The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #460-13 - 1132 SALEM STREET 12/10/2012 BUILDING PERMIT TOWN OF NORTH ANDOVER Y APPLICATION FOR PLAN EXAMINATI N Permit NO: Date Received 0o (� r �s9ss A7lD U Date Issued: %%Z /a /L gcH IMPORTANT: Applicant must complete all items on this page LOCATION. 4 p in , PROPERTY OWNER` Q MAP NO:A I PARCEL 5n�ZONING DISTRICT. Historic District yes no achine Shop Village:- yes - no TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial IKAlteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: Evbemolition ❑ Other 'Septic ❑ Well ❑ Floodplain (i Wetlands "' El,Watershed District 0 Water/Sewer Ayo 6��bfClVe 7'0 e4 SftaN 1� f��cJ�a2Vi c 'fa-IoSd� ��o . . dApse Identification Please Type or Print Cleary) OWNER: Name: t/J ek �jD _ 5 l a 0 Phone: 5-02-- 3,60-/6cn Address: 113. S� CONTRACTOR Name: Phone: ��5 Address: a , �.. Supervisor's'Construction License Exp.:.,Date; Home Improvement License: / Exp. Date: 4R � ARCH ITEC ENGINEER et' S c Phone: Address: Reg. FEE SCHEDULE:BULDING 1P�ERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Z/L�4!5�00 FEE: $ a,/0 0 4%- Check No.: 7,/ Receipt No.: �t NOTE: Persons contractin with unregistered contractors do not have access to the guaranty fund ignature of Agent/Own r Signature of contracto 7V` 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 ❑ ❑ COMENTS CONSERVATION ❑ COMMENTS 4�4 DATE REJECTED DATE APPROVED HEALTH- ❑ ❑ COMMENerS 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 Located at 384 Osgood Street 'FIRE DEPARTMENT - Temp Dempster on site `:yes no Located at 124 Main Street .-- Fire Department signature/date a %Z J S COMMENT Location No. 1-14v ,:� Date • • TOWN OF NORTH ANDOVER • �w,�;�1,4n r�Q�' � .,r Certificate of Occupancy $ M}, xaw Building/Frame Permit Fee $ �./�Q—• Foundation Permit Fee $ '' ! a 3j , Other Permit Fee $ TOTAL $ Check# � 3 26027 Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 17510'00.00 m $ - $ 2,100.00 Plumbing Fee $ 262.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 262.50 Total fees collected $ 2,725.00 1132 Salem Street 460-13 on 12/10/12 Two Bath Remodel on Second Floor Two Bedrooms added on second floor First floor to be opened to large famil room i 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-$1000 fine NOTES and DATA — (For department use) n d' ❑ Notified for pickup - Date i Doc.Building Permit Revised 2012 PROPOSALNO. MAIN STREET RVACr INC. V.Q'.Box �34 SHEET NO. DUNSTABLE, MA 01627 DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME 777 A ADDRESS ADDRESS f DATE OF PLANS /,/, PHONE NO.,,ra� .2 J,�q J� ARCHITECT® We hereby propose to furnish the materials and perform the labor necessary.for the completion of e�Yd cJQ t t eoll o - AQAr An All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi- cations submitte -for ve rk and c pleted in aAsubptanti Cc ma4ne,fo a sum of -te� t "fieL r �JDollars {$ Q ..cj with payments to be made-as foil yi AW `f /y e &r6N tM vplGEvu� n Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per �KOJ�I ate! over and above the estimate. All agreements contingent upon strikes, ac- cidents,or delays beyond our control. Note—This proposal may be withdrawn I by us if not accepted within.f days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory.and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. t Signature Date S ( � Signature 89— NC 3818-50 PROPOSAL y The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly R Name (Business/Organization/Individual): qty *ems , Address: City/State/Zip: CeA 4 e Phone#: Are you an employer?Check thejp ropriate box: Type of project(required): 1.Z I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. F]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ 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.1 required.] 5. ❑ We are a corporation and its 10.❑ 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.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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 sulimit 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 employees. If the sub-contractors 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: AC_25— �7 M� [('V-14 Policy#or Self-ins. Lic. Q U Fh P I Expiration Date: l Job Site Address:__&S2 �� 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 cert' nder the ins and nalties o er'ury that the info n provided above is true,and correct Sip-nature: Date Phone#: 7' 3 Official use only. D t write in this area,to be completed by city or town offwial, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Massachusetts -Department of Public"Sa#etr', Board of Building Regulations and Standa(clt` Construction Supen`isor _- License: CS-083004 PAUL E OLOUG#LJN PO BOX 290 ° Dunstable MA OR27 Expiration Commissioner 07/23/2014 -" _ZZ ✓1ze -�o��w�:anu�ealll o�✓�aoadc✓zueefta Office o4 Consumer Affairs&B siness'1 e01vhticn HO:ME' MPROVEMENTCONTRACTOR Registration: 1,63372 Type; Expiration fi991ion Partnership _ IVIA STREET HVA 1N G PAUL OLOUGHLfN-�, t'a 310 MAIN STREETI s l< DUNSTABLE,MA 01829 ' Undersecretary y t TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: 4&xorovt(_,w Md . fes Aa-5,e Est. Cost Address of Work Owner Name: �. Date of Permit Application: ZdZ,0 I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Permit No. Job under $1,000 Date Building not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: oe ft/ C %i'3'3 � at on actor Name Registration No. OR: �C.d Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name I OORTH Town $ �. t E : 1, O - 0 No. �► ' �O LAKE h " ver, Mass, /a � — CO[KICKfwIcK ��S R�7E0 I►P�''�,�5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .�`.,�!....�. `5,,� 5 . .vl. BUILDING INSPECTOR has permission to erect .............. buildings on Foundation Rough to be occupied as .............4Re" 'S ®' 4.... �......ra/s' Chimney provided that the person accepting 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 CONSTRUCTIO ARTS Rough Service ............. .... . ......... . .. ...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SEE REVERSE SIDE