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HomeMy WebLinkAboutBuilding Permit #375-11 - 157 LACY STREET 11/2/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: H Date Received Date Issued: ),--t IMPORTANT:Applicant must complete all items on this page LOCATION P PROPERTY OWNER Print MAP N0:jbS7LPARCEL: 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 air, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ®1Septic ®Well ' s Fl o'dplaui` �'p Wetlands ` �' ` D WatershedtlDistr ©jWater/,Sewer - ,� Wiar xi+r. DESCRIPTION OF WORK TO BE PERFORMED: Identification P ase Type or P 'nt Clearly) Q � OWNER: Name: i �� N J-2 Phone: I�l - 621,5 Address: S CONTRACTOR Name: J Z-�S E�� �' S,0_�C/-, Phone: qkl Address: 010 �) LO�P\-,k'r-J ` O-J — Supervisor's Construction License: �' f<� Exp. Date: a, l f Home Improvement License: jz�) j Exp. Date: 3//0// ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 6 . 4SS go-- FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty f d �Si`nafue'ofiN e".nt%Owner< : ,. :Si nature of contracto` g_ _9.�:_ 9—_-...__. __. .. .._.._..-- - ---- _- trd6, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ j f TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools h Tanning/MassageBody Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature 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 _ DPW Town Engineer: ignature: Located 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.$10041000 fine NOTES and DATA— For department use El Notified for pickup - Date Doc:.Building Permit Revised 2008 • I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. �I I 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 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) ❑ 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 ❑ Workers Comp Affidavit ❑ Two Sets of BuildingPlans (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 40TE: E. All dumpster permits require sign off from q 9 Fire Department p nt prior to Issuance of Bldg Permit n all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc-Building permit Revised 2008mi Location No. Date �oRT� TOWN OF NORTH ANDOVER MIIIIIIIIIIIIIIIIMs A A a # Certificate of Occupancy $ • i # s; MUS<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � v 23644 Building Inspector ORTH TO'" of And . , 0 . No.3 ,7 -ao 00 dover, Mass., O COCMICMEWICK �t ORATED ITS BOARD OF HEALTH Food/Kitchen .PERM IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THATDA06*A.0w..4( .V.................................:....... ........... ..................................... .......... ....................... Foundation has permission to erect..............:......................... buildings on 1.S7�k! U%.4 S Rough to be occupied as ............4..........&A.P.M.4 . ...................................................................'........ Chimney provided that the person acce ing this permit shall in every respec nform 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 CONS77 U ST TS Rough ........................................ ................. Service BUILDING IN ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the- Premises — Do Not Remove RoughFinal 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. 10/15/2010 07:05 6173545758 SMMA PAGE 01/03 203 wASHINGMN Sr 4256 PRESERVE SALEM.MA 02970 carpentry 1 painting 1 roofing I gutters nowB:578:745.8745 SERVICES K%x.97a74s.3476 SAU5@PMMFCVESERVFCES.COM David& Erika Fanuelc 157 Lacy St Date ei�W9/2010 Estimator•.Sean O'Connor North Andover MA,01845 (978)682-5765 ROOFING ESTEKATE CONMIEN'>('S I did apply a 10%discount to the below prise because we will be having a 101/0 of promotion as we enter the fall.All wood replacement will be done with Harvey Industries pai stable pvc. PRIOR PREPARATION PERNErITING: A0 permits will be obtained in accordance with the law as required. DISPOSAL: A dumpster will be used to dispose of the shingles. V� p,n fir.s 5 yk, g 9 c�u%l'y c,oUj ROOFING PREPARATION COVERING: Tarp the exterior of the house so as not to damage the siding. SHINGLE REMOVAL: Remove all layer(s)of old shingles NAILING: Re-nail roof de:cldng as necessary, CARPENTRY* Replace the plywood on the front slope of ft main house.✓ On the roof to wall junction on the main house cut up the siding 6"and install ice&watershield on the roof deck and run it up the wall; Install step flashing and a 4"pvc board aproximately 2"above the roof. Replace all the soffits on the house. Onthe underside install continuous ventilaiton. UNDERILAYMENT L +45d?�5 FELT: Install 15 bb felt on all areas not coveted by ice and water shield. ICE AND WATER SHIELD: Install 6 feet of ice and water shield on eves and valleys.Install.as necessary on other areas. FLASKING The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA. 02-111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/JC+lectricians/Plumbers Applicant Information � p Please Print Le ibl Name 7(Business/Organization/Individual): V ,d"Q AL,� Address: �3 WA �, �� City/State/Zip: \C\ � Phone e ou an employer?Check the appropriate box: Type of project(required): 1 a employer with 4. ❑ I am a general contractor and I 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. 7• F1 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. ❑ We are a corporation and its officers have exercised their 10.❑Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑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.] *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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing wor kers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Y Policy#or Self-ins.Lic.#: I r Y >< n 1 coyo Sol _ Expiration Dt/ Job Site Address: '�� L,*(—C,`l J 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 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. that the information rovided above is true and correct. d 2e c e ains and enalties o er•'u p X o Z reb certify under th .fP 1 r7' .f y .fy P P _ Simature: Date: ���1 0 Phone#: _ 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#: