj Acceptance of Proposal - The above prices, specifications fiJ and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment Signature-A will be made as outlined abo e, Date of Acceptance�' 7 Signature: I� Town NORTH of _ No. e3 d dover, MaSS., e 1-ae la 7 Q LAKE A_ COC MICMEWICK '7�A ORA TED IPa\ �C qS BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System A BUILDING INSPECTOR ,�1a1ww G �/I/S THIS CERTIFIES THAT...................................... ...... ........................................................................................................... Foundation has permission to erect........................................ buildings on..... ^..... .............................. Rough to be occupied as S��' ' Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in 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 G Final d ,D PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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. "_� E REVERSE SIDE Smoke Det.