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HomeMy WebLinkAboutBuilding Permit #237 - 116 HIGH STREET 9/21/2000 BUILDING PERMIT of"°oT" TOWN OF NORTH ANDOVER �? 4t`.4' '-�6'° o APPLICATION FOR PLAN EXAMINATION Permit Not.-IO/ Date Received �,ys'R,T�o•��",�.�5 Date Issued: 10-1 y1-/ SACHUS� IMPORTANT Applicant must complete all items on this page �^ CAM_ A_A N vH L} Y 7 4 l f h f­M-03 '� D '��o�.,='..� 2t.,� ..r: ,; n 21 �,, . kYi]�:s. r •`','T-F- ,�-�aX `�,x k� �,rdn� -�s �- x •.,. .+ e.' -�,. �y� af� ir �174�E71 iry[.� �a�•.a....- .� +1e...�r��»+� 4�r--�f�st�L',v, '.a; �. r'"-li j�''•t e.� '75- w,a x '� ,vf �,. F ���� � :. x�T�T.:.�Bw"!�'za-�bk�� y:�P? ?v'�" 4*y,.'?�maa--k. wt, P4 ••,.tr�nl t-."a'� tta.Ti-- IS'�t• `e °��" { � r'����J ���lJ�L �' •'� :.�` cx.u�., -P - '3 -1 �.. .*x4 '1��.T.Y -t �k>la}s�'���-' �7'�- +•L�'-�SZtlS`�r�.�p4�s b r9"3 i-gF"_.' 3�4,-�r�s � ,• CF t� a.o 'vs �+,7° � + -<,s^4 � l 'J t A ^�. ,4"..�-,e t .� `�,' m TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alterajon No. of units: oZ Commercial. /qepair, replacement Assessory Bldg Others: Demolition Other w �c:r � �lla � }��} FIoDplai 4I /etlatas°5 j r;jwffill -g 7r y. z J `�"1:. S•%'"*` -�'-t -L .4^.-I2''w=}'-�`s":� =i+•!'F �W f ! Y"- • -31 s � A �+4r11'�'�" �s.. -�� FI/Zie At �. a.._.._.:. ... .... _er5,.. DESCRIPTION OF WORK TO B� PREFOR D: �. entification Please Type or Print Clearly) OWNER: Name: Phone: x'78- - / Address: r �-•.+ a a z'r att w y rf' •4z. yc ztw-+'a� ,1 v� r` cyy�' "�'34.y','�9`.' > -_ v .r 'h., 4 Y�,. ,.( ..F •..,. }�tpJ aS1 �1:���{r��'��,���-•"�-;q- `}u„[�r;�an>•-� �yF..:. : •aim t• - q,,. � � - '.. {'t-, -�•. .. ' '•�. � � J.ft ;s.+��-"�rk�,,.cr rr --v ,r-,..,����s„rfi t���x.�lf�a,,.M 't.m ,yy -ya -t �.r��Y 1; ,may t j� YJsc e..s'. �=: '.`N,��u�'�.., ,t�.yv- ..,�. 4f' � �i-i�r"y '1'�`r.�.•-zrJ F4�'^vsr.��. �r'E ��'1-""� �,"d- 2` > tt'-S`�t-c �� a? ,� y c' •_ :,�, 4- ? .z�. -� M,'f-» i 't s�.1 �"q r-�,+��T'"�i ax.�' 4x,4.= ,�s US,Iftlbi w� ;- r 4�r, '�- t '' +` Sa-.tT't. . �,i' -F`'E '#^• -fit t: :� �. i .iw,-ivr sA t• x74`' G-F��. 'x ^-,'� r� a x, -. fa;� s -L,,,.Fs�,r �, ,�_ .q,.{ L-16,00M ,..-W_JYy: 1�C•t hT �_F.?T�1T�11iP. .Se '� 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: $ d 3 ©0 OO FEE: $ d �— Check No.: ' � 3 2 Receipt No.: NOTE: Persons conts acti with unregistered contractors do not have access to the guaranty,fund Signafur�Yof A er�#/Owner __ T-- _ Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tann ing/MassageBody 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 Signature COMMENT S HEALTH Reviewed on Signature COMMENTS 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 -�13��Di=��!►��-ME1�T T.ernp D�r�psteT�o���e yes` ;no _ "`Lveafed�t��4'�Ulam Street `r 1 ��re� e�artrrae�at s� a �reldate 4C01171]VIE.-NTS .. ` 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 i Doc.Building Permit Revised 2010 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 9 9, n Permits i ❑ Building Permit Application ❑ Workers Comp Affidavit . ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Reportlicable If Applicable) PP ) ❑ 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) o Building Permit Application o Certified Proposed Piot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract a 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:Building Permit Revised 2008 Location �, -11 S No. Date 1 -)0/0 MORTh TOWN OF NORTH ANDOVER 3?oi�"•D o � w Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s+CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 234 zr ` Building Inspector NORTH Town of _ Andover . 0 No. C11A K E -� dower, 1Vlass.,^ l– COC MICMEWICK ADQATED P'PE'�,�5 TS BOARD OF HEALTH Food/Kitchen PERMIT. T D Septic System ge �� Co Ar- THIS BUILDING INSPECTOR CERTIFIESTHAT.............................. ............................................................................................................................... VV/ �j .y� Foundation has permission to erect.....Aw/......................... buildings on ....... ..-I/�......../.�f�.....aL.a.:..�................ Rough to be occupied as........, ...t.......... .....:.. A. . .............. .....s ..:f W40-0 .................................................. Chimney ' e provided that the person accepting this permd shall ' every respect corrf'orm 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, 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 CONSTR STARTS Rough ...... ......... ..... ....... :..,���.... Service BUILDIIV G=IN�PRCT'OR '� 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. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts 1 Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 021II www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El Please Pri lumbers Applicant Information Please Print Le;;ibl r 5 N20 (Business/Organization/Individual): 1 S £ Co>4 S 1 ►N C by( Name Address: -3 S-0 RP r S f City/State/Zip: / ��{ fl'1/� 0/��/$� Phone#: 9 b 17 0�y 7 Are y an employer?Check the appropriate box: Type of project(required): 1. I am aP mplo er with�_ 4. ❑ I am a general contractor and I 6. ❑New construction employees es ful nd/or art-time .* have hired the sub-contractors p p ) listed on the attached sheet.# 7• ❑ Remodeling 2.F1I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. E] Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition 5 We are a corporation and its ince 1 repairs or additions [No workers comp.insurance 10.❑ Electrtca p e uired. officers have exercised their r or additions required.] 11.❑ P tubing repairs 3.❑ I am a homeowner doing all work right of exemption per MGL m . 52 1(4),and we have no l2. Roof repairs myself. o workers comp. , y i employees. [No workers insurance required.] 13.0 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 submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: SLI u IAV ki S U✓`a N C Q Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: .` i f City/State/Zip: /Q h rQ D✓�� �i1" 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 certif under the pains and penalties ofpesjury that the information provided above is true and correct. Si nature: Date: 2/a0 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): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone nuinber(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confinnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sur&that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia r , Dora of Itiafttl.a g 14il9ti0fisaddt+3an�' r6a Mom EI.S �NT COfstFtAl'fR € =r.�atidri: 13�8>� s Expiratlon: 4/14/2011. Tr# 282754' Type: DBA SCO" WRIGHT _ 350 RO-ANDOVEA,MA 01845 Nhssachusett - Department of PuF►lic_�ufctc Board of Building, Regulations and Standards Construction Supervisor License . - License: CS 102663 " Restricted to: 00 SCOTT WRIGHT E 350 BERRY ST NORTH ANDOVER, MA 01845 Expiration: 8/12/2011 ( nnmi.�imcr Tr-,: 102663 FREE ESTIMATES PROPOSAL Construction Supervisor Lic. # Cf 102663 FULLY INSURED H.I.C. Reg,# 138569 i- 3�8 WRIGHT GUTTERS AND CONSTRUCTION Specializing in Seamless # All Colors Available 350 BERRY STREET • NORTH ANDOVER, MA 01845 TELEPHONE: 978-687-2247 PROPOSAL SUBMITTED TO PHONEDATE � a6 STREET S� . JOB NAME I LOCATION lib - IJ Iii � CITY,STATE AND aP CODE JOB START DATE kn-doyey-, m4 Old S r R- move € Rpm (ace 6 Sjuar- of Qs�hallf S�I kvA bt S n c 6 I n I Sher 1o( 2q, oy,) cave. J l b jc/� II I � ' a n A Cil r t k 4e ct 30 vtl'r 10 3 n' � I t W ,J e tu ) 4 GAY Al ert T" C eN U� G rid i/J—ca t -v J, 1�GvI1 -fes �I We PIOPOSe hereby to furnish material and labor-complete in accordance with above specifications,for the sum of:$o(?00. 0 0 Payment to be made as follows %3 cPow.^ - 64IGhc.e office Cov-,,p4h All material is guaranteed to be as specified All work to be completed in a substantial workmanlike manner according to specifications submitted,per standard practices Any alteration or deviation from Authorized above specifications involving extra costs will be executed only upon written orders.and will become an Signature extra charge over and above the estimate All agreements contingent upon strikes.accidents or delays f beyond our control Owner to carry fire.tomado and other necessary-isu,an,e Our workers?.re f0y NOTE This proN. sal maybe c vend by Workmen's Compr:nsation Insurance Non payment by agreed party may result rn Idigatron withdrawn by us if not accepted within days. with penalties including court cost and compensation both real and punitive Acceptance of Proposal - The above prices, specifications and J conditions are satisfactory and are hereby accepted.making this a valid contract. Signature_ You are authorized to do the work s s ifiejd�Payment will be made as outlined Date of Acceptance Signature