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HomeMy WebLinkAboutBuilding Permit #167 - 84 WOODSTOCK STREET 8/31/2009 BUILDING PERMIT °� µ°RTF+ q 6�gtlC hb• �� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION10 Permit NO: Date Received �SSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page - -Irliaf. - `PRPEf�T1eJ11NEt /t r h A w +► CL -{ =�O1IGSTR�ICTstor�pusr� t yes -t ► Machin-, i";p�ailaSs s n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building t One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other r Septt�c:, /ell . .. :` Floz�l?lain Glands ( er e l s#r net, / ter5ewei:- DESCRIPTION OF WORK TO BE PREFORMED: LS�2 �0 �� i Identification Please Type or Print Clearly) OWNER: Name: sk(hl &:4 Phone: Address: COTIT ' tima M. � �c �''�^• �faor��. `�?:�.!''�5� �'� � PTY_ �- sen Ho ala pre r en1 cease .? I * cp bote. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.0 E 00.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 10,X a 4,aOFEE: $�� Check No.: Receipt No.: NOTE: Persons contra sting with unregistered contractors do not have access to tft guaranty fund J 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 4 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street °��R a MAT "EAi u � ter a� eta no .�2�cated�t�2# la�ntreef T .. re �epaItaeat �ae # Dimension Number of Stories: Totals square feet of floor area,ea, 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 Doc.Building Perrrut Revised 2008 I 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 1 Locationd�sC,r G No. l Date TOWN OF NORTH ANDOVER l0jO•`t`•o I•,hOOA Certificate of Occupancy $ s,cMusE` Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ Check # 0 225 `/ 4 Building Inspector Board of Bu�idutg Regula � � � `4 One Ashburton Place - Room 1301 Boston. Mlass4chusetts 02108 Horne Improvement Contractor Registration Registration. 137057 Tom_ DBA Exouadon: 10=010 tra 1t5ti+.4 ALL UNDER ONI- ROOF JOHN LANZAFAME 166 A MERRIMACK ST. METHEUN, MA 01644 Update Address and return card. Mark rea+un foo.chikorr. Address Renewal Empinymem Lost(;trd board of Baifd dtcalaa.+cx+ hq l�e:�ufa t sad Sb*dard* {, regatratm valid Ittr individaf am only HOVE!111114 YVEIl EW CONTRACTOR fs+e4 o the expo dtt, K remw r two te: R09*t(441411110, 1371357 8orartd ufBu =d Syrn&W& 1 ifr2r2010 Trill 2755 f O Oft Asbrtln Ftwe fto 1301 7%m: fes.fl9a,0208 R{V4E ROOF 1N J-AN AFAME A WRRIMACK ST Mfr-.s ala>,;tch(+.ctt. - Ucl►arrtntrnE uf'PuhGr 4tfct� Board ot'Builtfiu!o Reoulatiom ant! �tantlartl� Construction Supervisor License License: CS 69120 Restricted to. 00 JCTFfN W LANIAFAME i 30 TEMPLE DR METHUEN, MA 01844 Expiration: 413!2011 ( nnmi .6nur Tres; 13449 ll:r..acha+.�it� l}rltariutent of t'ul+fic aaict� Buctr(I orf' fitriftiitt; Rc;ul:ttiwne an(I ,s I, Construction Supervisor License License: CS 69120 Restricted to; 00 TIS .PERRY 1 NSURANU AGENCY 9786870149 I �I e+s3=L1CLst [ SCORU CERTIFICATE F �. ABILITY INSURANCE DATE(N{WDDDdYYYY) THIS CERTIFICATE tS ISSUED AS A MATTER OF INFORMATION ONLY ANIS COWERS NQ RIE3M UPON THE CERTIFICATE insurance Agency HOLDER.TIOS C9L'RTIFtCA7E DOES NOT AMEND,EXTEND OR Chickering Raad ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW, *0 Andover. htEA 01845 MAIC III AFFORDING COVERAGE o INSURER A. AI(}RFOLK 3 DEQFIAM IIVSURANGE COMPANY JOHN LANZAFAME INMER8 AtM ©BA ALL UNDER ONE ROOF INSURER Cl 30 TEMPLE DR INSURER 0- M4ETHUEN,MAA 01844 INSURER E I'' ►�GI S THE POLICIES O! sE15ttFiANGE LIum aFLow HAHE BEEN ISSUED TO THE QWRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.Np?1nPITNSTANDlNG RIMY RELIC ES OF IN, URA CE CONDITION OF ANY CONTRACT OR OTHER DOClA�E AT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY 9ED tiEi2ElN!S SUB IECTTO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRI riCiVVI�I MAY HAVE BEEN REDUCED BY PAID CLAIMS, POLICIES AGGREGATE LIMITS S PE PfYLlCtl R T0 f IMA1T& tTlR, @ae>1� TYOF DISURA ICI 1,0M.000 DO A GENERAL LIABILITY R0401433A 08/03r2O 3 OW0312009 MHOCCURRENCE S _ 1,000,000 OD COMMERCAAt GENERAL LIABILITY ES Eaeccucence _ CLAIMS MADE JZ XCUR MED EAP(Any one person) S 5 5. DD OD ` PERSONAL&ADV INJURY 1.DOD,D00 DO f DO GENERAL AGGREGATE �0 pROQUCTS-COMPIOPAGG S 2.000.00000 GEN'L AGGREGATE LIMIT APPLIES PER, POLICY 0 PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ IEa ctcident} ANY AUTO ALL OWNED AUTOS BODILY INJURY S (Pei person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY y (Pe;acadetX) mCft4N NED AUTOS PROPERTY DAMAGE S (Per accident) CiARA LIABILITY AUTO ONLY EA ACCIDENT S ANY AUTO OTHER THAN SEA ACC $ AIIT(T ONLY AGG $ "CESStUMORELLA LIABIIJTV EACH OCCIIRREN(E $ OCCUR E3 CLAI•i41S MADE. AGGREGATE E S DEDucriBL� —`-- RETENTION S $ B I c Trou AND AWC7009464012007 1/109/2008 11109120047-7 TDsty Llealrs Ea ,00.DOD.On El EA'CHACCIDENT AM PROETORIPARINERiMCUTfVE PR.d OFFICERNEMBEREXCLUDED? ELDtSEASE EIIEMPLOYEE Is 106,00000 4 os,describe undex SDO.DQD,DO SPECIAL PROVISIONS Wow E.L.DISEASE-POLICY UPe111' S OT"M VIP to I CAKCMJ A'nON CERTIFICATE HOLDER — S}IO1"AMY OF THE ASOW UgRCRIBIEa PoijCM5 BE CANCELLM BEFORE THE EXPIRATW DATE THEiRMP.THE MWNO"ISUTA R WILL ENf*AVOR TO AWL 30 AAYb WRITTr~N NOTICE To THE CERTIFICATE HOLDER MAWD TO THE LEFT.FIUT FAILURE 70 00 SO SMALL ®M� ©oma Chimnes Residential & Commercial Roofing � CI'1111APlEYS POINTED-REBUILT-CAPPED All Types Of Sidling Expert Mas my Work Mass Toll Free I*Roof Leaks Experts * Licensed & Insured Locally Owned&Operated Since 1976 a"«' 1-800-WAIT-4-US ® -�' License#034200 (924-8487) IKON Cage woeuw 0'r�chm 't=i We Work Year Round NJUCJ' - Proposal To: Mrs. Skinner Date 7/30/09 Street: 84 Woodstock 978-681-9787 N. Andover, MA Roofro osal P P 1. Strip all shingles from entire house Rear flat roof: 2. Re—nail any loose or lifted roof boards • Install 1/2"insulation board to roof deck with 3. Any compromised roof boards will be replaced at plate and screw fastening system. an additional cost of$2.25.00 per linear foot. . Install all new perimeter metal 4. Remove (2) older skylights in the rear of main • Install .060 fully glued EPDM rubber roof system house. Install (2)new Velux VS(venting)606 to entire flat roof. skylights with LoW/E glass and screens. Install • Rubber roof carries a 15mfg material warranty with new flashing kits and tie into new roof prop- erly. Some minor interior finish work may be needed,not included in proposal.l,,c t"9­' 5. Install heavy gauge 8" aluminum drip edge to all eaves and rakes. 6. Install 6' of IKO Armourguard ice and water shield along all eaves and top to bottom in the val- Total cost$ 10,200.00 I leys. 6' MA state code. — 7. Install all new pipe boots. 8. Above the ice a+tld water, install heavy 301b felt Balance due upon completion base sheet. 9. Install IKO or GAF 30 year architectural shingles to entire roof (highly suggest IKO) Referrals available upon request 10. Right side chimney:Counter-flash chimney with ice and water shield and seal with clear sealant. _Highly rated member of the BBB No black tar. 11. Center chimney: install all new lead flashing, ex- isting lead is in poor conditiion Thank you! 12. Building permit included. 13. Removal of all work related debris. In— H uSe eW, V Sub Contractors! 14. Shingles are covered by the manufacturer up to 30yrs. 15. Workmanship warranty= 10 years /x'11. cceptance of Proposal—The above prices, specificati ns and conditions are satisfactory and are herby ac- epted. You are authorized to do the work as specified. I layment will be made as outlined above. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): T kn Address: City/State/Zip: h-t 1 Phone #: f I Are you an employer? Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.�I am a employer with S F1g 6. F1 New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. Y P tY• 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.El Electrical repairs or additions required.] 3.❑ I 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.[i]'Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 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 tContractors 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 workers'compensation insurance for my employees. Below is the.policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie. #: A,­�e— "7 G ° ( Expiration Date: /1/1 / ,5 Job Site Address: �`F `~t°s0 S °Z J14 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 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 coverag.�.verification. I do hereby certify under the pans andpenalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: q 4,Y' 9/7 r .I S ( Oficial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# 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#: NORTH Town of 4Andover No. G - _ - dover, Mass.,0 LA ' COCHICMEWICK ADRATED C7 `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... 11: e�q ................................. Foundation has permission to erect................................... . buildings on .....!q-.I ....400 ........•.............. Rough ...... ................................. to be occupied as... ...... Chimney provided that the persona pting this permit shall in a 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 _ PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTR CTION STARTS Rough ..................................................................... Service ING INSPECTOR .�1 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. i