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Home My WebLink AboutBuilding Permit #339 - 171 AMBERVILLE ROAD 10/31/2007 ORT#t BUILDING PERMIT TOWN OF NORTH ANDOVER 0 Ad APPLICATION FOR PLAN EXAMINATION R� 4' Permit NO: 3 Date Received Date Issued: /e e17 C144u IMPORTANT:Applicant must complete all items on this page Snr` t "J" 0C K`11.-�'V 311�'�� A A ON' '4 -P M W N�' iq, 2, -ERTTY, 4D NEWR----� e R ROR t , TYPE OF IMPROVEMENT PROPOSED USE .,-Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others:' Demolition Other -w it dt Ic W. --b 0 `2 N� t d --.0billipa- , -, ;e a,n -e ;R dd DESCPIRTION OF WORK TO BE PREFORMED- /a Identification Please Type or Print Clearly) OWNER: Name: R *Q4>,2V6 C-ORO—Z!1AD J Phone: �-rV Address: -E� 0'R 4tN IRM�_O, �Z �T—ONTRAC -Addt' 4 x g � License - De " ' %so b A,�ij I -H _p 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: FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 2! - 2�� t V he Signature ; ,_W ,, :� `�� ,Signature atufgbi -contractor.......... Location 12114 IN 46o�e a/ No. Date O 3 O� NORTFTOWN OF NORTH ANDOVER • i ; . Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ v �SSAcwusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20752 Bui ding Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Wel] 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 & DEVEL,OPMENT � COMMENTS fAAA � / �.�.�►� .�.!lja.�cw..aG�li DA EJECTED DATE APPROVED CONSERVATION COMMENTS I DATE REJECTED DATE APPROVED HEAUH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water 8, Sewer Connection/Sic nature &Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENTS Temp Dempster onsite yes Located at 124�{atr'Street-. ti no Fire>Departmert signs#ureldate C011MElVTS �`" 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 �&At ❑ Notified foricku Date P P - V 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) ❑ 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 DEPARTMENTMFORM07 Revised 2.2007 oven "W ` � n oAndover o dover, Mass., & oLAKE COCK ICMEWICK ST RATED BOARD OF HEALTH 7 Food/Kitclien Septic System PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT............. .. ..:..... l :.`' (.. .H.: F................................................................................................... Foundation has permission to erect...................................... . buildings � � .......................... Rough t0 be occupied as..........................�t�.��CT�;�.......�...��...'':�.�,��'....'�/F.�,,9.��................/�.....Y...��..® 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. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS 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. I o Klyt r s.e' cLus ITY i4p, RECEIVED \; WCS MULCH �FiP` % �; - 4e, \\ OCT 2 7 2004 N cDr v�MANDOTION Isslo» e ✓rp � \ F,Q��09 \� _ -----•--- ---- NOTES: TREE q i� �� 1. THE D.E.P. FILE NUMBER FOR THE SITE IS �2', 242-885. WCS OULDER, '3'F 2. THIS PLAN REFLECTS GRADING AND WORK DONE ON THE LOT'AS OF 10/25/04. ------ ANY WORK DONE AFTER THIS DATE IS NOT 170 6.21 s.> /� REFLECTED. ' 66 .,LAMP'3' / \\ 3. THE LOCATION OF EXISTING PIPES, \ t \ �0(r MAIL CONDUITS, AND OTHER UNDERGROUND \ \� (1y30UR 6d — �` �� S 80X / t UTILITIES ARE NOT WARRANTED TO BE CORRECT AND ARE SHOWN BASED ON CONTRACTORS RECORDS, BITS 00, I �� o GRAVEL INFORMATION AVAILABLE AT THE TOWN \ \ \ \ \ CONC\ q \ \ / i �. ENGINEERING.DEPARTMENT, AND THE BEST RIVE Q TREE APPROXIMATION OF THE ACTUAL LOCATION \ p�ql�. \ p C �; '�� 2 \ p FROM A FIELD SURVEY. \ S' -.-f TTS \ �j\ G ' 4. CONTRACTORS SHALL VERIFY ALL FCS >>p� LOT 2• UNDERGROUND UTILITIES, CONDUITS, PIPES, 122,52 S.F. \ \ /K O i ETC, AND NOTIFY DIGSAFE PRIOR TO ANY \\ �• \ y Op�a \ EXCAVATIONS. \ .0 0.28 Ac. ^� L�• _� _ \ 2 146\ Y � c04,�sT \ \ o`v — .ate CO�o �' \\\\\ \ 17.1'ap00p� ``-_ZO CO -0- J `\ ZsoFcP�i `26.4Wc' - AS-BUILT SITE PLAN \ 4s• S \ \ \ e ® 10 - � MAIL LOT 27-FOREST VIEW ESTATES \ R�' 60.1' 55.1 �•. X61 o` LAMP BOX \ \51.9 �•, \W 6 \ ,� `� , p\ IN NORTH ANDOVER, MA \ \\ �BFQ P C ql F 53.9' Pn6rA8r ; 9�1�\ \\ \\ �j0 J � `' PREPARED FM, HOMES OF NEW ENGLAND,LLC SQ r' l �.^\ \ Fc" `s •'" \ '� �- 115 FLANDERS ROAD \L) \ \> d\ \ r �- �'� \ WESTBORO. MASSACHUSETTS 01581 +\A : P ` ° �;aFc� LOT 26 MarchiondaP \ \ ? \ 11645 S.F, 20 10 0 20 \ S, '•_ \ \ 0.27 Ac, `\\ 62 MONNALE�AVSME I�� STONEHAM,MAort6o DATE: 10 25 04 H:\PRO.ECTS\487-38\CONCOM\ASSUILT\LOTS2$-2H.DWC Pel)4386t21 FAX:(791)438-9654 $CALF' 1"=20 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: �L� is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws:Chapter 148 Section I OA. The debris will be disposed.of in: (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date the uummonweuttn uJ lvlassacnusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: A `f✓ City/State/Zip: 1 04�'(W fs r Phone #: Are you an employer? Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction ployees(full and/or part-time).* have hired the sub-contractors Remodeling 2. . I 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. 9. ❑ Building addition [No workers' comp. insurance 5. [1 We are a corporation and its officers have exercised their 10.E] 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' comp. insurance required.] 13.❑ Other *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. :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: Policy #or Self-ins. Lic.#: Expiration Date: 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 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 certify under the ins and penalties of perjury that the information provided above is true and correct. Si nature: Date: /V 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#: r m toard of Building Regulations and Standards Construction Supervisor License w License yCS 75045 Birthdate _ 6(18/1956 IEzpiFaUon 6%118%2008 Tr# 15828 f d Restriction STEVEN M. BROSSEAU 4 ANTHONY RD I NREADING,MA 01864 Commissioner ✓!ze Vo��reoaxcvea,L�li r�,�� Board of Building Regulations and Standards - HOME IMPROVEMENT CONTRACTOR Registration: 133858 a. Expiration: 8/20/2009 Tr# 132838 1 . Type.: Individual STEVEN M.13ROSSEAU STEVEN BROSSEAU 4 ANTHONY RD. N.READING,MA 01864 " Administrator :,rt --4l0HD0ao .SS0CIATES 731 438 96754 AMBERVILLE ROAD 3.4e. ol 26 26.3' 26.2' -32500 21.2' EXISTING FOUNDA'nQN TOP ELEV.w 171' 20'8' zpEcrl 26 0,27 Ac. (I 2B AC, LOT 27 12252 S.F. 60.1, 0.28 Ac. N46'O9'4,`W xy. N 46"08'41 W 24 WE HERESY CERTIFY I-HAI WF44^, 3, irrr_msL.3 m4u irtAt iric OUILUll'90 PLAN i5 INTENDED FOR ZONING ASm SHOWN.nTHE STRUCTURE SHOWN CONI'L-jORMS U ! JLY ;T +A)AC PP.r_PAP.r_b T6 Tl!r_ -ILANS AND RLr_'QR.O5 Rf' C7TING ,' THE MUNICIPALITY WHEN CONSTRUCTED. 41�0, AC(- )I'IC SHOWN LOCATED TO THE F.E.M.A./H.U.1), FLOOD INSURANCE PATF r,, mSTPUMENT SUPVEY, THIS PLAN COMMUNITY PANEL NO, 250098 0015 C it -H-OULD NilJ-T BE USED FOR PROPERTY DATED 6/2/1993 , THE STRuCTIAE IS NOT LOCATTA) IN AN ESTABLISHED 100 YR.FLOOD HAZARD 70NE. 19 MA R TIFF'Ewa D FOUNDATION PLAN ( TES 7 -) F VIEW ESTA MARCHIONDA & ASS ANC"OVER, MA :I- TH' ENGINEERING AND PLANNING CONSIJLIANT�'� P]'ERAREQ FOR 62 MONTVALE AVE- SUITE NEW ENGLAND, L.L.C. STONEHAM, IMA, 02180 t RAD �(j177. 200 (781) 438-6121 , �j SCALE: 1 30' DA 7. MA 01772 IL IZ PD WT- - t