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Home My WebLink AboutBuilding Permit #039 - 163 CANDLESTICK ROAD 7/16/2008 BUILDING PERMIT NORT►� O�tt�eo '6� • �O TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION n O 1- 9 ' •V Permit NO: ✓ Date Received Sys R,r„'p��y SACHU Date Issued: /6 PORTANT: Applicant must complete all items on this page IM pp i p LOCATION e f 'c k Print PROPERTY-OWNER To hL y t / C Print- MAP N0: /04.4 PARCEL; - /.L ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne famiI Addition wo or more family Industrial e0Ktera i No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other f , t:Septic;n V1Lell Floodplain Wetlands. Vllatershed District” ^ •Water/Sewer RDESCRIPTION OF WORK TO BE PREFORMED: / ,'g--A a 6a � 11 Vjl Rep Io-LeMe I f LH�' �a�o e. _s 11 ✓ avens yla � ; � h .�A a4 ��t� s s Identification lease Type or Print Clearly)Name: 6 Phone. ?7Y - y7 y -2 ,;, OWNER. � o � ��- r Address: tg 3 cx I CONTRACTOR °Name:_ - o-.► _ /�?.�Co bone.. CO Address 5�6 fe_�a�ol.% ^�' QPM ✓:. '< Supervisor's Construction cense _� a 8 3 S. exp :Date:. y 7 a - - _ Home Improvement License ;Date ARCHITECT/ENGINEER 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: $ 1-1.3 oas. D o FEE: $ k!�7 7 Check No.: ,/1229 Receipt No.: 017,1331 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund J e� Signature of contractor'=p cam_'Q � aye r Si-"natureof A entlOwner� ,�� _ �• �, 0 i Location No. 3 Date 16 j NORTH TOWN OF NORTH ANDOVER ' certificate of Occupancy $ �',b•�^�•'��' Building/Frame Permit Fee $ ss�CHU Foundation Permit Fee $ —-- Other Permit Fee $ TOTAL $ Check # Z2�2 2 if 331 Build ng/inspector I Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL =Publicwer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales ' i Private(septic tank,etc. Permanent Dumpster on Site i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature F COMMENTS t f k E� I f HEALTH Reviewed on Signature COMMENTS I i E 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: Signature: Located -384 Osgood Street FIRE DEPARTMENT Te_mp Dempster onsite yes a no Located--at 124`Main Street A. .Eire Departme;ntsriafiure/date k Dimension I 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) I i I I I a i I ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 I Building Department artment 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 d 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 p 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 2.2008 Town NORTH of _ Ar- 0 . �` dover, Mass., O COC ICE WICK 7�S RATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT...............................................;. ...................................................................................................... oundation Alffiff has permission to erect........................................ uildings on .......°............. 6e ..... .. . 'r' �?. :. � � . L. � Rough to be occupied as......... C :......... °'6imney o. Via. ,... . provided that the person accepting this,,per it shall in every respect conform to the terms of the application on file in v'vr It-tn 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. I PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION1TARTS 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. DINO'S CONSTRUCTION H fNVOHCE 46 KENDALL POND RD DERRY, NH 03038 Phone 978-360-4179 INVOICE #[100] DATE: JULY 14, 2008 JOHN LYTHE 163 CANDLESTICK ROAD NORTH ANDOVER, MA 01845 978-687-8845 I I DESCRIPTION UNIT PRICE TOTAL CABINETRY—CUSTOMER PAID $14000.00 GRANITE COUNTERTOPS - PAID BY CUSTOMER 4300.00 7425.00 HARDWOOD FLOORS—THIS INCLUDES 3.25"MAPLE HARD WOOD FLOORING INSTALLED IN LIVING, DINING AND KITCHEN AREAS TOTAL COST MATERIAL AND LABOR IS 6.75 TIMES 1100 SQ FT DOORS AND WINDOWS—THIS INCLUDES 7 REPLACEMENT 8300.00 WINDOWS AND REPLACING 4 DOORS SAME SIZE AS EXISTING GENERAL LABOR AND MISCELLANEOUS MATERIALS 9000.00 y TOTAL DUE TO CONTRACTOR $24,725.00 SUBTOTAL 24725.00 SALES TAX 0 SHIPPING&HANDLING 0 TOTAL DUE 24725.00 oard o f Bpildi `��2a`��✓u*cella_�' i �'. Constructi n8 Replatloas A4d Standards $upervlsor LiCense 82835 010 Tr# 24087 DEAN MCCOMI 48 KEN DALI.p - f` DeRRY,NH 03 OND �o- 038 Coaunfasloper Cx Board wilding Rcgotations And Standards HOME'"OV Registr. `� EMENT CONTRACTOR aticn. 147818 �ilratJor; i 8/9/2009 rYpe 'QBq T►# 132959 DINO'S CONST DEANMCCO RUCTION r I MIS.,j .y 46 KEN DALL PpN` D "ERPF 'Y,NH 03038 Administrator I� i I ti ti Y reCnmmonwealdi of Massachusetts Department ofbidustrial Accidents Office of Investigations 600 Washington Street ' Boston,AM 02111 www.inass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El lectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiom4ndividual): Address: 6/4 e City/State/Zip: Oe f l- " /V H 030 3 Phone#: 7 8 Are you an employer? y Check the appropriate box; I.❑ I am a employer with 4. Q I am a general contractor and I Type of project(required): ployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2a a sole proprietor or partner- listed on the attached sheet 7. ( Remodeling 1rrr�111 ship and have no employees These sub-contractors have g. Demolition working for me in any capacity- employees and have workers' , • I [No workers comp.insurance comp.insurance.I 9- wilding addition required.] 5. 0 We are a'corporation and its 10.[j Electrical repairs or additions 3.0 I tun a homeowner doing all work officers have exercised their 11.0 plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no ��0 ltoofrepairs 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 o fidavit indicating such. tContractots that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Irthe sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding worlcers'compensation insurance for any employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: i Job Site Address: 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 WORD 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 certify under thepains andpenalties ofperjrtry that the information provided above is true and correct. Sitartature: Date. 7 / J L Phone#: 17 1 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): I.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: