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Home My WebLink AboutBuilding Permit #607 - 1370 TURNPIKE STREET 3/30/2006 Of,40R7°•�ti0 3g°�,.,,•......•° OG TOWN OF NORTH ANDOVER o «* APPLICATION FOR PLAN EXAMINATION 7SS.1CHU5Et Permit NO: d Date Received: 9.26 ' Date Issued: 4 IMPORTANT: Applicant must complete all items on this page LOCATION 13719 -ru k2d Ice .S�— Print PROPERTY OWNER 1/S'-),, ; „.,In Ainbuo" Print MAP NO.: /@ 7 PARCEL: 112— ZONING DISTRICT: 'B/'C_ TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Repair, replacement ❑Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only ' DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: alai Phone: Signature v - Address: CONTRACTOR Name:— Z ,th Phone: 9yN.— ?2-.--61 ss Y Address: Supervisor's Construction License: 2230/-3 Exp. Date: n Zln.� Z2KW 9 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 6', .11a, Name: Phone: '7i;/— 2��— Address: _? / qP��r- .lip Reg. No. �, 0 FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ °��i o�'� x10.00=FEE:$ 4/00 9S C-®, Check No.: ,}' Receipt No.: Page I of 4 TYPE OF SEWARGE DISPOSAL Swimming Pools ❑ ❑ Tanning/Massage/Body Art ❑ Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ ❑ { Permanent Dum ster on Site Private(septic tank,etc. ❑ P Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to tire guaranty fund Signature of Agent/Owner Signature of Contract Plans Submitted ❑ Pans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 e DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS i � I -A DATE REJECTED DATE APPROVED 3 r HEALTH ❑ d 7- 11 COMMENTSv'-C� I-Z2 zLI, Ica 4L<. r Zoning Board of Appeals: Variance, Petition No: 1 Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signature&date Temp Dumpster on site yes—no— Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 it Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. i Total land area, sq. ft.: NOTES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 ❑ 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 I 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 j Page 4 of 4 Location 13 ' Z,1A)A,L f_ s:5:z r' No. b Date U ' MORT� TOWN OF NORTH ANDOVER �. 9 + 7I Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ � s�cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1J J` I 19 ( 1. 70 Building Inspector NORTH 0 Of s _ 4 over No. (go ? _ T ZQ Z- LAKE : dover, Mass., • • Q COC MIC NE WICK ORATED '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......, �r `.�.. ..OPP I.ft.t....r.-Ap .v�.......................................................... Foundation V� has permission to erect........................................ buildings on ../..�.?.O.....�......../�..��.�r.....� Rough to be occupied as......... ..��+..h. !.^..x`....... �7 .. ......... ........................................ Chimney provided that the perso accepting this permit shall in every respe conform t..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 CONSTRUCTIOVTW"' 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. IFSEE REVERSE SIDE Smoke Det. 4 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM P In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: /�w is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws<Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) � C Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date Ili The Commonwealth of Massachusetts 1 Ll Department of Industrial Accidents t, (l Office of Investigations VI '`� 600 Washin ton Street ;Ibis g Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Value (Business/Organization/In(lividual): Ranjgmin Farnt,tp (RpGtnn Hill Farm) Address: 1370 Turnpike"Strept, North Andover, MA 01 845 City/State/Zip: Phone #: 12c6 -bP j`7 A,ree an employer?Check the appropriate box: Type of project(required): 1.U I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. + ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 1 IT-1 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' 13.❑ Other comp. insurance required.] "`,any applicant that checks box#I must also till out the section below showing their workers'compensation policy information. r 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 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:nem Ff('yl-, i/ �o c Q(r( Policy 4 or Self-ins. Lic.11: 1 �C�S l� ( i� � Expiration Date: Job Site Address: 1370 Turnpike Street, North Andover City/State/Zip: MA 01845 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-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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}znahtre:,/ / Date•X Phone't: (Yfic•ial use only. Do not write in this area,to be completed by city or town olficiol. City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector 6.Other Contact Person: Phone#: ARCHITECTURE DESIGN PLANNING ISI The Commonwealth Of Massachusetts o ' SULLIVAN State Building Code A R C H I T E C T S I N C Construction Control Affidavit Project: Boston Hill Farm Owner: Ben Farnum Project Address: Route 114,No. Andover, MA Architect/Engineer : O'Sullivan Architects, Inc Architect/Engineer Address : 201 Edgewater Drive, Ste 215, Wakefield, MA 01880 In accordance with Section 116.0 of the Massachusetts State Building Code, 1, David H. O'Sullivan, AIA, Registration No. 6010,being a registered Professional Architect/Engineer, hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entirero'ect X Architec p J _ tor al Structural Mechanical Electrical Fire Protection Other (specify) for the above named project and that, to the best of my knowledge, suchplans, computations and specifications meet the applicableprovisions of the Massachusetts State Building Code all acceptable professional practices and applicable laws and ordinances for the proposed use and occupancy: I further certify that I shall perform the necessary professional services and be resent on the p rY p p construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the Building Permit and shall be responsible for the following as specified in Section 116.2.2: 1. Review of shop drawings, samples, and other submittals of the contractor as required by the construction documents as submitted for the building permit approval for conformance to the design intent. 2. Review and approval of the quality control procedures for all code required controlled materials 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standard listed in Appendix B. Pursuant to Section 116.2.3, I shall submit periodically, a progress report together with pertinent comments to the building inspector. Upon completion of the worV shall submit a final; report as to the satisfactory completion and readiness of the project for occupa Signature Subscribed and sworn to be before me this ^day of 20�.3 01 ,/Norui PublicV 2�IEWMW Qn§XPp P SUITE 2 1 5 WAKEFIELD, MA O 1 880 x/40 781 .246. 1 667 781 .246. 1 683 0 WWW.OSULLIVANARCHITECTS.COM FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANTPHONE LOCATION: Assessor's Map Number /4?d PARCEL '/o'L SUBDIVISION LOT(S) 6 STREET.t R V P,' kap S:�1&3 4z V ST. NUMBER_Z,-3-20 I OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED -0& DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS j2 l—Oj DRIVEWAY PERMIT FIRE DEPARTMENT re RECEIVED BY BUILDING INSPECTOR DATE i4