HomeMy WebLinkAboutBuilding Permit #012-13 - 547 SALEM STREET 7/5/2012 OORTH
BUILDING PERMIT °��s`E°
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TOWN OF NORTH ANDOVER F p
APPLICATION FOR PLAN EXAMINATION * n
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Permit N0: 0 I � ' Date ReceivedS RAT.°P'°� c�
Date Issued:
IMPORTANT.Applicant must complete all items on this pagwse
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building p,00ne family
El Addition El Two or more family ❑ Industrial
❑ Alteration No. of units: [J Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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�aa�er/�ewer�:
DESCRIPTION OF WORK TO BE PREFORMED:
is
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Identification Please Type or Print Clearly)
OWNER: Name: �` lJ Phone:
Address:
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ARCHITECT/ENGINEER Phone:
jAddress: Reg. No.
FEE SCHEDULE:BOLDING PER
$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BA ED N$125.00 PER S.F.
Project Cost: $ �� FEE: $ 1
Total P _
1 a
Check No.:
0� Receipt No.:
NOTE: Persons con ratting with unregistered contractors do not have access to the g ranty fu zd
nature�of contractor.. X
Signature of'Agent/Owner�� �`� . .. s .. .v, ...... _. �...,
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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
o Building Permit Application
❑ Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
o Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
L3 Building Permit Application
❑ Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o 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
f
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL 1
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well Tobacco Sales ❑
Food Packaging/Sales 11Private(septic tank,etc. ❑
Perm
anent D
umpster on Site ❑ I
i
I
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM _
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATEAPPROVED
OVED
CONSERVATION ❑ ❑
COMMENTS
E
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
1
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
Located at 384 Osgood Street
AFIRE DEPART>MENT ~ Ternp DtampstOrb , s to
Locatedfat 12CiMairi.18trFt ��
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Ftre Oepartmen signature/date- g x _ L
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4: C -3 ,� ,..y 'x .k *-a d.. �.y f� ✓ , *.. e sr ',y"x. y - +tP ,ate:*. sig'€... y ^. y. ^i lr S�'9;
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COMMENTS x . y
. .Nx ..,
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
NOTES and DATA— (For department use
I
❑ Notified for pickup - Date
_ __._...._..._._...- —- i
Doc.Building Permit Revised 2007
i
Location
No. Date J
• • TOWN OF NORTH ANDOVER
e
o Certificate of Occupancy $
Building/Frame Permit Fee $�...-
Foundation Permit Fee $
Other Permit Fee $
# M TOTAL $_
1
Check# 0
r
25482 I#uilding Inspector
NORTH
own o 2 t E : ., s ndover
o �►
No.® 2.— o = �.
LAK.kINA- h ver, Mass, �. T 0
COCMIC«ewKx y�'
A�"'A- ED
S U
BOARD OF HEALTH
PERMIT T LD Food/Kitchen
Septic System
THIS CERTIFIES THAT ....................�Zlwnr........ ..�.�'!I r.1.A.. .............................................
BUILDING INSPECTOR
has permission to erect buildings on Foundation
.......................... ....... .. ..... ..........�
....
�zo
... Rough
to be occupied as .........45.. ....... ....... �fry,
..........GO.... ... ......... Chimney
provided that the person acceptingthis permit shall in every respect co to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
I � _
UNLESS CONSTRUC ST Rough
Service
............ ........ . ...... ................ ..........
Fina
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
SEE REVERSE SIDE
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1 71
Afflw
L UNDER
R–himneysesidential Commercial Roofing All Types Of
Siding Expert Masonry Work i
Mass Toll Free � "E�" __-- Licensed & Insured
1-800-WAIT-4-(JS
Locally &Operated IW.xe 1976 a License#034200
`
(924-8481) We Work Ve-ar Round
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Proposal To: Jim Winning Date 6/7/2012
Street: 547 Salem St. Frank(son-in-law)
North Andover,MA 01845 412-818-9175
Roof proposal ghinassifa@ypmc.edu
I. Protect house exterior and landscaping as best as 11_Rear lower slope addition: Install Polyglass SBS
possible. (tarps etc.) self-adhering base sheet followed bt Polyglass SBS
2. Strip all shingles from entire roof (I layer) self adhered top cap sheet. This is a commercial grade
Garage roof: (2 layers) rolled roofing product designed for low slope applica-
1. Inspect and re–nail any loose or lifted plywood tions. 15 year mfg. material warranty. Conventional
or roof boards. shingles should not be used on low slope roof lines.
2. Any compromised plywood will be replaced at an 12. Building permit included.
additional cost of$55.00 per sheet of 1/2"cdx fir. 13.Removal of all work related debris.
Any compromised roof boards will be replaced at 14. Contractor workmanship warranty: 6 years under
an additional cost of$2.75 per linear foot of 1x8 normal wind and rain conditions.
spruce. 1 st 16' at no additional cost.
3. Install heavy gauge 8"white aluminum drip edge Main roof Cost: $ 7,200.00
to all eaves and rakes.
4. Install 6' of IKO Armourguard ice and water Garage roof Cost: $ 2,600.00
shield along all eaves. 6'MA state code.
5. Install all new pipe boots. Option: Cut all new lead flashing into existing shim-
6. Above the ice and water shield, install IKO Cool ney and seal. $400.00 additional cost
roof guard synthetic underlayment to the remain-
ing sheathing up to the ridge.
7. Install IKO Leading Edge or Certainteed Swift
Start starter shingles to all eaves. Balance due upon completion
8. Install IKO Cambridge AR or Certainteed Land-
mark Limited Lifetime architectural shingles to Referrals available upon request
entire roof. Mfg. warranty Pro rated after 15 years
(IKO) and 10 years(Certainteed)to original Hiphly rated member of the accredited BBB and
owner.
9. Install GAF Cobra ridge vent. Capped with color Amies' List
matched ridge shingles. Thank you!
10. Counter-flash chimney and all roof protrusions f�
with ice and water shield, re-seal and tie into new
roof. Existing lead is tarred, Please see option. d
Acceptance of Proposal—The above prices, specifical ions and conditions are satisfactory and are herby ac-
cepted. You are authorized to do the work as specified. Payment will be made as outlined above.
The Commonwealth ofMassachusetts
Department oflndustria(Accidents
Office oflnvestigations,
600 Washington Street
Boston,MA 02-1.11
yV
www,massgov/rdia -
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A licant Information
).'lease Print Le ibl
Name(Business/Organization/1'ndividual): w
Address:
City/State/Zip: Mrc�j e-ltJ Phone#:
[1:11
an employer?Check the appropriate box-
El a employer with 4. I a�a general contractor and I Type ofproject(required):
loyees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction
a sole proprietor or partner- listed on the attached sheaet.t 7• ❑Remodeling
and have no employees These sub-contractors have
ing for mein any capacity, workers'comp,insurance ❑Demolition
workers'comp.insurance 5. ❑ We aie a corporation and its 9• ❑Building addition
ired.] officers have exercised their10.0 Electrical repairs or additions
a homeowner doing all work right of exemption perM(3L 11.❑Plumbing repairs or additions
lf.[No workers'comp. c. 152, §1(4),and we have no
ance required.]t employees.[No workers' 12.0 Roofrepair
comp,insurance required.] 13.❑Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information,
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.
ain ormation.an employer that is providing workers'
infocompensation insurance for my employees. Below is the policy and job site
• .
Insurance Company Name:
Policy#or Self--ins.Lie.#:
,, / Expiration Date: - -
Job Site Address:_ ,��'� �rd't 'r^'1 'S %
City/State/Zip: Al� J-4 .
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 maybe forwarded to the Office of
Investigations of the DIA,for insurance coverage verification.
fP J rY `
Ido hereby certify u der t1 pains an penalties o er u thatthe infor�ttationprovidedabove is true anticorrect.
SJ'
i ature: 23 ` L
Date:
'hone#: e-�
official use only. Do not write in this area,to be completer)by city or town official
City or Town: Permit/License#
Issuing Authority(circle one): ,
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.PIumbing Inspector
6.Other -
Contact Person:
Phone M
Information and Instructions
uctions
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 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 shallwithhold 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 fo 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 must submit multiple permit/liceDse applications in any given year,need only submit one affidavit indicating current
policy information(ifnecessary)and under"Job Site Address"the applicant should writ allocations n (city or
town)"A copy of the affidavit that has been officially stamped or marred 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 notrelated toF any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOTrequired 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 Co.-wmonweE& of��assacl�>?setts
Department of Tadustrial Accidents
Ofte of anvestigatlons
600 WashiVon ftee4
Boston;M:A,02111
TQ1.#617-•727-4904 ext 406 ox 1-877-MASS FE
Revised 5-26-'05 FAX#617-727-7749
www.mass.govfdia
ACORD• CERTIFICATE OF LIABILITY INSURANCE `
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.(THIS 12011
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the
terms and conditions of the Policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME:
DAVID E ZELLER INS AGCY PHONE FAX
(AIC,No,Ext): FAX
.370 LYNNVAY (A/C,No):
E-MAIL
ADDRESS:
LYNNI NIA 0I90I PRODUCER
25D6D CUSTOMERID{I:
INSURED INSURER(S)AFFORDING COVERAGE NAIC 9
INSURER A: ACE AMERICANINSURANCE CUNIPANTF
BERRY FRANK&BERRY JAMES DBA FRANK SONS INSURER B:
INSURER C:
45 WINDBROOK DR INSURER D:
EPPING,NIi 03042 INSURER E:
COVERAGES NUMBER:CERTIFICATE INSURER F:
THIS IS TO CERTIFY THAT THE POLICIES OF NSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORT E POLICREVISIONY PERIOD INDICATED-
HICH THIS CERTIFICATE MAY ISSUED
OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOW LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
TYPE OF INSURANCE ADDLSUBR POLICY EFF DATE POLICY EXP DATE
LTR POUCYNUMSER (MMNDMYYYY) (MwomyYYY)
GENERAL LIABILITY INSR WVD LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS MADE OCCUR. DAMAGE TO RENTED $
PREMISES(Ea occurrence)
MED EXP(Any one person) $ I
GENT AGGREGATE LIMIT APPLIES PER: PERSONAL&&ADV INJURY $
POLICY PROJECT LOC GENERAL AGGREGATE $
AUTOMOBILE LIABILITY PRODUCTS•COMP/OP AGG $
ANY AUTO COMBINED SINGLE $
ALL OWNED AUTOS LIMIT(Ea accident)
SCHEDULE AUTOS BODILY INJURY $,
HIRED AUTOS (Per person)
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
(Per accident)
UMBRELLA LIAS OCCUR
EXCESS LIAB CLAIMS-MADE EACHOCCURRENCE $
DEDUCTIBLE AGGREGATE g
RETENTION $ $
ORKER'S COMPENSATION AND WC STATUTORY I NITS OTHFR
MPLOYER'S LIABILITY YIN UB-dGaq_P8Q_3-11
ANY PROPERITORRARTNERiexeCUTIVE Y 07,222DI1 07122.2012 E.L-EACH ACCIDENT $ 100,000
OIFICERiMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100.000
(Mandatory in NH)
If yes,describe uncle:
DDESCRIPTION OF OPERATIONSbelow - E.L.DISEASE-POLICY LIMIT $ 500,000
...•wrmus�re..�wF�,.(c�*=*.+
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REP(ACES A1W PRIOR CERTIFICATE ISSUED TO THE.CLRTMCATE HOLDER AFFECTING WORKERS COMP COVERAGE
NO PARTNERS ARE COVERED BY THE WORXERS'CONIPI3%TSATION POLICY.
CERTIFICATE HOLDER
.JOHN I.ANZAF.4M CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
32 TEMPLE DR BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ME•r7-ItiEN.MA 01844AUTHORIZED
J. Lupica
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`I,i...�.hu'rtl� !k'ti.ii III wnt I'll i)ih �.Ilri
Ku,uvl .ri 13uthitn:: Etr;att:uiuu. ,tn�t �t.nt�i.,r,)
!,t�rlStrltGtlnn SU�c3rn5O!' L.iCt3n5...
Li�ensB CS 69120
JOHN W LANZAFAME
38 TEMPLE OR
METHUEN.MA 01844
4l3r2013
Tri 14108
Office of Consumer Affairs and Efusiness Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Cvtor Registration
Registration 137Q6
Type: DBA
Expiration: 10/2/21012 T►# 204021
ALL UNDER ONE ROOF
JOHN !'L.ANZAFAME
166 A MERRIMACK ST.
METHEUN, MA 01844
Update Address and return card.Mark reason for change.
.Address Renewal t-Pioymknt Lost Card
umer A y License or registration valid for individul use on IN
office of on3t�mer Ai acro l�B iet nt�tio+s
HOME IMPROVEMENT CONTRACTOR before the expiration chit. if found return to:
$a .t Office of Consunker Affairs and Business Reguiatin
' z s``;„ Registration: 13745' Yom' 10 Pork Plaza-Suite 5190
E=xpiration: 10/212012 OBA Boston,MA 02116
Ad UNDER ONE ROOT
PPHN t.ANZAFAMfE
166 A MERRIMACK ST
AAT IEUN MA 01844 Undersecretarc tit alt -14t Sl�nattltY
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