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Home My WebLink AboutBuilding Permit #806 - 15 WILEY COURT 6/16/2006 Oa NORTH 1H teo TOWN OF NORTH ANDOVER 3:,c,,, ,•,�e ti v T APPLICATION FOR PLAN EXAMINATION 9' CHus{�'r Permit NO: v y Date Received ",/,/6 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ! Ly`'C/_ i C -e Print PROPERTY PROPERTY OWNER r G S' A ,41.> ✓eJ-J' Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building AOne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: V,Zepair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED o V('!94 < —;G �r s er—F &zee /44OL-0 til r f y1e,L', Idenntification Please Type or Print Clearly) C� OWNER: Name: ( vlA4 f AOW /F Phone: ` ? 6- Address: L - g j� CONTRACTOR Name: �� I^< Phone: G Address: i(fe AA)-D/ A)D a4 Supervisor's Construction Licenser G ae --2 Exp. Date: Home Improvement License: z Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST B SED ON$125.00 PER S.F. Total Project Cost :$ p < c x10.00=FEE:$ ---' Check No.: S^`�7 Receipt No.: / �3 0 Page 1 of 4 TYPE OF SEWARGE DISPOSAL Swimming Pools 11F1Tanning/Massage/Body Art ❑ g Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ ❑ ❑ Permanent Dumpster on Site Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access tot a guaranty fund Signature of Agent/Owner 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 z HEALTH ❑ ❑ COMMENTS 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 Temp Dumpster on site yes_no Fire Department signature/date Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIM ENS ION 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 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 Location No. 4R UDate Fes • N�RTN h TOWN OF NORTH ANDOVER . 00 41 f D " Certificate of Occupancy $ MU `� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �> j _ Bu(ding Inspector NH ORT TO" Of _� 19Andover O No. A K dover, Mass., C OCMICKEWICK A. RATEo BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ............5#.h..a...Vrve.00... .......... ............................................. Foundation has permission to erect........................................ buildings on IT.........W.%A40.\.....C.0.wL. ......................... Rough to be occupied as SVA �.... ��`�.. 11. Chimney ................ ..... provided that the person accepting this permit shall in a respect 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRLJ STARTS Rough Service B 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. PROPOSAL Nt. t en Cnn";truct• ion Co. Construction Supervisors PROPOSALNO. ;3 Andover ST. License -11�040927 Andovsr,Ma.019453 97 3-e R'- --4q 7 SHEET NO. DATE May ?4 t ZOOh PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME L f < Shl a tl n e s s y ADDRESS 9 15 11iley Court ADDRESS 19 r4iley (7curt t DATE OF PLANS t Nort'n A7riover,Ma .01845 PHONE N0. ^� _6 7_ 3 ARCHITECT v o_ 16:;_77g1 r--'V1 #t We hereby propose to furnish the materials and perform the labor necessary for the completion of rrn f i -�n r-. THis quote wi11 pettain to certain areas of th^ I)ui Idinct roof' lavout , :aeci ff- Ly he areas -rhere the two low sloped roofs exist with ad-joining shingled area-7;. + aep3ra>;� *�; Yana tluo e •ii be -Mated .later.No buildtng hermit is r-cjuired -.--� � u o .lki,t L IJU LI11il 1.ZI •71. 3.3. Q •'t. n rra r7 From F n i . .h Ci ^yrrNjrn a-Ha n:I.i rf-; a the areas whiCh converge on ttie low sloo-�d areas. f'Emoe U:, k rvyL-a C App 1..-1 y , wh i ch are locate con SFif ngtd� ata 4. ilnul. Gra r% r-P waf-Ar qhi a1 ,a ; .. . � . .ca nfutt 1y a ounF; �t X11 skyghtS.CQVr Qny.._.. a ;n, ;q > 7.@nt.,grap ice shield arorind 71, it T �, y e nr ru .tea install smartvent ridge venting, install Ci3 s.Reinstatl . � . � f � . ;� a <}ate u a1T roar inr cue r1 s.:Shingles are 25yr limited � arrantec3.ContraCtc7r ,t�,. :'� Ca ae �) acts �r nature RnW.1n • P'a, not CO<2Z'e�. .r 2- t �..t.., r w w t , ., 7 ,.- _ ..... _.� iA J 4...-. U l._. a 1 l1 ti Yi\.. All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of :fx, u,3an,,3 ;''l.r7ht hu n Dred Dollars ($ Sfte';O00 ) with payments to be made as follows. 3 3"4(101v n $7'766 .0n p a l a nc— due 3t completion $4 Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac ' cidents.or delays beyond our control. Note—This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are autiorized to dojthe , as specified. Payments will be made as outlined above. SignatureDate - t '% - Signature MAdams 3818-50 PROPOSAL MADE IN USAA ✓fie �ai�vrrea�z�uea� a�,� tude�4 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 109740 One Ashburton Place Rm 1301 Expiration: 9/24/2006 Boston,Ma.02108 Type: DBA ALLEN CONSTRUCTION CO ROBERT ALLEN 86 ANDOVER ST G� r , u✓ ___,___�/�/_ __—_ ---- --— N ANDOVER, MA 01845 Administrator Not valid without signature ✓fie iaa�r�ma�aurea`C-fi a�.iN/.a;t�¢cfiu.�se�6 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 040927 Birthdate: 05/04/1957 Expires: 05/04/2007 Tr.no: 12462 Restricted: 00 ROBERT W ALLEN 86 ANDOVER ST N ANDOVER, MA 01845 Commissioner a IN The Commonwealth of Alassachuselts Department of Industrial.lecidents a'; Office of Investigations 600 Washington Street „ Boston, ,b14 02111 WWW.mass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kpplicant Information Please Print Legibly Mame 1,t3usina s;f)rzaniialia,nnndividuall: /k ;address: A1,1 D/ ei -5 7 — city: Phone #: a l l- ,%re you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ 1 am a general contractor and l 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. ' F1 Remodeling ship and have no employees These sub-contractors have 3. ❑ Demolition working for me in any capacity. workers' comp. insurance. y. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its airs or additions required.]] re officers have exercised their 10.F1 Electrical repairs 3.F-1 I am a homeowner doing all work right of exemption per MGL I I.❑ 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' 13.0 Other _ insurance re required.] comp. q ] .\ny,applicant that checks box P I must also lilt out the section below showing their workers'compensation policy information. y I lomeo,vners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating;uch. Contractors that check this box must attached an additional:,beet showing the name of the sub-contractors and their workers*comp.policy information. I am an employer that is providing workers'compensation insurancefor r my empl gees. Below is the policy and job site inf armation. Insurance Company Vame:___-- - ------- __--- --- --- Policy I or Self-ins. Lic. =k: ---__ _ Expiration Date: Job Site Address: City;State/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 Fine up to$1.500.00 and/or one-year imprisonment,as well its civil penalties in the form of a STOP bk ORK 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 DLA for insurance coverage verification. I do hereby certify and r the pai nsaad penalties o . erji at the information provided above is true and correct. tijMtture: nate: ! ty]iic•ial rise uuly. Ito;rut tarite in thio urea, to he i•onrpleted by riot-or to mi official. City or Town: I'+:rmitlLicknse Issuing Authority(circle one): 1. Hoard of Health 2. Building Department 3.City/Town Clerk T. Electrical Inspector 3. Flumbing Inspector 6.Other Coof.,ict Pcr,on: Phone