HomeMy WebLinkAboutBuilding Permit #740-2016 - 29 BARCO LANE 12/17/2015''� - _� NORTf�
Z�v < 4J" � L�- BUILDING PERMIT O� z�eo ,biro
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION '' ~
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Permit No#: 2o y° Date Received
�i9 A�q'TIED
SSACHuse
Date Issued:
nnIMPORTANT: Applicant must complete all items on this page
LOCATION2n� !"
PROPERTY OWNER
Print 100 Year Structure yesno
MAP PARCEL: 61 ZONING DISTRICT: Historic District yes n
Machine Shop Village yes n
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
❑ Septic ❑ Well
----[]-Other
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
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Identification - Please Type or Print Clearly
OWNER: Name: GAR Phone:
Address:
Contractor Name: J &4-L -Phone:
Address:
Supervisor's Construction License: 06-9 l2 -a Exp. Date: qL6 (2,i
Home Improvement License
ARCHITECT/ENGINEER
% ® S ? Exp.
Phone:
Address: Reg. No.
bl �-1�16
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 1 FEE: $ 7/ —
Check No.: Receipt No.: 03-�
NOTE: Persons contracting kith unregistered contractors do not have access
fund
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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 ❑
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
0
COMMENTS
Reviewed On Signature
Reviewed on Signature
Reviewed on Siqnature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
e
a'Water & Sewer Connection/Signature &Date
Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
PAR�TMENif, Temp®ite.
p umpster. 'obis
124IVIainiStF.eet
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 lies No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A —F and G min.$10041000 fine
NOTES and DATA — (For department use
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
M
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
4. 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
TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
4 Building Permit Application
Certified Surveyed Plot Plan
4 Workers Comp Affidavit
4 Photo Copy of H.I.C. And C.S.L. Licenses
4 Copy Of Contract
Floor/Cross Section/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
OTE: 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
TOTE: 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: Building Permit Revised 2014
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Mass `mall Free
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1924-34871
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Proposal To: Peter Weger
Date 10/19/2015
bcrnsed & Insured
y=No` License #034200
NAI- Work Year Round
,
Street: 29 Barco Rd. 978-857-3957
N. Andover, MA
Roof proposal Weger.pb@gmail.com
IKO Cambridge
1. Extra caution will be taken to protect building
exterior and landscaping as best as possible. (tarps
etc.) Magnets run at final clean up.
2. Remove all shingles from entire rear main house
and rear window.
3. Inspect and re -nail any loose or lifted plywood.
Any compromised plywood will be replaced at an
additional cost of $65.00 per sheet of 1/2" CDX
fir.
4. Install heavy gauge 8" white aluminum drip edge
to all applicable eaves and rakes.
@5. Install 9' of high temp grade ice and water shield
to rear main eave and rear window.
6. Install synthetic underlayment to remaining
sheathing up to ridge.
7. Install all new pipe boots.
8. Install new standing seam (ABC MFG) 4' metal
panels to the entire rear roof and rear window
roof. Metal on rear window will extend past roof
line for sufficient watershed.
9. Install IKO Cambridge Limited Lifetime Charcoal
Grey architectural shingles to the entire rear main
house. 15 year non pro -rated warranty by mfg.
All shingles will be installed and fastened
according to mfg. specs.
10. Counter flash chimney lead and all roof
protrusions with ice and water shield and seal.
11. Install a new GAF Cobra ridge vent capped with
color matched IKO hip and ridge shingles.
Acceptance of Proposal—The above prices, s
accepted. You are authorized to do the work as
Date of Acceptance:
12. Removal of all work related debris. Planks will be
placed under dumpster to prevent any damage to
driveway.
13. Building permit included.
14. Contractor workmanship warranty: 10 years
under normal wind and rain conditions.
Total roof cost: $ 5,900.00
• Install rain diverter over front entry
• Option: Install (1) new Lomenco 2000HT
power vent with thermo/humidistat controller.
$350.00 additional cost. No electrical hook up
included
*Note*: Please be advised if applicable, valuables in
the attic should be moved or covered due to minor
debris, dust and asphalt particles that will accumulate
during the stripping process. All Under One Roof not
responsible for any damage or clean up that may
occur in attic.
Balance due upon completion, no deposit required!
References available upon request
Highly rated member of the accredited BBB and
Angie's List
Thank you!
ions and conditions are satisfactory and are herby
d. Payment will be made as outlined above.
Signature:
a
The Commonwealth of Massachusetts
Department of Indu%strial AppWi!its
Office of Investigations
600 Washington Street
Boston, MA 02111
`'4 www.mass.govldia
";=_
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): A /// �� `� c� � R c 4 °i'
Address:
City/State/Zip: i `��� Phone #:
Are you an employer? Check the appropriate box:
I am a employer with 5 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
',. ❑ I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself [No workers' comp.
insurance required.] t
These sub -contractors have
employees and have workers'
comp. insurance.#
5. ❑ We are a corporation and its .
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12. ❑ Roof repairs
13. L?bther /s, J J�
*Any applicant that checks box #1 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.
Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
1 ani an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: A a`
Policy # or Self -ins. Lic. #: r Gk.. �'�� L/ Z �/ Expiration Date: l I ( 2a 110
Job Site Address: 29 ! )G / 2 -IJ City/State/Zip: /lf/ n_-2b,J_
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.
1 do hereby certify under the ins and enalties ofperjury that the information provided above is true and correct.
101/1J"3
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License #
12.I 1`1 124/3
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
WORKERS COMPENSATION AND EMPLOY RS LIABILITY INSURANCE POLICY
INFORMATION PAGE
A.I.M. Mutual Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
TEM
1. The Insured: All Under One Roof
DBA:
Mailing address: C/O John Lanzafame
30 Temple Drive
Methuen, MA 01844
(800) 876-2 r65 NCCI NO 26158
POLICY NO. AWC-400-7009464-2015A
........._.._..__.............__........_._-_-__._.. _......_..... .."
PRIOR N0. ' AWC-400-7009464-2014A.
FEIN: **-***8251
Legal Entity Type: Sole Proprietor
Other workplaces not shown above: See Location
2. The policy period is from 11/09/7..015 to 11/09/2016 12:01 a.m. standard time at the insured's mailing address.
... .........
3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers' Liability Insurance: Part Two of the policy appliE s to work in each state listed in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident
Bodily Inju by Disease $ 500.000 policy limit
Bodily Injur by Disease $ 100.000 each employee
C Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: EE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules; Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
. ................ �_.._..... __ _.._ ._..._ ... ........................_.... ............................ _._...........
ClassificationsPremiu 1 Basis Rates
Code Estimat d Per $100 Estimated
No. Total A I ual Of Annual
Remuner tion Remuneration Premium
INTRA 174355
INTER SEECLASS CODE SCHEDULE
Minimum Premium OW To al Estimated Annual Premium
-.1 .._....... _ D posit Premium up
GOV GOV
.STATE CLASS
MA 5474 State Assessments/Surcharges
$12.00 x 5 7500% $1
This policy, including all endorsements, is hereby countersigned by `` 10/05/2015
- M Authorized Signature Dale
Service Office: Perry Insurance Agency LLC
54 Third Avenue 522 Chickering Rd, Rt 125
Burlington MA 01803 iNiorth Andover, MA 01845
WC 00 00 01 A (7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
used with its permission,
4 Massachusetts - Depaitmenit of Public Safety
Board of, Building Regulations and
Standards
l Vil'i111A1Ui11i .11ll JL3tttittl
License: CS -0&9120
JOHN W LANZAFAME
30 TEMPLE DR
METHUEN MA 0184Q
r
oartr�assi �g;er
04/03/2017
Zig} ;
Gityrrown _.. , State code i
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REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION
ADDRESSEXPIRATIONSTATUS
NAME INDIVIDUAL NUMBER
ALLUNDER ONE ROOF LANZAFAME, 137057 166 A MERRIMACK ST 10/02/2016 Current.
JOHN METHEUN, MA 01644
0 2012Commonwealth of Massachusetts.
Mass.Gove is a registered. service mark of the Commonwealth of Massachusetts.
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