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Home My WebLink AboutBuilding Permit #114 - 174 SANDRA LANE 8/13/2008 BUILDING PERMITo* "O oT f qti TOWN OF NORTH ANDOVER ~ yt' a•670 O APPLICATION FOR PLAN EXAMINATION eh t Permit NO: / Date Received °9q��-'c.e�w, > 4 ��SSACHUS y Date Issued: LI o IMPORTANT:Applicant must complete all items on this page LOCATION / 7'Y 5 /41)ae PROPERTY OWNER MART�" � .jqxan 1- Print MAP NO: /0 PARCEL: C ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Ch /P/IYL 4- u//rA Identification Please Type or Print Clearly OWNER: Name: a12 /1 6,0 Ao JY L'' Phone: Address: /7 41 __S-fAiY,41Fl`J, L.,14hl Zf /y® 14/Y, UGR M7f4- �CONTRACTOR Name: / Address: '6� fl e-ig)S 11,yl Supervisor's Construction License: -Z- Exp. Date: -3 Home Improvement Licenser Exp. Date: 7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PggmIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ yv�lJ FEE: off, 1 S Check No.: �O �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ature of Agent/Owner Signature of contractor � ' Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools I 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 DPW Town Engineer: Signature: Locate s ood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street, Fire Department signature/date COMMENTS 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 2008 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 2.2008 1� V%OR TMJ Town of Andover 0 No. y o. dover, Mass,eflIsl e T O LAKE COCHICHEWICK V X1,95°"�A re o BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ILD INSPECTOR BU ING THIS CERTIFIES THAT A/o.^...1...F.......� 4. `� � .. .......................................:..........:......................................... Foundation ��a/t/C�rc; �,G% has permission to erect........................................ buildings on .y...........................................A1 :........................... Rough r :... .............................................. Chimney to be occupied as.............................lh. ...y..�...... l..G'.<.:�:�.,.... .. . .. . � provided that the person accepting this permit shall in every respect c for to the f"erms 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 CONSTRUCTI TARTS Rough ........ . . ...... ....G` ............................:.............. Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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. Propool Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted To: Job Name Job# GCJ Address 1 /7q / f Job Location# Date 4 Date of Plans .eiCKt Phone# F6x# Architect We hereby submit specifications and estimates for:.........................._._......,_....................................__..._..._..........._.._........_......_......_..._...__............._..... _............__..._........._..._.._......._..._'_......l._._.._......_._..............._....................._........._........._.................................... ( f/ .._ -�' ......_.._.._._...._......_._...... ._ ! ......._f...............Gy ._......__..`�._.._._,. . ............__.........__.............. ...................... ___ ✓ Ltd�_...�i��''LTt4-�t/ - .. __....... . ...__ __............... ........ ..... �..1- , - -._._._...._ ._.. ..........__......................... -. , - . ., .�.� ....... � _ ...._ .c�-l-6_... ...... _ _ _------._._.._______._.______ _. . . ------------ ___ _-------. r_ ., - ............_. ........................._,. :..........._ ��................., ......... .. _.c,�-�.�_ -- -- _ ._.._........_.._...._._.........._........_....._._._..___....... _.. ... .. ... .. We propose hereby to urnish material and labor—complete in accordance with the above specifications for the sum of: '� 0 �ES��, Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully �(N� executed only upon written order,and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. 01cceptance of joropool # _ The above prices,specifications and conditions are satisfactory andare Signature I/ l fit f V/� hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature 600 !3'ashington Street r` Boston, MA 02111 w wn�.�.tncass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information PIPACP Print T otribi�r Name(Business/Organiza6on/Individual): Address: \5 ASP Pel% City/State/Zip: O �/7/D 01/�/Z /k/#Phone A:_ 'I�7�" 60f - 6 737 Are you an employer?Check the appropriate bo 1.❑ I am a employer with ' 4. I am a general contractor and IF7. e of project(required): employees(full and/or part-rime),* have hired the sub-contractors ❑New onstruction 2.0 I am a sole proprietor or partner- listed on the attached sheet.' Eafemodeling ship and have no employees These sub-contractors have g, (�Demolition working for me in any capacity, employees and have workers' [No workers' comp.insurance comp, insurance.: ' 9• BuilG Mg.addition , required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised.their I I.t]plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL insurance required.]t c. 152, §1(4), and we have no 12.0 Roof repairs 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 affidavit indicating such. 'Contractors that checl:this box must attached an additional sheet showing the narne of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance,for my information. employees. Below,is the policy and job site - Insurance Company Name: P)CP 6/# S Policy#or Self-ins.Lic. #: 70 Expiration Date. Job Site Address: `� �i(/,Q � `� City/State/Zip: D Attach a copy of the workers' compensation policy declarationa e(showing F g ( owing the policy number and expiration date). Failure to secure coverake 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 5250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investieations of the DIA for insurance coveraze verification, Ido hereby certify tder the pains-andpenalties of perjury that the information provided above is true and correct Siertature: � G��%�f Date c Q � Phone Fhe only. Do not write in this area, to be completed by city or town of/ieiat n: Perntit/License# thority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: ✓lre rD0�17z�Yeoozlu� ovG!'�aY.lactiu6P,ltt6 Board of Building Regulatio s and Standards _ HOME IMPROVEMENT CONTRACTOR Registration: 103358 Expiration: 7/7/2010 Tr# 271352 Type: Private Corporation A.J.WALSH&SONS,WC. Arthur Walsh,Jr, 55 Pleasant St N Andover,MA 01845 Administrator ♦la�•achu•cit.- Dctuu-tmcnt of Public �afct� Board of Building- ke,',ulations and Standard., Construction Supervisor License License: CS 22680 Restricted to: 00 ARTHUR J WALSH JR 55 PLEASANT ST N ANDOVER, MA 01845 Expiration: 6/9/2010 ( i��uii..ivur Trt: 27002 Location /7V No. /��/ Date MORTM TOWN OF NORTH ANDOVER IO. 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ — sncNuse 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t. Check # Af - 2 I 2 Building Inspector