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HomeMy WebLinkAboutBuilding Permit # 12/17/2015 _ 1 BUILDINGPERMIT O oT TOWN OF NORTH ANDOVER �= y� g` o APPLICATION FOR PLAN EXAMINATION Permit No#: ! �' Date Received �y Q�Ra1.PPp,Ry SSACHUS�� Date Issued: l IMPORTANT: nApplicant must complete all items on this page LOCATION e� AJA P of PROPERTY OWNER �� (a) -el Print 100 Year Structure yes no� MAP U. PARCEL: a �{ ZONING DISTRICT: Historic District yes n Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other f� Septrc r ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed Distract �rVyater/Sewer- f r DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Vl*') �� Phone: Address: ' Contractor Name: 3-41L ¢ � �� Phone: Email Address: fi de- J 5 Supervisor's Construction License: 00� �° Exp. Date: Home Improvement License: /3,� 0 S^? Exp. Date:_ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ / FEE: $ Check No.: 23 Receipt No.: C12/ 0 NOTE: Persons contracting -th unregistered contractors do not have access t he guaranty fund %40RTI Town of Andover ® iT h ` ver, aSSy n O� COCHICHRWICH �®A04ATED S U BOARD OF HEALTH L U Food/Kitchen Septic System P RM I �T moll BUILDING INSPECTOR. THISCERTIFIES THAT .............. ...... ob"0110....................... ....... ... .. . . ...... .......................................I.......... Foundation has permission to erect .. ........ buildings on .. .............. �. .d•••`•••• ........ It Rough .. ....... ..... .. ..............+ to be occupied as ....... . '... .... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the ap ication Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIEXPIRESMONTHIN 6 ELECTRICAL INSPECTOR T® Rough UNLESS CTITA T Service ...............?.�9 ..... ................................................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required t® Occupy Bulldln Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or all To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. r--.7 t3'_t' � E�!> I�L1 �� ,.,ii, �itt,i(' t y�� Lll J ✓t � AMD Type Of c�.'...F it Sit u'� �..il 7.��usuv..z. .F ...� i, ._:,,.. _fi.i. ��,✓9`�.. 4t5.•J''�,...:-i' i."Tpa Cull t Tpilasonry Work Niass `f-ali V-:ca Licensed & Insured 1-800-efVAI -4-US, r�, 1 , 'tr ,<„_r' iv % f;� License#034200 (924.8487) _s i,!: '..;t:._ s: "g7 c.%z t r _` Vve Work Year rRound Proposal To: Peter Weger Date 10/19/2015 Street: 29 Barco Rd. 978-857-3957 N.Andover, MA Roof proposal Weger.pb@gmail.com IKO Cambridge 1. Extra caution will be taken to protect building 12. Removal of all work related debris. Planks will be exterior and landscaping as best as possible. (taips placed under dumpster to prevent any damage to etc.) Magnets run at final clean up. driveway. 2. Remove all shingles from entire rear main house 13. Building permit included. and rear window. 14. Contractor workmanship warranty: 10 years 3. Inspect and re-nail any loose or lifted plywood, under normal wind and rain conditions. Any compromised plywood will be replaced at an Total roof cost: $ 5,900.00 additional cost of$65.00 per sheet of 1/2” CDX • Install rain diverter over front entry fit. Option: Install (1) new Lomenco 2000HT 4. Install heavy gauge 8" white aluminum drip edge power vent with thermo/humidistat controller. to all applicable eaves and rakes. $350.00 additional cost.No electrical hook up 5. Install 9' of high temp grade ice and water shield included to rear main eave and rear window. 6. Install synthetic underlayment to remaining sheathing up to ridge. *Note*: Please be advised if applicable, valuables in 7. Install all new pipe boots. the attic should be moved or covered due to minor 8. Install new standing seam (ABC MFG) 4' metal debris, dust and asphalt particles that will accumulate panels to the entire rear roof and rear window during the stripping process. All Under One Roof not roof. Metal on rear window will extend past roof responsible for any damage or clean up that may line for sufficient watershed. occur in attic. 9. Install IKO Cambridge Limited Lifetime Charcoal Grey architectural shingles to the entire rear main Balance due upon completion, no deposit required! house. 15 year non pro-rated warranty by mfg. All shingles will be installed and fastened References available upon request according to mfg. specs. 10. Counter flash chimney lead and all roof Highly rated member of the accredited BBB and protrusions with ice and water shield and seal. Ancie's List 11. Install a new GAF Cobra ridge vent capped with color matched IKO hip and ridge shingles. Thank you! Acceptance of Proposal—The above prices, specifica ions and conditions are satisfactory and are herby accepted. You are authorized to do the work as specify d. Payment will be made as outlined above. Date of Acceptance: Signature: The Commonwealth of Massachitsetts .Department of Industrial Acctttents 8 Office of Investigations 600 Washington Street Boston, IIIA 02111 www.mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /1V Address: � .�- � �.. �^�-c-TI, �.v �.t City/State/Zip: ` « ` Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 5"' " 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' pomp. insurance. 9. E] Building addition [No workers comp. insurance p' required.] 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions 3.❑ officers have exercised their I am a homeowner doing all work 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required,] t c. 152, §1(4), and we have no employees. [No workers' 13. ther 12 6 6 comp. insurance required.] *Any applicant that checks box#I 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ani 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. z4 v .Z-- ' Expiration Date: Job Site Address: �, '�'-� City/State/Zip: /1.�M2,',J 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 WORT{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 coverage verification. I do hereby certify under the ins and enalties ofpeijuiy that the information provided above is true and correct. Sinature: v� Date: t2 1�1 f 2 /S Phone#: / "//J 3 Official use only. Do not write in this area, to he completed by city or town officiary City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Cleric 4.Electrical Inspector 5. Plumbing Inspector 6. Other WORKERS COMPENSATION AND EMPLOYRS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, M ssachusetts 01803-0970 (800) 876-2 65 NCCI NO 26158 POLICY NO. AWC 4U0-7009464-201.5A, PRIOR NO. AWC-400-7009464-2014A ITEM 1, The Insured. All Under One Roof DBA: FEIN:*°'--*'"*8251 Mailing address: C/O John Lanzafame 30 Temple Drive Methuen, MA 01844 Legal Entity Type: Sole Proprietor Other workplaces not shown above: See Location 2. The policy period is from 11/09/2.015 to 11/09/2016 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA I B. Employers' Liability Insurance: Part Two of the policy,appliQs to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injur by Accident $ 100,000 each accident Bodily Inju by Disease $ 500,000 policy limit Bodily Injur�by Disease $ -100,000 each employee C Other States Insurance: Coverage Replaced by Endorserrrent WC 20 03 06 B D, This Policy includes these Endorsements and Schedules: IEE SCHEDULE 4. The premium for this policy will be determined by our Manuals f Rules, Classifications,Rates and Rating Plans. All information required below is subject to verification and cha ge by audit. - - Premiu Basis Rates Classifies{ions - -- Code Estimated Per$100 Estimated No. Total Annual Of Annual RemunerAtion Remuneration Premium I I INTRA 174355 i INTER SEE;CLASS CODE SCHEDULE Minimum Premium OW To at Estimated Annual Premium ..................._.__._.....__._ Deposit Premium GOV GOV STATE CLASS St to Assessments/Surcharges MA 5474 $1 .00 x 5 7500% $1 rr � �- t atu`• i �7C- t�e•- s�z 10/05/2015 This policy, including all endorsements,is hereby countersigned by - Authorized S gnalure Date Service Office: P rry Insurance Agency LLC 54 Third Avenue 5 2 Chickering Rd, Rt 125 Burlington MA 01803 N rth Andover,MA 01845 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation insurance, used with its permission. -- --- _ ..... ...._........... S3 3 j {}j B i } l 9 , Massachusetts -Depa;irnent of Public Safety -� Board of Building Regulations and Standards i u:atiii ii i:uUn xi a Y.�iKiie License CS-0691120 (-). JOHN W LANZAR-IME, 'r. r " 30 TEMPLE DR METHUENMA 01844 Expiration Ccinnti�siosier 04103/2017 Zip City/Town code Search Registrantsi Click an the registration number to view complaint history,You can also view arbitration andand Guaran Fund histo The list is current as of Wednesday, October 8, 2014, Search Results REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION STATUS ADDRESS DATE NAME INDIVIDUAL NUMBER I ALL uNDERONE RoaF- LANZAFAME, 137057 166 A MERRIMACK ST 1 0102/2 0 1 6 Current JOHN METHEUN, MA 01844 ©2012 Commonwealth of Massachusetts. Mass.Gove is a registered service mark of the Commonwealth of Massachusetts. inrnr)ntn