Loading...
HomeMy WebLinkAboutBuilding Permit #210 - 1600 OSGOOD STREET 9/18/2007 tkORTH BUILDING PERMIT ° <t`eO "o TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: ��� Date Received °RAT!° ��SSACHUS�t Date Issued: IMPORTANT:Applicant must complete all items on this page C t,77 LflCAT1C3N 1 flTlt Y PROPER Y W OER n ZflI z AP Nf3 PARI�L ING,C3ISTRICTIit�rtc D�srtct MW des no b Wh .� a � ,� � � 1Naclarne Slop Village �yes no ��k a ,,.ted. a f� sG_- �, *xis, XY, .u, � •3 sH.?^. - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition El Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ` FioodplAin 'Wetlands Watershed D�stndt Seit�c Cl Welf f h k llil.ater�Sewr„ w. . , .. F. DESCRIPTION OF WORK TOB, PREFORMED: �J .t , YC f � Identification Pleas Typo r Print Clearly OWNER: Name: f C a Phone: Address: _6c S °� t Yr d 3 S 9 � � CCONTRACTtR NamePhone ` Supervisor's C©nstuct�or ,Ltcense Exp Date`h fG Hcarre lmprouerient License Exp: Date ARCHITECT/ENGINEER ��jL_� Phone: kQ—if q��--- Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 4-P Total Project Cost: $ FEE: $ Check No.: Receipt No.: :;2 O 4 of NOTE: Persons contracting '/1 unregistered contractors do not have access to the guaranty fund Signature of AgentlOwneSignature o#.contractor �� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ . ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS bning 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 Located at 384 Osgood Street fIRE'DfPARTMENT Temp Durxrpsteo i site ye' ;Located at 124 Majn street, m � re-Ds- pal ndn inature/date. COMMENTS -7-77777777 777 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) ❑ Notified for pickup - Date ........................................__......................................................................................._......................................................................._........................................... ........ Doc.Building Permit Revised 2007 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) j ❑ 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 Doe: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location A r No. ��V Date NORT" TOWN OF NORTH ANDOVER T?O�,f`•o I•,hOOL • ; ; Certificate of Occupancy $ �'�s''^°•t�� Building/Frame Permit Fee $ MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y� Check # �_ 2 0 6 L "di uilding Inspector NORTH Town of Andover 1l `L�— K O dover, Mass., T 0 LA /`. COC Ho ME WICK 7�ADRATED PC:) `S V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System C) 6 ,�� BUILDING INSPECTOR THIS CERTIFIES THAT......../ .d........ 1Y.0.0.4e ......... . .�....(.r. .. . .. . .....1/..�..../�.�............... Foundation has permission to ere ' g ` ....................................... buildings on �,�.��......r�r�r.`.®�±. ....... ......... ...../.�.....��.�..� Rough 1 to be occupied as. ...... . �,}....... Chimney L..!�i.� .. ..!1^.................................................................................................. provided that the person acce� 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 UNLESS CONSTRtJCTI STAR ELECTRICAL INSPECTOR Rough Service BUIL G 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. Town of North Andover E ooRTH q Building Department � 4� �._eO ° 6 ` . ::, r O L 1600 Osgood Street Building 20, Suite 2-36 L North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 , sS�CHVs� DEMOLITION OF BUILDING AFFIDAVIT DATE r 0 OWNER' NAME &ADDRESS _ 1 LOCATION OF PROPERTY TO DEMOLISH DESCRIPTI Naz �- CONTRACTOR'S NAME &ADDRESS ` DEPARTMENT SIGN-OFFS DEPT. OF PUBLIC WORKS - WATER: SEWER: / GAS- ELECTRIC TELEPHONE T CABLE TAXES POLICE FIRE U EXTERMINATOR DUMPSTER-ON OFF TREET DIG SAFE NUMBER ,- J-O Z .J &9 DATE RECD l/ BLDG. INSPECTOR Building of Building Affidavit revised 8.2006 ✓�te v�omv�iao9uuPa� j&jad BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 048040 Birthdate: l.0) 9Wi955 Expires. 10129/2007 Tr.no: 8053:0 — —Restricted 00 TADEUSZ DOWGIEERT 175.BRADY AVE SALEM, 'NH 03079 Commissioner I The Commonwealth of Massachusetts s Department of Industrial Accidents Office of Investigations ==t;u 600 Washington Street "s f' Boston,JVA 02111 www.massS ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciandPlumbers Applicant information Please Print Legibiv r Name(liusinessfOrganinition/lndiviidunl): ag C f g2k -e—, Address: City/State/Zip: e t,J fk 1, z4 ,Phone Are you an employer?Check the appropriate box: Type of project(required): 1.R��am a employer with lD 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.t 7. emo�ling ship and have no employees These subcontractors 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 required.] officers have a cercisW their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work tight of exemption per MGL 1 I.[]Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]d.]t employees.[No workers' 13.[]Other comp.insurance required.] + ing Any applicant that checks box g 1 must also fill out the section below showWeir workers comps isation policy infoniuition. Homeowners who submit this affidavit indicating they ale doing all work and then hire outside contractors mist submitit new affidavit indicating such. Contractors that check this bait most attadrod an additional sheet chewing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is proving workers'conVensaten insurance for my employees Below is the porcy and job site information. Insurance Company Name: jc� Policy#or Self-ins.Lie.#: 7D O W a 9 3 �n Expiration Dane: .lob Site Address: t9 � 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern under the pains and penalties o rjury that the information provided above is true and rn.�••• - r Signature: -2 Date: Phone It: - - --- " Official use only. Do not write in this area,to be completed by city or town official City or Town: PermiNLicense# issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 Mar 06 07 12:48p 6038900192 p,1 , Yl/1Vl iYVf •.a�w •gar �.�...��--�-- .ACM.. CER'T1FlCATE OF LlAl3RJTY INSURANCE 1 2 1rip.t a"WAW.18 i6StiED AS A 1AA gO�S 3WWU AGO= u4c.mum any 1 e�►iE ODES � PaLms a , Ab'[ER 7lI�OOYEitA6�e ME 1050 046100® STB �g AxOVm M& 01645 WOUNME ='N4 we W -. a Q 8 11 m i r I PARK NUMB* �OvBR, 10► 01810 x �' R a C011naYc�d!oniei 00N wn, 'W�t T"�wr BE 90 oa +o�resoF+ s� a'� tro a wrt�eo �otEt �t�c.�rpe�ao0s�o�a►�a�orw�sAD aR :Clmgxnm lrl7 P T�iE R 7lIE P011G�6 0 � TO AL im R1118.E tt S AND CON1ItrnllS OF 8 �(,/��f�WN#fArili►VE�M11�1If�ED�iNQ�iIA�b' LM11`i lOL�7. MI1� Tw • ae�t.uealry s 50.004 -DCAMWOE CE ocuw CpP006443? 10/26/06 10/26/07 • 0 a Z b s-ea�eoo s 0 Q LLM.rWpa�►T6 uff A� ra�cr PER aoc #ArMM K&L#Baar oLatNtrur s AMA= AUOWN pAVM ow _ GODLYPUMV nomDAU�sqcmsmxwAUTw s MQ1t0Y1 � 0 A1fi00Nt.7-6►�� s _.�.� CANA96UASLMY pi p7XAa iA11 a xrrwvro wroOeuT-. AOti s amu'iVALnP eowa�t" s cavR 0 a s p�lICn11tE 6 1lEf61nOw L y pVLN"ONANO e�fJ►u� a Sao 49 g��,pTgit'UMRRY D sortexuew+ v=703930 10/26/06 10125/07 Ea as E-ooue+►ue s SODS d a�R VdEm— p�IPT10MCF aa�116 NBSCc6if.MCtL9ON6A�C� Lim. 4 -B -0 CER7IFIGTE snoYtD+�aRt►t?weavao Pouae�K Caa�tm�TMeooru�+ oR+E +ssu�ae RwLle+ce+woaTOwa10 yrsWFMENN 058Y pgpP$R>ETBS ao=.Ml e e ala'"*L M Oft FMAMTo 00 50 GUOU 1fi00 VAOP*soPD ST she no cuivalm OR LOOLM OF ear w o uron IM M IUiWM*A ,my mmovm, !al 01845 m"'tie eAt:ORD GORPORItT10N1616 Iit�DAD25(2001(D81