HomeMy WebLinkAboutBuilding Permit #278 - 196 CARLTON LANE 10/15/2007 0UiLu11vv rcruvu i
q TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit N0: V ° Date Received �vs
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Date Issued: 6' S" q-
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building O'One family
❑ Addition ❑ Two or more family ❑ Industrial
❑ Alteration No. of units: 0 Commercial
❑ Repair, replacement ❑ Assessory Bldg ❑' Others:
❑ Demolition ❑ Other
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DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: S Phone:
Address: Z tJ AIA
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $_A c��� � 3 FEE: $ SO
Check No.: !��7 Receipt No.:/;-3�
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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No. - Date ���S "D
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�oRTh , TOWN OF NORTH ANDOVER ,
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+ ; . Certificate of Occupancy $
'ss....- , .�' _.'_.........�. _�I I... :�.l ,cMusE`� Building/Frame Permit Fee $ �JU=
Foundation Permit Fee $ a
4,
r _ Other Permit Fee $
1. i
TOTAL $
Check # i
r 20665 t:
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_ Building Inspector r
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Plans Submitted ❑ Plans,Waived ❑ Certified Plot Plan,[] Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 13'
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 rivewa Permit
Located at 384 Osgood Street
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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
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NO
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NOTES and DATA— (For department use)
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❑ Notified for pickup - Date
Doc.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
P P
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 recordin
must be submitted with the building application
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
NORTH
Town _
0%_t - O it ti_ - .4` •^".r�t.�'t..,
No.
"o-
�` dover, Mass.0
COCHICHEWICK V
7�S RATE D �
BOARD OF HEALTH
Food/Kitchen
Septic System
PERMIT T D
BUILDING INSPECTOR
THIS CERTIFIES THAT........................ i .'-0..................................................... .... .............................................
Foundation
0A............................
has permission to erect................�.................,... b41dinn ./%4............ .. . &..................:.... Rough
to be occupied as....... .......i ....... . .�.. ........................................:...............
Chimney
provided that the person accepting this permit shall in every respect c rm 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
Final
3 PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRU ST TS Rough
..... .................................... .... .......
. ... .. . ...... ........ Service
BUILDING SPECTOR
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.
oaGr o ui mgegul ons"an tandar s
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Construction Supervisor License
License CS: 69120
Restriction: 00
Birthdate: 4/3/1959
Expiration: 4/3/2009 Tr# 11855
JOHN W LANZAFAME
30 TEMPLE DR
f
Update Address and return card.Mark reason for change.
Address ' . Renewal Lost Card
3 50h4-05jo&PC8490
T tidns tan ards
construction Supervisor Uconse
' Licemse: CS 69120
B�rtftclat� 4/311959
iraC 009 TO 11055
JOHNW, LANZ4t
30 TEMPLE DR ti s' -
METHUEN,MA 0184 r ._`.`'f F Cord issioner
� ..1I� Crfva�c?nemuiea+cue o�✓GLriddr�ude�6
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:
Registration: 137057 Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Expiration:`111/2/2008 Tr# 128146 Boston,Ma.02108
Type- DBA
ALL UNDER ONE ROOF
.JOHN LANZAFAME
166 A MERRIMACK ST. a
Not valid without s' store
METHEUN,MA 01844 Administrator
ALL UNDER
ONE ROOF
Chimneys Residential & Commercial Roofing All Types Of
' Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work
Mass Toll Free Roof Leaks Experts—*] Licensed & Insured
1-800-WAIT-4-US Locally Owned& Operated Since 1976 6'---
® -W License#034200
(924-8487) IKO G�aBB �oQJ1l oz�o�Zn FMS We Work Year Round
. .
3 EjZe~0_ee-4 978-975-7531
70 jefferson st., North Andover, MA 01845 e4eez&&,el, 57e-eA" 30 Temple Dr., Methuen, MA 01844
Proposal Submitted To Phone Datef
Street Job Name
City,State&Zip Code Job Location
�J Job Phone
We Propose hereby to furnish and labor in accordance with specifications below, for the sum of:
,4r-,T L y,26,1 C7e.tr41t�T ,--d
Dollars ($ vJ ob
'S C? ,, �, i�Cs-Cv' l76'0� 7`y�^ G .. /°2 �`a / /a✓� ``.°cc,e v
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 proposal 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 within6 days.
We hereby submit specifications and estimates for&7p,;V�2 .f 1,0C /Fa 6/--
,C,&-R r/-/,A-3
ld'Installdfeet Q����e and water barrier protection along all bottom edges of roof
and torp to bottom in each valley.#roof is stripped, we will apply conventional ice and water shield
o_
( 6 ) 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 per sheet of plywood.
Install heavy gauge aluminum drip edges along every edge surface of each roofline.P'-/,7``e
Cover entire roof (s) with IK ' rglass; premium grade shingles
(Color of choice).P:�j,/-jc 1j :.y
Replace all pipe boots where possible.
Seal all flashings with clear Geo-Cel sealant. No black tar unless previously applied.
U1 Remove all work-related debris.
&Contractor warrants roof against all leaks.due to defects in his workmanship for 12 years under
normal circumstances.
dLocal current references and proof of workman's compensation insurance gladly given.
Q RemarksoC0 i,f 741 s;7:M QA_- Y-ZA /?.+?G6;- UC-17,S sZP11 /-,J-e J
06 q, r,7717 . 01'=1 IV'; ,717 1�110& e/t c ay �l r d f y ) ✓� `f O/J 1�C G// Y? •`r ' r'C .
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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 above.
Date of Acceptance:—X. Z
-
Signature: a
The Commo►►rvealth of/llussacht►setis
I)('I►ar1111e ►t of 1►►d►tstrial Accidents
a Office of*lr►vesfigatio►►s
600 I Vaslringto►r Street
Bosco►►, AIA 02111
wlt'rt'.crtass.govldia
Workers' Coll)petlsatioil Insurance Affidavit: Buil(leYS/Coll tractors/Iaectricia ns/1'11111-1be1-s
Apulicant information Please Print Legibly
f
Natue (Businessiorgaliizatiot>rt„t►ividvall: L/ 17,61 t,
Address: z Kph/ /'c ��.� -- ----- -- —
City/State/Zip:_�v] zJI-) J-C1,1 /III
Are you an employer" Check the appropriate box: 'Type of project (required):
1.❑ 1 ant a•ettlployer with /" 4. ❑ I am a general contractor and 1 6 ❑ New constnlction
employees (full and/or part-time).* have hired the sub-contractors
2.F-1I am a sole proprietor or partner- listed on 'Idle attachcd sheet. t ❑ RcmodelinK
ship and have no employees 'these sub-contractors have 8. ❑ Demolition
working for nre in any capacity. workers' comp. insurance. y. ❑ Building addition
[No workers' comp. insurance 5. ❑ We arc 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 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof rchairs
insurance required.] t employees. [No workers'
13.❑ Other
comp. insurance rccluircd] —
•Any applicont that checks lxrx BI mist also fill out the section below showing their wutkcrs'compenuttiun ixtlicy inrurnwtion.
t Homeowner-,who sulnnit this affidavit indicating they are doing all wotk and then hire outside contractors nmst sulrnit a new afli(lavit indicating such
lConhnelors that check thishox must attached an additional sheet showing the uonrc urlhe subcontractors and Ihcir wutkcrs'comp.policy inrornwtion.
lam all employer that is providing ryorkers'compensation insurance for•my employees. Below is the policy acrd job site
information.
Insurance Company Nanic: ".J /"j Lt Id (
Policy 11 or Self-ins. Lic. If: C Y-6V0 Z°''5 _ Expiration Date: it ej le '7
Job Site Address: C
I C � zWvr Af city/State/Zip: `j•7
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 file Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify made►•the pains and penalties of pc►j►ny that the information provided above is true and correct.
Si ature: ------ — Date
—`-- A
Phone H:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: PernliULiccnse #
Issuing Authority (circle one):
1.Board of Ilealth 2. Building Department 3. CityrFown Clerk 4. Electrical Inspector 5. Plumbing inspector
G. Other _
Contact Person: I'hone I1:
Jul
!N1 ERNE 1 1 NS11Rl�NCf. f ax.9786B7fl149
GERTIFIGATE
OF UABILISY INSURANCE 0712412067
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