HomeMy WebLinkAboutBuilding Permit #800 - 7 FULLER MEADOW ROAD 5/7/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 6 s % Z- Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION �% /�����
Print
PROPERTY OWNER S e'-�� MAS -c—:11, Unit #
Print
MAP NO/JPARCEL: ZONING DISTRICT: Historic District yes o
Machine Shop Village ye no
100 year-old structure ye no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
0 One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
O Septic p Well
❑ Floodplain q Wetlands
Watershed District
0 Water/Sewer
OWNER: N
DESCRIPTION OF WORK TO BE PERFORMED:
f le.-_ lec"a J,;r
dentification Please Type or Print Clearly)
C4. fi114SCr-l<
4,17Y& Z36s
Address: 0 rl dL.L -e/j vJ /J/_1
CONTRACTOR Name: n /a 4 ZA09 044 Phone: 23 6-9'
Address: A D T-e� K?( -e-
Supervisor's
Supervisor's Construction License: Exp. Date: 6f
Home Improvement License: %� S�� Exp. Date: f6(2 j( Z
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.:�'
Receipt No.:__a � a (e 001
NOTE: Persons contracting with un egistered contractors do not have access to t1K guar my fund
Signature of Agent/Owner Signature c& contractor-
Location 72 1-7V//e 1 e414'y ooel-
No. e) Date Z
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee' $ .�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #"'r (s
25266 Building Inspector
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
DATE REJECTED
El
DATE APPROVED
u
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: _ Com
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Drivewav Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
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 UA I A — Wor Oepartment use
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
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: Doc.Building Permit Revised 2008mi
The ionwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Kashington Street
Boston, .AIA 02111
^� ••'wlvfv.tnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/L, lectricians/Plunnbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): �j ^a� o► ,1 �i1D fes, L�
Address:
City/State/Zip: v"�,J //�Sl Phone #: 4rJ�• �7 f` -fl �ci,
Are you an employer? Check the appropriate box:
1. ❑ I am a'employer with
4. am a general contractor and I
employees (full and/orpart-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet, t
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
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.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. [:1 repairs or additions
11.❑ Plumbing repairs or additions
12.0 Roof repaiyg�
13.0 Other ��JJ
Any applicant that checks box It must also till out the section below showing their workers' compensation policy information:
f llomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
tContractots that check this box must attached an additional sheet showing the name of the subcontractors and their workers' comp. policy information.
I am art employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
irrfor►nation
Insurance Company Name:
Policy # or Self -urs. Lic. #: Expiration Date:
Job Site Address: 1 r"A_ `k C.7'A%i %Z�—_-- City/State/Zip: /i�
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 crinihial penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the fonrr of a STOP WORK ORDER and a fine
of up to $250.00 a day agaurst the violator. Be advised that a copy of this statement. may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify under t& pains andpenalties of perjury that the information provided above is true and correct.
a^� `
Official
Oficial use only. Do not write in this area, to be completed by city or town official.
City or Town:
Pernrit/License #
Issuing Authority (circle one):
1. Board of health 2. Building Department 3. Cityrrown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
Page 1 of 1 8/26/2011 12:39:38PM
�I.I,,.I: itu,rtt+ Ucdtar►mrni +rl Nuhlir ,:Tito
Board Irl' Ruiltlila' Rc;atlatiun, ,Intl standard,
Construction SuoerviSor Lrcens�
License CS 69120
JOHN W LANZAFAME
30 TEMPLE DR
METHUEN, MA 01844
-�-- — Expiration, 4/32013
Tr#: 1410$
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 517€1
Boston, Massachusetts 02116
liome Improvement Contractor Registration
Registration
Type
ALL UNDER ONE ROOF Expiration
JOHN LANZAFAME
166 A MERRIMACK ST.
METHEUN, MA 01844
i
13747
DBA
10/2/2012 rr# 20402 t
Update Address and return card. Mark reason for chr+nLc,
:address Renewal • LmPloyrnent t.osl Cara
'"'-ON
Ac"RD
P*Ootm*"
Perry insurance Agency
522 Chir -kering Road
Noah Andover, MA 0184
CERTIFICATE OF LIABILITY INSURANCE I
09107; 1,
THM CERTfFICATE IS ISSUED AS A MATTER OF INFORMATION -
ONLY AND COWqMS No RtG"TS UPON THE CERTIFICATE
HOLO) MS CERTIFICATE DOES NOT AMEMD, EDITEND OR
��� irc e1>A.tcTt�t�= SY THE POLICIES It3i?L�.
INS IRERSAFFOROMIGCOVERAGE { BAIL w
- -._... -
tn Mi5tXiERA. hTlANT1G C,MSUALTY Ifit;3tlR'AtYGE
JQt IN ! JANZAVAME
DBAALL UNDER ONE ROOF C-
30 TEMPLED { t 9PJRER n
--i----
METHUEN, MA 01844
WSWER E
THE POLKNES { AiSi1R/d 10E i I5TE0 8£1 OW HAVE BEEN ISSUED TO THE NSLMW NoAmm ASWE FOR THE POLICY PERIOD IND"TED NDTW ITHSI AN1) 04
KWY RE IT. TEESYI OR CAPiD1Tm OF ANY coot RAu OR OTHM DOCUMENT WITH RESPECT TO WHICH THIS CER70CATE MAY BE ISSUED OR MAY
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Mass Toil Free
1-800-WAIT-4-U•S
(924-8487)
ry ��
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Residential .,.& Commercial Roofing
CHIMNEYSPOINTED-REBUILT-CAPPED All Types Of
Expert Masonry Work
'ffi �` ,X.� ; Licensed & Insured
1',ocaldv Owned & 01--wrate.................
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STrrce1976 .......b License #034200
ea eeeGpr-W €w ,i7AJV We Work Year Round
Proposal To: Bruce Masek
Street: 7 Fuller Meadow Rd.
N. Andover, MA
Date 4/17/2012
978-689--2365
awA cvu,1
Roof proposal I lmasek@comcast.net
1. Protect house exterior and landscaping as best as
possible. (tarps etc.)
2. Strip all shingles from entire house.
3. Inspect and re- nail any loose or lifted plywood.
4. Any compromised plywood will be replaced at an
additional cost of $50.00 per sheet of 1/2" cdx fir.
5. Install heavy gauge 8" white aluminum drip edge
to all eaves and rakes.
6. Install 6' of IKO Armourguard ice and water
shield along all eaves. 6'MA state code.
7. Install all new pipe boots.
8. Above the ice and water shield, install IKO cool
roof guard synthetic underlayment to the remain-
ing sheathing up to the ridge.
9. Install IKO Leading Edge shingles to all eaves.
10. Install IKO Cambridge AR(algae resistant) or Cer-
tainteed Limited Lifetime architectural shingles to
entire roof and shed. 15 year non pro -rated war-
ranty by IKO mfg. 10 year non pro -rated period by
Certainteed mfg.
11. Install new GAF Cobra ridge vent.
12. Counter -flash chimney and roof protrusions with
ice and water shield, seal and tie into new roof.
13. Building permit included.
14. Removal of all work related debris.
15. Contractor workmanship warranty =6 years under
normal wind and rain conditions.
Acceptance of Proposal—The above prices, specificai
cepted. You are authorized to do the work as specified.
16. IKO Shield Pro Plus Extended mfg. warranty:
100% coverage, fully transferable, on material, la-
bor, tear off and debris removal for a full non pro-
rated period of 20 years. Offered to our Angie's
List customers and included in this proposal at no
additional cost. (only with IKO)
Total cost: $ 12,200.00'
Option: Upgrade to'WK Grace ice and water shield.
(best available defen a t eaks from ice dams)
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
Angies' List d
Thank you!
and conditions are satisfactory and are herby ac-
nent will be made as outlined above.
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