Loading...
HomeMy WebLinkAboutBuilding Permit #166 - 1600 OSGOOD STREET 8/30/2007 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received U Date Issued: /07 I IMPORTANT: Applicant must complete all items on this page LbcATIO:N Pnnt al 91, "PROPERTY OWNER mu P MAP NO' PAROL: ZONING DISTRICT - Historic'rk District yes no7 nMachie Shop Village yes no TYPE OF IMPROVEME.NT PROPOSED USE Residential Non- Residential 0 New Building 0 One family 0 Industrial 0 Addition 0 Two or more family [I Alteration No. of units: Q Commercial EoRepair, replacement El Assessory Bldg 0 Others: 0 Demolition 0 Other Septic bw .Oo,dp a4n: t�d'District W attic/Sewer cl, DE�SRIPTION OF OR�KTO BE REFORMED: en 4-N Identification 7 Please ;Aype Print Clearly ,/,/ , �/ OWNER: Name: lZc�0 Lrjv�kc !22= Phone: Address: 7, 777- 7 Name ', -)P -Phone: 'CONTRACTLf, Ad r.ss lk q q perm bp EL atp: st H license, Om, imppy6my nt . ............. ARCHITECT/ENGINEER Phone: 2 Address: Reg. No. FEE SCHEDULE:BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASJD ON$125.00 PER S.F. Total Project Cost: $ !g5-eeC-420 FEE: $— Check No.: ,� Receipt No.: L NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 7 n'tractor nature of Agent/Own Si -e Si, tur 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 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 Located at 384 Osgood Street FIRE DEPARTMENT :.Temp Dum s r on site . p yes no Located at 124 MainStreet: ; .Fire Department signature%date con��l�NTs -� z a 9-15 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/Crossectlon/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 II o 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 Location 16 00 Osa -a,-A' S—lq�.W-91 No. �24-- / Date d 7 &ORT" TOWN OF NORTH ANDOVER G oL F 2 Certificate of Occupancy $ sAc►,us Buildingi..Frame Permit Fee $ 6 Foundat' n Permit Fee $ Other Permit Fee $ TOTAL $ 76,7f;' Check # 20551 Building Inspector NORTii Town of No. Ra 1 p Act -_ dover, Mass., T 0 -- LAKE COC.'C.e.CK V S RATED P'?? BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �2rf/ Gr BUILDING INSPECTOR THIS CERTIFIES THAT...AK(9...........(.� .� �f� ..........�........g.� �/l /��. ./) �C Foundation has permission to erect........................................ buildings on �� ,S' ..�/ .. ? `. ...f Rough 6............. � �... Rou to be occupied as .... ... him p� ... !��.:. l`."?%2 ..-.,ld✓ ... ✓'G,t�Sc�/r3�........................... 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. Roush Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONITS Rough ........................... ........... .............................. sem BUILDING INS 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. ✓fie �ai�v�izo�zc«eu�C�p�./l2ivaelld BOARD OF 161WING REGULATIONS. License: CONSTRUCTION SUPER1.VISQR 4 Number.-CS 048040 i Birth2911'955 ;Facpires: 1012912007 Tr.no: 805.3.0 i Restricted:; 00 , TADEU.SZ Do GIEERT 175 BRADY AVE SALEM, :NH 03079 Commissioner Mar 06 07 12:48p 6038900192 P•1 ftU t.i!fYV t sa•.ry ♦w— �►.....����-� p��1100tY�t AC y UM8UWCE M. MRTFICA OF2 MLy An myr OR sum "a 13C- ALMM THE :068 0,4mom s"MT MM AUDOVM D8. 01545 ! &i81jw Cc Y 178- 7 cw Co-, M- sWAN cl 8 =ORS PATS Ma AvoWRR, UK 01810 e AM Eooud� r + °B�oact wnxn+e °fsuac+ Aw °uwm �q°iauoc�l .n asrn s ■ s —SID.-008 UMILM CLOWN" =Q/Z6lOQ �/��� asa►+� s 0 'Cp006437 s 2 ��e0yr�vrAoo em *ELwa M"Ax lOL�'f ' S J1RrtA= i ALOY1AEDAnvs MU!'1'D WOfa - ypO.0y�g1P6S OMAR6E 3 f N��O�Y• s fA1CC = ' gROONj.�: JIQG S NKJ�ViO EIfCH S �lgislLlfY 1 COMA Q cuwdwxm a �— s s oFre�no+E s F.L. t a BQO.OQG_ a+Pt� t+esaisr _000.�► a Soo D D=70393g 10/26/06 10!2610? -VO=UWI s soo Oo MAR o �oc a +�u�on6tva�eG+o�gA6 • GO —8 —0 �nraR ws�ren Pmjc slwcAwcuA owspm* G �101� no wy IO oars vmrm We tom.>� v�u �,� �rootosNitSi Ytn' TOas90a1Ku oz" �+RpP8RIT85 aF pan wao uro�+r+e« as�M 2.600 ose= ST g R, HL 01845 @J� iN�i19s8 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 't To www.mass-gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Al2plicant Information Please Print Legibly r Name(l3usincws/Organirationllndividuat): ( _tom.• �- Address: City/State/Zip: L,,(,.o 1-7k5;770Gr fl L�Phone#: 3 Are you an employer?Check the appropriate box: Type of project(required): 1.R��am a employer with (-9 4..❑ 1 am a general contractor and 1 6_ ❑New construction employees(full and/or part-time),* have hired the sub-contractors. 2.0 I am a sole proprietor or partner- listed on the attached sheet t 7 emodeting ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers'comp.insurance. g, ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ t am a homeowner doing all work right of exemption per MGL I t.❑ Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees.[No workers13.❑Other comp.insurance required.] :Any applicant that checks box#1 must also fill 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.pulicy 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: LZr• ✓` w� Policy#or Self-ins. Lic.#: 7D Q 32 9 Expiration Date: © 0 Job Site Address: 140,0 City/State/Zip: 91,6 B E - .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 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. 1 do hereby certify under the pains and penalties oLpedury that the information provided above is true and r Signature: Date: � � Phone It: t1 7� (�`—7 2--2 2-=, Oficial 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#: f L..