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HomeMy WebLinkAboutBuilding Permit #678 - 1600 OSGOOD STREET 4/23/2007 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER N i ri APPLICATION FOR PLAN EXAMINATION * ; y Permit NO: Date Received l? V D"" 9SSACNU`��� Date Issued: • �6 i IMPORTANT: Applicant must complete all items on this page Fk � 00 ,� .mac .. §s v ''�•! 60}. "�r s� � ". ' ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial &APteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other #tet4 $, "fir �` $ N uwr F. ... r DESCRI TION OF ORK TO BE PREF RMED LOLL�o Identification Please Type or Print Clearly) OWNER: Name: D p d L/�L Phone: 7tg Address: x ddreI�A4 X v q Si, ,. Tn [tri Jqe •pe 1, '..¢ pRl �/rtrey , "n ,yW.. lu 'l''4 - .pj •. 3 '{' 4' '+ � T ", i- 414r { 91 ARCHITECT/ENGINEER Phone: '" S _� Address: ,,,, 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: $ V610 FEE: $ �V Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 4r SI nafure A e C7ivwne w. Si" nature of co ©r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer fl,, r ;� ❑� Tanning/Massage/Body Art ❑ Swimming Pool's . i .❑ Well ❑ ' Tobacco Sales ❑ Food Pack* i4SZales' , 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Conngction/Signature& Date Driveway Permit Located at 384 OsgoodrStwe( FIREflP MI Temp IumFste o sloe ;YQ ' i,'OC-titd� tq Ire,Lepd ..4 _ MWr a .16 :w s yr �.m... .i Yo-,- K . 0 Dimension jr �9 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 nt use i i -I ❑ Notified for pickup - Date .................................................._._................................................................................................................................................................................................................................................................._.......... .__......................................................................... Doc.Building Permit Revised 2007 _ _ r J 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 ❑ 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 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 submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Locationy Zl /G No. Date /L? . NORT1y TOWN OF NORTH ANDOVER 9 � y � • i ; , Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ �-- s.+cHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 201 Building Inspector i ,;/fie T�omv»zonuueaGut a�✓'�4a"�ir�-� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR jimpo"aNumber:.CS Am 048040 Birthdate: 1012911955 Expires: 10/2912007 Tr.no: 8053.0 Restricted•. 00 TAD EUSZ DOWGIEERT 175 BRADY 03079 A VE SALEM, Commissioner I Mar 06 07 12:48p 6038900192 p.1 SLC •• CERTIFICATE QF LIABILITY INSURANCE 1 20 Zm CERflWAm 0 AS A mutTm OF lWrAAnON PaoOu� ONLY AND ODWWW NO i WIM UPON 7!E CER7iaCA n ND mv. TS INSDRi�1RCE 11GB C'1 INC. HOLDER. TNN; CeRT6'{C�►�A iDED e7-ME Po ES t= AAAMEMun,mS HIED. 1060 ommm STU" ALTER THIS tiD= pjWOVM MR 01845 MAt s Ia.forA6 cam NAICit untow DOW IEW 1;;Msllf=i'Im I=., scare- aa�e� srio�os� e�u�. i� nos w w Eueu�a e: 8 �6E 8AR1t figum C! 1►liDovSR, 1�► 01810 eQo a TME �Fim7�HEtAWiIAYFIm 4laP�ItCT�IOCmFMTEWYE�O AW ReQ<aR9a�V M 0R CONOirNO W THE POLIID"Opp NERM ISS St1SiECT TO/ILL T1tE YEaI .EXCI USIdNS AND L`ONDRIONS OF SUCH mymaw�yAREtiA Eta/TSS110WNifMfWU1C�11VMUCED6YVA�t LaitT'6 PaLR'Yi MUM oowoer�uaakmr wmDOw� ana«.«u s 0 W. ®oaw 07 +"cv"a" 06437 0/26/0610/26/ CpP0s• 000 a 00,000 n�0ouc5rs-ttoP Ae0 a 1 O i Poax r we CINAIMM MMMUwr a - �,rrarosaeuAeaar waxll�nq _�...__ ' NlrAUfO ALLOWNEDAUM .:■gam _ — WME°ua°tyros . ILY naa�DAvras s wowaw�wa�s vat s ... - auraoN�.-aAccoEN* s GARAGE LIAZAA Y EAACC a ot�anuu�t �wvralio wtRooN�r. AM i EAC"OCCssatENCF a eDCEasneMewxu►av�saarr A08REti1►� s axOa 0 aAMASWO e a ,_ s oEOucnatE a rCOMFFJVYIiltI0NAN0 E,LEAp1ACC10ENt a30�9 e�wtarza�w�snm �pC703930 10/26/06 10126/07 C'-a -a a 500.00E x o.�. F-L.0eWsE-vouCvtw a 500 00 oma+ pE P71pNRFOPBtAnOtiS/lOCA1�DNEJVE lES►pIClU8anmom WOOD livwftFACV-som • 6 –8 – CERTffICATE p A1W oFTNE�eovEOESO�pattpeees CAtIQE�ICC aEr�t►E esr�wmoe� We s"Map.TW iasuaw.asunEa W"fpOEAvon nD wa 10 ars VYFMFx orgy pRppmTEs ter eur ouan "0090 41ML 3.600 40S600D ST of=no oeueAYM 06 UAWTV OF ANY WO W"Tn!"EUN'K f S"IMS Ck gg� AlWCV2R, ISA 01845 Arm— kltNoamo narmwew,,^— gACC==WORATRM'lV= �ozsttoosme� 4s� The Commonwealth of Massachusetts Department of Industrial Accidents n Office of Investigations 600 Washington Street Boston,MA 02111 f ►� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl 7/7 Name(13usincss/Organir;ttion/Individual): -7 IL tl� Address: IE:ts C. S City/State/Zip: ."o f���Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.R��am a employer with, c!�) 4• ❑ 1 am a general contractor and[ * have hired the sub-contractors 6. ❑New construction employees(full and/orpart-time). 7. emodeling 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. q• E] Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its r10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 Ln Plumbing repairs or additions myself. o workerscomp. c. 152,§1(4) and we have no Y M ' P � 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp. insurance required.] `Any applicant that checks box#I must also till 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 of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: r ✓` tU� Policy#or Self-ins. Lic.#: r t0 "2 9 36 Expiration Date: Job Site Address: © , �` Ci /State/Zi tY P ��I, Lc E ..._ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). T � 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 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. I do liereby cercfy under the pains anl e_ a tes o erjury that the information provided above is true and correct. r Si nature: Date: Phone U: q 7Zl5� 7 2-9- 2, Ojficlnl use only. Do not write in this area,to he 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#: IAORTH Town of _ over AA = dover, Mass., 112 COC1L4EWICK y1. 7�AoRATED `r BOARD OF HEALTH Food/Kitchen PERMIT T Septic System �` • BUILDING INSPECTOR THIS CERTIFIES THATQ � q.0-0.0e r...........� n.........,7�— ... ( ........... d.7. ..�... Foundationanon has permission to erect........... on......10....jo.......c . Ajlt ............. Rough to be occupied as...........&V....r&04..L- �?i.fi.. ...... .......................................................................................... Chimney ............ provided that the person accepting this permit shall in ev 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 Find PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU ST S ELECTRICAL INSPECTOR Rough .. Service T.................................... . ...................... 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.