HomeMy WebLinkAboutBuilding Permit #931 - 204 SUTTON HILL ROAD 6/26/2012Permit NOA3.1
Date Issued:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
I IMPORTANT: ADDlicant must comDlete all items on this Daae I
LOCATION
Pont
PROPERTY OWNER
Print
MAP NO:: PARCEL: ZONING DISTRICT: Historic District
yes. no
0
Machine Shop Village yes (not
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
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
swe 't /�< /'�'o 6/'�
"7 /0 -) sizjz' -Tzr / 0 a-? -
Identificati'on Pleas ype or Print Clearly)
OWNER: Name: &-it Phone:
Address: S lvfA-
Phone:
CONTRACTOR Name: -
Address:
Supervisor's Construction License:- Exp. Date: L/ too-->/
Home InlDrovement. Licenses' _5
-Date- /--z,
ARCHITECT/ENGI NEER 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.
/ 3,
Total Project Cost: $ FEE: / (4�117
Check No.: Receipt No.:
NOTE: Persons contracting with u gister d contractors do not have access to the gITrantyfund
'9'1 -na 6"re of contractor
7 9
S6 (Agent./Owner
6�1_1 I/ V - Z-1/ —
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
CONSERVATION
COMMENTS
HEALTH
COMMENTS
81
DATE REJECTED DATEAPPROVED
Reviewed on Signature
Reviewed on Signature
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
DPW Town Engineer: Signature:
FIRE.DEPARTMENT -Tem'-p-Dumpsteronsi.te yes
Located -at -124 -Main street
Fite Department - signatijre/date-
COMMENTS
Located 384 Osgood Street
no
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 21 A —F and G min.$100-$l 000 fine
NUTF-5 and DATA — (For der)artment use
El Notified for pickup - Date
Doc.Building Pennit Revised 2008
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
L3 Photo Copy Of H.I.C. And/Or C.S.L. Licenses
c3 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
Lj 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)
Ei Building Permit Application
u Certified Proposed Plot Plan
Ej Photo of H.I.C. And C.S.L. Licenses
Lj Workers Comp Affidavit
u 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
c3 Engineering Affidavits for Engineered products
NOTE: All d.umpster 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 2.2008
Location 6f /I
No. Dat
a�hok--
Check#-�-' 7/
25457
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $7��
t
Foundation Permit Fee $
Other Permit Fee
TOTAL $
Building Inspector
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C'aristruction
U(.unse GS 69120
JOHN W LANZAFAME
30 TEMPLE DR
METHUEN. MA 01844
40=13
T rzi 14108
Office of Consumer Affairs and Efusiness Regulation
10 Park Plaza - Suite 5 170
Boston, Massachusetts 02116
Home Improvement Contnactor Registration
Registration 1370�� 7
Type: DBA
Expiration: 1012/2012
ALL UNDER ONE ROOF
JOHN LANZAFAME
166 A K4ERRIMACK ST.
METHEUN, MA 01844
How IMPROVEMENT CONTRACTOR
Registrationn 137057 Type:
Expiration: 100=12 DBA
, 4 �:'i
ALL UNDER ONE ROOF,
1�)HN LANZAFAME
166 A MERRIMACK STr
AE 1'HEUN MA 01844 Ifudersecrelory
Tr# 204021
Update Address and return card. Mark reason for chanpc,
, Address ; � Renewal , Employment tost Card
Ucense or registration valid for individul use ont
before the expiration date. If found return to -
Office of Consumer Affairs and Business Regulption
it; rark Plam - Suite St7l)
Boston. M A 02116
" at 91i
-4t signature
The Commonwealth ofHassachusetts
Department oflndustr&Nccide�ts
Office ofinvestigationg
600 Washington Street
-Boston, MA 021-1.1
Www-marssgovldla
Workers' Compensation insurance Affidavit: BuildersICOntractorsfFIectricians/Plumbers
wlicantlnror.m tion
Name (Business[Organizationfindividual): At L)61_/2zW
Address. It>
CilylSlate/Zip.__A,�_�� �j4ij&�j Phone #:
Are you an employer? Check the appropriate box:
I am a employer 4. EII
with.
am a general contractor and I
employees (fall and/or part-time).*
2.EJ I am a sole proprietor or
have hired the sub -contractors
listed
partner-
on the attached shget
ship and have no employees
These sub -contractors have
working for me in any capacity.
[No workers' comp. insurance
Workers' comp. insurance.
5. El We ake a corporation and its
-required.]
3. El I am a homeowner doing
'Officers have exercised their
all work
myself [No workers, comp. -
right of exemption per MGL
c. 152, § 1(4), and w a have no
insurance required.] f
employees. [No workers,
comp, insurance renpired i
Type of project (required):
6. E] New construction
7. EIRemodeling
8. 0 l5emblition
9. F1 Building addition
10. El Electrical repairs or additions
11.0 Plumbing 'repairs or additions
12 -El Roofrepairs
13,Etother /?,,, zv,'
!A61 applicant that checks box #1 to
ust also fill out the section below showing their workers' compensation Policy Mormation.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside cOntraGtOrs must submit a new affidavit indicating such.
tC011tractors that check this box must attached an additional sheet showing the name of the s ub-contractors and their workers, comp. Policy information.
lam an employep that isproviding warkers, coinpensatioll
info]-mation. ')1s11ranCeJor7nYe1nP10Yees- Below istIlepolley andjob site
Insurance Company Name: t4r' t -"k MY�'UA-(
Policy # or Self -ins. Lie. ExpirationDate:
Job Site Address -- CQ tA, -� ( - I
Attach a copy of theworkers' c * City/State/Zip: ljl-q
OmPensation Policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required Wider Section 25A OfMGL 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 fme
Of Up to $250.00 a day against the viodator. Be advised that a copy of this statement.may be forwarded to the Office ok
Investigations of the DfA for insurance coverage verification.
rdo hereby certify, uqqrtJ1e,&1nS and enaliles is
Signature: OfPerjury ffiatthe infOTMadonprovided above trueandcofrec4
Date*
"JJ'clal zse ONY. DO not wMe in this area, to be coin
pleted by elly or town offlclaZ
City or Town:
PermitfLicense R
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. CitY1T9Wn Clerk 4. Electric
6. Other allnsPector 5. Plumbing Inspector
ContactPerson: Phone #:_
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statate, an employee i;defined as '�..every person the S rVico of a 0 r der a y co a t of e
'I or written."
express or implied, ora in e n the un a ntr c hir ,
An employer is defmed as "an individual, partnership, association, corporation or other legal entity, or any two or more
oftho foregoing engaged in ajohat 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 apartinents and who resides therein, or the occupant ofthe
dwelling house of anotiler who employs persons to do maintenan*ce, 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'wjthhold the issuan ceor
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 0* f compliance with the insurancd coverage required."
Additionally, MGL chapter 152, §25C(7) st�tes "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpUblic work until acceptable evidence of com�liauce 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-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Pal eyships (LLp) with no employ s other an th
members or partners, are not required to carry workers, compe sa 0 tri ce th
n ti n insurance. If an LLC or LLP does have
u e
employees, a policy is required. -Be advised that this affidavit may be s bmitted to th , Department of In'dustrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be retained 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 qVestions rega�diug the law or ifyou are required to obtain a workers'
compensation policy;pleaso call the Depahment at the number listed below. Self-insured companies should enter their
self-hisurance 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 fill out in the event the Office Of Investigations has to contact you regarding the applicant.'
Please be sure to fill in the Permit/license number which will be used as a referenceinumber. In addition, an applicant
that must submit multiple permit/licej�ise applications in any given year, need only submit one affidavit indic�ting current
policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in ty
Y or town may be provided to the
town)." A copy of the affidavit that has been'officially stamped or marked by the cit _(ci or
applicant as proof that a valid affidavit is on file for future peimits or licenses. A now affidavit must be fffled out each
year. Where a homeowner 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 affidivit.
The Office of Investigations would like to thank yoiiiu advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Departinent's address, telephone and fax number.
The Commomwearth of Urassaeame-its
Departtue,ut of fadu�strlaj Accideuts
off(ce of InvesUgations
600 Washivon Stmet
Boston;M-A,02111
Tel. # 617-727-4900 oxt 406 or 1-877-MASSAFE
Revised 5-26-'05 Fay, # 617�727-7749
www-mass..gov/dia
,"-U 6- /; fJ 0 U -/
PVT
LV Poofinq
Chimneys ��;n qF.;Sm All Types Of
Siding CHIMN;EYS POINTED -REBUILT -CAPPED A Masonry Work
ExpeiL
A- ROO' Licensed & Insured
Mass Toll Free I . .. . . ......... .
1_oeal�v Ow"ed .1976 License #034200
1 -800 -WAIT -4 -U -S a� 4( ,
(924-8487) IKO wagwv aer 90/jrwr i:�� We Work Year Round
Proposal To: Bill Krueger
Street: 204 Sutton Hill Rd.
North Andover, MA
Roof proposal
I . Protect house exterior and landscaping as best as
possible. (tarps etc.)
2. Strip all shingles from entire roof
3. Inspect and re– nail any loose or lifted plywood
or roof boards.
4. Any compromised plywood will be replaced at an
additional cost of $55.00 per sheet of 1/2" cdx fir.
Any compromised roof boards will be replaced at
an additional cost of $2.75 per linear foot of I x8
spruce. I st 16' at no additional cost.
5. Install heavy gauge 8" white aluminum drip edge
to all eaves and rakes.
6. Install 6' of IKO Armourguard ice and water
shield along all eaves. 6'MA state code. Full cov-
erage on rear lower addition.
7. Install all new pipe boots.
8. Above the ice and water shield, install IKO Cool
roof guard synthetic underlayment to the remain-
ing sheathing up to the ridge.
9. Install IKO Leading Edge or Certainteed Swift
Start starter shingles to all eaves.
10. Install IKO Cambridge AR or Certainteed Land-
mark Limited Lifetime architectural shingles to
entire roof. Mfg. warranty Pro rated after 15 years
(IKO) and 10 years(Certainteed) to original
owner.
11. Cut and install GAF Cobra ridge vent to all main
and dormer ridges.
12. Counter -flash chimney and all roof protrusions
with ice and water shield, re -seal and tie into new
roof. Existing lead is in good condition.
Date 6/7/2012
Acceptance of Proposal—The above prices, specifical
cepted. You are authorized to do the work as specified.
wpkl934@gmail.com
13. Remove and dispose of all gutters
14.Building permit included.
15. Removal of all work related debris.
16. Contractor workmanship warranty: 6 years under
normal wind and rain conditions.
Total roof cost: $ 13,950.00
(Angie's List discount included in total cost)
(2) Skylights
Install (2) new Velux M06 (30x46) venting sky-
lights. Size will be as close as possible to existing.
Some minor cosmetic interior finish carpentry
may be needed. (Not included in proposal) .
(1) Velux telescopic operating handle ($50.00)
Balance due upon completion
Referrals available upon request
Highly rated member Qf the accredited BBB and
Aneies' List
Thank you
and conditions are satisfactory and are herby ac-
nent will be made as outlined above.
MATERIAL PICKED BY MATERIAL CHECKED BY
5-st -Page
MATERIAL RECEIVED BY
DATE RECEIVED # OF CARTONS