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HomeMy WebLinkAboutBuilding Permit #400 - 145 BOSTON STREET 11/26/2007 BUILDING PERMIT of "°oTH' +�. TOWN OF NORTH ANDOVER so `A `?`- 6'° °p APPLICATION FOR PLAN EXAMINATION Permit NO:& Date Received A 'gwrso Date Issued: (O w SS'gCHUs� IMPORTANT:Applicant must complete all items on this page LOCATION -f b Print PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: _ Historic District yes no 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 T pe or Print Clearly) OWNER: Name:�� f C r . ��>�r4 Phone: Address: CONTRACTOR Name: Phone: d '~ Address: i fA LZ P Q`/ Supervisor's Construction License: Exp.Exp. Date: t; 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: $ FEE: $ Check No.: J S Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaran and signature of Agent/Owner Signature of contractor 4 }r = Location 4117 ,64�vh, No. d Date MORTH TOWN OF NORTH ANDOVER A. + : ; Certificate of Occupancy $ ss,KMusE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20821 Building Inspector 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoa ing 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 Located at 384 Osgood Street FIRE DEPARTMENT -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. 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 Doe.Building Permit Revised 2007 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 o 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) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u 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 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street < Boston, MA 02111 s. www.mass.gov/di a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): - Address: , City/State/Zip: Phone #: Cp / j 4_ Are an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. # E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. [1 We are a corporation and its officers have exercised their 10.F] Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL l l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §l(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' i 13. Other �o� p comp. insurance required.] -r—TIc 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 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: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address:— n��;; +le E r–4- City/State/Zip: d lR�4 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 under the pains and penalties ofperjury that the information provided above is true and correct. Si nature: Date: - O Phone#: d Official use only. Do not write in this area,to be completed by city or town official. 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#: � rte_ .�..� ,,,-•-r ... - -. , oi`f3uild1119 Ri.gulLaUtidons and fa darc+s SOME IMPROVE MENT CONT4gCTOR s Re istratton 8 151818 ExP►Caton �; } 7/5/2008 • ' $TY� g 0. Pnvate Corporation 9P AVIUEL A LUJ<,"i T. HOME,IMF�R°p �ENT C ITRIOS ORP rCARAGIORGpS y t. f,lh��Fhvf�r MA�1841 Samuel Lukas gome Improvement Cop. 91 Higb Street Lawrence,MA 01841 (97s�s1s-sos� (978�s8�-7873 All material is guaranteed to be as specified. All workmanship is guaranteed to be for a period of 1 year from date of completion. All work areas are to be kept clean by contractor. V4' All insurances are to be carried by contractor. e61 r,Ar-T eer is responsible for obtaining necessary permits. Total cost of all labor and materials is $5,900. $2, 450 is due upon signed contract and remaining balance is due upon completion. Respectfully Submitted, Dimitrios Karagiorgos Acceptance of Proposal The above prices, specifications, and conditions are satisfactory and are accepted. Samuel and Lukas Home Improvement Corp. is authorized to do work as specified. Payment terms are accepted and will be made as outlined above. Signature `�' Date Il age d Customer f Signature Date '12- jr)=-iL President of orp., Diinithos Karagiorgos Peter Radulski Roof Page 2 of 2 NORTH Tc ® of No. 4/D v o dover, Mass.,Ao COCMICMEWICKGV 7�S RATED BOARD OF HEALTHp'P4 �y Food/Kitchen PERMIT T D Septic System ...... .� (ZkAAs- L-t BUILDING INSPECTOR THIS CERTIFIES THAT � ................................................................................................................................. Foundation has permission to erect........................................ buildings on .. y ....��d.h.m.......$14 ................... Rough to be occupied as............. �"� .� .. .. .............................................................................. Chimney provided that the person accepting his permit shall in every re ct 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 STT Final i1Mr !— PEEXPIRES IN 6 MONS ELECTRICAL INSPECTOR UNLESS CONSTRUC IS ARTS Rough ............. Service BUILDING IN ....CTOR 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.