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HomeMy WebLinkAboutBuilding Permit #213-11 - 1 HIGH STREET 9/13/2010 BUILDING PERMITo "°DT bgti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION x . Permit NO: Date Received reap) gSSACH�15�� Date Issued': t IMPORTANT:Applicant must complete all items on this page LOCATION l - Pant , PROPERTY OWNER- 7ki GIelzs_ Print /IAP NO- PARCEL: ­ZONING DISTRICT: Historic,. Y Dlstrict � y es`' Machine Shop Village no 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 Otherh,� Septic_ Well,' �tx Floodplain Wetlands' z, _;Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: o� l3 A0 Identificati n Please Type or Print Clearly) OWNER: Name: v-e�s-� Phone:72�,Q 9(a-�7�7 Address: < e�l�Uj,-Y� p h0. A CONTRACTOR Name: e-S � F Phone:_. Address: /0 �2' x s s Supervisor's Construction License: ` I - r F Exp. Date: Home Improvement License: Exp: Date. ° ARCHITECT/ENGINEER Phone: Address: Reg. No. i FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $/.27,-S-- FEE: $ - Check No.: I 0a S� Receipt No.:_ "-;� -- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature oTfAgent/Owner 6_ZZ:7k, Signature of contractor %,:•' u . 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 y 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 j COMMENTS t Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE:DEPARTMENT = Temp Dumpster on site yes no Located at 124 MainStreet Fire Department signature/date _ mY COMMENTS k Dimension Number of Stories: Total square feet of floor area, 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 21 A—F and G min.s100-$1000 fine NOTES and DATA— (For department use i I _ i ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 Location ��rA No. Date �oRT„ TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ S''^"�t�' Building/Frame/Frame Permit Fee $ s�CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2347 Building Inspector NORTH TONM of Andover No. oo dormer, 1Vlass., LAKE I. COCMICKEWICK V ORATE D RATED BOARD OF HEALTH Food/Kitchen PERM IT� T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT d ............ ............................. .........................�kus ................................................................... Foundation ' .............. buildings I 0.................... Rough has permission to erect..............:........... gs on ....... ...... ...1!�,.........s..�°....... � � Q to be occupied as...... =i�g­tejermft ..... .................................... ..... .3.......0...............1..:...�.....' Chimney �d Ch' e provided that the person accshall in every respect conform to the terms of the application on file in Final 7 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 3d PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU O Rough ..... .. .......................................................................... Service BUILDING INSPECTOR 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner f Street No. Smoke Det. SEE REVERSE SIDE 21,111 Aw _§§dd 3? �,,, F}-f>;.4 _hstv5ky �xx er 'd,�+;,2y•�,,�'y ....,p i ��h,��,t:;3}�#3�x� '7��.��#b7g�`aw{ss��x�,���y:„gg�-at s dt�i ttt� ro�ae i r'ce Jaz ° ? y t qv, � �,yd's �"' !3'�`���s��F# ss5�� �� � i'� •��},�' �#�p����r� �'t� ��M '£f4l� f �� Td' ����*e}��$���'��� '�y `'� '�►� x Eska ± � ,� :�tt �2'., ex Y �`"a�`. c 1 `a yo-r ssr ! .l � s s. 1� IMMtJ' t,x �xP� s ,€ efts: ,` V�}x�'�yi "" 5� i- qs, "'�• - �3 syr { � tib�.. � � ` 2��" U � 7 f��i t. �p�Jt l53 { aSLtfd, �� •ku�� �SY !s{e'M+ �s'y, .3�:F�� at. ".rta.,k 4..Y�ixr.. y' � -0{ r Cal CRL1C.ICII�G�L�LPLILPLPCPC�CJCICD EE-1IE 7 5 NT DOCUMENT REGISTRATION ISSUED BY S 5 APPLICATION �,� Date of Shipment S ®Lucy 5/12/2005 NUMBER �� INDINC.® SrF � � EVANSVILLE, INDIANA 47725 Tent Identification rr� ` `u S 140.1 MANUFACTURERS OF THE FINISHED 04048575 � 5 TENT PRODUCTS DESCRIBED HEREIN S This is to certify that the materials described have been flame-retardant treated U 5 S (or are inherently noninflammable) and were supplied to: 5 5 657150 5 PETERSON PARTY CENTER INC 5E 139 SWANTON ST 5 fi 51 WINCHESTER MA 1890 S 5 5 5 S S 1 5 Certification is hereby made that: ", 5 5 The articles described on this Certificate have been treated with a flame-retardant approved Schemical and that the application of said chemical was done in conformance with California Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 Serialslo9lol (I) # S 5 Description of item certified: [5 CENTURY MATE 30Wa60 SNYDER ; WHITE VINYL I6oz 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And is Effective For The Life Of The Fabric 5 SNYDER MI'G NEW PHILADELPHIA.OH Sig ed: 9_1 '-)SPECIAL EVENTS DIVISION•ANCHOR INDUSTRIES INC. � 5 � cPrn�:'�u��`c�Jc1-eJu"�ctc.l�cJ�rPc�'�r��rJ�rJ�rsc,�rJr�r.��.Pr��.Pr�rlcPrJ�r.PrJ��.l�cP�r1�'J���rJ�rJ�c1rJ�cJ7rJ�rJ�r�J��Pcfr.tcfc1rJ@Pr.P�P�P�P�P�.PcPcJ��Pcl�PrJ�rJ��r.P cJ� 0 TI; 0 's,"rh,I AI C C it-ic Office 0o f'ItIvestigatiolis 600, JV05/, gfon Street 14 i: VI/of J Applicint f P forin-,I icit, Ple2se P I lit Legibly Nallic wsincss 0;>a, -t' Address: 640 S'7L— clty/state/zlp:_(J/Or Phone #: -2 9/ 72 errlr'fo�or? Check t(Ic box: O'l r� [2 a am a employer with 90--c) am a general contractor�nd I Type of project (required): m Ne- Are you arae ernf,,!o,,. employees (full -time).* have hired the sub-contractors 6- ew construction emPlOvees (full and/or part-time).' 6. ❑ N em lo' sole pro [2.El I am sole proprietor or partner- listed on the attached sheet. F7. 0 Remodeling S. __I ship and have 1)o employees , r❑ _ These sub-contractors have S. E) Demolition working for me in any capacity. workers' comp. insurance. 9. [:] Building addition [No workers' comp. insurance 5. El We are a corporation and its .red.] officers have exercised their ns 0 requi, 10.El Electrical repairs or additions 3.❑ 1 am a homeowner d.o,;,-,g 21,' work right of exemption per MGL I 1.0 Plumbing repairs or addi,;0r_.s myself. fNo workers' comp, 12 §](4) and we have no insurance required.] c , , 12.0 Roof re,,��!;rs f` Pio,Ve.es. [?'4o worker's comp. 13.2 Other Any applicant that checks box#1 mp. insura-rice required.] J 1 _!��. 7 must also rill out the section below showing their workers*oomp==tion policy information. HOmcowncrs Who submit this affidavit indicating they—doing all work and then hire outside oontractors must s' 'Contractors that check-thissubmit a new affidavit indicating such. box must aft—ached P-1 additional sheet showing the name orthe sub-contracto,and their workars'comp,po!4 information. I am an employer that is providhig workers'compensation Insurance far ray employees. Below isthe policy and fob site information. Insurance Company Name: Policy# or Self-ins. Lic. 9.4126--d-7-11P_6 96 /_)f0,;7, Expiration Date: Job Site Address: City/State/Zip.- Attach a copy of the ,worker .co worker m pens2tion 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 fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to $250.00 aday against the violator. Be advised that a copy ofthis statement may be forwarded to the OfTice of Investigations ofthe DIA for insurance coverage verification. I do h ereb r certif 1,under th�e *ns andpenaftles of perjury that the information pros-Ide;d above Zis rue and correct P _Znature: Phone 9; use ottlY. no,, ores, to he conzp"'Oted Ctt J:Cic City or Town: Permit/License# u Jr, 'or Issuing Authority(circle one): a of Health 1. Board ofHealth 2. Building Department City/,Town- Clerk- 4. Electrical Inspector 5.Plumbing Inspector . Other C 2 J, ' ui 1) 0 ro, c C) J COV: -:7— L. P.r, L Du, D j A s C T PC C "ILL T h 7 T7,Rjci f:.*s " A: cf lof'- S r C)L ICY I T 10,10 0 XC. ------ D 0 G - -------- ICS PE F: y ---- "T E LimIT I.."p 000 o0c) I GENERAL AGG"'-G 4 rE S2 000 000 MlyPRODUCTS.co'.J,�/ A yAUTO AGG $2,000 000 , ALL O%VrqEc)/,UTO, CiocIll 0 LE umir (Ea accj�fe,[) 11,000,000 X BODILY It,'Jury ODiE.V f:: 'ELI"�DA-"-G IY AJ,"i'AU I D ------- 0", I A U-TO ot,,L y C CA ACCIDENT OTHEr A_ CA ACC AUTO Ot" c� AUT 0 0 NG 4 2 02 CA ACC --- I X I CL IK.s Io AG. 0 C, C, j c 0 4GG'�CGATE ___G00 000 5 Nonc IVORKCPS COMPENSATION AND , . ------------- EMPLOYERS'LLASILrTy WC2ZI1259617029 OFFICE I ol'jg/()g ANY PROPRIETORIPARTII"E:-XEC(JTP,,c 10/09/10 s _R/MEMBCR EXCLUDED? X %'�C S TAT U- PRO"s,oe,, t to- OTHER E.L.EACH ACCIDENT S500,()Oo E.L.DISEASE.EA CMPLOYE. $500 ()oo E.L.DISCASC-p,,ICYt I'AiT S500,()Oo OF OpCr t OCA Tl),, tjSln#,'S A Occ BY r DORS EMC NT PC C LAL PR 0%15IONS CERTIFICATE HOLDER CANCELLATION SIIOULO ANY OF THE A(30vc DATC THEREOF.THC ISSUING DCSCR'OCD POLICICS OC CANCELLED CCT TitC rypIRA, lNSuRCR WILL C110CAVII TO 111L __3a_ GAYS V.-R,T-,C, 10,4 "OTICC TO THE CERTIFICATE HOLO CR NAMED TO THC�L-C F IMPOSE NO 013LICATION OR LlAafLrry OF ANY KINO .©VT rAlL-U F(E 70 00$0 SHALL REPRESENTATIVES. UPOU TI(C jt;SUR,,R,FS AGENTS OR AUTHORCED PCPRCSCtITAT;VC 2 3 US,3373 c ICOF-,o \I<��,acl►u�cttti - Departrttent of Public SafctN ' Board of BuIldim, Re�ulatiunx .tncl Stanciarclx Construction Supervisor License License: CS 60219 Restricted to: 00 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4/27/2011 Ci Tr-#: 14425