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Home My WebLink AboutBuilding Permit #6 - 1077 OSGOOD STREET 7/3/2007 NORT14 BUILDING PERMIT oFsz�Eo bq�o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION i a1 Permit NO: Date Received �9"�R%Too SSAc►+us� Date Issued: IMPORTANT Applicant must complete all items on this page x N' MC �• . �� • � � ��'_ � �L� �O� G C�ITI�). � -��ISTO�t �TR1Fri � r��,- � TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other tIG O F cxtd lain �etta�s s 11 VV r t4 q DI� IPTION OF WORK TO BE PR FORMED: �� r d�Sa�� Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: a „F 5s a� ye �� sr teAkI` QIL€ �rts:_ � 1 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: $ _ S� FEE: $ � Check No.: '��& Receipt No.: d (o, NOTE: Persons contracting with unregistered contractors do not have acce s to th ty fund Signature of Agent/Owner Signature of contracto i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water $ Sewer Connection/s9nature Date Driveway Permit Located at 384 Osgood Street 7711 F1R DEREfi Tempautls#er cin si#� es LoQ�ed c `124(�Ialr 5� � g = T10 s 3 patent l inatUreld77777a 1 ytk 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 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date 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 o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products 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 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 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 2.2007 i Location �V�4 060 / 0 No. Date A —U NORTq TOWN OF NORTH ANDOVER N 9 • • s Certificate of Occupancy $ JMUsE<`'• Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ + TOTAL $ Check # a � 20166 Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers u de s/ Contractor A licant Information s/Electricians/Plumbers Please Print Le ibl Name(Business/Organization/Individual): Address: City/State/Zip: / Phone#: Are y an employer?Check the appropriate box: 1.11CJ I am a employer with q. Type of project(required): ❑ I am a general contractor and I 2.❑ employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on the attached sheet t 7.ship and have no employees ❑Remodeling These sub-contractors have working for me in any capacity. workers' com . ' g emolition [No workers'comp. ' P �anCe' 9. ❑Building addition p insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10•❑Electrical re pairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no insurance required]t employees. [No workers' 12❑Roof repairs comp.insurance required,] 13.[]Other "Any applicant that checks box#I must also fi Homeoers who submit ll out the section below showing their workers'compensation policy information. t wnthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. !Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy I am an employer that u providing information, workers'compensation insurance for my employees Below is the pocy and job site Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: Z City/State/Zi Attach a copy of the workers'compensation policy declaration Page showing the policynu , / Failure to secure coverage as required under Section 25A of MGL . 52 can lead to the imposition bof criminal pen on datea 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 may be forwarded to Penalties of a Investigations of the DIA for insurance coverage verification. the Office of I do hereby cern he a and penalties a+jury that the information provided above is true and correct. Si na e• Phone#: FEfU only. Do not write in this area,to be completed by city or town uJ)9ciaL n• Permit/License# ority(circle one): Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector on• Phone#: NORTIy Town of No. o� , �` dover, Mass., T O - LAKE COCHICHEWICK V 7,95 RATED `,�5 BOARD OF HEALTH PERMIT . T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............. ...er..*. .... ........... .................. Foundation has permission to erect........................................ buildings on J. .. ....... ............. ..... «+... ........ Rough to be occupied as.... .......�!!!1iQ.........0 . . ►. ... . ........4......Ne A...164.0.*.... W 4.C..S.. .............. Chimney provided that the person accepting this permit shall In eve respect conform to the terms the application on file in P P P 9 P every P PP� Final 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 Z, PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TRU T Rough ........................ ... .. Service . .... .... .... ...... ....... ..... BUILDING INSPE R Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Na Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. I Board of Building om Re u Contle at hs'�a 7 Construction Supervisor oda rds I P or License License; CS 86410 I Sirthd6f6 l'2/1/1954 Expiraiioi5 2'/1/2009 Tr# 9799 Ffesirict�on��`OOj'ifs' I VINCENT C GRECO 45 HIGHLAND VIEW JNO ANDOVER, MA.0184 - I Commissioner Ile ;z„z�6 J P,�