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HomeMy WebLinkAboutBuilding Permit #023-11 - 1174 TURNPIKE STREET 7/11/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION f i Permit NO: U �� � Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page i 4y LOCATION PROPERTY OWNER J t � Unit# Print MAP NO: ' PARCEL: ZONING DISTRICT:'K� Historic District yes Machine Shop Village yes 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 ❑ Repair, replacement ❑Assessory Bldg - ElOthers: ElDemolition El Other _ _ _ - 0Septic 0 Well -T ❑Floodplain= ❑ Wetlands Watershed District q Wate"r/ Sewer, - DESCRIPTION OF WORK TO BE PERFORMED: DAk ' (Identification Please Type or Print Clearly) q�?k OWNER: Name: Phone: Address: CONTRACTOR Name: Phoned 3 Address: Supervisor's Construction License: Exp. Date: t_ Home Improvement License: Exp. Date: II; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ y� FEE: $ v i Check No.: Receipt No.: NOTE: Persons contracting with unre istgred contractors do not have access to the guaranty fund i � t Signature_of agent/©caner# Signaure: of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL a , 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 I COMMENTS 0)C:1 -1 - � .,�s ocrz, ti .^ W V� 1�y Q Q (� Q J G-o 1� � 0,Qj Aj CJS \06 p0a) i=AL'TH �' j; Reviewed on Si nature I COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments I Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature:� r Located) 4'Osgood Street FIRE DEPARTMENT - Temp,Dumpster on site yes no �' Located at 124,Main S#reet� Fire Department signature/date COMMENTS , 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 Doc:.Building Permit Revised 2011 June/mi I 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 u Building Permit Application o Workers Comp Affidavit Li Photo Copy of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks u Building Permit Application u Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) Li 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) u Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit Li Two Sets of Building Plans (One To. Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) E3 Copy of Contract u Mass check Energy Compliance Report o Engineering Affidavits for Engineered products (VOTE: 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 i Doc: Doc.Building Permit Revised 2008mi I Location._ No. eq,3 Date � " Y l TOWN OF NORTH ANDOVER F w f t + • s; Certificate of Occupancy $ �� Building/Frame Permit Fee $ �CMUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �3 7`019_ ! 24660 Building Inspector VAORTPI ® of 6Andover . 0 VO No. 3 -_ _�+ l A K fl over, Mass., I� COCHICHEWICK !�AORA T E D P"' U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............ r ............... !1.............. ........................................... Foundation has permission to erect................,..:..................... buildings on .... . . .q.........I......!�-�I?���......�®.p....... Rough to be occupied as.....0�...'F.........A�. :(fid✓! ... .................................. ................... Chimney 5. h provided that the person accepting this permit shall in every respect 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, 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 CONSTRUC O S ARTS Rough ........ Service BUILD SPECTOR 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. •Rw"'tw sma-r MAP 107C LOT 9 N/T 1 MICHAEL PUTNAN 1080 TURNPIKE STREET MAP 10]A L 138 BN.8J)4 PG 81 N. RLNEItT YANSCUR 1001.AWNSON SREET BN.1281 PG J80 Y NJlT4.0j.W, WP 1—LOT 194Ar y T&S>f• 1MOMAs UONiBURN �.n 8 1015.AIHNSCN STREET FOR REGISTRY USE ONLY PeR.IW28 240 TUFNPME—T g Irm ry._ ) PG S (FnOJ {� LOCUS MAP-N.T.S. •e�� W 'ro mn �' MAP 10]A PARCEL J2-2 (� �od� 8).988 s9.R JOJ' 'Jj E `1/ f.96 arr•. a �;T Mi�K fON Lo 108 OERALO FEFRAGAMO 11 Iron FaJ 1112 TURNPIKE 5/REET I.� Y\ MAP ION OT.0 W. M 4189 P4 2B Y y� � 215`4 (Fn0-Bmt) H wr XUAN IRUONO OrA9 Hde UMNq 1180 NR.ME lI ]199 P4 1]BM �.�� Raf.Nm •� NO Vk, ONro ARE 9AWO I)ZONING CLASSIFlCARON-R2 \1 BEARINGS ON M.H.LO OF NRNPIRE STREET 4, F---P-1.-7A 2) PAFCEL J1-1 DAM JUNE 2 1814 6^844,oJT ea.R. LEGEND J)111E PURP09E OF RI's P Is TO SUBpNOE ti� '� a 1.01 acres hm R� pSSESSORs YAP 10)A LOT 31 INTOiN0 SEPARATE TL0 N,Y Post M RaA Fnc. \ $ (Fntl) NJ1-1 AGAX HNMAN PPARCEL J2-1 AFEA-41.O1T SF 5195'IJ' '�n CO CLEANOUT ARCEL I1EA�9).988 Y 0 a— Aa w.11ana n --d �j tNo ONN Htle ;0 1 j-'.- UOUttOs ..LiA011TA0E-188!0' TOTAL TROVTACE FJ F4 w IM•i • WERANO MG L-n.49' �lLL HdE Sb'J1'48'E 18890' S4B'JI'48-EJ10.I1' . R�19�) 00 O k IRON PIPE OR ROD .O• PROPERtt UNE D0 .— INNA)FTNCE HIONWAT fLARORAIL OR SALEM TURNPIKE ROUTE 114 P27-- ^^ ^^^^ -9F uNE (60'WIDE STATE LAYOUT) [mmm t 3 PLAN OF LAND ET --OF NORRI AN WR APPROVAL URGER THE NORTH 1174 ANDOVER, MASSACHUSETTS t 9oswL9scw CLWTROL uW NOT KwRE0. 1 csMry uaL fni.qm Moe yr f IDs Re0letwe—.f if DaeEe.aaaem9e wu Pre d For m.nn.e m9,.9wmlane oJames Mnle DATE y Prepared By LeBlanc Survey Associates, Inc. 161 Holten Street Danvem.MA 01923 _p (978) 774-6012 ME P1lNNINC BOARDS ENOO45EMENT OF)NE PLAN AS NOT REOWBNO May I2, 2011 Scale: 1"-30' APPROVAL UNOPJt ME SUROIN9ION COViPp.UW IS NOT A OEIERNMAMAV AS TO THE CONFORMANCE..THE TO.OF NGRNV ANOOYER ZO9110 GNAW AND REGUUIIOVS PROPE59CNAL LANG SURVEWR OAIE - NOR.SCALE IN FEET .A 0 30 75 150 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 �,4 5�•' www.mass.gov/dia Workers' Compensation Insurance affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl P Name(Business/Organization/Individual): Address: City/State/Zip: le"—, ;4, Phone#:_��� �_. Are y mployer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. E]New construction em -ployees(full and/or p e).* have hired the sub-contractors 2.El,I am a sole proprietor or partner- listed on the attached sheet.# 7• ❑Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance $• ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.El am a homeowner doing all work right of exemption per MGL 11.E]Plumbing.repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' 13.0 Other come.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: &46W til S 6`•J Ce,+1V=2! 770_� Policy#or,Self--ins.Lic.#: WC. O OC7 Ya - 5 O v2�. Expiration Date: Job Site Address: l 17 Y y—(�(LOf�-��, S i City/State/Zip: AJOXT44 fits Pc3V--K i^^rA 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 u er e ' andpenalties ofperjury that the information provided above is true and correct. Signature: Date: - 1 7 ( a Phone#: � � Co-77 Official use only. Do not write in this area,to be completer)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 Phone#: Contact Person: :1lassach,jN t _ $card W. f}Re,ul-It. "I•Pui)I1c S; Buitriin fZc•s 1I', � ch- I Co .• •1tt1 n )) � • s#ruction su ) .1ncl Stand;)rcix License: cS 104770 Pervisor License JASOIVV. 2513AY STANTOSUOSSO WAKEFIELD,. MA 01880 ExPiraion: 1/6/2014 Tr#: 104770 (14 .41aq aadd�� ;1�vrfib`�l C\t VIII r w CIV U 20 L Zia jig- +� '4 yrrr2 �ti Zoo -�, I1 ,Z -t�� �� s lei WL Or =------- if Y21 UK A LI t ,- C�t'1 ►�.� 'PSP �i N l G¢�VE I-��,-r` �� n ��� .} �� w jolt