HomeMy WebLinkAboutBuilding Permit #682-2017 - 217 WINTER STREET 5/1/2018 _ L
NORTH ?
BUILDING PERMIT
TOWN OF NORTH ANDOVER o �= ;
APPLICATION FOR PLAN EXAMINATION
0 1:
Permit No#: ' 2I Date Received �� �qs RATED I"' 1
a sacHuse
Date Issued:
MORTANT: Applicant must complete all items on this page
.��y.
PROPERTY OWNER 60 _•-� _- °
to ti Print 1 DD Year Structure yes no
s , ' DISTRICTS ' His-tc,5 istnct est no
MAP PARCEL:. i�ZQNING=
1 .w.. l �� =� " $ ' : `•; , . Macli ne Shop Villages yes no
Wer '3 t: - -
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family r
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
epair, replacement ❑Assessory Bldg ❑,Others:
❑ Demolition ❑ Other
❑ Septic ❑Well - ❑ Floodplaim ❑Wetlands ❑ Watershed District
JAW
ater/Sevver
DESCRIPTION OF WORK TO DE PERFORMED:
ZG'
Identification- PIease Type or Print Clearly
OWNER: Name: �Ay�' ,Z P_ ` O� �'T2 Phone:q 7&y�^6� ?� Z
Address: CQ `1 °dITcA
-Contractor Narrie 4!1 01'hbhetl
„.,
`Address
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3
- -, t !%r; ci„ aie,; trot
Supervisors Construction License r Expr.7 Dater .o
r• - ." g. w..r..^-a.� r"'i-a,n'`^'ts :.4 s .. .,�-<. r a !44€ qw"f^'• i"' �`."/
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Home lino, merit License'.
/
ARCHITECT/ENGINEER Phone:
Address: Reg- No.
FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
__rotal Project Cost: $ ���vd FEE: $ /
Check No.: Receipt No,,
NOTE: Persons contracting with egistered contractors do not have.access to the g aranty fund
S_igriature_of_Agent/Owner Signature of contractor
Plans Submitted ❑ Plans Waived 01 Certified Plot Plan ❑ Stamped Plans ❑
TYPB'bF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/MassageBody Ast` ❑ 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
i
PLANNING & DEVELOPMENT Reviewed On V-60) M Signature_
.COMMENTS UAJ5� � ��C� �S��j ►'� �i11 � ���r
CONSERVATION Reviewed on Signatur
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance Petition No: Zoning Decision/receipt submitted yes
cUs�9
Manning 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
limension
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
®ANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$10041000 fine
NOTES and DATA— (For department use)
i
❑ Notified for pickup Call Email
ate Time Contact Name
Doc.Building Permit Revised 2014 _-
'III .. .... •- /
I
Building Department
The followingis a list of the required forms to be filled out for the appropriate permit to be obtained.
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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
o 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
o Building Permit Application
o Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
Ei Copy Of Contract
o Floor/Cross Section/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 {
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
o Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
i
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Ii Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o Engineering Affidavits for Engineered products
40TE: 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 {
'. Doe.Building Permit Revised 2014
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No. tC f 201-7 Date 1,;� as �'f co
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 0
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
-7 � � �
J 3 9 (� Building Inspector
� N �
Town of : ORT ndover .
O ti. -
to
No.
L.K. h ver, Mass,
COCMICHl WIC'
U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ....... ...... . iC...la... Qw .� BUILDING INSPECTOR
......... ....... . . . . .
. �. Foundation
has permission to erect.......................... buildings on .... ..... ... .....w,...... ........................ g 1
Rou h t
p' .. N.c* y
t0be occupied as ............,.. ........ ..... .............................................................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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
7
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI TARTO Rough
Service
.......... .. . ............................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
Smoke Det.
70.
49.
Yk
Chimneys Residential & Commercial Roofing All Types Of
CHIMNEYS POINTED-REBUILT-CAPPED
Siding ---� Expert Masonry Work
Mass Toll Free I�aof Leaks Experts � Licensed & Insured
_
Locally Owned& Operated Since 1976 RIM
1-800-WAIT-4-US ® �}� License#034200
(924-8487) IKO vuBe 'Norm oz.�Zolan iz&;j We Work Year Round
Proposal To: David Leibowitz Date 12/28/2016
Street: 217 Winter St. 9787505-7722
N.Andover, MA
Deck proposal David.leibowitz@oracle.com
1. Remove existing ledger board and bottom courses
of vinyl siding. Total deck cost: $8,500.00
2. Install new 2x10 pressure treated ledger board,
counter flashed with ice and water shield and vinyl
ledger flashing. Fastened to code. Balance due upon completion
3. Install (3) Goliath Tech galvanized steel 2-7/8"
support pilings. References available upon request
4. Dig and pour new 4"thick cement pad to code to
accept stair stringers. (Width determined at time of Highly rated member of the accredited BBB and
installation) Angie's List
5. Construct new pressure treated 12'x14' deck with
4x4 railing and 2x10 frame construction. Thank you!
6. Install triple 2x10 PT support beam with 4x6 PT
support posts.
7. Install new pressure treated 5-1/4" deck boards to
entire floor and stairs. All deck boards will be Note: Price includes (1) day of labor for digging
screwed with all weather fasteners. and installing footings. If any unforeseen interference
8. Construct(1) 5'set of pressure treated stairs to
code. in the ground is found, it will be subject to additional
labor costs. Any additional work needed will be
9. Construct pressure treated rail system for deck and discussed and confirmed with homeowner before any
stairs. 4x4 support posts, 2x4 rails with square additional work is done.
pressure treated balusters.
10. New deck will have open bottom.
11. All installation procedures, material, fasteners and *Any unforeseen damage or rot will be discussed
metal connectors will be compliant with 2016 MA and confirmed with homeowner.Any damage or
State codes. rot will be replaced at an additional cost of time
12. Building permit included. and material. No work resulting in extra costs will
13. No painting or staining included in proposal. be performed without homeowner consent.
14. Removal of all work related debris.
15. Contractor workmanship warranty: 1 year
Acceptance of Proposal—The above prices, specifications and conditions are s tisfactory and are herby
accepted. You are authorized//to do the work as specified. Payment will be made outli ed above.
Date of Acceptance:X f d Z �� Signature:
1
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N�9�V
Ae Commonwealth of Massachusetts
Department of IndustrialAceldents
M . _ X Congress Street,Suite 100
_~ d Boston,MA 02114-2017
,�Y www mass.gov/dia
,QOM S'.}
-Waikers' Compensation7nsmranedAffidavit:Bmildexs/COAUI tOSItITY. ciabs/Plum exs.
TO BE FILED WUH'IM PEIf please pxSmt TJ 'bI
A licantInformation
NaMe(Busiuesslorgenizafion/Individual): fN
Address:
-c-- -t,✓l t2t/C 4fJ Pho-ne#: �"ld �f -� ���• _
City/Statelzip: b`"�
Type ofproject(vequired)_
Axe you an employer?QLeck the appropriate box:
1, am a employer with—emPloyees(full and/or part time).
7. El Nem construction
2QlamasoleproprietororpartaushipandhavenoemployeesWorking for me in 8. �Remodeliiig
any capacity.[No Workers'comp.insurance required] 9. ❑Demolition
e oworkers'comp.ursurancerequired.]� 10E]Building addition
3.E]I am ahomeov=r doing allworkmys li IN
¢-❑I am ahomeowner and wM be hiring contractors to conduct all work onmy propert1
Y I will
101.[]Electricalrepairs or additions
ctors either workers'compensation insurame or are sole ,
ensure that all contra. bili repairs or additions
`'`p ees. 12_L]Plum- g p
proprietors with no em Ioy
[]5.❑I am a general confiactor and I have hired the snb-contractors listed on the attached sheet. 7 3•. R06fr0airs0-S C/<
These sub-contractors have employees and have workers'comp.insurance. 14•i—�'�ther Per
6. We are a corporation.and its.ofEcers have exercised their right of'exemption ed-] c. ��i
152,§1(¢),and v e have no empldydes.[No workers'comp-insurance required]
*Any applicantthat checks bbX41 m=ust also fill o'rtthe sec' below showingtheirworkers'compensationpoficy infounalion"
i Homeowners wha submit tivs of d rs must
mh an additional tugthey are doingshowing the name of the sobhire a ccontracto�s and state wsubhthn°ew n SOS 1es iachcatmg
y c�
�Coufxactors that checkthis lio�m .. .. ... .
employees. Ifthe sub-coniractars have employees,they must pro=vide then workers'comp.policy number. .. - `
ail Volk audtTlen -
X am an employer'that is providingyvorkers'compensation insurance for my employees. Below is t/iepolicy arzdl'ob szte
information.
Insurance Company Name: � v ✓
4eo JT�
2_ oT
Policy#or Self-ins.Lir-.4:
f� t'�`� City/State/Zip:_
Job Site Address: of C(Showing,fhe policy number and expiration.date).
Attach a copy'of the Worco
kers' mpensation p obey declaration pax
up
Failure to s
ecure coverage as required under MGL c.152,§25A is a criminal violatRy, RD�land �Of P to $250.00 a
and/or one-year imprisonment;as well as civil penalties inthe form of a STOP
day against the violator.A copy of this statement may be forwarded to the Off ce of Investigations of the DIA for insurance
coverage verification.
certd under epains andpenaltieg ofperjury that the information provided move is true and correct:
--Ydo Hereby fy 2,14
Date: 2
Si afore: �� —
Ph
#:
Official use only. Do not write in this area,to be corrrepleted by city or town officiaL
permitUcense#
City or Town-
Issuing Authoxity(circle one): p Inspector
i.Board of}3ealth 2.Building Department 3.City!'X'o�w:a Clerk �.Electrical Inspector �.Plnimb�ng
6.Other
phone#:
ContactPerson:
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 ofhire,
express or implied,oral or written."
An employer is'd'efiited as"an individual;partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enferprhe,and including the legal representatives of a deceased employer,or the
receivet'or trustee Qf an individual,partnership,association or other legal entity,employing employees.However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant ofthe'
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 b6 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
applicautwhij has not produced-acceptable evidence of compliance with the insurance coverage xequired."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic 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
recess
supply sub=co c
ntra tors name(s),
P Yaddress(es)
P () and phone numb er(s) along with their certif cate(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 b eing requested,not the Department of
Industrial-Accidenis. 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 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 reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
Policy information(ifnecessary)and under"Tob Site Address"the applicant should write"alt 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 permits or licenses. Anew 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 Department's address,telephone and fax number_
The Commonwealth of Massachusetts
i
Department of Industrial.Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE
Fax## 617-727-7749
Revised 02-23-15 www.mass.gov/dia
DEC/30/2016/FRI 07: 33 AM FAX No, P, 002
From!AIM 781 221 4660 12/29/2016 15;44 4x640 P.001/001
o�rv® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
1 2/2912 01 6
THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ 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 CERT151CATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the cartiflcate holder Is an ADDITIONAL INSURED,the poficy(ies)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 endomement(s).
PRODUCER D2051-001 JRpCT Brunch 2051-1
Perry Insurance Agency LLCu,Ex1; (978)685-7690 .Ne.: (978)697-0149
rUDkering RdAlas
North Andover,MA 01845
OE
A.I.M.Mutual Insurance Company
INSURED INS
All under One Roof INSURER B
C/O John Lanaafame
30 Temple Drive INSURER 0
tdmthuen, MA 018d4-0000
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 I$ SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN
TYPE OF INSURANCE I POLICY NUMBER PMlDO LIMITS
LTR GENERAL LIABILITY EACH OCCURRENCE i
COMMERCIAL GENERAL LIABILITY D
PREM
CLAIMS-MADE Q OCCUR MED EXP(Arty one person) I
PERSONAL&ADV INJURY $
GENERAL AGGREGATE E
ENLAGGR60ATELIMIT APPLIES PER; PRODUCTS-COMP/OP AGO
OUCY RD" OC
AUTOM091LE LIASIUTY COMBINED SINGL L 5
1
ANY AUTO BODILY INJURY(Per person) S
ALLOWNEO 3CHEDLILED
AUTOS AUTOS BODILY INJURY(Per ccciosr� 5
MIRED AUTOS A101fNUB1�rlED PR A E B
Per c 1
s J
UMBRELLA LIAO OCCUR EACH OCCURRENCE g j
EXCES$LIAR CLAIMS MADE - AGGRQGATE S i
DEO RETENTION $ X
AND EMPLOYCILPS LIAILIYY x �TIlfs 94"
A �II�� I �� ECUTIVEr N/A AWC-400-7009464-2016A 11/9/2016 11/9/2017 FOL EACH ACCIDENT 6
IIMandatarylOFInpNy�MI u E.LDISEASE-EAEMPLOYEE 5
M ON OPERATIONS below E,L,DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional ReMarku SChedule,if mere space is required)
f
The workers compensation policy does not provide coverage for John Lansafama
CERTIFICATE HOLDER CANCELLATION
Town of North Andover
Attention:Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
120 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I
North Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE ,
1998-2010 ACORD CORPORATION.All rights reserved.
ACORD 29(2010105) The ACORD name and logo are registered marks of ACORD
Massachusetts -De1:a,Kiren2 0:?ua►:r,�i".:
$aarti of i3uitding ncyU10ricna ona S. :•�^
CunitruCtiun Supj:ll'i,ul'
L'Cense: CS-069120
JOHN W I�ZA?AME
ZMNt 01844 ,
r
04/03/2017
' Office of Consumer Affairs and Business Regulation
tj
` :. 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Regist(ation: 137057
Type: DBA
Expiration: 10/2/2018 Tr# 291333
ALL UNDER ONE ROOF
JOHN LANZAFAME
166 A MERRIMACK ST --
METHEUN, MA 01844 —_—
Update Address and return card.Mark reason for change.
SCA 1 20M-05111
] Address 0 Renewal ❑ Employment f] Lost Card
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
P
ex iration date. If found return to:
-i HOME IMPROVEMENT CONTRACTOR
Registration: 137057 Type: Office of Consumer Affairs and Business Regulation
%x .;t Expiration: 1'01272018 DBA 10 Park Plaza-Suite 5170
Boston,MA 02116
ALL UNDER ONE ROOF
JOHN LANZAFAME
166 A MERRIMACK ST tC +e
METHEUN,MA 01844 �de� rs' etre— to--
'� of valid wi t signature