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HomeMy WebLinkAboutBuilding Permit #694 - 32 SAUNDERS STREET 4/27/2007Permit NO: L Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received /3? • , b.. ; :6N- 0 QL TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building t`One family `� �9_ � wew.cw • �• ��r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building t`One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: ArMnnee- ARCHITECT/ENGINEER 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. Total Project Cost: $ FEE: $ b oy/ Check No.: �5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaran fund Signature of Agentht> er Signature of cantractor 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED El DATE REJECTED El DATE APPROVED ❑ — DATE APPROVED 11 DATE APPROVED 11 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ti Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT' - Temp Dumpster on site yes ` n Located at124 Main Street Fire Department signature/data 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 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 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 ❑ 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 Location�� No. l G� — Date D �� OfM, ORTol TOWN OF NORTH ANDOVER t..•♦ •M Certificate of Occupancy $ ,�ssACMUSE� Building/Frame Permit Fee $ Foundation Permit Fee $ 0, Other Permit Fee $ _,-- TOTAL $ Check # 2015i Building Inspector r•F CO) CD Z W O d a� a� -o o p CD CL Q�"_ CD CA d d O C c co) CDd CD CD CDy O CCD O CD O � C?�o d 2 rom O cn N cn X n m n T O cn "$n Z ?� M G w O o cn � C?�o d 2 rom O d-�NOQ O,• N y X m n T CL y m "$n Z ?� M G w O T O • .nr d p y N 40 lcE* m O m m �o O 0 SL 0 , y CL 4 O .moi• 5 m C CD m O m a , CCID O y m N CL Q 0 EL COO) C to ca V 1 ? Cie m� ilk m FF oC.)o►y O Ojcit y 'O O 0 0 .% N om O d CL ..o c o o cn cn vy -m rom �M X m n T al cn "$n G w T r rA 0 z :71C: G Cl. • • d 0=3 0 c . .. ....... . .... ... Z 31 H 0 r nZ_ a, LE M r Residential & COmmercial Rooiinq CHIMIKEYS POINV-.-D-REBUILT-CAPPED Snq Mass Toil Free - 4 800 -WAIT- -US Ll;��__.!_�Ilpolln;d _&0flerared since J 9 76 IKO 924-8487?1 j '� LA , :7 - - - _ All Types Of Expert Masonry Work 1 icerised & Inswed License #034200 We Work Year Round Proposal Submitted To Phone uaie 7 Job Namc, Sir& 1� Vic) lob Location fob Phone -ity Statc & Zip Code I I ir, accordance with spec isfications bellow, for tie sum of: `We Propose hereby to furnish Talear -) / A] Dollars C L ';' � All rnattri�j is g1taranteed to be as sp_ccifvM. All rIto be rompleted in a work-rn anlik Authorized k manner according to standard practices. Any alteration ui dtviani 011 rs b Signature: low involving extra custs .vm be c.xecu t -e" 0"' ai cxtra charge: o e Cst;m_#. over iibove th .11 agreements contingent upon strikes, accidents NOTE: This proposal may be or delavbevond our control, Owner 70 CaiTY tirem . to.adoand �)!her ricc'—sary wsifraoc-e withdrawn by us if not accepted within s , C e_nsu -' f" - days. u_� Our workers are full"y 'cov' e' by Vvorkm'!mls �\nq-'T Kl tib and estiniatcs fol'.' We hereby submit -spec S T 0 U'Install 10) feet of spek"ic-41 "r--anve, 43an' is and watrar barrier nrotectonalsong all bottomedgesof rof-:n"o —e and water shieldand top to bottorn M eakcif Vcx1K'-V. 'Mn" is Ciripped, we will appy rov -at r -rw"Il .verthe ft. higii 'In ns previously described -and tair ian H. y r.placed at, X" % per linear ft. remaining bare wood. lAry - roftedor lamageud boards wia I '- ­ - or per sheet of plywood. I MnTime. Lt Unlace of ­�ch 0 Install heavy gauge aiurninurn drip edlges alrong every edge s , i.� j: 7Z:' -m rig-qr4p shing'es lyCover entire rool (s) with I i eer lass, --remi 9 (Color ofchoice' .Xf­ 0 Replace all pipe boots where possible. -a, imless previc-1-1--irink-d 4d Seal all flashings w th 1-11:aar No black L � U i . ta --y -rr&z 0 &Remove all work-relateud' (-'Jebri-s. C - n 0 12 ea W Contractor warrants roof against all,, fe-2�tKs to defects in hils workmanshi- for nears rs under normal circumstances. 43 Local current reilerences amid, procF, of w0rknlan's compensation insurance gladly given- �,4 tidRernarks.- z"I ------------- - Z 0, ' O 7-6 V-_-4 Acceptance of Proposal - 11"he above- prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment Signature: will be made as outlined above, vi Date of Acceptance. Y -,F -o'-2-00,/0 lY 05' �`��' ACORD CERTIFICATE OF LIABJUTY INSURANCE DATE {Mrvoorrrrr) 11/09/2006 I5",ALTER THM CBRT"CATE IS ISSUED AS A MATTER OF INFCIOMTION ternet Insurance Agency ONLYAND CON"= NO WGIfTS UPON THE CERTIFICATE 2 Chickering Rnad HOLDER, TM CWMCATE LIM NOT AMEND. EXTEND OR THE COVERAGE AFFORDED BY Anoaver, MA 09845 THE POLICttti BELOW. iNSUPEFtS AFFORMNG COVERAGE4CO"MPANY y IHHSURERA- NORFOLK 6 DEDHAM INSURANSE JOHN LANZAFAMEAi1A_— DBA ALL UNDER ONE fiQC7E rNsi►R� c — `_ 30 TEMPLE OR METHUEN. MA 01844 INSUwp..o TW POLICIES OF IMStRiANCE LISTED BELOW HAVE BEEN MW TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO14Y;7HS 7ANCHMG ANY R IKTHE !NSU TERM OR CONDITION Y OF ANY CONTRACT OR OTI4ER DOCUMENT WITH RESPECT TO WHICH THIS CEAi1FICATE )MAYBE ISSUED OR MAY PERTAIN. THE WsURANCE AFFOR{7ED BY THE POLICIES DESCRIBED HEREIN IS SUB,iECT TO ALL THE TOWS. EXCLUSIONS AND POL ICIES. AGGREGATE i. AMMS TS SHO%VN MAY HAVE BEEN REDUCED BY PAID CLAW. CONDITIONS OF SUCH r=l POLACY WORM -- A G1lLtI1.HLITY 20155063E - - - —.. ....R rr LIWTS 1 513120(6 81312(07 EAC"0CCURRENCE 1,000.030oo CAMnAERCHAI GENERAL L+A.)LIT'� _ I © CLAOMSNAM OCCUR I 2— S 1.1�Q,OQO.Cn i f MED EXP IMY -0 porwi S 5 MW OJ iii 1 I PERSCINAL L ADV INJURY S 1.000.000 m GEN'! AGATE LWII'1' AJ�D{.Ic$ PER. 11111 RENERALAGGRECATE S 2.10,00 7, POLICY P"Ar-T t Lot � PRODUCT& • CUI�+IOP ACi(a S 2.000.000.0Q iii T7,7ET.0 LE LIMIT AUTOS SCkEOULED AUTOS SAY BURY j Ij MREO AUTOS NONOWNEp AUTOS S 1 QAIiI1H:i L1M�ITY PROPERTY DAMAGE iPd amoerlt) ANY ALTO AUTO ONLY • EA ACCIDMT S I FA ACC tiJlc9sarUA111ImuA u wLITY OMIR 0 CLAIMS WAGEEACH OCCURRENCE � OEDUCTWE TiliTIOH1 i �x e�n�OMJ�"O AWC7O09464012003 19I;9/Z00& 11!812007 Tn. L p�Hrm� ER�J(ECUTttic E.L EA.'.►I ACC►OENT S t00.0U0 G� R 1Rl0lr .,.. I rop"W21tEq 0 b*k w E S U Si►Si Lr EWi01?t S 100,000.00 D'iilEA t: L DISEASE • POtYcY Lowmi. s SQe.�Q QQ fNOULDAWOF TM AWW 0fWjWppLXWS Mg �`xmwlom CAK(Et + H:n.E�AE TME !%PHRA OATS TIEREOF T!* O3III�.iH9WM WDLL ENDEAVOR TO MA)L 30 GAYS TION NOTICE Tp TIE TEIl"Fr-ATS MUM WAVED TO THE UWr, OUT FAi1.U1E TO Gp y0 qlo N N@ 08U"7M OR t OF ANY KM WW' TIE WVAM IT. AGENT. on I�HHE.BIf�tww� L. I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naive (Business/Organization/Individual): AU_ L U n a LA O� Z �° °F J �A n 2A jaws? t Address: 3 � Te�KP LI` O/7 City/State/Zip: M C-- 74 J ti� VV11443 Phone #: 9 I - 9I.r- IlrIJ 1 Are you an employer? Check the appropriate box: l . I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors h d h t I 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for mein any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t fisted on tte attac e see . These sub -contractors have - workers' comp. insurance. ❑ 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 1 l.❑ Plumbing repairs or additions 12.ERoof repairs 13.❑ Other *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. $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: A_T in M o V Policy # or Self -ins. Lic. #: A LJ C ' r7o oQ � G qt, t Z 1, ° 3 Expiration Date: i l o'\ job Site Address: 32 SAun �'6 Gam( City/State/Zip: A 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 coverg verification. I do hereby certify under he pains and penalties of pe►jury that the information provided above is true and correct- 0 orrect _. D� n JA nate- Q �a(,J-° 1 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Contact Person: Permit/License # City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Phone #: 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 of hue, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation 6r other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legalentity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the 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 be 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 applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public 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 necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(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 being requested, not the Department of Industrial Accidents. 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 rnust submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all 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. A new 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 bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia �n gdeei uions an tandar sIN oa� 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 TT# 11855 Update Address and return card. Mark reason for change. Address ' Renewal Lost Card s a6 n a s Construction -Supervisor License License' CS 69120 9it#i�das. 43/1959 E �ffi7 4/3f#009 Tr# 11855 JC tiNW 'L ANZA4I iii TeOPLI DR = MMUEN,11A�101844^ _ t. Z; -m issioner ��€ �ti�,i.9nooe..tiea�l%i a�.l�ua!(uael�3 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: .137057 Expiration 10%212008 Tr# 128146 Type DBA ALL UNDER ONE ROOF JOHN LANZAFAME 166 A MERRIMACK ST. METHEUN, MA 01844 Administrator 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