HomeMy WebLinkAboutBuilding Permit #710 - 128 DALE STREET 6/2/2008 i.
BUILDING PERMIT o`"°oT"q4.
TOWN OF NORTH ANDOVER o? bt '`- `-�`'°
APPLICATION FOR PLAN EXAMINATION14.
7D
Permit NO: Date Received 04
��SSACHUS t�
Date Issued: -
IMvPORTANT: Applicant must complete all items on this page
LOCATION �ZO 217 &6--,- S1—
Print
PROPERTY OWNER Y/�J�' M 0 0 C14 (-)i (_Z
Print
MAP NO: PARC L: ONING DISTRICT: Historic District yes no
2 (v 0 3 -- — 'ate Machine Shop Village 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 Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or.Pi'nt Clearly)
OWNER: Name: "044 (— 1-t 0 N CHZ Phone:
Address:
CONTRACTOR Name: _�1 �/-I�2r�j�iYJw� Cs Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: ' ° Exp. Date:
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: $ S-V' FEE: $_
Check No.: �QU-gip Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund
Signature of Agent/Owner Signature of contractor �i
Location
r No. 7e/U Date
NORTH TOWN OF NORTH ANDOVER -
0:� . o
f?;• •• Ow
9
# Certificate of Occupancy $
t i �
CNUs Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
2 ; 9 7 `m` Building Inspector
J �
I
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
COMMENTS
CONSERVATION Reviewed on Siqnature
COMMENTS
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/Siqnature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpsteron 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. 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
I
NOTES and DATA— For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
Building Department -
i
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
❑ 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
❑ 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
❑ 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)
❑ 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)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit j
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And 1
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products y
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 j
i [
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
I
_ \ n
gp
`. ...... " "� rxax
�.
� -,�.��tts '�•��a �. °at'�^ ..Ks �,rt� r as few' '� '
- -
w>�aati�-� '- a3 s=c >as`�€Tni"Free SFr srw
Hoop -
l-0 UV VVOw€1-4 tal: -.s z 1sr=rr••' €.3sa..e�'.r,.l.'i d _c- -
a
a
s �..--a-s-.v. s•,����� ��:- �.,Qa._,ct==p
we _4;W_P.k "�Q.,
tt� �m8'^:,�H+' � �6 __a ga�"•i. S .$:E3� !��-�;m�a� - as �. '� -,- �...,,�:al�....__..:.�,.,�,�.,�.�- s�� ��.�,s.>r,;:�"`"�a�3�-4"n
V t�
a sjfl.�'.W . µ-^•'M1 v._...-.e T S'x 'eN f
_._ L_4_
'
s mak' �'g 05i~ art, ipy iv _ua z--it, ���u _ k.-j ii ��a ak-touz x"m;=�� se_z� spas b�y�as�t��s mAw. mul tac s irk €,1 �
�..•^�' r/Y i, 3.,:''C,.,, 2`,,,.r ? a3$ c
I All ! rsx i. fi in hr eY19:c{' k.t L ne hf `:a Z-. t - ! "1P1`ti€' �-e` i i` •9 ,J ,/ i
low invOiY;tom L"kt.Ta e.1_C vvi.t:b, t'G?#i.C:ses,.,X urp"'PT" .e_:.Terl i_<3€'3.s. Ma`, f 3lk.-OMt
1
e YYharpc.t3-S and ,b(vet e: kt;r}.?;;, A- - csq'f-e-- _s'n 3i sEi = x C°ZT StTir - {rz US
a t l i
- f 7a ... �.1 .Y-;^P.... nr'1tR S' ?^' + i _*€'+ .;"-.. t s.n_';,};'3.9., .� ✓-_.. x S3. - p:vss .v w L•_ !
.v_
r
?T
fiV 1•F(if x� f-
.µ:Sr._ .` % . .F''F?1W1}'2fF_—,..,.�... .7LC_ '
z Ili
Our�*1f)i PLL.+:•$fL'1.l':2V Lzd3 3.S T.S.�- `:'IS:.iLi ii . � r
-
.5l.li}t.if.i3 ot.)T.v-i_z.ty;isFiT�-.3.sai.4,..v.. xctiTGw $.i✓'z.. "'*. i..r x( ..r '' t _.. ..3'4;o+-v'�. x_a t �.
E
i fir
04 Oeaf ii r; aifEsi water +da-Ri 4 to -.tfrtftl{_,-; �j = fJS1tt_;;y f,-tjiti; €t_t;. �
u--
nCI iG j i $ y ias # _.:;`sBV_ - icuo q�.; ;e•:;P€t�t„'a �� .'� � 4.; �:at�ib�03 Wu
nai4 SGS and wai—i' SCIS s !
a` E
f d' S'i 11 fY`4 C1 ice•* "je }t1i9q itns k"°'- V!01 PC tF r-i C CtFf a 101 Y
. ,_ .3=w .arsm..«s-s,� .., �.re_r ...3,.:.<F 'ff'�i _tl..r i-, <
3' r11.—r_ ;, na {. ai e won r-ti Y'`a e i rr;. farara.el -oalt -J.vvti_,..� ;"•-;.�c+-:e:.a;,i] pt 5 .,✓+�a'ti.. -lY;?C-.rieai
.•T
AYUCOT
`13 tn"r! t :h ti :3!C-11A0 '�'"l -^^'.{'t = J f,aof....-_- a` naotlme
t
txLF p
--..� w.r...-.fie rr-i rai t-• t P l� ftp
".nit ---b I#.-c` > :r+E.- MMM.gin n 5w#e nr#r.r
t..'4 Y t •+__..; Gr f .tsi F t £•ac.� 2!' �g .-.. } 4. PYe.I T,�: f
F.fY"" <fi.: __EL1 __2..3 �t µ _
a
;s t .r"�1 � i.:. t hrr t r - �i.. Tr .1 ,?s•r ���lr ��, {
; 1
ttl
RP,-,,P 1.P" t'f ? _-'Fs r t.. �S ,j:1'..i r S'?�/
f f
l _!! fl
£�.:n t �••.�.r4 t - f.z:-n N- ._.t„ p. ++ e. _� at rtt ec .a s•t in.rat er-�F-# 1
_�. r: ,ate uvaaPi t._ a:-t �r�r-•f _
�� ..! ._..
-..� a,..3f';, ,.-...i .2__,.....5,'i...... _-_.. _,�'�• ...: .>:. ._>....., ^
"- VVi lira caor t�F'a1 ral fss tV-_r r m t ..+i- f i> :,s� ., 3� $i3 tv t i Y4cC^ 4RIF` :ei`i e''" �f�'4 z'.+"JS TJ i> ticvU tp�z ti:'iy-gip'
s `.�s i. 1-- . id 4
a 1
norm-al ci'Clu'
t
L:rool .Y"tP ^SA"Ir`1"3S�Ct'{.'4'iiy�1Y9G"G - i o In—ui_�a[�
•:Ct_} __L.tf.. _,., � «Y,C?�\a3
m
�� Imo.w�Ar..YY a rll C^r --- ,�` / t
?,`aC.. t �:=r n }^.e?.S-d'Ea ., °rr 3-- .s.-- .�"r;:•-�;- e.5-'r, - ' -�a;
y ;
a
.......... .._.... - ry
_ �,"_ r- ^.� !r �rf �. i t- �T Y :YYfi M �✓
n
`"'v-t" - t`,f,. -�6.a-T�.� ``s :-.:d�,•%,m ?'�,..�J'L`r :..a "•• �s-s.:'i,•-._r f-3w3 a �;::y',jam_ -
i
: f
,ign aw:_
The Commonwealth of/1lussachtusetl.c
Ugwl—lmenl of I!►/INsI)7Ql Acci(lellis
' Office ofIII resligalior►s
60 I1'ashirrgloti .S'freet
Boston, 11111 02111
www.mass.go v1dia
Workers' Corupensatiou Insurance Affidavit: I3Ullller'sIC.UlltractOrs/I:Iectricians/I'Ittliibers
Applicant lnfor•nlation Please Print Lep_ibly
Nam (Business/Organizatiot>%ln(tividual): 1! l�'►/�G� des �� �6✓�
Address:
City/State/Zip: M t:�-J�,-. -/a Phone //: � -17
�?�
Are.you an employer? Check the appropriate box: Type of project (required):
1.❑ 1 am dcrtlploycr with s 4. ❑ 1 am a general contractor and,1 6' ❑ New construction
employees (full and/or part-tone).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner listed on thic attached shfel. t 7: ❑ Remo(iclinR
ship and have no cnlplo.yces These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comb. insurance. 9. E] Building addition
[No workers' comp. insurance 5. ❑ We arc a corporation and its
officers have exercised their 10.El Electrical repairs or additions
required.]
3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions
rnysclf. [No workers'.comp. c. 152 §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.❑ Other
c•�mp. insurance miuired.] –
*Any applienni that checks box Irl most nlso fill out the sectiou.below showing their workers'compensntion policy infonnalion:
t 11omeownets who sutnnit this affidnvit indicating they pie doing nll work and then hite outside conttnctors Imw sutTlllt a new arri(lavlt in(hcnt ing suc)L
tContractors that check this box trust attached an ndditional shect showing the name ortlte subcontractors and their workers'comp,policy information.
I am an employer that is pro riding rt,orkers'compensation insurance for nu, employces. Below is the policy and job site
Mformatio►r.
Insurance Company Name: 1q;7;-\ I l u N
Policy #or Self-ins. Lic. 11: A'^1 ?•�fl 7 Expiration Date: /t /y.
Job Site Address: If S'j _City/State/Zip: )iln
Attach a copy of the workers'�compensalion 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 pet ialties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in lie 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 c•e►Yif}'under they pains and penalties of pe►juty that the injift-mation provided/above is n•ue and correct
Phone
Oficial use only. Do not nvite in this area, to be completed b-y cite or toren official.
City or Torun: PeriniULiceuse #
Issuing Authority (circle one):
1.Board of Ilealtlt 2. Building Department 3-. Cityri,own, Clerk 4. Electrical inspector 5.Plumbing luspector
G. Other
Contact Person: ]'hone n:
—
N
tAOR.T#1
Town of
No. 7/o 01.
.
z==
LAKE
o , �` dower, Mass.,
COCMICMEWICK y�
ADRATED
S BOARD OF HEALTH
Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT...... ..A LVO.......... ..........................
" ' " Foundation
11
has permission to erect................:....................... buildings on...1...Lk....... .... ........ ....... . .......o.............. Rough
to be occupied as..... ....t....... .. a ...................................................... Chimney
. . . . . .. . . ...
Ch'
provided that the person accepting this permit shall in eve spect conform to t 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 CONST R.UC 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.