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Home My WebLink AboutBuilding Permit #12-12 - 113 SECOND STREET 7/6/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 01 — 1� Date Received Date Issued: -? IMPORTANT:Applicant must complete all items on this page LOCATION / J3 S,T Print PROPERTY OWNER 21VP/J C-1-7 0/h7�^J Unit# } Print MAP NO: 1 ARCEL:?,'7— ZONING DISTRICT: Historic District yes no I Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial .J�epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: /�e�r4-c n- �cl�r?�^4 �/��G� ,. �?741•� /S G�.4-�� /�-9sz (Identification Please Type or Print Clearly) OWNER: Name: SS Phone: Address: CONTRACTOR Name: yWAI-7— Phone: 6-o2, 3 5 Address: /u jj Supervisor's Construction License: �'J ��? Exp. Date: l 2 6 2 Home Improvement License: /`s -?-2 5-3 Exp. Date: /I Z t l ARCHITECT/ENGINEER Phone: Address: Reg. No. f FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: ol Receipt No.: 9 34` NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contractor ��lG _ _ 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 ❑ 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 Si nature COMMENTS HEALTH Reviewed on Signature COMMENTS I Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i I Conservation Decision: Comments j 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 Main Street Fire Department signature/date COMMENTS I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I 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 Doc:.Building Permit Revised 2011 June/mi 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 L3 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 o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) o 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) Li Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit . o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a 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: Doc.Building Permit Revised 2008mi Location�� C�d» 45�— .. No. Date NORTry TOWN OF NORTH ANDOVER i • • i : • Certificate of Occupancy $ -MUs c�' BuildinglFrame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2C� J �ri� Building Inspector 1 r The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02II1 �,4 s�• www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: , 'All f--Y Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction 2.rloyees(full and/or part-time).* have hired the sub-contractors I a sole proprietor or partner- listed on the attached sheet.# ❑Remodeling sip and have no employees These sub contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. 9 yEl Building addition [No workers'comp.insurance S. ❑ We are a corporation and its required.) officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs p insurance required.]i employees.[No workers' 13. Other ipo/L � 4114 comp.insurance required.] *Any applicant that checks box#1 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. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam 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.#: Expiration Date: Job Site Address: City/State/Zip: 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided aba is true and correct. Si ature: Date: _37c::1 L Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: NORTH TO" of 0 No. . _2- LAKE o-I dover, Mass., 2COCHIC HEwICK ,9S RATED P? C2 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System lry•%.1�•. BUILDING INSPECTOR THISCERTIFIES THAT........... ....... ......................C............................................................................................................... Foundation has permission to erect........................................ buildings on....1.. ... .......�..�....t............... Rough to be occupied as.. V.I..I.Q�......... .I.sl1Ict .. jq .rr Chimney c provided that the person accepting this permit shall in every conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Afteration-and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PENT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC ST TS 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 Street No. 1jSEE REVERSE SIDE Smoke Det. Ol 41-7 � 1 i I �L Garabedian Home Improvement Invoice 11 Matthew Dr Salem,NH 03079 Phone# Date Invoice# 603-235-4005 7/5/2011 384 Bill To STEPHEN CROMTON 113 SECOND ST N.ANDOVER,MA.01845 Terms Quantity Description Rate Amount PORCH RENOVATION CUSTOMER HAS AN EXISTING PORCH THAT IS ROTTING. WE NEED TO TEMPORARY BRACE THE ROOF UP AND REPLACE THE POSTS AND DECK FRAMING. THE STRUCTURE IS SITTING ON CONCRETE BLOCKS THAT ARE SETTLING INTO THE GROUND.WE NEED TO REMOVE THESE AND DIG 4'HOLES FOR CONCRETE AND SAUNA TUBES. ALL THE DECKING AND TRIM WILL BE AZEK WITH STAINLESS HARDWARE. ALL FRAMING IS GOING TO BE 2X8 PT AND 4X6 POSTS PT. THIS QUOTE IS FOR THE LABOR ONLY. CUSTOMER SPECIFIED HE WOULD PROVIDE ALL THE MATERIALS. I LABOR 2,400.00 2,400.00 Xn Q�ti.=J C4,y DATE: b !/ DATE: I/ Please make check payable to GARABEDIAN HOME IMPROVEMENT and remit to above address.Thank-you Total Page 1 Garabedian Home Improvement Invoice 11 Matthew Dr Salem,NH 03079 Phone# Date Invoice# 603-235-4005 7/5/2011 384 Bill To STEPHEN CROMTON 113 SECOND ST N.ANDOVER,MA.01845 Terms Quantity Description Rate Amount ANY UNFORESEEN ROT OR DAMAGE FOUND DURING THE INSTALL PROCESS WILL BE CONSIDERED AN EXTRA COST.IN THIS EVENT WE WILL QUOTE A PRICE FOR THE MATERIAL AND LABOR TO FIX THE PROBLEM. PAYMENTS ARE TO BE:$800 WHEN CONTRACT IS SIGNED, $800 WHEN WE ARE HALF WAY DONE AND$800 WHEN THE JOB IS COMPLETE. MASS LICENSE#094797 MASS HIC LICENSE# 157753 REFERENCES UPON REQUEST. Please make check payable to GARABEDIAN HOME IMPROVEMENT and remit to above address.Thank-you Total $2,400.00 Page 2 V'r