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HomeMy WebLinkAboutBuilding Permit #826 - 234 BLUE RIDGE ROAD 6/12/2007Permit NO: O- Z- Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building [] One family 0 Addition El Two or more family 11 Industrial El Alteration No. of units: 0 Commercial Repair, replacement 0 Assessory Bldg 11 Others: ❑ Demolition[I Other 'D Septic- rl"Well^'..' --QFJo " olairf I Wi-at-16-hds b =77 ,,Q Wgtersh'ed ❑ aterj$ewe UtbUKIF t ION OF WORK TO BE PREFORMED: s7n"P, Riq-r G-0&C1/J60(zC1C--/z Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: 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: $ 6 c) FEE: $ 15-k -, Check No.: /(-1 [-./ Receipt No.: � u 3 0 2 -- NOTE: Persons contracting with unregistered contractors do not have access to the ��ntyfund U I Signature of Agen't/Ow'ner. Signature of contractor 4 Location d3 ! No. Date �oR,M TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ �� s''^° • AC MUS E<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ! 20J�, Building Inspector 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 DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments COMMENTS'--_'.. p Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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 2007 I 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 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 2.2007 E Vf Z y O cm m Im C! c CAO L- 0 O cp QC N m Z O 2 O CD K1 co to .now z u C/) I CD Ccm O•— CACD Q 'O .� y O O ' m m CD 0 CD L. CL _~ Z O� � Q L t�C O a o .6"� C cc ■Q C Z s CL V y � C LL! IIO U) 19 W ce ,,Www Y/ w° C a w2 aQ' U w a w a°' w a w �a w w a CO U) cn E Vf Z y O cm m Im C! c CAO L- 0 O cp QC N m Z O 2 O CD K1 co to .now z u C/) I CD Ccm O•— CACD Q 'O .� y O O ' m m CD 0 CD L. CL _~ Z O� � Q L t�C O a o .6"� C cc ■Q C Z s CL V y � C LL! IIO U) 19 W ce ,,Www Y/ M Chinximays_-- Siding Mass Toll Free F 1-800-WAIT4-m All Types. Of Expert Masonry Work Licensed $� Insured Locally Owned & Op¢rated Since 1976�' License #034200 IKOi° G�QLL° arm oe• , jv�r We work Year Round ?f unT �c��•�r Street city, state a Zip Code , t t_ 1 Phone Date I8•GYz-q«?14 s e Job Name w6Avt - ?18 - Job -Job Location Job Phone we Propose hereby to furnish and labor .in accordance with specifications below, for the sum of. ,,r ,r 00 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 p s*maybe or delays beyond our control, owner to carry fire, tornado and other necessary insurance, withdrawn by us if not accepted within `° days. Our workers are fully covered by Workmen's Compensation Insurance. We hereby submit specifications and estimates for: v c�2 4 -AW Cr Instal! 3 feet of special "Save Seal" ice and water barrier protection along all bottom edges of roof and top to bottom in each valleyA roof is shed, we -will apply conventional ice and water shield (� 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 (•aa ) per sheet of plywood. Urinstall heavy gauge aluminum drip edges along every edge surface of each rooflne: 1d Cover entire roof (s) with IKO s, premium grade shingles (Color of choice). e,;V-, '0 ;- Replace all pipe boots where possible. Seal all flashings with clear Geo -Cel sealant. No black tar unless previously applied. &Remove all work-related debris. O'Contractor warrants roof against all leaks due to defects in his workmanship for 12 years under normal circumstances. LdLocal current references and proof of workman's compensation insurance gladly given. URemarks:�-Z u iu u.l 04;i!: °a&tA PYG�� UC `7 9i i ,-&- ,&A !'71 �•d .V;7 �? a j -Cs C/zGrw 4 Acceptance of Propos 1- T'htr above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized.todo the work as specified. Payment Signature: will be made as outlined ab�� ve. �y Date of Acceptance: SSi �ature: rtanddar�s� eoaarroWuViimng4degulii(��Want One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Construction Supervisor License JOHN W LANZAFAME 30 TEMPLE DR License CS: 69120 Restriction: 00 Birthdate: 4/3/1959 Expiration: 4/3/2009 Tr# 11855 Update Address and return card. Mark reason for change. Address Renewal _ Lost Card Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR _ - Registration: 137057 Expiration: 1012/2008 Tr# 128146 Type: DBA ALL UNDER ONE ROOF jOHN LANZ.AFAME 166 A MERRiMACK ST..4.` METHEUN, MA 01844 Administrator Tr# 11855 Commissioner License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid without signature INTERNET INSURANCE Fax:9786870149 dun 4 "LUu/ I3:3L ACS - CERTIFICATE OF LIABILITY INSURANCE in%mt Insurance Age q 522 CWAerirg Road North Andower, MA 01645 JOHN LANZAFAME DBA ALL UNDER ONE ROOF 30 TEMPLE DR METMUEN, MA 01844 ONLY AND COWERS NO RIGHTS HOLO W THIS CLVfHgCATE OM AI:FOROM COVERAGE r.UI �DATEIII�uoonYYr� 06/04/2007 E OF DEFORMATION THE CSRMCATE SND. EXTEND OR Tw POLvm OR 1tISURANCE LwED Bww HAVE BEEN wm" TM FUMY PERIOU Art7tCATeR NQTYYITMTANDING �TAu�i URAma AMMED BY THE POLICIES DESCRIBED HEREITM Olt CONOMM OF ANY CONTRACT OR OTHER NECTTO ALL TTtE:WITH REMPECT �TffdA& EXO WHICH CLUSIONS AND COMMONS Of SUCHCEKfflCATE MAY BE ISAUED OR POLCIES ACCRMTE UWS SHOWN MAY HAVE BEEN REDUGEU BY VAJU UU M6. TYPE Of WWJRMM POIJGY . umn A tea, uMm COMWMAL GENERAL LIMLIW ❑ CLAW MAN © O=UR R0401433A 6/312007 81312008 EAGH 0=wwm E s 1.0m ma.00 S I,DDoaDo.DO MED FJIP (Anlr qIA pOtSOII) i b 000 00 _. PERSONAL & AOV IN&RY t i—000:000;oo — ENI. AOGREGAIE LIMIT APPLSES PER: nmacTo Loc GENRALAGWGATE s 2.000.00 00 PRODUCTB-4OWW. *M S "WOW"Pamv All"Um I.E uomm AMY Autos Auo�wNEDAVToa BCNWIA.£DAYTOB HIRED AUTD6 I�i4YkNED A11T'OD Was �NJtiIE LIMB (Por�ar ft Y 1 i pq� tEee' ��rtp t aARADS mow" XN Aura , AUTO ONLY. EA ACCIDENT s p T�ww EA ACC S NlfoObar AM s LSA61LaTT OCCYR cmw NAGE DE011GTb1.E RETENTION i t, ELei lurnTD�a A ANY 00F10ERAuIEAI E1fi�BUDEIM� y! @ fit EBiESAi PRl1It81 l 6w AWC7009464012003 11119/2006111912007 EACI+OCOI>R�NCE i AGGREGATET t t 1 i LDiQT$ R ELL EACH ACWDENT I +00,000.00 ELD!!EA -EAEMPtOM t 100,ow.00 E.L. DISEASE • POLICY UNIT s OOO, 00 OTNER SHO"Aff Of TME M OVE DSSCMM POL=r GU CAMC LLED BEFORE THE EXPiRATIOI DAltimt9w.?NmmomamnmLLOWAVOR700LAL 30 DAYB WWTEN NO, TO THE CmVVcATE MOLDER NAMED TO TB& LEFT, OUT PALMS TODD SO 414ALL IMPME ND ORLMSATKIN OR UARMW OF ANY RMUM THE #MwsR, ITS AOSNTs OR NO wylvinwTm AUAiOIM S ITAIM w _ t The Commonwealth of Massachusetts Department of Industrial Accidents Ogee of Investigations 600 Washington Street Boston, MA 02111 __c3x— www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: � n 1 e:1, PLc= 0/7 City/State/Zip: y 4 c=T 4 6F -r,-) n113 Phone #: 9,2Y-9,7 s= 1%.5j Y Armee you an employer? Check the appropriate box: 1. CI i am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. E3 1 have hired the sub -contractors am a sole proprietor or partner- listed on the attached sheet. x ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.ORoof repairs 13.❑ Other --^ ... 1—' -1— V u< enc sccuon uelow snowing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they am 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. Insurance Company Name: /11 1-t U-1 U-4 1 Policy # or Self -ins. Lic. #: PwC -")^S 6 11�'G, v I -Zd u o Expiration Date: / 1 � ql Job Site Address: 2-7,f -JL 0 c R i �� ez City/State/Zip: AJX� 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. Ido hereby certify under a pains and penalties of perjury that the information provided above is true and correct Signature: Date: / Phone#;,�- Official use only. Do not write in this area, to be completed by city or town oJjiciaL 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 #: