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Home My WebLink AboutBuilding Permit #360-13 - 148 COVENTRY LANE 11/1/2012 "oRTN Of a0 #e'�M BUILDING PERMIT TOWN OF NORTH ANDOVER ;o APPLICATION FOR PLAN EXAMINATION 2 Permit NO: ✓6 Date Received Date Issued: L SS�CFO ' IMPORTANT:A licant must complete all items on this page ` LOCATION A75 WU5A)71a- LN Print PROPERTY OWNER O E� C / *int MAP NO:�fPARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building AOne 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 0 Water/Sewer DESCRIPTION 0 WORK TO BE PREFORMED: IUSTALL — — .� /,l, lu5 �.` No i Identification Please Type or Print Clearly) OWNER: Name:�- /Yt � !(A�I-) 8,4&e-l' Phone: Address: Ac CONTRACTOR Name: �1,i � Phone: 90/-7/41-6 ? Address: �f(G, 7 Supervisor's Construction License: 14DleExp. Date: Home Improvement License: /a 46' �9- f3 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. � Total Project Cost: $ 46 Y7 ---- FEE: $ (?I 00 Check No.: 26 Receipt No.: NOTE: Persons contracting "h unre istered contract do not have acc t aranty fund Signature of Agent/Owner Signature of contractor i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER Print ! Print lob Year Old Structure yes no 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 PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sign ature:offHgen!Qwner Signature.of contractor __ ] Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ } Location Date • ' ' TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check �J— (f 25899 &ilding Inspector 7 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer 11Tanning[Massage/Body Art E] Swimming Pools El 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 I CONSERVATION Reviewed on Signature COMMENTS HEALTH• - Reviewed on Signature COMMENTS � I i Zoning 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at=124,Main Street:- Fire Dep artment'siignatu"re/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 El Notified for pickup - Date Doc.Building Permit Revised 2010 1 i r Building Department , I The fo4owing 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 Application Permit A lication ❑ Certified Surveyed Plot Plan o 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 o 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 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 subm:ated with the building application Doc: Doc.Building Permit Revised 2012 C NORTH own of EAndover A- A-MW No. _ L^bq, h ver, Mass, CoCNICH.WICIt "1. % S U BOARD OF HEALTH PER - T. T L D Food/Kitchen Septic System THIS CERTIFIES THAT ........ ......'`.. ........ l �f �C ............................. BUILDING INSPECTOR ................................................... nea°��14 Foundation has permission to erect .......................... buildings on ... .. ...................................... Rough �» a ��G rt Ad'e1 .......................................................... Chimney to be occupied as ................... ./.�/.........�.......... �:!+� ... y provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service .......... ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE { ' I Oct q0 12 04: 09p Richard Fallone 4014531367 p. 3 loo GQG r e:trt+ncnt of Puttiie ti:tC�Sti t� �Ltasuelnt�ctt}-•01'1 lit Buil d'+:^„ R�'-Mutt Specialty tlLlcense c4+ Construction Su;.er•isoCS SL C Sp 1�L686• Restricted to: W8 ` ALAN PAINTS 11 10TH Avi+NJE IL01630 r . M�01 a30 . NA H ,, .,s txp'sration:'812112012 . • • ' �.�/y 7r�: 100696 . ('num,icvium r 1 ry f� Yy_ may! �,• L Y:.,eF �6 :� � � V .� r Y� tY'•wi, ?yio. no i F: r cv 4MLg o cr1 bW4 0 cn w4 •� ca?+ b „ :s - A:• C4 OV AUA9 O:p�lx DOYS88L8$:..a'�� a�uanbaS -=�'Fsu2=S�snuO -:yQtg�ua�u�sn�pti O:�utcAPuB ti:=�q0 Dt9:a�'fSaxn�deD OZgi:aaqum�TeFxeS O:�y67�0 0&�� OSTSLOZ'I�1� 00'OOLS��4O� t66T95V0ES9�xa��t� t66T96bDg59taunoo�� ztOtlEL�gpeazepaxna e0 - �►t bbl 9bhD�59 S�D��5.Z 0�t.Og+ .aa� ��0®°a . . g Sv' Md me= kv Ovt Broom u oK vEt• . aTi�ts�•a .6WPle I GMOPUIM 914 --�! d;5 OUT ++ •d L9ETest'TOf+ auojjej p.aeyoia CIBD:iO a OE -400 tZ The Commonwealth of Massachusetts Print Form'y Department of Industrial Accidents Office of Investigations ' I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name (Business/Organization/Individual): � m Address: �'rj�5s �g� FeRP_ City/State/Zip: t-f�NT� Q� 3�33q Phone#: 0(:)� ''45-7 S7tot Are you an employer? Check the appropriate box: Type of project(required): 1A I am a employer with ZD 4• ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. E] Demolition working for me in any capacity. employees and have workers' insurance.$ 9. ❑ Building addition comp.[No workers' comp. insurance p• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 13. Other p employees. [No workers' comp. insurance required.] 0 *Any applicant that checks box#1 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I I am an employer that is providing workers'compensadon insurance for my employees. Below is the policy and job site information. Insurance Company Name: LEY) MS - Policy S .Policy#or Self-ins. Lic.#: W V0 7 736Qls Expiration Date: Job Site Address: City/State/Zip: & Attach a copy of the workers' compensation olicy 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. 1 do hereby cerd under the cains and enaltie erjuryt#at the in ormadon provided above is tr1e and correc4 Sig piature: T, Date: 10& l Phone#: 7/y'' 43 9 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#• Sep 26 2012 9s30,PM MIKE SIBMRN p. l BOMB ITAPMW- IM CQ:NINACr PLUM RUdD THIS Br[IIt+�Via► >i�s4aa ]�; � �,�. Pit�WELAW md eM1ltgdwbyt i 908 Sia T`umpu�,UI&1. iait-wasy,NA 01343• TbU n— )657=518-1,gam.iNe3)9454017 •a CT Lac�, f # e Mi M.NitC�41RYP.Ti3i#Rul^f MIt?Tlif�4EM4 C-hy zip r. n. i F.;Yll iA'[ 3 [ i?�'`'•X'�� }.� Y y S-'—; -rte Via^- .. A � ..--.rte•«, a /1 v O ice o onsumer ai and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improve . Contractor Registration Registration: 126893 Type: Supplement Card z Expiration: 8/3/2014 The Home Depot At-Home Servi `� ; ANDREW SWEET IT 2690 CUMBERLAND PARKWAY ISE: m `o, ATLANTA, GA 30339 16` Update Address and return card.Mark reason for change. 't Address 0 Renewal F-] Employment F� Lost Card DPS-CAI Co 50M-04/04-G100"1�21.66 �� Office oransaer�airs usiness egu ation License or registration valid for individul use only TTHome OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 693Type: 10 Park Plaza-Suite 5170 Expirat aSupplement Card Boston,MA 02116 Depot��t-HSetr ANDREW SWEE\7 r, 2690 CUMBERIAN� a`ti�r39`A,GA 30339f� " �yS Undersecretary all it ou signature