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Home My WebLink AboutBuilding Permit #212 - 151 PRESCOTT STREET 9/20/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION No oT61+ 6 nn o p Permit NO: O�� Date Received '%%Too Date Issued: - SS CH -------IMPORTANT:-Applicant must complete all items on this page LOC ATION Print / PROPERTY OWNER J 1-,0� -----------_ _----- -- Print MAP NO.:�_PARCEL: 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) G( Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TQ BE PREFORMED tee Identification Please Type or Print Clearly) c OWNER: Name: r,02 fI 4>7 Phone: Address: CONTRACTOR Name: _�j oY► �d �GI/1 1;7 U Phone: �� 6 Address: /'3 / z/7 Supervisor's Construction License: 070 � Exp. Date: 2— 7 Zz x Home Improvement License: % (�-o -75- Exp. Date: 'r � 4 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost S Y — FEE:$ U. -� I q Check No.: 1 _ Receipt No.: Page I of 4 Ii TYPE OF SEWERAGE DISPOSAL Swimming Pools 11Tanning/Massage/Body Art E] g Public Sewer ❑ Tobacco Sales Food Packaging/Sales ❑ Well ❑ ❑ Permanent Dumpster on Site Private(septic tank,etc. 11 Permanent Meter location to project NOTE: Persons contrac 'ng with unregistered contractors do not have access to the guaranty Signature of A ent/Owne Signature of contra low Plans Submitted ❑ lans awed F1 Certified Plot Plan El Stamped Plans El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-If FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS rj DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT - Tem Dum ster on site es no P p Y Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Sianature&Date Drivewav Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required= Provided Required Provides Required4 Provided 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 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 ic.,i ��•) No. Date � �(0 NORTH TOWN OF NORTH ANDOVERv 3? � . . oL p ` Certificate of Occupancy $ ��s'"°•tt� Nus Building/Frame Permit Fee $ �-- wc Foundation Permit Fee $ Other Permit Fee $ j TOTAL $ Check /fes_ r 1959' .G Building Inspector NpRT►i ,� Town of tAndover No. 24 *2ww 24 _ A K E dover, Mass., COCHICHEWICK ORATED 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT..�•� !�...... .. .. ............................................................................ Foundation ........................... S has permission to or t........................................ buildings on ...... .s,.......... 41+.0... ................ Rough 0 to be occupied as ... . .. . . . . �........................................................................... Chimney . provided that the person accepting this permit shall in every 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 CONSTR<( Znmo ' � ST l TS 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. t tti rQ ' I 111 - -1 ------ -- --{- i - -t .0i -=---- -- E i : I • I r ond),J o. JIM oi J i i _ '1'' -71 E ._e.,,� 3.'� z_-- —E--{ jb�'7� `or�.I,l.-�.•�.Rt�.. n I f_.{ —E a � I 1 \ E r .. ''� '• �.. - "—'�'—'-"C-tom.. . , - f 1 J i L _ The Commonwealth of Massachuselts Department of IndustrialAccidents Office of Investigations 600 FVashington Street Boston, ,Vf 4 02111 4; www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers applicant Information Please Print Legibly r� Narne ll3usincssi(hganiialion/lntli�iduall:( Address: /)-s City/State;Zipoi , , Phone #: q�2F' Are you an employer?Check the appropriate box: Type of project(required): IEN am a employer with 4. ❑ 1 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 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 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,$1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] ".\ny applicant that checks box�I must also lill out the section below showing their workers'compensation policy information. +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 or the sub-contractors and their workers'comp.policy information. I am tin employer that is providing workers'compensation insurance for my emplgvees. Below is the policy and jab site inf armation' / Insurance Company Name:_L� Policy !.f or Self-ins. Lic. El: (��. 1 17 7tel Expiration Dater Job Site Address: 'j e_-C60! City/State/Zip: /if _ ;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 iN IGL c. 152 can lead to the imposition of criminal penalties of a Fine up to 51,500.00 and/or one-year imprisonmen ,as well as civil penalties in the form of STOP WORK ORDER and a tine Of up to$250.00 a day against the violator. 13 v' ed that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins ince co a verification. I do hereby certify ane a pa' . enalties q/perjury that the information provided above is trite/and correct. i Date:� 0 J V 5i�rn:tture: — Phone !)%ficial use only. Do not write in this arca,to be c oinpleted by ei(v ar town official. 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#: S �e f, In gu 10 a� �oaf('Jor CONTRACTOR - - HOME IMPROVEMENT Registration: 136095 ExP iration: 61712008 - Type: Individual JASON A. SABATINO ,\SON SABATINO � "— 23 FATHERLAND DRIVE nt Administrator Dep Y RyFiEi_C.MA 01922 BOARD DTION SUPERVOF BUILDING ISOR IONS License. CNSTRUC Number: CS 078729 Birthdate: 05127/1976 Expires: 05/27/2008 Tr.no: 2331! Restricted: 00 JASON A SABATINO PO BOX 931 BYFIELD, MA 01922 —commissioner