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Home My WebLink AboutBuilding Permit #855 - 1267 OSGOOD STREET 6/15/2011 TOWN OF NORTH ANDOVER , APPLICATION FOR PLAN EXAMINATION ff � I Permit NO: Dare Received Date Issued: YMPORTANT:Applicant must complete all items on this age _LOCATION 1�7 ®D /Vi 42 Prin- Print i PROPERTY OWNER �. F ►^ MAP NO: 3i PARCEL: ` ZONING DISTRICT: Historic District yes no Machine Shop Village yes no mit TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Imine family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _ ❑Other Septic. Od1Well '_ ®hloodplainl �OtWetlan s; ® �W f hedDi's`tr ct; 4 -01 D—SC -P TION OF 1WO �TO BE P'�RrOt 51 r @ 'nit (Iden 'KI; lease Type or Print Clearly) OWNER: Name: IAS e (' Phone: Address: IAI-050 % /V( &C1, CONTRACTOR Name: JGi rjv?eS reCei�i r Phone: �Sl� Address: Z,04cla el-/- Supervisor's l'YSupervisor's Construction License: Exp. Date: Home Improvement License: �� Exp. Date: ARCHITECT/ENGINEER Phone: mil Address: Reg. No. G FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F. ag Total Project Cost: $4r gyd FEE: $ � Check No.: ! zoo Receipt No.: - NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 1 Signatu�e'of'Agerit%Owner _ _ v= lgnature_of_cont�act` r_ - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ TanninglMassageBodyArt ❑ Swimming Pools [] Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board'Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPAR-h T -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions.----., Total land area, sq. i.: t ELECTRICAL: Movement of W1 ter 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 2008mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding,ding, Inter►or Rehabilitation Permits ❑ Building Permit Application ❑ '��_I kers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Per; Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contrall- ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And y Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Pend I 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .P errri F 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 AORTH Tomm Of _: Andover 0 �. o , dover, Mass., b • Ire tt Q - LAKE A_ COCMICMEWICN V 7�A0'4ATED BOARD OF HEALTH Food/Kitchen Septic System ..PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT............. � .�.................. .... ......................................................................... Foundation Q �� has permission to erect........................................ buildin on ...�.�6�........................ ..............`i..�.......a..... Rough • Chimney to be occupied as.. ....................... .� ........ �� e provided that the person accepting this ermit shall in every respect co rm to t e terms of the app kation on le 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 CONSTRUCTI 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. SEE REVERSE SIDE Smoke Det. \ : sr ra)(\ dal y! b \R\*K wend: cast - ? , . gmm /!¢ . A E¢S OESREC(m . . \\N-A—G . : . y 9\\b§\E4§f_H 03053. . z. . .. � . � . . . . � . . � /.P . 0.0 . ,!« -1, `+ nam 2:\ \ � oil HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED Y THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN HE ISSUING INSURER 8 AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER, IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the policy(iea)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require and endorsement A statement n this certificate does not confer ri hts to the certificate holder in lieu of such endorsement. PRODUCER Degnen Insurance Agency 55 Salem St Lawrence,MA 01843 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED James Debrecen) Dbe Family Roofing And Painting 2 Tanager Way Londonderry,NH 03053-0000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE ROVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 00 LSR 7YRE or NWRANO! POLICY NUMBER FOUCYEFR107NE DAT! POLICYNAPIRATION DATE A WORKERS COMPENSATION AND EMPLOYERS'L KOLITY LIMITS E PROPRIETOR PARTNERVEXECUTIVE OFFICERS ARE: INCL❑EXCL❑ 2453365 5/1112011 5/11/2012 ATUTORYLIMIfS OTHER C0vWvgs App11"to MA Opara(Ianv O*. CH ACCIDENT $ 100100 ISEASE POLICY LIMIT $ 500100 ISEASE•EACM EMPLOYEE 10000 DESCRIPTION OF OPERATION&VEHICLIWOPECIAL ITEMS RE:THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR JAMES DEBRECEN. CERTIFICATE HOLDER CANCELLATION COTE 6 FOSTER SHOULDANYOF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE 21 AEGEAN DR WIHTETHEPOLICY PROVISIONS. METHUEN,MA 01844 AUTHORIZED REPRESENTATNE =OURNIER Family Roofers & .Painters JAMES DEBRECENI:- EX7E1310R PAINTING - CARPEM-rRY tROOFING v1APLE ST. -iUEN; MA Q FR EST1MgTE5 . 978-683-5127 . e . e ompriny am t V CC,-4e f ht�yl�s tr Street Address(do not use a Post Office Box address) �hj, �-� �y Contractor/Salesperson/Owner Name Cintyl�fown/��t State Zip Code lusiaes Add, s(must include a street address) Daytime Phone Evening Phone 'ity/Town Slate I Zip Code 97� a7f S ,7,7r� �Hom�OMV=,W Mailing Address(II different from above) usiness Phone Employer ID or S.S.Number taw requi�ea tat mop home im- Contractor Reg.Nmnba Expiration dile pmvinlent eOntraetora have a I laa,sgiarnpoa nlaabQ ?� The Conti-actor agrees to do ilia following work for the Hameo mer: ey g TIM o e r rZia7rtf'nRRTx7 err n —_�L�+s53ira tr ncl�vary,t &csC' S� a Required Permits-The following building permits are required—Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be `�, excluded,from the Guaranty Fund provisiontJ s of Date when contractor will begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule I The Contractor agrees to perform We work,furnish the material and labor specified above for the total sum Of-. («) Payments will be made according to the following schedule: upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $— — by or upon completion of by _/_/_ or upon completion of upon rompletion of the contract. (Law forbids ler'"Iding full payment.unci contract is completed to both party's satisfaction) ' The following material/equipment must be special S__T-in het paid for ordered before the contracted wall begins in order S to be paid for to meet the completion schedule.(") -- NOTES:M Including all finance charges('*)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special orderedia advance to meet the completion schedule. I xare«Warramh-Is an exams tvarramty belma provided by the comtractar� Nn Yee r [t terms of he w < ust be attach d t tr. Subcontractors Tfieeontractor agrees to be solely responsible for completion of the work described regardless of tine actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments MatedillA and I de P y to all subcontractors this ontracto !l ebor under t u agreement nt rs for err me Contract Acceptance-Upon signing,this`document becomes a binding contract under low. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest lies beer]placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor flag a valid H me Improvement Contrac or Re i t'o The law re subcontractors t—e—stre i rt- quires most home improvement to be rov registered etco tr ed w- contractors g tilt the Director of Home Ian rovetnon. p tors end registration by writing to the Director at One Ashburton Place Room 1301 Boston,MA02108a by calling 617-72inquire b 3200 ormclor 1-800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read die Important.Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. =ua ds agreement;F it has been signed at a place other than the c normal place of business,provided you notify the ng at his/her wflin office or branch office by ordinary mail posted,by telegram sent orb delivery, following tine signing of this agrecmenL See the attached r Itice of cancellation form for an explanation tinof this right. ter than of the DO NOT S ICN '`'HIS CONTRACT W-14-1 ERE ARE ANY BLANK SPACES!!! 'f Two identical copies of the contract must be completed and signed. One cnpy should go to the homeowner. The oilier lmuld be kept by tite conuactor. Homeowner's Signature Co9r. or'sSignature — Date — 6 p / f / Date Location No. 55Date NORTh TOWN OF NORTH ANDOVER 0 F w Certificate of Occupancy $ �'�s''•'°' MUS tt�' Building/Frame Permit Fee $ AC Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2457 v Building Inspector