HomeMy WebLinkAboutBuilding Permit # 8/8/2016 NORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER
7 APPLICATION FOR PLAN EXAMINATI
Permit NO: Date Received 7
Date Issued: —17
must complete all items on this page
MR
'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
3 1 WM7_7
Identification Please Tape or Print Clearly)
OWNER: Name: Phone: 7,94-c2 Z
Address:
ARCH ITECT/ENGI NEER Phone:
Address: Reg.No.
FEE SCHEDULE.,13ULDING PERMIT.,$1Z00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost:$ —FEE:$
Check No.: = 74��V Receipt No.: ',VI-4—U
NOTE: Persons contracting with unregistered contractors do not have ace"thgAu_ J,
.grant fund
Signature of Ag'6nt/OwneT-_� vi"rdttat4re of Pont
Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑
TXPE OE SEWERAGE DISPOSAL
PnHlicSewer ❑ TanningMass' -BadyArt ❑ SwnnmingPools j
well ❑ Tobacco Sales ❑
Food Pacicag-g1sales i7
Private(septic tank etc. Permanent Durnpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
XPLANNING ,�c DEVELOPMENT Reviewed On ' /'l Signature_ 6111COMMENFS a'�1✓� �/ t 1
CONSERVATION Reviewed on 42 l tv Signature
COMMENTS
HEALTH Reviewed ori ' ( Si nature
COMMENT f of 4 fl 1 r _
i
Zoning Board of Appeals:Variance,Petition No: Zoning Decisionlreceiptsubmitted yes
Y
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer Connection/signature&Date Driresray Permit
DPW Town Engineer:Signature:
Located 3$4 Osgood Street
FIRE D�F'ARTMINT -Temp Dumpster on site yes
Located at 124 Main Street
Fire Departmentsignature/date
COMMENTS
_1
Town. of I.S,0IR:..,.
T"
6 Andover
0 .
No.
h ver, Mass, 24HP
BOARD OF HEALTH
Food/Kitchen
PERMITT ILD Septic System
THIS CERTIFIES THAT............ .... Alk........r)!ON A ...................................... ............. BUILDING INSPECTOR
Foundation
has permission to erect............._..........buildings or, 41...................... Rough
4
to be occupied as 161:70644elk. kj1.!4.0.......Raw...Attkof6de. Chimney
provided that the person accepting this permit shalkn,every respect conform to the terms of the application Final
on file in this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS DONS TIO Rough
Service
FinaBUIL INSP TORl
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildin Rough
Display in a Conspicuous Place on the Premises—Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
r ovoli N( Page No. _ of Pages
HO"SSE CONSTRUCTION
16 Edgemere Ave.
BURLINGTON, MA 01803
{617}272-1252
c
'PROPOSAL SOON TIED TO I PHONE DATE
fo17-"7 'q4 '7 fIe
STREET JOE'�NAME
CITY.STATE AND ZIP COOP 108 LOCATION
ARCHITECT DATE OF PLANS JO8 PHONE
We hereby submit speciticaticns and estimates for:
t_4�
2 41
LApe
—1
i0P t1IU}U18P hereby to furnish material and labor—complete in accordance with above specifications,for the sum of:
' ; - _ dollars($ J'� `� ).
Payment to made as follows:
1> (Jif a vIt 45zs
All material rs guaranteed to Ix as specified.All work to be completed in a workmanlike
cording to standard practices.Any alt,—u or deviation tram above specifica. Auf oriZed
tions envolvinI,extra cans will be executed only upon written orders,and wk
became an Signature —
extra charge over and above the estimate.All agreements contingent upon strikes,a<cldents
or delays beyond aur contra+.Oe�ner I.carry tire,--ft and ower necessary insurance. Note:This proposal may be
our workers—fully ccxere¢¢d by workmen's Compken=_ation Insurance, withdrawn by us if not accepted within days.
LD.te
ti$ttlttt bTb rO13110 1—The above prices,s�-Ilmrized
itlons are t sfa ory and are hereby accepted. You arSignature
work as sp c h .Payment well be mz e as outlined above.
cceptance 7 C� Signature I /j�j°JC�T ��a v �
4k PhA
r
AZ-- �
06V kw6
'i
jA
1
;v z
Ll-,"L5st C rnsEry<�yn
i
-----------------
23
Alt
,w
f I
i I a
lI.
I ,fi
Z L7-
1,;
zL 115
7 ) P!
C�
s 7�.:n,c5 r- 1 t)
- tit
North Andover MIMAP June 7,2016
,i
�lp
6 t�v«o m.Ma sae eiane coo,��n�sr:rem.cemm NA�a,
{aORTH - -
xs OT{<.so,a9'T'p ew- ass .The ntosmeu.+�dep:ned ants- -
n•.ens 3'T a ` OL Ery duan-v wPos�s M,nM ins - _
Parcaa � 9 dMaKES NO WTRF YTIESINEz R�P<I�eCNCE�
^e '
THE AGGURACY,CAMP ASsocIATEUTI AN-o4fSF o,Ts
HT4E U5E OR AISL
Y;#^o,eap rt.'� vslhFORciATION
�SSACNU`+ft
1"=114ft "�`
North Andover MIMAP June 7,2016
106.A-0072 r 106.A-0242
,�. 106.A-0247 106.A-0240
06.A- 241
106.A-0038 106.A-0219-, 106.A-0244 t.65
at?.;.- In 106.A-023
#230 #25 _ G7 #48
106.A-0225
Ul
lit. moi__ #60 m o
i - d 106.A-0224 #871
n
6 106.A-0261' .
MA-00 - m
#59 °f '>
#66
106.A-0221 - 106.A-0267 t6
#247106.A-0039 #93
q0- 106.A-0262
#72
106.A-022106.A-0223
#255 2 j
106.A-0263106.A-0079 #57 � !!tt
uz
106.A-0220 =
#99 T
#21 -F,
106.A-0080
v4,,< 1l I
Al
RI
106.A-0 ✓� ti 106 A 0260.m !
JF
m.
iI< I06.A-0011
106.A-0013 I
106.A-0082 6 - #346
#295 _ i a._ a14 .. i
- 106.A-0014 :iit �SO6lAtE0215 !' 1
#328 r` AL
#326
106.A-0083
0
#'327
�2 S�rP #340
lO6.A-0193 ..��
106.A-0142':.
>> #350 #360
106.A-0218 106.A-0140
106.A-0015
#333 V335
146.A-0412 #23
106.A-0217f
. - #370 /
106.A-0149 IO6.A-0034
�M
_�vee m ac
HORTM
PreEss=_oT lMPt Ec x M
y Easerenis u[;aM'.Feart s - THE* sno Y C0.A,C
EE
❑13,,.6 AGCU S$OC TTEaENiiN TiHE US 5 Pe'sUSEYc
F
Ee p anh .a I,1 nFORMFi oh
ts$ACRU`�ES
T'=191 fl
4
Orill W o a
j 4 l y y -4!:'61 j
pp
h a ry n O
a o \ m ix
4<<
z
O
6 0
� p O
N
N
CL
�-
lK
��*
O
7
�
The Commonwealth of Massachusetts
Department of Industrial Accidents
_ 3 Office of Investigations
600 Washington Street
;+ Boston,MA 02111
www.mass.govldia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address: i.7
City/State/Zip: : rh Phone#: -Mb
Are you an employer?Check the appropriate box: Type of project(required):
1.®I am a with w
employer 4. ❑I am a general contractor and I
�_* have hired the sub-contractors 6. ❑ ri
New constntcon
employees(full and/or part-time).
2.❑I am a sole proprietor or partner- listed on the attached sheet. 7. B Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers'comp.insurance comp.insurance.$
required.]
5.❑ We are a corporation and its I0.❑Electrical repairs or additions
3.❑I am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] c.152,§1(4),and we have no
employees.[No workers' 13.❑Other
comp.insurance required.]
*Any applicant that checks box gl 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 than lure outside contractors must submit a new affidavit indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
amployees.tribe sub-cmarsams have employees,they must provide their workers'comp.policy number.
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. L Expiration Date:--i ZJI ST .
Job Site Address: �� Y oT f�� 5 City/State/Zip: L4,d y,,_�l 9qS'
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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby c5 ' under the pains and penalties ofperjury that the information provided above is true and correct.
1,7-7
Phone 9:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: PermitlLicense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
0.Outer
Contact Person: Phone#:
Office of Consumer Affairs&Business Regulation
"I HOME IMPROVEMENT CONTRACTOR
$ J] Registration: 122054 Type:- Expiration: 7115!2016 DBA
HOVASSE CONSTRUCTION INC.
RICHARD HOVASSE
12 COLBURN ST
BURLINGTON,MA 01603 _ Underseeretary
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License:CS-063351
Construction Supervisor
RICHARD E HOVASSE
12 COLBURN ST" -
BURLINGTON MA 01§
Expiration:
Commissioner 0713012017
SUMMARY OF VERTS BUILDING TIES
SEWER @ FDTN. 94.47(6'OFF)ALDG. CORNER A B C D THIS PLAN CERTIFICATION IS NOT
SEPTIC TANK IN SEPTIC TANK OUT 38,024.7 - - A WARRANTY OF THE SUBSURFACE DISPOSAL
SEPTIC TANK OUT 96.81 PUMP TANK OUT 40.3 34.41 �- I - SYSTEM. IT IS A RECORD OF THE LOCATION
PUMP TANK IN 96.74 DIST. BOX 23.7 35�.8 _ 1 - AND ELEVATION OF THE,EXISTING SYSTEM
DIST, BOX IN 98.77 COMPONENTS.
DIST. BOX OUT 98.59
INV. IN CHAMBER 98.50 "1 HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL;
BOTT. CHAMBER 98.22 EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS-BUILT SUBSTANTIALLY
AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK
OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET."
APPROVED DESIGNS PLANS.
SIGNATURE OF DESIGNER DATE
M WN MAE 1aBA
22WN LOT I
(1.5 AC.)
Elm
f 64-
N/F N/F
BIEUK
It
L
VENT
IN)S
P4 T
1 00 GAL
TIC TANS
1P00 GA� D-BOX 40
PUMP T#MK _6�_
I T-1
_4
54.72
v Ll L-39
P
LEAMELD oJwsT STRW W/40CH INFILTRATOR
CHAMBERS
SN OF MA
VLADINR L
NEMCHENOK
AS BUILT PLAN L
OF
TP ',zvzTT*-'MACE IS SUTU"'SURV SYSTEM
ri
LOCATED IN
z NORTH OVER, MASS./326 FOREST STREET
AS PREPARED FOR
MARK BIONDI TM: 106A
8-18-14 TL: 13
SCALE: 1"=40'
0 20 40 80
MERRIMACK ENGINEERING SERVICES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810