HomeMy WebLinkAboutBuilding Permit #218 - 74 BUCKINGHAM ROAD 9/20/2007 NORTH
BUILDING PERMIT 46°���`" 6
TOWN OF NORTH ANDOVER F
APPLICATION FOR PLAN EXAMINATION
Permit NO: d2 Date Received �► q°q�T.D "'�5
�SSACMUS��
Date issued: Ad :d
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑_New Building One family
❑ Addition ❑ Two or more family ❑ Industrial
❑ Alteration No. of units: 0 Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
11Demolition [I Other
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K .ass,�'J};.„
I 'c'�In 40
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
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>��;' e• �Y �i�;�� <T� Std� ',,,� � �.,' � J ��� �`i° '
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost:.$ ' FEE: $ �°
Check No.: S(-Y- 93)-5- Receipt No.: -2
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
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Location [JG G
No. Date i3 Z[? o 7
mac.
�aRTN TOWN OF NORTH ANDOVER ~`I'
` Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 7/f-'
2061 ,
Building Inspector
Plans Submitted ❑ Plans Waived ❑
Certified Plot Plan ❑ Stamped 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
HEALTH
DATE REJECTED DATE APPROVED
ElCOMMENTS ❑
-------------
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming pools ❑
Well ❑
Tobacco Sales
Private(septic tank,etc. ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision:
Comments
Water & Sewer Connection/Si nature Date
Located at 384 Osgood Street Drivewa hermit
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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
❑ Notified for pickup - Date
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
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)
o Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
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)
E3 Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
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
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
at: is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11, S150A.
Also, note Permits are required under Fire Prevention laws!Chapter 148 Section
10A.
The debris will be disposed of in:
(Location of Facility)
0 Sin ure of Permit Applicant
Fire Department Sign off:
Dumpster Permit
Date
The Commomi,ealth of 111assachuseffs
Del►artmellf of'Industrial Accitlews
Ojjice of I►►vesfigtllio►rs
600 1Vashingfall Street
Boston, MA 02111
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iviov.mass.go v1dia
Workers' Compeiisation hisurauce Affidavit: 13uiltlers/Contractors/i:Icctricians/1'luu:><bers
Applicant Information Please Print Lep_ibly
Nwne (Business/Organizatiott/In(lividual):
Address: (3 T��t;A��' /Jt? H tFW�J&X) mss
City/State/Zip: (01,r"4 Phone -59S-7j—3t'.
Are you an employer? Check the appropriate box: Type of project (required):
.�1
1. .t am demploycr with 4. ❑ 1 am a general contractor anti ( .
G. ❑ Ncw constnlcfiou
employees (full and/or part-time).* have hired the sub-contractors
2.E1. I ain a sole proprietor or partner- listed on the attachcd sheet. t ?. ❑ Remodeling
ship and have no employees 'These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insutance. y ❑ Building addition
[No workers' comp. insurance 5. ❑ We arc a corporation anti its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 1 1.0 Plumbing repairs or additions
myself, [No workers' comp. c. 152, §1(4), and we have no 12;,®'Roof repairs
insurance required.] t employees. [No workers' 13 ❑ Other
conip. insurance required.] —
*Any applicant Ilial checks box/I l must also fill mut the section below showing their woikers'compensation lx)licy it,rut rmnlion:
t Homeowners who summit this affidavit indicating they are doing all work and then hire outside contractors numel summit a new affidavit indicnl ing such
lcontractors that check this box must attached all additional sheet showing life name of the sub-conIiactors and their workers'comp,policy infor-nlot ion.
I am an employer that is providing workers'cunrperrsntion insurance for my e►rrployees. Below is the policy a►rd job site.
infornratiom
Insurance Company Namc:
Policy,H or Self-ins. Lic. H: A ac -246 94i G Ful 2 Expiration Date:
Job Site Address: urt47A, /,z /yy� _City/State/Zip: C/S `l
Attach a copy of the workers' compensation policy-declaration page (shoNving 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 infprisonntcnt, is well as civil penalties in life 1`61-111 of a STOP WORK ORDER and a fore
of up to$250.00 a day against tic 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 fire pains and penalties of pe►jrcrj'that the irrji►rmatiorr prorided above is Imre and correct
Sijwafore: a_.t, -------- --------Dalt_ /►19
Phone H:
Official use otrlj,. Do trot write in this area, to be completed by city or town official. _
City or'rown: PermiuLicense #
Issuing Authority (circle one):
1. Board of health 2. Building Department 3. Cityffown Clerk 4. Electrical Inspector 5.Plumbing luspector
G. Other
Contact Person: Phone fl:
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= One Ashburton Place - Room 1301
- Boston. Massachusetts 02108
C-OnWuction Supervisor License
License CS: 69120
RestFlGiion. •-00
fie: 4iF31Mq-
JOHN W LANZAFAME. Exvirawon: .'-473r2W9
30 TEMPLE DR
[Imp, N 11111
Update Address and return card.Mark reason for change. .
Address : Renewal
SOM-0.5106
---.�- .. . . .1. . ,....... �,,,..._._._.-.... .. - .....
B a8 of Buag`i€`eguleti�f��a�a'tK anda`
;. Construction Supervisor License
i - License: CS 69120
Birthdate 4/3/1959
��" r Exptnstion 4/3/2009 Tr# 11855
`�' � ffi -Restriction d0'
JOHN W LAN7
30 TEMPLE DR �--�--
METHUEN,MA 01844 Commissioner
.�. f/,.(:' l?(fII[NtlYltlllF.'ClI./IL•0�..'�(,(L•JJQGYLuvG(.(!i
J1 .
Board of building Regulations and StandardsLicense or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 137057 Board of Building Regulations and Standards
Expiration.• 10l?J2008 Tr# 128146 One Ashburton Place Rm 1301
Type: DBA Boston,Ma.02108
1 UNDER ONE ROOF
)HN LANZAFAME
6 A MERRIMACK ST.
ETHEUN,MA 01844 Administrator Not valid without signature
ALf CJ u CJ
A,IILIL VMIDISM
0)M13 IQoorF
Chimneys Residential & Commercial Roofing All Types Of
Siding CHIMNEYS P01INTE®-REBUILT-CAPPE®
�Roof Leaks Experts * Expert Masonry Work
Mass Toll Free P Licensed & Insured
Locally Owned& Operated Since 1976 a"""t,
1-800-WAIT-4-ldS ® License#034200
(924-8487) YK® Czee
Wozw oe,9vlxja %'===I We Work Year Round
�' � Imo ' • • � � :� �' �� � � :� �
Proposal Submitted To Pho,a Date
Street Job Name
City,State&Zip Code /�,,�, n y Job Location Job Phone
/j1't"rJb J cm
We propose hereby to furnish and labor in accordance with specifications below, for the sum of-
6.96-4
f:
( a t� �c� Dollars($ U 4 bis t "
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized
manner according to standard practices.Any alteration or deviation from specifications be- Signature:
low involving extra costs will be executed only upon written orders, and will become an
extra charge over and.above the estimate.All agreements contingent upon strikes,accidents NOTE:This proposal may be
or delays beyond our control, Owner to carry fire,tornado and other necessary insurance.
Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within' days.
We hereby submit specifications and estimates for:
46 Install feet of special "Save Seal" ice and water barrier protection along all bottom edges of roof
and top to bottom in each valley.d oof is stripped, we will apply conventional ice and water shield
( ) ft. high in the same locations previously described and tar paper will cover the
remaining bare wood. Any rotted or damaged boards will be replaced at ( ) per linear ft.
I
or per sheet of plywood.
&Install heavy gauge aluminum drip edges along every edge surface of each roofline.
C/Cover entire roof(s)with IK n-fiber lass premium rade shingles
9 . p 9 9
(Color of choice).
k! Replace all pipe boots where possible.
Seal all flashings with clear Geo-Cel sealant. No black tar unless previously applied.
&Remove all work-related debris.
&Contractor warrants roof against all leaks due to defects in his workmanship for 12 years under
normal circumstances.
U(Local current references and proof of workman's compensation insurance gladly given.
I
[a Remarks: ' �� - `7-Y e��� c' L/&C i
,� Q.1� -a6- S<'c ,T- f l mat 7C c- lgoff12�
Acceptance of Proposal- The above prices, specifications
and conditions are satisfactory and are hereby accepted.
You are authorized to do the work as specified. Payment Signature:
will be made as outlined above.
Date of Acceptance: i •"i Signature: ��'
NORTIy
Town of
�/Wz
dower, Mass.,
COCHIC HE W ICK
oRATED CF�t�C5
VV ` BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT........................... e../Y.e�.�- ........... ��'��... F .................................................................... Foundation
�i
has permission to erect........................................ buildings on ....�.�Z'...1 �1-+�,. ... . ...10j ......................... Rough
A.to be occupied as .... ¢ �0 r+ ...................................................................................... Chimney
provided that the person accepting this permit shall.in every respect conform to the terms of the application on file in Final
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? SIN 6 MONTHS ELECTRICAL INSPECTOR.
UNLESS LESS C®NSTR V ST TS Rough
:........................... ...................
........ .... Service
BUIL ING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.