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Home My WebLink AboutBuilding Permit #411 - 491 SALEM STREET 11/20/2006 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0�t iO aTh ° Permit NO: Date Received Date Issued: ' �4ITS CHus��y I IMPORTANT: Applicant must complete all items on this page LOCATION `--f- l l �/ ( NA int PROPERTY OWNER QL 0 L- V Print MAP NO.:3—!rPARCEL: D ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑ Addition ❑ Two or more family ❑Industrial ❑ Alteration No. of units: `11epair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED 's �o�r Identification Please Type or Print Clearly) OWNER: Name: IOAyL ,51q o y L X Phone: Address: 4% S� r CONTRACTOR Name: ��h cl.f�`n?J nG� Phone: 9 qY 9��7S car Address: Supervisor's Construction License: C l Exp. Date: Home Improvement License: / 3�ys / Exp. Date: L z , 0� ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERM11T. 00 PF�rt,�j000.00 OF THE TOTAL ESTIMATED COST BASE ON$125.00 PER S.F. Total Project Cost :$ 0 Q t� FEE:$ o. C7 CJ Check No.: / q 7q Receipt No.: Page I of 4 '! TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Well -❑ . ❑ Permanent Dumpster on Site ❑ . ` Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund i Signature of Agent/Owner Signature of contractor u'X Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ 6amped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ J COMMENTS 4 FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection/Signature& Date Drivewav Permit Building Setback (ft. ) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I Total land area, sq. ft.: NOTES and DATA—(For department use) i i i I i i Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 r 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 l ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks V ❑ Building Permit Application ❑ 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) 1 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 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:BPFORM05 Page 4 of 4 t Location C1 � ��fco S No. Date W_Z d �oRTM TOWN OF NORTH ANDOVER 9 t Certificate of Occupancy �'�S'••°•Eta' Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ 'i Other Permit Fee $ ': TOTAL $ Check # 19816 Building Inspector �y t':•.� BOARD OF BUILDING REGULATIONS _ r License:'CONSTRUCTION SUPERVISQR c � ;r Number's 069120 ;Birthdate 04/03!1959 "xn _ i 1`• k �xpiPes 04/03/7007 Tr.no: 10500 Restricted! 00 t a( JOHN W LANZAFAMx' d I t 30 TEMPLE iDRQ,, r METHUEN, MA 01844 C" Commissioner i The (.'ommonwealth of Massacnusetrs Department of Industrial Accidents Office of Investigations . d 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Build ers/Contractors/'Electricians/Pluna hers Applicant Information Please Print Legibly NaMe (Business/Organizationflmdividual): �� (.1✓1�� t �s �' �� ' '6�'�' �''L� Address:_s�ts -�-•�LZ City/State/Zip: M t-..-1 A15S Phone #: � 10 S Are you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2. L❑ I am a sole proprietor or partner- listed on the attached sheet. t 2 Remodeling ship and have no employees These sub-contractors have 8- ❑ Demolition working for me in any capacity. workers' comp- insurance. g. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions required.] officers have.exercised their 3-F-1I am a homeowner doing all work right of exemption per MGL 11.[:] Plumbing repairs or additions myself. [No workers' comp- c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box 41 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. iContractors 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 roorkers'conipensatiorz insurance for n:y employees. Below is the.policy and job site information_ //�� Insurance Company Name: I-r� M c>�JI'� Policy#or Self-ins. Lic. #:Vie-- 60 4Lt C q o , Z 6 y� Expiration Date: /t / A .7 Job Site Address: !, �/'!7 " City/State/Zip: /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. I do hereby ertify nder tl pains and p realties ofperjury that the information provided above is true and correct. Si -ature: Date: Phone#: / J`7 Ste"1,571 Official use only. Do riot write in this area,to be completed by city.or town official. City or Town: PermitfL.icense# 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#: 1 � ,t «�k�r� C iGATF +� L � � m 1 '11.. r �� __ t'. _ -.I 1t..,,,� t,� + Mp �-.w w r �..>,, i � �w �► +�� fir. .�-� - r -� .T.... .�.,... 'i• �r1�w� ►sf ��. 4 }mow f Misr ri��F •� �•�• `l tiw. 1 +�a� . '_ ��alb .t _ ��'� - �` � ` � �- I� �� =�--- ...�` 1 � - - .. .-�... � �•_�- �r '��' k. ® �� - ��, ..,�, ■ � �� _., � T _ � t. .e.�I, �_�_ � �� .,<.. . -�--��. �.• � r Residential &Commercial Roofing Jjjj4jj Chimneys AMI Types Of CHIMNEYS P01IdTED-REBUILT-GAPPED Siding Expert Masonry Work Mass Toll Frey rRoolles/ta Experts*� Licensed&Insured 1-800-WAiT4-US o�^rc.+�rsc .asn License#1034200 JJ (924-8487) - wee lZ0jW,0Z}17,&" 'We Work Vetur Hound . _ 8 I V I QUANTITY DESCRIPTION UNIT PRICE AMOUNT o46,� sin I /J1 P-A-d"Ic MY d Results http://db.state.ma.us/bbrs/hic.pi Home Improvement ent Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City,Name,or License number 11anzafame Select Search type: AND r OR Search Search Results Reg.No. Applicant Street City State Zip Name Title Expiration ALL 166 A 137057 LNDER MERRIMACK METHEUN MA 01844 LANZ F, OWNER 10/2/2008 ONE ST. JOHN ROOF Total of 1 Records matched. Back to biome PaLre BBRS Pnvacv Statement i 1 of 1 10/9/2006 1:36 PM