HomeMy WebLinkAboutBuilding Permit # 8/11/2016 t%ORTN
BUILDING PERMIT 0. 1,�-tv)
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TOWN OF NORTH ANDOVER 1 0
APPLICATION FOR PLAN EXAMINATION
Date Received TFD
Permit No#: S US
Date Issued: L i
E IMP011TANT: Applicant must complete all items on this page_
LOCATION so N
Print
PROPERTY OWNER
Print 100 Year Structure yes no
IST Istoric
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes nt
TYPE OFIMPROVEMENf PROPOSED USE
Residential Non- Residential
[I New Building 0,0116'family [i Industrial
&,A'&d i t i o n [i Two or more family
[I Alteration No. of units. ❑ Commercial
11 Repair, replacement 11 Assessory Bldg [i Others:
[i Demolition 0 Other�y t7 Flood lain n
Watdr8hbd�
Wetlands I a n ds�
2 MAIN/
an
9
/A
aim
Se J
J, A
/N
at 036 10
DESCRIPTION OF WORK TO BE PERFORMED:
Identification - Please Tvi)e or Print Clearly
Phone:
OWNER: Name. )CLIZZ2,
Address: _':
Contractor Name: I" Phone:
Email: LILO Lf Vep,22"4:67)�J
Address:— ZY-1
Supervisor's Construction License:C ._Exp. Date: 7 '75�/
Home Improvement License: _Exp. Date: 77S' .)�62
2C -7
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.-BULDING PERMIT.,$12.00 PER$1000.00 OF THF'TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $— Po 4
ipt No.:
Check No.: Rece
NOTE:.. Persons contracting tli unregistered contractors do not have access to the guaranty find
---------------
a Plans Submitted ❑ Pians Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DTSPOS.A.L
Public Sewer Tanning/MassageMody Art ❑ Swin ning Pools ❑
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Pennanent D'ampster on Site ❑
3
THE FOLLOWING SECTIONS FOR. OFFICE USE ONLY
INTER®EPART�fi ENTAL SIGN OFF w U FORINT
PLANNING DEVELOPMENT Reviewed OnIL Signatures
COMMENTS
CONSERVATION Reviewed on / Si nature
kCOMMENTS Qe'�C\ A v S ,�� p nst0,VV\ (0
HEALTH ReevOwed on V Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: zoning Decisionlreceiptsubmitted yes
Pianning Board Decision: Comments
Conservation Decision: Comments
Wafer & Sewer ConnectionlS�n�ture �qa�e ❑riveway Permit
DPW Town Engineer: Signature:
Located 384 asgood Street
z
'Alf EPAR+TI1lIENT TemptDumpst_er ort;�ifie: :yes no
Located at 124 Main Street a
Fir ®epartmnt srgrraturelclate
GOMMENTS
The Commonwealth ofMass�chusetts
Department oflndustrialAccidents
;M M : _F d I Congress Street,Suite 100
.Boston,.A 02114-2017 ,
www.mass:govldia
Workers'Cornpe'nsationllnsurance.Af davit:Builders/CoxltiractorsfFIectriciansTluxnbers.
TO B.E' MED WfTH TEE PEPJvffTTINCx A.[J xg()R':L` '
A licaxttXnfoxxnatioxa. - l`'IeasePrint Le 'lxl
Name(BusmesdDrgawzationTntlivi..dual):
Address: 6
City/state/Zip: Phone
Areyou an employer? Clzecicilie aplixopriaie box: 'hype of project(Terluired)
1.❑I am a employcrvotla _.. : employees(full andlorpart limo)* 7.• Q Now coxisfaaotion
2. I am a sole pmpzi etor or paztnersbfp audhave no employees cVorkuore rggi
G
y eapaaity [No workers'comp.insurance required] Demolition
Q I am ahomoownerdoiug all work myseIZ ENO wozkers'comp..iusorance required.]_ 10 El B-uitqing addition
4.E]I am a homeowner=d will be hiring contractors to conduct all work on my property. 'Vi"
ensure that all contractors either have workers'compensation insurance or ara sole 1 1.Q Elect ical repairs or additions
i
pr6,prietors vrithna eznployses. 12 Plumbing r'epair's or additions
5.Q I am a general contractor and I have hired the sub-contractors listed on rho attached sheet, 13.'C]Roofrep a7xs
xhese sob-contraetor's aYe employees andhave workers'comp.insuranco.t
_ � � 1�•. Other
6.0 We are a cozporation and i#s o cers have exercised their right of exemption per 1VICT c.
152,§I(4},andwelzaya ma.employees.[Naworkers'corny.insurance required]
'Any applicant that cheolos box 41 must also-M out the section beIaw showing their worlcers'compensation policy informaffon.
Homeowmrs vVho srilim:it'#his Adav-it indicating they are doing all work and then hire outside contractors mast submit anew affidavit indicating such
fConiractors that checkthis box must,attacJ2ed as additional sheet showing the name of the sub-contractors and state whether orpot those entities h.TO
employees. Iftho sub-conliaaiuzs have�znplopees,}?icy musE pra4idetheir workers'comp.poiicy number.� .
lain an employer th at is pro vrclzng-workers'compensation insurance for my ernplayeeS'Below is the policy ttrid job site
infoxanatia�t. - .
:Insurance Company Names'
Policy#or S elf ins.liC.#: Expiration Date:
Sob Site Address: d e � City/State/Zip; ___
Attach a copy of the woXckers' compepsation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MCx.o. 1.52, §25A is a criminal,violation punishable by a fZno up to$1,500.00
and/or one-year ivaprisoxonent,as wolf as civil,penalties in the forru of a SWOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A,copy of this statement may be forwarded to the Office ofiuvestigations of the DLA_for iuffararrce
coverage vorificatiori..
2 do hereby cel u�rrtet'trze uir�s and pe�talties ofpetjxzry that the inforraaatioxr providedbave is rtze and car.ect
r Date: •" d'1
Si atoxe:
Official Use only. Do notxvrite in this area,to be complete'by city or to}vn official•
City or Tow-: Perbxf"Mcense g
Issuing Authority(circle one): F
1.Board ofRealth 2.Buffdingl7epartmoit 3.City/Town Clerk d.Electrical inspector 5.721ux bxngIhspector
6.Other
Contact Person: Phone#:
t%ORTI
Town
of �_ ndover
® 0
No. _ � _
Ck
ON
�.K. h ver, Mass,
LO[.+eC�aEwrcu Y�'
�RRTED ApA�,c�3
U
BOARD OF HEALTH
Food/Kitchen
PER IT T D Septic System
rv�.� �r _
THIS CERTIFIES THAT ......... .��,... � BUILDING INSPECTOR
has permission to erect .......................... buildings on.. 4. .......� .�., .-f g.................f... Foundation
.�. ...... �.... ... .. Rough
to be occupied as .. .� ...................................................... Chimney
provided that the person a cepting this permit shall in 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 CONS T Tl Rough
Service
... .. . .... ............. Final
BUl NG I PECTOR
GAS INSPECTOR
Occupancy Permit required to Occupy Bu 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.
„i�r�r1 „d,v;f 1lii I,ri V(,."4I
`Ik iris i,4Cr,p,ert, 1 .�aQ.^it'�Fw;3
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t'ropasal ra Saabanttted •/ Phone Date
__ ,l:
llcldress___._ Joh Name
i ✓ Jab location
Archster t Datc of f'larrs Job r'honc
. . .^. .. .__...........................
61
_�_� .�....
We Ptercaby sutarrtit sfrecifiaations aru'f estirrdatesYcrr:
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...,..__................................ ........... ........ ..... _._-_............ ._-. ________._ ._.____ -_.._____ ......._.
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I S : he-r-e y for t'ttrrtislt rrf t r"rrrl r el I I~rrrr m_ rrrtr l t urr crrrl, rrc e w-i—t h, 1fic a tion laird, for tli, lr r cry
✓, lallars($ r:
( . .._...., . ...
.y e made as follows: °
P rnent to
r rr
All material is guaranteed to be as specified,All work to be completed in a workmanlike Authorized Y, f,
manner according to standard practices.Any alteration or deviation frorn above specificationsSignature --
involving extra costs will be executed only upon written orders,and will become all extra
charge over and above the estimate.All agreements contingent upon strikes,accidents or Nate:This proposal may be withdrawn
delays beyond our control.Owner to carry fire,tornado and other necessary insurance.Our by errs if not accepted withindays.
workers are fully covered by Workman's Compensation Insurance. _ ”."...._..
Acceptance of Proposal:
The above prices, specifications and conditions are satisfactory and are hereby acceptech
to w 6
You are authorized to do td c work as staccrtePayment Wr �e a..cautloaod above. Signature
t w
Date of Acceptance._._"�� _._y::_. �.��...,,L. „ ________�..:.. Sigatati.rrr. ...., _...._ _..._------
North Andover MIMAP 304 Chestnut St August 12, 2016
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Interstales
Horizontal Oa(um:MA Stataplano Coordinate System,Datum NA083,
Meters Data Sources:The data for this map was produced by Merrimack
SR tkORTH Valley Planning Commission(MVPC)using data provided by the Town of
Roads Ot e r q� North Andover.Addillonal data provided by the Executive Office of
tMe Easements } 4a +gyp QO Environmental AffalrsfMassG1S.The informatics depicted on this map is
Parcels for planning purposes only.It may not be adequate for legal boundary
�O definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
{l. % THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
4A s ^ X OF THESE DATA..THE TOWN OF NORTH ANDOVER DOES NOT
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
o THIS INFORMATION
sSACHuse
1"=33ft W r.
8/11/2016 Town of North Andover
( ease Map }F 2iii
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------------...�
060.0-0300 Owner Prop—ID Address
BURKE, MARY BYRON',098.C-0071-0000.0',304 CHESTNUT STRE
060.0-0101 274 CHESTNUT ST
°,tib 8
1.selected To Mailing Labels To Spreadsheet
Property Building Permits Plaing Septic Puanpt
09&C-0055 J nnPrint
Oa8.0-0404
Owners BURKE,MARY BYRON
Owner2
R3 2 i CHES'HIUT'S"T / Address 304 CHESTNUT STREET
PropertyID 098.C-0071-0000.0
Lot Size 25265 S
Fiscal Year 2016
Land Use Code 101
Last Sale Date 19970324
7P Book/Page
Total Valuation $473000
Building Type CL
" _ Year Built 1988
09&C-0005 Y. Finished Area 2194 sq.ft.
v;. More Info: Click here for Assessor website
r`1leAssessor Map NorthAndoverAssessorMap98C_26x36.
aatrlUt titre
� Water Tie: CHESTNUT STREET_0304.pdf
09&C-0008
09&C-0007
Property Search Page Go 1.1,0(production) AppGeo Save Map as Image .._......
http://mimap.mvpc.org/NorthAndovermimapMewer.aspx 1/1
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Qffiee of Consum E Af;a�rs&business Regulation
�. M8 IMPROVEMENT CONTRACTOR
eglstratton: 182620 TYp 3
>Ipirattott, 7/8/2017 a ]nalittidual
DAVID M. MORIN _
i
DAVID MORIN
365 SUTTON ST
N.ANDOVER, MA 01845 .<4::,r_=- :.-
t Undersecretary
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=77
Massachusetts Department of PublicSafety
Board of Building Regulations and Standards
License CS-0400
Construction Supervisor
DAVID M MORIN
366 SUTTON STREET'
NORTH ANDOVER I+11, .
6 /
. M=
/4�""� l� Expiration;
—Commissioner 07/0412017
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