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HomeMy WebLinkAboutBuilding Permit #598 - 206 WAVERLY ROAD 5/11/2009 BUILDING PERMIT OtOORT NORTH 6Atio �r` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received74w�Awito �SSACHUSE� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION_ 2 Ouj ao L-i2 Print PROPERTY OWNER 1C AL- - Print MAP NO. PARCEL ZONING DISTRFCT Historic District yes no p 0 j � °Machine Shop Village 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 Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: M/4 rT CQ,T-7Z-- Phone: Address: a �_J 40 C-n CONTRACTOR ''Name: (/ L1h•x74--4 6AIZ% Ifb 4 Phone: Address: Supervisor's Construction License: _ 6 l l Cr3 Exp. Date: a Home Improvement.License: d . Exp. Date; 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: $ oe 600' o o FEE: $ �— Check No.: Ax, Receipt No.: a a D 3 NOTE: Persons contracting iwQt unregistered contractors do not have access to the gu ranty and Signature of Agent/Owner Signature of contractor .M i i I 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on__ Signature COMMENTS HEALTH Reviewed on Signature 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 Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site „yes no 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 NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 `t 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 E ❑ Building Permit Application j ❑ 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 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 a 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 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 recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No. 59 4E Date NQRTp TOWN OF NORTH ANDOVER f � 10- Certificate of Occupancy $ ,SSACHUSEI Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 22U 3 Building Inspector & %AORTH 0 of t 4 over 0 0 y ti dover, Mass., J6`' /�' of T O LAKE I� COCKICKEWICK V 7,9 ADRATED Ilk `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT........l��t.�..�..QT.� F. BUILDING INSPECTOR ............ Foundation (� has permission to erect........................................ buildings on .2�.i�................�V".l... ...........� ........ Rough to be occupied as.. ...'y........ .... ..4...f".*, Chimney ..=i14-t-e--r--m--s .............................................. provided that the person ciZ! g this permit shall in every respect c forof thea lication on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final 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 CONSTRI, T S 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. SEE REVERSE SIDE Smoke Det. 3oar4of ui g I aloe /aWnff rtan'�u%� One Ashburton Place - Room 1341. Boston. Massachusetts 02148 Hoene improvement-Contractor Registration Regislratittaat: 137057 :a.. TWm: DSA .. E-xpin3 ion: 10=010 Tro 275510 ALL UNDER ONE ROOF JOHN LANZAEAME 1661 A MERRIMACK ST. METHEUN, MA 01844 Updaft Address acrd return card.Mark reason for change. Address Renewal Employment Lost Card ' .. porn u5+rx,flt;as��x, Board of Buildisg Regaladeks and Stuadaands Lwam or regastrabou valid for indavidul an only HOME WPROVENWNT CONTRACTOR tfe%re the expiration date,. If f9mW return to: moi+: 137057 Board of BtaiEldl g Ri;:gnlations sad Standards Oat Ashburton Place Rua 1301 1wo2010 Tr* 275510 Win.Me.aloe Tylo.- MA LJL UkMR ONI:F40C1F )NNIL�0.tVAN ZAFAME 15 A MERRimAck..sT. e ETNEUN'NIA 01844 AdWWW.0W Not va ld v fdx 4�re �la..arhusrtt> - Ucit:u"IIr1Cf11 of Public `afcf� Board of Buildiu;; Regulations ami 'starrd,u"d's Construction Supervisor Ucense License: C5 69120 Restricted to: 00 JOHN W LANZAFAME 30 TEMPLE©R {° METHUEN, MA 01844 i a e,,o pnO r1,r16 CERTIFICATE OF LUMILITY INSURANCE STC (YY tsC rx. t1�6!'LtiU� T11 S jt- W lit OWED"A MATTER OF WFORIMTION -- .15,'K.pP ONLY No campm I* t1►M THU Cg"FWAU '4 +rV thavWance Age—v N "M CgKVVC^T6 WM OW Ate.EXTEND OR Q2 ' ':tckertng Road two ww SY TM POLKUM it Et-OW �"h .Andover MA 0184 "9SUMM AFFOWAMS Ctrl/E9tOAL i MAIC n �•�+ec . .....___. ... - beA A NORFOLK D£Qi4A 4 MESURANGE Y JOMWLANZAFAWE: + * AM pHA ALL UNDER CAVE RAF 30 TEMPLE OR Rauipm o ,-- METHUEN. 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'EAE3t OCCUttJ�M:F +1 --__.. k A6TiRE6`slt7 t < - . !! son*AD AWC7009468012007 111x19lR008 1100w20d3 TQRvtetN s Ea -- i WY FROPRR WMO�NAPI/id�Il MtftsEA@C-411Yf El EACMALVOENT– L +"`'rµt`�•.y_. lj .7FF+CERM.f AERCi.UOEDT Sa'tf ym ` E;tY5[r5t U k+lpr.t7+F F A P'ArMsto"s "t,GGCi'j, comma""" M"Ast Pmit,r+thttt L { r i RTW`KTB FMi7FiRR 1 71(ibYt s11O►�p#aWeM 1bF!!1[Ai16�OYlGWN4�W)V"OL101Y30E LAYCElt ER BE W'E}RE t)iF FfRW.'.5,.,. f OAT*TWiL3WF.Tw w4woaW)W1WblAI IAflt lJ�6AtrUA tG tYALL �U o.�vs ww..:. tlOstUE�EW1E CtR774CA7E gOI.��W MAiIEA TC TML Lk6t,O4IT FM'.ltR6 T[t Ui;Xis�,+,:r. Chimneys Residential & Commercial Roofing All Types Of POINTED-REBUILT-CAPPED Siding CHIMNEYS Expert Masonry Work Mass Toll Free I* Roof Leaks Experts * Licensed & Insured Locally Owned& Operated Since 1976 L' 1-800-WAIT-4-US ® License#034200 (924-8487) IKO G,aBB or,gOlin We Work Year Round ZZ Proposal Submitted To: Pat+Tom Marcotte Date 3-31-09 Street: 206 Waverly Rd. N.Andover, MA 01845 Roof proposal 1. Strip all shingles from main house,addition and Window and sill trim. Color as close as possible to shed dormer, not small wings existing house. 2. On the(2)front dormers: Strip off aluminum and 14. Removal of all work related debris wood shake siding aswell as the white aluminum 15. Building permit included window trim 16. Warranty Info: 3. Inspect roof deck, replace any compromised roof • Contractor workmanship 10 p p= Years boards at additional cost of$2.25.00 per linear . Rubber roof on material only=30 years by manu- foot facturer 4. Install 6"of WR Grace ice and water shield to all • All Under One Roof upgraded warranty: IKO eaves and top to bottom in all valleys Shield Pro Plus= 10 year full coverage and full y 5. On lower left side addition: install full WkGrace transferable at no additional cost to homeowner ice and water shield for Cambridge syle. Full 15 years of coverage for 6. Install 301b felt underlayment above ice and water a(LT) shingle shield to the ridge . Note: To upgrade to a(LT)there will be an ad- s. Counter-flash chimney lead with ice and water ditional material cost of$400.00 shield and tie into new roof . Total cost: $10,000.00 8. Install new pipe boots 9. Install IKO 30 year Cambridge style shingles 10. Cut and install GAF Cobra ridge vent if possible Balance due upon completion 11. On rear dormer: Install 1/2"strucoo deck board 12. Install .060 Genflex fully adhered rubber roof sys- _Referrals available upon requests tem 13. On front dormers: Install 3/8"owens corning Sty- Highly rated member of the BBB rofoam insulation, new flashing and ice and water shield. Then install Certainteed .046 Monogram Thank you! yinyl siding, along with new white aluminum eceptance of Proposal—The above prices, specificati ns and conditions are satisfac ory and are herby ac- epted. You are authorize to do the work as specified. ayment will be made as outlin d above. Date of Acceptance: ° l J Sign :�– Signature: XAn The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 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): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1.�I am a employer with 41- 4. ❑ I am a general contractor and 1 6 employees (full and/or part-time).* have hired the sub-contractors ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ 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 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plum vrg repairs or additions MY [No workers' comp. c. 152, §1(4), and we have no 12. oof repairs insurance required.] t employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks box#I 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 lContractors 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. Insurance Company Name: M �i1 fid' Policy#or Self-ins. Lic. #: C 17 O J Q Y 6 q,01 0-0 a`] Expiration Date: /IA 1 Job Site Address: l7 W no C__n 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 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 fihe violator:-Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage.venfication. I do hereby certify under Ahe pains andpenalties of perjury that the information provided above ove is true and correct- Signature: orrect:Si ature: Date: Nye Phone#: Oficial 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#: