HomeMy WebLinkAboutBuilding Permit #630 - 45 FRENCH FARM ROAD 5/19/2009Permit NO: 6 &�
Date Issued: 1!5
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received 5-2 3
• D
I IMPORTANT: Applicant must complete all items on this pate
LOCATION '�4� )57",KWI /
P 'nt
PROPERTY OWNER fc-0 D tJC.{c<
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
7-1 o i-, 5 / 60 73 Machine Shop Villaqe ves no
TYPE OF IMPROVEMENT
PROPOSED USE
9171
�� � � 2� s
Residential
Non- Residential
New Building
One family
2 m�
Addition
Two or more family /
Industrial
Alteration
No. of units: /
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
LM—�iJ
L l S (T��(-�-� '��0��j
Identification Please Type or Print Clearly)
OWNER: Name: r2C� Phone:
Address: �,/S' 14F&U 4 /-?l
CONTRACTOR Name: —T-44 Phone: �1." '71/f
Address: -16 t. 12�t �/7
C,c.l
9171
�� � � 2� s
Supervisor's Construction License: 6L,( f U
Exp.
Date:
3
2 m�
Home Improvement License:
ARCHITECT/ENGINEER
U
Date: (a (z- ( ( u
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: $ /���� b FEE: $ �� 2
Check No.:
NOTE: Persons contracting
Signature of
�Q U Receipt No.: a a0
unregistered contractors do not have access t the aranty fund
Signature of contracto
I --
Location
No. Z-4 30 Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check # J�5—(.)
Building Inspector
a
X,
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
Po%4lodl /1
CONSERVATION
COMMENTS
COMMENTS
DATE REJECTED
I/Z `%rd Is IV�' I--,
Reviewed on
Zoning Board of Appeals: Variance, Petition No:
Planning Board Decision:
Comm
DATE APPROVED
ing Decision/receipt submitted yes
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes.
Located at 924 Main Street
Fire Department signature/date
COMMENTS
Located 384 Osgood Street
no
0
�6 r
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 2008
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
o 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
a Building Permit Application
o 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)
o 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 2.2008
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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 hire,
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 includir-ig the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, associatioim 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 maiumenance, 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 irrto any contract for the perfonrranee of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the corttracting 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) atrtd 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 requiredz to carry workers' coTnpensation 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 nurnber listed below. Self-insured companies should entatheir
self imurance"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 permittlicense number which vwill be used as a reference number. in addition, an applicant
that must submit multiple penniMicense 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 Investi-gations
600 Washington Street
Boston, MA 02111
TeL # 617-7274900 ext 406 or 1 -877 -MAS SAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
The Commonwealth of Massachusetts
Department of Industria! Accidents
# Office of Investigations
ili ' 600 ff'oshington Street
a i Boston, MA 02111
"air, www_nwssgov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Atiplicant Information Please Print Legibly
Na.Ille (Business/Organization/Individual) A(,(.. (J 4,06 --t? dtJGs
Address: 3-0
City/Sta.'te/Zip:_ 1A lksj OU'l Phone #:.tri
Are you an employer? Check.the appropriate box:
1. [C�1 aro a employer with S"
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. ❑ I am .a
have hired the sub -contractors
listed t
.sole proprietor or partner-
on the attached sheet,
ship and have no employees
These subcontractors have
working for me .in any capacity,
[No workers' comp. insurance
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..)
---••• - u.. n t lw' uL tuso Int OUT IDC SGCnOn below showithi
er woA. .1iI O
ng ompen6atl0rl pOI�Cy rttorrllatton,
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 cheap this box must attached an additional shaet showing• the name of the sub -contractors and their wON=' coup, colics information.
lam an employer that is providwg:workers'' compensation insurance for my employees;
information. Below is the policy and job site
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
S. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
I I.❑ Plumbing repairs or additions
12.❑ Roof repairs
I3.7 Other ~'
Insurance Company Name: 4�k n - -1-U tk (
Policy # or Self -ins. Lic. #: �C�. Do q `F` �o � �o J/'�
Expiration Date: I o `)
Job Site Address:�'1c, City/State/Zip:
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 font 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.
I do hereby certify under tV pains qnd penalties of perjury that the information provided above is true and correct
ficial use only. Do not write in this area, to be comfpleted by city or town ofcial
City or Town:
Permit/License #
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
tq b
Contact Person
Phone #:
t„6,faoce Age"cl
MA 0184�
,,,--RTIFICATE OF LIABILITY INSURANCE
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North Andover MIMAP
May 18, 2009
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Rail Line Wetlands
Interstates Exempt Lands
Interstate
Horizontal Datum: MA State lane Coordinate System, Datum NAD83,
Major Roads WSP Z—A
Meters Data Sources: The data for this map was produced by Merrimack
Roads WSP_ZoneB
p10RT1Y
Valley Planning Commission (MVPC) using data provided by the Town of
North
0 rthAndwer. Additional data by the Executive
WSP
i Easements _ZoneC
Of 'So
6
provided Office of
Environmental Affairs/MassGIS. The information depicted on this map is
0
for only.It may not be for legal boundary
Streams
MVPC Boundary
0
planning purposes adequate
definition or regulatory inlarp"ati.n. THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING
E3 Municipal Boundary
THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY
Watershed
OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
C. Watershed Sub -basin
THIS INFORMATION
[I Pamels
Hydrographic Features
Floodplain
157 ft
I 1 100
500
3oard of Buil in R Yons andg egultan &s
One Ashburton Place - Room 1301
Boston. Massachusetts 42148
Home Improvement Contractor Registration
Registration. 137057
Type: DBA
Examtaon: 10/2/2010
ALL UNDER ONE ROOF
JOHN LANZAFAME
166 A MERRIMACK ST.
METHEUN, MA 61844
Boord of Dalldtaa Regultutobs rind Standards
t = HOME 1094ROVERE214T CONTRACTOR
Rog( *mfti rs 137057
Expbzftw IW212a10 Tro 275510
Ty": U8A
Trt7 2755 i c�
Update Address and return card. Mark reason for change.
Address Renewal Employment 1..051 Card
Liteme or registratiao valid for iadividat am oety
lsefare the esph mmdw daft. If rvwro to:
Ssmnd of BuNdbIT P4Pbt== and Star ds
(kt As#liet+rtm Pbw Rcs 1301
. Ms. 0211118
- UNDER ONE ROOF
!i'!tY LANZAFAME
i A MERRIMACK ST
2A lug 61W Not A 4MI ,. 1`4
aik Nlassachusett. - Department of Public Safety
70Board of Buildin, Regulations mill Standards
Construction Supervisor License
License: CS 69120
Restricted to: 00
JOHN W LANZAFAME
30 TEMPLE DR
METHUEN, MA 01844
Expiration: 4/3/2011
i,wucr Tr#: 13449
�ia.�acllu.ctt• - Dcliartntrnt ul Ptihltc �afct�
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Construction Supervisor License
License: CS 69120
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' Residential & Commercial Roofing
All Types Of
(ChimmrWays CHIMNEYS POINTED -REBUILT -CAPPED Expert Masonry Mork
Siding- i��srf ��� � ���p is L,censed & Insured
' Mass Toil Free License #034200
I oca yY Owned razed ' ,O G sera
1 -800 -WAIT -4 -US 1fk�O� I.�GG IfrC/ Off' .+raj[ We Work Year Round
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Proposal To: Fred+Mary Boucher
Street: 45 French Farm Rd.
N. Andover, MA
Deck proposal (2)
New Deck:
1. On rear of house, construct new 8'x20' deck (no
rail system)
2. Dig and pour cement footings to code.(under nor-
mal conditions) If any extensive obstructions are
found during the digging process which require
heavy equipment use, homeowner will be notified
and additional costs will be discussed and con-
firmed before work resumes.
3. New deck will be constructed with a 2x8 pressure
treated frame and Timbertrch grey composite
decking
4. Existing siding will be removed to flash new deck
properly to code.
5. Contruct (1) set of stairs, two treads, and no rail
system, on new cement pad. Stair treads will be
timbertech grey composite decking.
6. All decking will be fastened using grey composite
Date 4/24/09
split stop screws.
7. Install 5/8" x 10" timbertech grey fascia to pe-
rimeter rim
Sliding. Door:
1. Remove existing sliding door
2. Install new Anderson 6'x6'8" 200 series terratone
sliding door with full screen and Anvers bright
brass hardware. 1" Finelight GBG terra/terra grill
3. Install new exterior and interior trim to match ex-
istin2. (no sainting or staining included)
tanee of Proposal—The above prices, specifical
. You are authorized to do the work as specified.
of Acceptance:
978-686-2656,home 978-807-5517c
978-739-3116fred cell
Total cost$ 1541400.00
)Payment schedule:
. Start = $55000.00
1/2 = $5,000.00
Final. due upon completion
Referrals available upon request
Highly rated member of the BBB
Thank you!
-Removal of all work related debris
-Building permit included
-Contractor workmanship warranty = 10 years
*Note*
There will be an additional $400.00 upcharge to origi-
nal proposal total cost for hardware and grille up-
grade. The $400.00 is now included in total cost of
this proposal.
and conditions are satisfactory and are herby ac-
nent will be made as udined above.
Signature: `�