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HomeMy WebLinkAboutMiscellaneous - 523 WINTER STREET 4/30/2018Location r -u �-,, J� , No. 4,/1 75, Date / z� r _,• �ORTh TOWN OF NORTH ANDOVER 3?'�' Via• ti0o Certificate of Occupancy $ E��' s�cMus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 18839'. Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE,OR DEMOLISH A ONE OR TWO FAMILY DWELLING .'.Sy i ae+y,Yi. DATE ISSUED: BUILDING PERMIT NUMBER: Z1,2 SIGNATURE: Building Commissioner for o uildin Date SECTION 1- SITE INFORMATION 1.1 Property Address: �.3 M/loqA 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R firedProvided ReqWred Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood pone ❑ 1.8 Sewerage Disposal System: Municipal ❑ Oa Site Disposal System ❑ 1 1 SECTION 2 - PROPERTY OWNERSHW/AUTHORIZED AGENT J ' ' "- 2.1 Owner of Record 62-rru2 in 3 �✓�,v�' r� �s � Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Lensed Construction Supervisor: VA -& J Liuysed Construction Supervisor: Addressrj I �-,a! ",Z� 2 �— / n " `t �r��� �" Signature Telephone Not Applicable ❑ Q Q Cr T) C9'QJ License Number Expiration Date 3.2 Registered Home Improvement Contractor N 6, CV5%ate OX, 5100', Not Applicable ❑ Company Name L a W C Lf % Z 4 �r,/ L /44- C Registration Number Address Expiration Date S' nature Telephone N,6 nu M z W M _r YO SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 & 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building rmit. -Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check 'applicable) New Construction ❑ Existing Building Repair(s) IV Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ! /Zi � �.od �/NC �/-�j � �LiCS A��� i�/l �✓�L i� 1 �' f2 �' �� /J g` / At Tile /Zcs p A -VD i / 06 rC i/i1.gct % !C/ r i R� /i�oUs�'`� �'�-v�•� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit a licant 1?iFFCIAL TSE OXY. d • Z I . Building O, 2 1 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 —PlumbinE Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection b Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relativvee/�towork authoort/ized by this build g permit application. t / 4 / 'P Signature of Owner T` Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, V +( J i t, Aw 7/4 as Ownert thorized A� of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief V�- J . Prin ame f -:�_ --7 Si ature of e Date .. N.O. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVMERS 1ST 2 3 PD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r DIRECTOR -HOME IMPROVEMENT CONTRACTORREGISTRATION ' One Ashburton Place, Room 1301 Boston, Massachusetts 02108 Telephone: #617 727-8598 This Agreement is made on � e1.26 , 20yS , by and between New England Custom Design, Inc. (herinafter, "Contractor") and owner&f (/f l� 11r�T�2 r��9�� (hereinafter, "Owner"), of City / Town �Y/y b o V e le- State "-/eu Zip ,�7 / `/S ~ HPhone M> '(,, ki 23 C l Job Address ("The Premises") New England Custom Design, Inc. J WPh G/I� i►'lGJ�zf Cr T',�tu/iir Roofing will be applie only, on slope rooT surfaces below, over present roofing shingles unless MATERIAL ...... (,.�MC�cGS =: %`C'.........:3.0...........!!2........................................ Co Main Roof .........ye,S........... Bay Windows ...�,L CAL.e....... Extensions ............... Porches: Front ... ...... Side .....F: k'.a`Z ................ Rear ....kZ. oxY ...................... Oth NOTE: Roof board Replacement Cost ,2 . S— per foot OR V/ ,, - " per 4' x 8' sheet of REMARKS / EXTRAS: _Missing or defective lumb m -war i' ed in any category of work unless sp/ecified under REMARKS. �%.Yi''1.li.lf 1. 1.!�. tr �37U.`?. �. '4'. h C'.... ��5�f. :J f....4i, ...I � 2f.:r........C...(1lG'i:�..Y... . ^ .. .... ✓ 1 _. f ..CAjRAJ ....... ... �,�... :........................�(...... �� ..�...rrr�.��.,��,�-;.r�i.....Td....�.<<.....c`... : f, .. ..v...... C I - > ✓ , s c7 f 4 T.............=� ... <!�.`��. . � C �...G�Jt.. !� ......�R... .5...............1/............fir................... `1...ac.. ...... 1�"..:�'1..... r l ............ G /�'.....-�.r.. r.......4�.:�!? �....1-1.......'�• �. �.G'..:......moi t....:T.�/................ r� ...... ..�.......... ....... , 1'r L'�'?.�.... .. .::' �J:.............. ..�..5. GY.1�.�....4.:..Yl. irk. C..:C ..... �Y. I�s.�t^cr: (.T �).... ��r.... .....................f�............ .......... }-� .. .. "Oe YL P-4 i 4 e .� 2 Sc�.Ua plv�6l'✓ 1.3e%e •t3 C' � � 1` �Llc,'r The Contractor agrees to perform in a good and workmanlike manner all work detailed above. . ,,cc� �z, NOTE: All Roofing Customers CASH PRICE $ .........4f! .....: ........................... DOWN PAYMENT $ .............iz.!` : ° New England Custom Design, Inc. will not be held PAYABLE ON START OF WORK $ ......�.�...5�........................... responsible for dust and debris falling in attic area ", during roof installation. - 1-0 PAYABLE ON COMPLETION $.......K , •• •••`/ ••••.•. Please remove or cover valuables._,,, j(l DATE:...........f / ......................... .... 20 .%.��....40 14 RIGHT TO CANCEL The Owner may cancel this agreement if it has been signed by the Owner at a place other than the address of the Contractor, which may be his main office or branch thereof, provided that the Owner notifies the Contractor in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. See attached Notice of Cancellation. A cancellation fee representing 30% of the contract price will be in effect if cancellation is requested after the legally allotted time has elapsed. The Owner hereby certifies that he has read this Agreement, that the terns and conditions and the meaning thereof have been explained to him, and that lie fully understands them and that there is no understanding between the parties, verbal or otherwise, than that which is contained in this Agreement, and agrees that the said Contractor is not responsible nor bound by any representations not contained in this Agreement, made by any of its agents, unless the same be reduced to writing and signed by the Contractor. A"T@TENTION OMEOWNER: DO NOT SIGN THIS CONT"IC"T IF HEREtARE ANY BLANK SPACES. Owner's Signature Date Ne England ustom Design, I c. Date Owner's Signature Date LICENSINO Department of -Public Safety I ` `:�J;� E� .�'cl���•rvil•c���t•u�rz���. o,r`r'�:rll z:1;�cit•it:«:1•e�`�;� Board of Buildin Re g Rulations 011e Ashburton Place, m 1301 Boston, Ma 02108-16.10 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 04/20/1051 Restrictad To: 00 „J/ta '�pp�y�n.0•iuuelc�(ii O�✓s't�GC/iLulBQd BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR y Number: CS 008626 s ,, ''• Blrthdote:04120/1951 Expires: 04/2Q/20.06 Tr. no: 21051 Restricted: 00 Tr, no; 1 rJ51-E VAL J LANZA 34 BIXBY ST REVERE, MA 02151 Acting Gc mis, oner Board of Building Refnilations and standards Massachusetts Home Improvement Contractor Registlratioa 9 G c7�e_62 Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Zmprovemelit..Gojitractor Registration Registration: 102467 Type: Private Corporation ` Expiration: 7/2/2006 NEW ENGLAND CUSTOM DESIQ.N, INC. Val Lanza 226 LOW ELL ST. WILMINGTON; MA 01887 Update Address'Ld return card. Mark reason for changt na.R.rn, r, •cnu.:rWnn.rimoiF n Address (-j Renewal F-] Employment f1 Lost C. ACORD * CERTIFICATE OF LIABILITY INSURANCE OP ID KC NEWEN-1 DATE(MMIDDIYYYY) 03/10/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LTR ONLY AND CONFERS NO RIGHTS UPOWTHE CERTIFICATE Kilgore Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 33 Centennial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, LIMITS Peabody MA 01960 Phone: 978-531-6550 Fax:978-531-9442 INSURERS AFFORDING COVERAGE NAIC# INSURED. INSURER A: Western World Insurance Com an INSURER B: Safety Insurance Company 39454 New England Custom Design Ron Weinberg & Va Lanza INSURER C: Travelers Prperty & Casualt INSURER O: 226 Trowell Street #B4 -A Wilmington MA 018 7 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACHOCCURRENCE $ 1000000 TrEEr— PREMISES Ea occurence $50000 A X COMMERCIAL GENERAL LIABILITY IN I S SUE 03/14/05 03/14/06 MED EXP (Any one person) $ 2500 CLAIMS MADE K OCCUR PERSONAL BADV INJURY $ 1000000 GENERAL AGGREGATE. $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 10 0 Q 0 00 POLICY PRO- LOC JECT B AUTOMOBILE LIABILITY ANY AUTO 0062853 04/05/05 04/05/06 COMBINED SINGLE LIMIT (Ea accIdenl) $ BODILY INJURY (Per person) $ 2 5 0 0 0 0 X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ 500000 HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ 100000 (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN • EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ $—,.--....__.—._. .... - - - - OCCURCLAIMS MADE _ ... _ _._ . _._. .._ ..... _....._ ..-_—..._9GGBEGAIE.-__..... S $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND julm TORY LIMITS ER E.L, EACH ACCIDENT $100000 C EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 7PJiTB503X108705 03/14/05. 03/14/06 E.L. DISEASE - EA EMPLOYEE $ 100000 E.L. DISEASE - POLICY LIMIT $ 500000 If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER uANGELL.AI IuN 1234343 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPR ENTATIVE ACORD 25 (2001108) U �) L ) , © ACORD CORPORATION 1988 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 c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: 7" /6iW S}I �✓� 6Pl i P1kZ10JSa- 111 (Location of Facili ) Signa " of Permit App cant Fire Department Sign off: Dumpster Permit ,1 7 v Date • z rA 2 n. z r • A4 I R+ a 2 CD O CD • cc L }O f..i Z a O h C C — I CCM ._ Q* 0 m m •� 3 as Lm Cc o c ca CD Cla = � 10 0 CD C Z m 0 CL c C — C— cc CL cm W W 19 W x a a w w w pG U iw a: w" oG Pc. nG .o u; ra cn cn z r • A4 I R+ a 2 CD O CD • cc L }O f..i Z a O h C C — I CCM ._ Q* 0 m m •� 3 as Lm Cc o c ca CD Cla = � 10 0 CD C Z m 0 CL c C — C— cc CL cm W W 19 W