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HomeMy WebLinkAboutBuilding Permit #56 - 179 COVENTRY LANE 7/21/2009 BUILDING PERMIT No DT 6�ti TOWN OF NORTH ANDOVER F2`° '`- "-*' ' °p APPLICATION FOR PLAN EXAMINATION j * Z Permit NO Date Received �,R"�q,..o v gSSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION it /Ml Print PROPERTY OWNER �C, Mc Print MAP NO d I� PARCEL: ZONING DISTRICT: Historic District yesno 7 Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alterations No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer D CRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: J&xAes N4receplf Phone Address: ';�11 c L-,CL con Al, I7 o_ 4 -' Supervisor's Construction License: 17( , ' Exp. Date; Home Improvement License: Exp. Date: ' /0 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: $ C,�/00 FEE: $ Check No.: `oe Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acc-e's' the guaranty fund ign�ature-of Agent/Owner �Tet Signature of_contractor a Location No. Date MaRTh TOWN OF NORTH ANDOVER � F Certificate of Occupancy $ Building/Frame Permit Fee $ �CNUS t� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 106 22t �: ,� Building Inspector I Plans Submitted Plans Waived Certified. Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Salesf 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 Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zduring 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 -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 ' i i 0 Notified for pickup - Date .............---- Doc.Building Permit Revised 2009 i 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 o 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) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o 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 Li 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:Building Permit Revised 2008 �s JAMES DEBRECENI 1008 DBA FAMILY ROOFING AND PAINTING 168 MAPLE ST. METHUEN,MA 01844 PAY 5-7515-110 DATE D TO THE ORD OF " s. -77 6� DOLLARS u F„.... Sovereign Bank®,r FOR -- - - ---------- -----"-P 118001008111 1:0 l LO 7 5 L 50I: L00 2 L 3 L 39 WO r NORTH 0" . o � _ 4 over . / 0 �� y`{ No. dower, Mass., a- • T O - LAKE COCMICKEWICK V ADRATED C2 `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ....! .............................. ..�. .. .. �.�........ .....:...................................... Foundation has permission to erect........................................ buildings on ...� .Q. ....C.o.. •... ......... ........... ............ Rough 40� so Chimne to be occupied as........f ....` ............ . . ............................................................................ y provided that the person accepting this permit shall in every respect form 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 CONSTR STARTS 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. ,tom �� Board of Building Regulations and Standards.. HOME IMPR_bVEMENT CONTRACTOR- Regist att n: 122385 E cpiration 8/26/2010 Tr# 274007 J&D WEATHERSEAL,1,17-9 iii JAMES DEBREGEt31 ' , f 2 TANAGERWAY\ `s,�� F..�•"�- . LONOOND'ERRY,NH 03053 Adak4,Istrator `. Depal-ilrlent of!'tjl)lic 7aFci t3u,tr.cl of Buifdit; Re��ulatiun, incl Stan-dr it.,} Y Construction Supervisor Specialty License a License: C9 SL 99685_ .Restricted+to: RF JAMES DEBRECENI .2 TANAGER-WAY . LONDONDERRY,.NH 03053, Expiration ~1216/2,611", ; f«ananissi+yne r Tr# 99685 � J • ``• \ The Commonwealth ofMassachusetts Deparbnent of Industrial Accidents ice of Investigations a 600 Mr Kington Street ti�o i Boston, MA 62111 c www-mssgov1dia . Workers$ Compensaifon lwhrance Affidavit: SuilderslCorsectricians/Piambe A p lieant Infflrmation. ontract /Eirs Please Print Legibi Name(Busjaws/drganization/lndividoal); tic• � Address: ✓` (� Citystate/Zip: /-C>4 Phone A,rree yo all employer?Check.the appropriate box: I•Ly I°am a employer with ❑4. 1 Type of project(regained): ffir► a genera!contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑'New coristrucNon . 2.F1 sip a sole proprietor..o partner_ listed on the attached sheet 7. Remodeling ship and have no employees' Tbese sc&COntractors have working for me in any capacity. workers' comp.insurance. $ Q Demolition [No workers'comp, itiMir ice . 5. we are a corporation and its 9• ❑Burnding addition required.] officers have exercised their I O•E Electrical] 3.❑ 1 am s homeowner doing all work right of rxeinption per MDL l 1. �ah oradditions myself [NO-workers'co []Plumbing repairs or additions insurance iced. t � aw 152, §1(4),'and-we have no N ]. employees. [No workeet' 12. 00f repairs 't+m3 apptic�mtsirer cOmP• insurancerequired.] I3.[].Other ctrccks hoz'!{l mutt ciao fill Dirt rite section below showing d1ir.workat'compeesetion policy information t Rome wbo submit this affidavit indicating th ars Goin an ;Contacmrs dw check this box reust g wm*and th=hie ouraide contactors rmiat submit a new aSdavit indi an cdriitiaasi sheet showitt .the mama of the sub- �6 such.' contactors and their workers•cer^w.,ar•iicJ mfom�ation. 1 am an ersu►yer that isprndctg:worNe�scossersaainfornradoz rn tnsuranefor nr emoye� Below is the poNry ant'job site . Insurance Company Name: Policy#or Self-ins.Lie.#: ExpDde Job Site.Address:_ �6tJP���. . Attach a copy of the workers' compensa>laosl PoY d�iaratioo showiaer � � �� Fail=to secure coverage as required under Section 25A of MGL (�lead to the imthe position cumber and expiration date}. . fine up to$1,5D0,00 and/or one-year im sanm rmposition of criminal penalties of a- of up to$250.00 a i y �as wen as civil penalties in the form of a STOP WORK ORDER and a fine day aga nst the violator. Be advised that a copy of this statement may be forwarded to the Ottice of Investigations of the DIA for insurance coverage verification. I do hereby c fy under th andenalties o e ' P fP r7wY tlfiat the information Provided above is true and aoarect Si tt1Te: c #: (� ��''�` Date Phone • j _© Ea onfy do not write in(fits ar>°a,a4v be conrh%ed by�1'or town o•�trw n: Permit/Limnse# hority(circle one): Heatth 2. Suildiug Department 3.City/Town Clerk 4. Electrical Inspector S. PlumbinJ­ (If son• Phone#: AL FOURNIER JAMES DEBRECENI Family Roofers & Painters -1" MAPLE STREET _ ET METHUEN, MA 01844 978-683-5127 EXTERIOR PAINTING - CARPENTRY- ROOFING FREE ESTIMATES ----- Date:_ 7o�C�-®� - T0: l�G�k ��r-S h� Mc C/(J, 84e7v X79 Cie �, NEW ROOF STRIP t/ LAYOVER Install 8" ---- 5" Drip Edge Entire Perimeter Install 3ft —� ----6»ft of Ice & Watershield at Eaves Install Ice & Watershield at Valleys & Chimney Install 151b Felt Paper rest of Roof Install Vent Pipe Flanges Install 30y, 1/ 40 r 5 y , 0yr Architectural Shingles Install Ridge Vents - s Install /Z" Insulati a Board Install Drip d fire Perimeter Install Full d .060 Rubber Install Cover ape Install Neoprene Around All Protrusions TOTAL /(� o i ON ACCEPTANCE CO�Z 7"+d- WHEN STARTED4f Opd HALFCOMPLETE BALANCE WHEN3 DZ� All Workmanship guaranteed 10 years Co All checks paid to James Debreceni or Albert Fournier I� I