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Home My WebLink AboutBuilding Permit #200 - 119 PENNI LANE 9/19/2006 TOWN OF NORTH ANDOVER NORTFI APPLICATION FOR PLAN EXAMINATION �`�t��° �6 6 O p 0-0 q—/ 9 {t Permit NO: Date Received e * HU ��y Date Issued: ` O �9SSAC `' IMPORTANT: Applicant must complete all items on this page LOCATION t l q ?e nn i �Qrtc. Nor t�(LOAV Prinr� PROPERTY OWNER CD I CAL.. :QA►eo �' Print MAP NO.: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential U New Building 0-0 One family ❑ Addition ❑Two or more family U Industrial Alteration No. of units: U Repair, replacement u Assessory Bldg ❑Commercial U Demolition U Moving(relocation) U Other Others: U Foundation only DESCRIPTION OF WORK TO BE PREFORMED .5 S e. Ann& Identification Please Type or Print Clearly) OWNER: Name: , ke- hone• 509 "5aS9 Address: 1 lq pcna a r A Me,%te r MR o !4 if CONTRACTOR Name: (1 ld ill Si r 1 c-ou lAU6'11 m W((14 Phone: W 3 4-Z O Address: 100 S V n S-Ne-C-A Mnr� k Andover' WA 01W Supervisor's Construction License: Exp. Date: .. Home Improvement License: w Exp. Date: d b ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERI T:$12.00 PER$1001, 0.00 OF THE TOTAL EST/MATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ o0 .0FEES Check No.: ! ,7B- Receipt No.: Page I of 4 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 I ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:IN'SPFUHONAL SF.RMI]S DEPARTMENTAWFOR1105 i TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art F] Swimming Pools Public Sewer F-1 Tobacco Sales L� Food Packaging/Sales We I I � � Permanent Dumpster on Site �_I Private(septic tank,etc. -_i Electric Meter location to . project ` NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor C �•�ei Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed-Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Temp Dumpster on site yes_no_ Fire Department signature/date II Building Setback (ft.) Front Yard Side Yard Rear Yard Re uired Provided Required Provides Re uired Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. • i Total land area, sq. ft:: s s NOTES and DATA—(For department use) L TPage 3 01'4 Doc:INSPECTIONAL SERVICES DEPARTMEN7:BPFORM05 Created 1MC.1an2006 Location No. Date NORTH TOWN OF NORTH ANDOVER 3�0�•t`•o •,hO •. OL F 9 Certificate of Occupancy $ sACMUS Building/Frame Permit Fee $ - Foundation Permit Fee $ Other Permit Fee $ TOTAL s- - Check # 19586 '-Bulfding inspeo r U e_. k tAORTH Town of :: 4Andover 0 2,00 = dover, Mass.,— Z�fi�-06 o LA It COCHICHE W ICK V A°RATED PPS\ •C� E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............C................ ................. ....... .. .. ..................... ..................................... .......... �� Foundation has permission to erect........................... ........... buildings on ....... .... ............ ................ . ................. Rough l' tobe occupied as ................................................................................................................................. chimney provided that the person accepting is permit shall in every respect conformto the terms of the application on file in Final this office, and to the provisions 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` T 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. DAVID CASTRICONE ROOFING,SIDING&REMODELING REPLACEMENT WINDOW&, . HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 1045 C '? , 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 v D 7 HILLSIDE ROAD,BOXFORD,MA 01921 SEP 12 9905 In Nordh Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 By-.--....... Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to fumish all necessary - materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises Wow described: Q Owner's Name......t ......F e..........................................T ephone#.... '2 Job Address.....1.1..:{......l...g.nn-wl.......Lo..".e........................city... a.,.../T o.tk ...................State......-Ah........ Specifications: trip exlsting shingles(0 ply new drip edge to all edges.,"/ J-e,>;� 4 u ...................................................................................................................................................................................................................... Apply 6 feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. ................. ........... .......... .....,...............................................�... ............................................. .........`.. �^( y_ t4pply felt.p�er under yment. wfnstail ridge vent to 3 •g. ��,.-�s �x -'.` 3`�Z/' I Y-,VjrT.. ... g ........................ .....�......... .......... ..... ................ .... ✓12eroof usin shingles with a SO year warranty. -- wCounterflash chimney. LAew vent pipe flashing. gal disposal of all debris. / Area(s)to be worked on:... .P ;.� ....:�.....................'fA�'1 i-CC9.. i C��aC.�C ......... . {1 fp. ..... a„1„�a,h...... a o..u,� ......... P.r i A.. .3�.fl R, �¢�t..�•c.�.... . .... ..�y.W. . ........6 .........1......S..G�.a r.3.....if-e i'..... W................ .�L...t' S.....0......f�Qd.• , .............................,..a'................../................. ... mail/.s ......Y.e�w.x.....a�a�� .....l,a ... .. ......tnr)....- I. i. .... C,,�.`. .-.. 1..: .. . .o...................................................................... .. .'.. .....ro°!... t. 3;i6;Year Workmanship Warranty(Not Transferable) .He1Manufacturer's Warranty"=.-Cm... anufacturer �jMaterials and Labor to cost .......... Payable......{.•y•QO..........on..... Payable.............................on.................................. Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job is in operation. Contractor is not responsible for any damage to the interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials specified above (i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces,water stains when roofing shingles have not had adequate time to cure). Upon completion of above work,all undersigned agree to execute and deliver to contractor,theirjoint note in accordance with his(their)above obligation as requested by contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid,immediately due and payable. It is agreed that,if permitted by law,contractor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith. It is further agreed that this contract may be assigned by contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or estates. The undersigned warrant(s)that he is(they are)the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names(s). There are no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration One Ashburton Place Room 1301,Boston,MA 02108 Tel:617-727-8598 �r Any and all necessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction-related permit or deals with unregistered contractors shall be excluded from access to the Guarantee Fund. n. Approximate starting date ofwor .. _ .. . ........AJr...A0.Q1,0Completion date...........:.................................................. Receipt of a copy of this contract is here acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Owner has three business days to cancel this contract and incur no penalty. IN WITNESS WHEREOF,the parties have hereunto signed the' es this.......... ........day of.... .. Accepted: Sig .. ... .................Owner Signed.........................................................................................Owner r Per....... Representative Town of North Andover ati 1"0' RTN �eo '6* MO Building Department o ,, 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 °4 ° ° �• �` 4°R�rEo �Pay.(5 9SSACHUS�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: C. 4 Facility location Signature of Applicant ghg /oc Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I The Commonwealth of Massachusetts Department of Industrial Accidents 5.2 I Office of Investigations 600 Washington Street Boston,MA 02111 r- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegiblV Name (Business/Organization/Individual): A V(b S V,l U/J 6 kp 0 F'i J6 + s i"b W & - C. Address: Zoo s um/� -sr Shire u(o City/State/Zip:I rD 4-00(16f, M14 l ltT Phone #: q 7 r334a4 Are you an employer? Check the appropriate box: Type of project(required): LN I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6, El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet_ 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. [] Demolition working for me in any capacity. workers' comp. insurance. g. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ 1 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 insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box#I 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 infoTimation. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �V1 Insurance Company Name: Policy#or Self-ins. Lic. #: Y V V C 600 ! 4 i DOI 0(.0Ay`f Expiration Date: ' a 3 ' Lo Job Site Address:_1 19 Penn; �tt�ne City/State/Zip: Wr+ 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 tine up to$1,500.00 and/or one-yearlunprisonment, 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 and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: Oficial use only. Do not write in this area,to be completed by city or town officiab 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#-