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HomeMy WebLinkAboutBuilding Permit #Exception - 145 CARLTON LANE 5/1/2018 (3) Of NORT$#1h 3=a'+"o:;.,•,et A TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o e 19 �9SSACHU`+ES Permit NO: U e Date Received: 130' eD k0 Date Issued: 2_3c)—o(e IMPORTANT: Applicant must complete all items on this page LOCATION / Y CAP Z -74,,v A� Av P, VC—), PROPERTY OWNER 7-,4 P/� J C// 14/ N 13, gi:-If Print MAP NO.: /O C PARCEL: / ;L/ ZONING DISTRICT: 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 .57 Identification Please Type or Print Clearly) A OWNER: Name: Phone: Signature Address: l ll'I1 /f /d' /:�h ,A� Phone: CONTRACTOR Name: /U' � I Address: Supervisor's Construction License: Exp. Date: Home Improvement License: 131 9-�;-® Exp. Date: IgP1,13�a 6 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PER T.•$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 4/J4 '7 11a x10.00=FEE:$ , . Check No.: . a�G 27 20 _ Vz\,,,,---Receipt No.: / o ZZ Page Iof4 Building Department fThe 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 TYPE OF SEWARGE DISPOSAL i wmmn SiPools 1111Tanning/Massage/Body Art ❑ g Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales 11❑ Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner CFf C'Ol4��� Signature of Contractor Plans Submitted ❑, Plans 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS II Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signature -&date Temp Dumpster on site yesno Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 i Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided I . DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq.ft.: NOTES and DATA—(For department use) Page 3 of 4 Doe:INSPECTIONAL SERVICES DEPARTMENT BPFORM05 Created JMC.Ian.2006 r Location v No. /ten Q Date 2—2e'04 MORTM TOWN OF NORTH ANDOVER 9 a � y 1 ;# Certificate of Occupancy $ s�cMo;ttn Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � G � - Check H 19071uil - / ' . Bding Insp��6r NORTH Town of And 0 1008 •30 * 0 z : A K E dover, Mass., "06 COCHICHEWICK 14 S RATED 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....................... ....... ........... ......................................... """ Foundation has permission to erect.......................... ...... buildings on ......................................,.............. Rough to be occupied a ........ Chimney provided that the person accepting is permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions o he 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 CONSTRUCTIONS S 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. Propotal Page# of pages Norman L. Blad Construction Tel: 978.687.6263 40 Femview Ave.#10 N.Andover,MA MA Lic.016141 MA Reg. 131950 Proposal Submitted To: / Job Name Job# Address Job Location D / Zj Date / Date of Plans Phone If p/'7 �� ��Z Fax# to / (, Architect We hereby submit specifications and estimates for _ .. ...... _-- _..._. --- -- --yy�� / ,1 -------- --- ../s- ... J�.._.._ ....... -._...._._,%C�tJ�`''/pY Yom- . ....._._ ✓.V_....... .......... ......._ .. ............... We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: Dollars with payments to be made as follows:. /� 2 0 Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order,and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays brL d our control. Note—this proposal may be withdra by us if not accepted withi r� days. 21cceptance of opo at ry ,specifications and conditions are satisfacto and are Signature .You are authorized to do the work as specified.made as outlin d aboO� tanceJo1J� Signature I ( If NC3B19 MADE IN USA BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 016141 Birthdate:X03/15/.1947 ! � Expires: 5/2 03/1006� Tr.no: 2169.0 -' - - - Restnctetl NORMAN L BLA � �, 40 FERNVIEW AVE„#,101r;; G— N ANDOVER, MA 01845 F Commissioner E GTS-�amm ��✓G�� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 131950 Expiration: 10113/2006 Type: =Individual NORMAN L.BLAD NORMAN BLAD. 40 FERNVIEW AVE #10 N.ANDOVER,MA 01845 Administrator ;1 i The Commonwealth of Massachusetts + Department of IndustrialAccidents Accidents h. as Office of Investigations 600 Washington Street Roston,,V14 02111 "zw www.niass.gov1d is Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 14 ,q / 24140Please Priint Legibly Name lllusincss/Orgauirationllndividuall; � / +/� h ' Address: tl 0 ICE 3i _-- C ity;StateiZip:,/�.14ti a Y49-hc,71PI4 0J /Mone#: '?7 F — 6 .82 63 Are you an employer?Check the appropriate box: Type of project(required): [2, .❑ I am a employer with 4. El am a general contractor and 1 6. E]New construction mployees(full and/or part-tiine).* have hired the sub-contractors [ 1 am a sole proprietor or partner- listed on the attached sheet.= ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. workers'comp. insurance. q, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself.[No workers'comp. c, 152, §I(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp. insurance required.] ,\11y applicant that checks box 91 nmst also fill out the section below showing their workers compensation policy information. i Ilomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. {:ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am rrn 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.4:—­----- Expiration Date:_ _ -_— Job Site Address: City1State/Zip:__ —_ -- 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 5250.00 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 perji that the infiirmutinn provided above is true ural correct. Si m:dure: . Date: 'hone - O�fic•iul use only. Do not write in this area,to he c•onipleterl by c•itl'or lmwt olfrcial. City or Town: Permit/License# Issuing Authority(circle one): t. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector j. Plumbing Inspector 6.Other Contact Person: Phone#: NORFOLK AND DEDHAM MUTUAL FIRE INSURANCE COMPANY SMALL CONTRACTORS POLICY RENEWAL CERTIFICATE Poiicy # R0412920 Named BLAD, NORMAN Agent INTERNET INSURANCE AGENCY, INC Insured 40 FERNVIEW AVE #10 Phone (978) 685-7690 N ANDOVER MA 01845 Agent # 20155 FORM OF BUSINESS: EntEfv 9 LfuH3. Policy Period: ONE YEAR from 02/04/06 to 02/04/07 This declarations page together with the policyTjacket, the policy form and any endorsements, completes this policy. Coverage begins at 12:01 A.M. Standard ime at the covered premises. E. P0 #. 0 PRI= MxUll $ A'I�tD [ 1T $', Basic Annual Endorsements State Taxes Total Annual Add'1/Return $957 $957 Bid /Location 1 Address if Different Mortgagee Information Business Description p CARPENTRY POLICY DEDUCTIBLE $250 BUSINESS PERSONAL PROPERTY Limit $10,000 Included TOTAL PREMIUM PER BU I L D I N G $957.00 EXCEPT FOR FIRE LEGAL LIABILITY, EACH PAID CLAIM FOR THE THE FOLLOWING COVERAGES REDUCES THE AMOUNT OF INSURANCE WE PROVIDE DURING THE APPLICABLE ANNUAL PERIOD. PLEASE REFER TO PARAGRAPH D.4 OF THE BUSINESS LIABILITY COVERAGE FORM. LIAB & MED EXP (OCCURRENCE/GEN AGG/PROD COMP OPS AGG) $300/ $Boo/ $600 Included MEDICAL EXPENSES $5 Included DAMAGE TO PREMISES RENTED TO YOU $50 Included I Premium SEE ATTACHED PAGE .......... ..................................... •SifAt�... Ail�t�A'1":t�ttiS�';:>::>>;::><::»::>:>€«:>[><>? i::<::::<:<:::: ><: <::,;«< :;:,` <: ;:...,< ,: ".: � >'::>><»>>< < < 3>€�<< ......... :.::::.... 1,µE`........... BOP-2 (REV.04/05) _ _ Type of Payment: DIRECT BILL 10 PAY - 5981 Cf Date.................................. tko TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS Thiscertifies that ................................. .......................................... has permission to perform '" " ^.^ ................................... wiring in the building of ... ........ ........................ .................. .North Andover,Mass. Fee��-— ..... Lic. ........................... .***"**""* .. ..... ELECTRICAL INSPEkrORtf/ Check # I\ Commonwealth of Massacnuseus Department of Fire Services Permit No. o� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fec'Checked 3S� �' [PCV. 11/991 leave blani APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to N_performed in accordanceµith the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PI,EASE PRINT IN INK OR TYPE A11 INF IZ�,fATION) Date: City or Toi4'n of: of d©Ue r To th hispecto o wir-es: By this application the undersigned gives nonce of his or her tenuon to perfo the electrical work described belo«. Location (Street& Number) �� CG1 r Owner or Tenant c X15 1"` Telephone No. Owner's Address Is this permit in conjunction with a b Iuildin permit? Yes No (Check Appropriate Boz) Purpose of Building l�P51 Gt�'M IA I Utility Authorization No. Existing Sertiice Amps / Volts Overhead ❑ Undgrd❑ No. of Ntctcrs New Scr%ice Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: A>y0_-1 Conn 'e[ior:o lire fu!io'l, 4:ble rwv be k'm ed by die In, error n; /� No. Of Total No. of Recessed Fittures V No. of Ccil. Susp.(Paddle) Fans f Transformers KVA No. Of Lighting OutlCts No. Of Hot Tub; IGencrators h11A Above In- No. n Ir o. o mcrgency rg ming No. of Lighting Fixtures SIN irnminr fool grnd ❑ gr-rad. ❑ Batters Units ND. of I'CCCptaCic OutlCts (q No. of Oil Burners FIRE ALARrNIS No. Of"!_,encs No. o Detection and No. of SIN itches No. of Gas Bunicr-s Initiating Devices Total No. of Ranges No. of Air Cond. Tons No. of Alerting Devices --- ticat Pump i_uatbcr Tons heti If-Contained .. No. of Waste Disposers Totals: _... ._.......... Detection/Alerting Devices I'lunrcrpal No. of Dishwashers Space/Arca Beating KW [oCal ❑ Connection ❑ Other Bcatin.a Appliances K«' Jccunty }sterns: f No. of Dn'ers _ No.of Desices of Ec uivalcnt 'S nisi K1}, No. otr o. o Data Wirino• Heaters _Signs Ballasts No.of Devices or E uivalcnt TCICcommunlcatlons Iv�"frog- N'o. Flydromassage Bathtubs No. of Motors Total ITP No.of Devices or E uiN,alcnt .4t!,,7c1t r0drr+ott idEQTI r'desire,l or Rs regrured bj'ri;:'1r:5(!-Dr INSURANCE COVERAGE: Unless by the o%%[i;-,, no permit for OIL p_rforniancC ofelCctrical stork nr:a} issu: uni'=>> the licensee pros id---s proof of liability insurance inclulnc-completed operation's co'•crags or its substantial cgtus a!enr_ The undersigned certifies that su,_h Cover �c is in force, and Lis exhibited proof/of sante to Lhe f,;rnur issrnric office CHECK ONE-: INSUP.ANCE 0`n ❑ 01HER ❑ (SpeciF}:) �t✓3kl r EstfmaLcd Value of Electri-al NVork 2550 (.�`,rheri required by rnunicipnl polio.) `riork to S4nrt �� Inspections to b rc�uestCd in aaorda_nee %Midi i-C Rule 10. and upon comrlction. 1 certif"f, under frac p in' ac d per,al[ies of per ury, fhaf[fsc irfurrr:a[iorr ore f{"S appllcu[ori is[rue and complete FIIvti1 NAME: "f^� C / / `/ Lc ( LIC. NO.: fT 2_5/1' Jat'� U�J L�I�l �i 1, �(�v {��/ �� /J� �n'►5 Signature LIC. NO.:�_ ((fapplrccbfc, crier e.r +pr"irrliielrcerrsenuni5erbne) Bus. Tel. No.;-7il— yg 7771 Address: t `, � 04d wa,� 1AC1019- b y7� Ale Tel. No. 0WNER'S LNSURANCE ti�AIVER �G I am aarC rans t Lhe Licensee does nor him t1r_ liability insurance coverage normally required by la% B)' my,signature below. I hereby«give this requirement. I am the(check one)❑ owncr ❑ Owner's ager ONNner/Agent PF-Rh1IT FEE: 5c. Signature Telephone No. _ Commonwealth of MassachusettsMmmmm on«ial Use only Department of Fire Services Permit No: BOARD OF FIRE PREVENTION REGULATIONS Occupant'and Fee'Checked (Fet.11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICALWORK } All work to be ptrfotmed in accordanceµith the tifassachusetts Electrical Code(NEC).527 CMR 12.00 (P1,E4SEPRIWTIN'INK0RTYPE'AILLINF R,.L4TION) Date: Z15� City or Town of: lyr �J il, r To the Inspector o wires: By this application the undersigned gees notice of his or her' tenUon(o perfo the electrical work describ+d belga. Location (Street& Number). Iy Cir -�� Owner or Tenant `C vel S /: Telephone Owner's Address Is this permit in conjunction with a buildin permit? Yes No (Check Appropriate Boz) Purpose of Buildingtq 1 _ 9pJ Utility Authorization No. Eristing Service Amps _/ _Volts 0+•erhead ❑ Undgrd ❑ No. of Meters New Senice Amps / _Volts Overhead❑ Und rd g ❑ No. of hletcrs Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work: — d LSI �G CJa`'t COTlotion o the/o!lo.ir: tally rrav be ti arced hi the I u ector No. of Recessed Fixtures �/ No. of Cell.-Susp.(Paddle) Fans. �o. of Total -- Transformer No. of Lighting Outicts No. of Clot Tubs _ Generators KVA No. of LightingFires Abose In r o.o tncr ency ro itim, xtuS++irnming Poo( rnd. ❑ rnd. ❑ IBattery Units c No. of Receptacle Outlets NO. of Oil Burncr FIRE ALARMS No. of Innes No. of S))itches No. of Gas Burners No.OTDcteciron and Initiating Devices iNo. of Ranges _ No. of Air Cond. , Tons .tin. of Alerting Deviccs No. of Waste Disposers heat Pump i"un be; To K;� No. o 'el -Contained Totals: ... Detection/Alerting Dctiices. No. of Dish++ashers Space/Area Ilcatinc, KW [ocal ❑ Nlunrcrpal o Connection Othcr No. of Dryers I1eatinE Appliances KW Secunty vsterns: r o�o�� ater rtio. o No.of Deices or•F.g aivalent Heaters KNY o. of Data Wiring:. Signs Ballasts No.of Devices or Eq uicalent No. flydromassagc Bathtubsti'o. of Motors Total Telecommunications Wiring: No.of Devices or F, ui+alcnt OT[MR: � lrtich addition:(deurr!i,:•''desiretf. or ns required by ri;.b:SpciUr q li'r ai INSURANCE COVE RAGE: Unless «aired by the o,,tincr. no permit fur dic perforrrtance of electrical %:or;: mai issu::unl:s> the licensee roti ides roof cf Iiabihcy insurance in^lud! P P _ n, completed opc.raUon' co.crage or its substantial equi%•a!,-irt The undzrsigned certifies shat such CO Ver ,c is in force, and toy e�tribited proof of saris;to the ptirniit iisuing office CHECK ONE: INSURANCE FOND ❑ OT-HEP, ❑ (Spccif) ) t rg 'b `j" , oc"Cyo a Estinia[ed Value*pin f Elri-z! %','ork: (� (When required by municipal polis.) (Expiration Ujt:_ Work to SL-utOr Insp?Ctions to be r.queSted in accordance with MSEC Rule 10.and,upon corlpietion I certify, under tacrd penalries of per ury, that the irformation on this applicat'on is true acrd complete ' FaM NAME: U�'1� 'rft� L e, l icensee:_ 5 ppfij t b� Signature LIC. NO.: f appltcable• eater"e.rerpt"in/he license taimber hr,`.1 ! ,J Bus. TCI. No. ddress: f1 �l04d wtg+.� Ar Iv h4 7th'► O�X1.77 AIL Tel.No.: �Vr\'ER'S LNSURAh CE �ti AIVER f am a�+are ra[fire Licensee does rror hen e t1i_liability' insurance coverage norrnafh quired by law: By my signature below, I hereby s+aive this requirement. 13m the(checkI one)( ot+ner ❑owner's aacn 0c+ncr/Agent Signature Telephone No. t � er�