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HomeMy WebLinkAboutBuilding Permit #71-12 - 402 JOHNSON STREET 7/30/2012D,""D L H p i \fillanP : VP.S TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildingne ❑ Addition ❑ Alteration family ❑ Two or more family. No. of units: ❑ Industrial Q Commercial ❑ Others: ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Other 0 Septic . f7liVeli Floodplain.' II II�e#(ands fl Watersfed' Utsuic� D Wa#er/Sewer DESCRIPTION OF WORK TO BE PREFORMED: %I P --� /'� �e' R6 Identification Please ype or Yi OWNER: Name:_O Address: aO 2 J -E) S Clearly) 9� 2,1 Phone �' � Y3 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: $ /' qC) FEE: $ f Check No.: Y % �� Receipt No.: 5 3 NOTE: Persons contracting withtered contractors do not have access s to he g�anty f 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 COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Commen Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street ttOMMENTS` 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 Doc.Building Permit Revised 2007 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/ �( ,7Uh4��& No. Date Check #� / � r 25553 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector w •J LLI _ oCA m +� Y O LCL N ? In O LLI CL Z z J_ D co O m > LL- > w N U LL O z Z J d =5 d' LL O Z v t3 W J W 9= y (%j a z z cr- a CL W W cc LL L O Z v N D In uj am o LU CO) Z 0 CO Q 0 E �O y Z c' X Z o LV o 5 ~ W rn :a a Z m O 0 N O O O z w ti E CD O O d Z N O .c y Q .Emm O+ d O � (L O C. Q O ,,_• V —j -a .Q 0 C Z V VY/ CL U) 0 Ac:[. Ro 144� "otllpr p A pJwnv insurancti Aperlcv CERTIFICATE OF LIABILITY INSURANCE ,bi"N 1-4NZAFAME DBA ALt UN, �ER ()NE PO(-'jf T"S CERTIMATE 15 ISWED AS A MATTER OF INFOFMATKYN j ONLY A*D COmFeRS No RIGHTS UPON THE CERTIFICA-1, MAIWA. TWS CERTIFICATE DOES P40T AMENDEYTEND'014 ALTER THE COVERAGE AFFORDED flY THE POt ICIES OF (Ji%' mewmRs AFFORDING covERAGf tiSfiiZE146 AM tt6URER C. K,, TEMPI -F 11P METHUEN Ni�01944 'HE POLICIES OF INSURANCk LISTED KLOW HAVE BEEN ISSUED TO THE WSURED NAWD ABOVE FOR THE PatCy FIEPIC:) b\0#CATF(' N0TVvJK�','.N!­_ ANy pEC"pa&NT 7ERAA OR CONOtTiON OF ANY CONTRACT OR OTHER 0OC4MENT VffH RESPECT TO WW_m THE CERN W%C ATE MAY Bi• tsSul-D t� :>FRTAIN -HE WSURANCE AFFORDED BY TME POLM*S DESCRIBM HERE" IS SUBJECT TO Al.L n4L 7FRWS E XC"StONS a,140 -'0t;QlES AGGREGATE LM # i SHOWN MAY M^*V'E SUN REDUCED By PMD CLAAAS. �Z_ T ypt OF INSURANCE poucyu-6wwa UMI T 5, GkWRAL 0ASOL L'iBOW227 !20 12 I TO PfZWTCC -;EP, A,,, I IA,61, (TI t A'aAs "-.I* fA­ OkU70W*R, E L LAal: I Ah -;T A TO r_I AA,CtL i I S. L AWC?009464012010 11109mi1 tifQ9l2ii12 tMrMls av MTRATN"" 1 1 OrAT kRTIFICA-TE HQLDFR CAUCELLATI314 ""OULD ANY Of THE ASOV* CIESCROVI) POUWI� C 159 -ANCr'! �y "'K �n;- VLjr- l"pVvsI!;' M"k MW L F�'AWQ>P 'WAil DATE THEOF. TOOG WSUREA' WILW I --- '. -z' 11 1 — W NOTiCt TO THF CERTW4CAT-F HOLDER K"fV tt. TW 1, ffl MUll GAA t —m hij't II, lit 41.111111t'I11 ul 1'0111t SmI'i lfaa,l IYI t't It i 111 ln- k4: I i I ; I I I+ln. ,I I i I ti1.I I141.I u; '.�Uf!Stfi.iCtlnf7:;UCie,f'•iiS��f" tjcony. L II. ef)Se C5 69120 JOHN W LANZAFAME 30 TEMPLE DR MEfHUEN, MA 01844 Exj+aataun. 4!3/2013 i ,>ratun��i�,t+cr ; rjt 14108 ft 4 Office of Consumer Affairs and Efusiness Regulation ;' ' 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration 1370"•' Type: DBA Expiration 10/2/2012 ALL UNDER ONE ROOF JOHN LANZAFAME 166 A MERRIMACK ST. METHEUN• MA 01844 1. ii ,,,h:.•..,., .1 .• , Trd! 20402' Update Address and return cares. Mark reason for change. Address Renewal Employment lost Curd � tit *?titt�+ lM.tft .. Fif t gran License or registration valid for individul use on IN Orfire o nntnrtler Al sirs sietss HoME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: " Registration: 137057 Type: Office of Consumer Affairs and Business i eg"Intion cT c's 9 10 Park Plan - Suite 5170 Expiration: 1012!2012 DBA Boston, MA 02115 ALL UNDER ONE ROOF i !-Ira LANZAFAME / i5Fj A M RRIMACK ST OF74HEUN MA 01844 t`ndersrcredn" of all �tsignature 3 Chirnnsys Siding. Mass Toll Free 1 -800 -WAIT -4 -ISS (924-8487) Proposal To: Joanne Damon Street: 402 Johnson St. J 7. 8. N. Andover, MA Roof proposal Protect house exterior and landscaping as best as possible. (tarps etc.) Strip all shingles from entire house. Inspect and re– nail any loose or lifted plywood. Any compromised plywood will be replaced at an additional cost of $50.00 per sheet of 1/2" cdx fir. Install heavy gauge 8" white aluminum drip edge to all eaves and rakes. Instal 16' of IKO Armourguard ice and water shield along all eaves. 6'MA state code. Install all new pipe boots. Above the ice and water shield, install IKO cool Date 6/29/2012 roof guard synthetic underlayment to the remain- ing sheathing up to the ridge. 9. Install IKO Leading Edge shingles to all eaves and rakes. 10. Install IKO Cambridge AR(algae resistant) Lim- ited Lifetime architectural shingles to entire roof and. 15 year non pro -rated warranty by IKO mfg. 11. Install new GAF Cobra ridge vent. Capped with color matched hip and ridge shingles. 12. Counter -flash chimney with ice and water shield and seal with black roof cement. (See options) 13. Building permit included. 14. Removal of all work related debris. 15. Contractor workmanship warranty =6 years under normal wind and rain conditions. 978-804-1331 978-683-6259 Joanne_damon@yahoo.com Total cost: $ 9,900.00 Chimney option: Cut all new lead flashing into chimney. Counterflash with ice and water shield and seal with clear sealant. Muck cleaner appear- ance and longer lasting watertight seal. $450.00 additional cost Notes: Please be advised, 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 Referrals available upon request Highly rated member of the accredited BBB and Anaies' List 'Thankyou! Acceptance of Proposal—The above prices, specifica ons and conditions are satisfactory and are herby ac- cepted. You are authorized to do the work as specified. Payment will Vbemloesuth d above. Date of Acceptance: Signature - 1/7 !l, A r>l Rosi+denti,+l & Commercial Roofiing All Types Of CHIMNEYS POINTED -REBUILT -CAPPED Expert Masonry Work ����. � �s�� � ��► � �- , Licensed & Insures ,� a� wed R �r,a r�«<� .sr ::.� r vae a ~ License #034200 we Work Year Round € Proposal To: Joanne Damon Street: 402 Johnson St. J 7. 8. N. Andover, MA Roof proposal Protect house exterior and landscaping as best as possible. (tarps etc.) Strip all shingles from entire house. Inspect and re– nail any loose or lifted plywood. Any compromised plywood will be replaced at an additional cost of $50.00 per sheet of 1/2" cdx fir. Install heavy gauge 8" white aluminum drip edge to all eaves and rakes. Instal 16' of IKO Armourguard ice and water shield along all eaves. 6'MA state code. Install all new pipe boots. Above the ice and water shield, install IKO cool Date 6/29/2012 roof guard synthetic underlayment to the remain- ing sheathing up to the ridge. 9. Install IKO Leading Edge shingles to all eaves and rakes. 10. Install IKO Cambridge AR(algae resistant) Lim- ited Lifetime architectural shingles to entire roof and. 15 year non pro -rated warranty by IKO mfg. 11. Install new GAF Cobra ridge vent. Capped with color matched hip and ridge shingles. 12. Counter -flash chimney with ice and water shield and seal with black roof cement. (See options) 13. Building permit included. 14. Removal of all work related debris. 15. Contractor workmanship warranty =6 years under normal wind and rain conditions. 978-804-1331 978-683-6259 Joanne_damon@yahoo.com Total cost: $ 9,900.00 Chimney option: Cut all new lead flashing into chimney. Counterflash with ice and water shield and seal with clear sealant. Muck cleaner appear- ance and longer lasting watertight seal. $450.00 additional cost Notes: Please be advised, 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 Referrals available upon request Highly rated member of the accredited BBB and Anaies' List 'Thankyou! Acceptance of Proposal—The above prices, specifica ons and conditions are satisfactory and are herby ac- cepted. You are authorized to do the work as specified. Payment will Vbemloesuth d above. Date of Acceptance: Signature - 1/7 !l, A r>l The Commonwealth ofHassachusetts • - Department of-IndustriglAccidents Office oflnvestigations Uf 600 Washington Street Boston., MA 02111 www.massgov/d'ia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbera Applicant Information P' lease Print Le>sibly Name (Business/Organizationfidividual): 411 if rl QtjG",- 0,6 Address: City/State/Zip:_ Phone #: Are you an employer? Check the appropriate box: Type ofproject (required): 1.i am a employer with ^_5- 4• ❑ I am a general contractor and I 6. [] New construction employees (full and/orpart-time) * 2. El am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub -contractors have 8, ❑ Demolition working forme in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9. ❑ Building addition required.] officers have exercised their ME] Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. c.152, §1(4), and we have no 12.Q Roof airs insurance required.] Ti employees. [No workers' .13,�'Othe a comp, insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submitthis affidavit indicating they tie doing all work and then hire outside contractors must submit anew 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. X am an employer that is providing workers' compensation insurance for my employees. Below is ihepnlicy anrljob site information. / Insurance Company Name:. 6f,/t-41 J72J '' 1 Policy # or S elf -ins. Mc. #: Expiration Date: Job Site Address: 4[o '1 •s J City/State/Zip: ©I Attach a copy of the workers' compensation 13 olicy 8eclaration page (showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL o. 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido Jzereby cert un r the ins and peenalties ofperjury that the information provided above is true true and correct. Sionmurw � V, /I nates• i / 2 / / 2 J / Z Offklal Ilse only. Do not iVYile in this area, lobe completed by clty or town off cW City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: 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 "...everyperson in the service of another under any contract ofhire,- express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or 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 legal entity, 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapterhave 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 -contractors) name(s), address(es) and phone numbers) 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. Han LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents fox 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 printedlegibly. The D epartment 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 pennit/license applications in any given year, need only submit one affidavit indicating current Policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit thathas 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 orpermit to burn 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: `rho Colmmwoalthofmassaehumats I3. op.adment ofDidustdat Accxdo . Q�'�ce o£IJa�esti�atiotos • 600 WasWag o ll Stxeet Boston,, MA, 02111 Toll # 617-72,74900 PA406 or 1-877�AWS.AFJ3 Revised 5-26-05 FaY, # 617"727"7749