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Home My WebLink AboutBuilding Permit #181-2012 - 18 PENNI LANE 9/1/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Dare Received / / Date Issued: �'ORTANT:A licant must com lete all items on this age LOCATION J0f d/l/ Print PROPERTY OWNER Sfpgr Print MAP NO:_�"ARCEL:_,5eZONING DISTRICT: Historic District yes n Machine Shop Village yes o ff[i EOF MPROVEMENT PROPOSED USE Residential Non- Residential NewBuilding WOne family ❑ ddition ❑Two or more family ❑Industrial Alteration No. of units: ❑Commercial ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other D�Se tC ` ®Well-F�" 14 ' ''® 1 0o p�la�nOWetlancls' � r' : .=,t®��{Tr*1Te1��t�f eW2r� �,f#;�•��'�"�`.� �* <.=+��r '��w7 fit :^ �.a��!F.�� 12?i�� +�'t ��i.�t �:�� r ��s t 3';, ` DES Ct 1► T TION OF WORTS TO EE PERF,O_WE-D: (Identification Please die or Print Clearly) OWNER: Name: oV_ 62iLeq -19C W/ Address; d 17; L ft e— CONTRACTOR Name: %lJal esc---- Phone: F Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Ex-P. Date: p p ARCHITECUENGINEER Phone: Address: Reg. No. FEE SCHED ULE:B ULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F, Total Project Cost: $ FEE: $ SO Check No.: Receipt No.: S NOTE: Persons contracting with unregistered contractors do nothave access to the guaranty fund S!gnatu�e:ofA erifilOwner�� _ :..-:�- - Si' nature.of:co =:=`'-= r�- - —=�k�•=� _.�,_�..:-- -_-.�:_9r..-.-.._._,.._. . -- _-.:9_?-,__..------=ntractor`�._==•� �: __ _ - - i Plans Submitted El Plans Waived F1 Certified Plot Plan ElStamped Plans El TYPE OF SEWERAGE DISPOSAL Swimming Pools Public Sewer ❑ Tanningm sagemodyArt El ❑ Well ❑ Tobacco Sales Food Packaging/Sa1cs ❑ 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 CONSERVAT ION Reviewed on Sic+nature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlrecelptsubmitted yes i { Planning Board'Decision: Comments Conservation Decision: Comments { Water & Sevier Connection lSi nature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street no FIRE DEPARTMENT -Temp Dumpster on site yes i Located at 124 Main.Street Fire Department signature/date COMI MNTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq.ft.: - ELECTRICAL. Movement of Meter location, rust 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 ® Notified for pickup -- Date L Doc:.Building Permit Revised 2008mi 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 a 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 Conitlact ❑ 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.L.C. And C.S.L. Licenses _❑ Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (1f 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 CIerks 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 rnust be submitted with the building application Doc: Doc.BuildiagPermit Revised 2008mi Location No. 2 d 1 c Date / f/ a of NcoTN, TOWN OF NORTH ANDOVER o 3? .•.. 0L R a } Certificate of Occupancy $ �sJuMUS E<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ty r 24564 uilding Inspector - ... .. maw i - f' /'`fir' �� • ' - - 'R 7-7 >w ' I � t r a "r /4-yi y. 1 f -3s.�,i Y' s t ^r'`3': 'M1 ��•tSm ton -77 1 p Too ,4,��._ (.�.__, -syr/��•';+� ... E�' � s'SY'}a.'F"`t. -� t ,r},. -77 oil i5 \�.CL 7`76' Z, ------------- r y t Y! ' TYx a ?y Y h"f .,Y Ads" '• "� K �r� as a�"T�jk��-z r w r r t N®RTH ® o over ti... 0 o dower, Mass.,LAK I�O COC HIC EWICK �oA?ATE D P??`B�� a V U ! BOARD OF HEALTH �R M I Food/Kitchen Septic System f PE T T D BUILDING INSPECTOR THIS CERTIFIES THAT....................t...../..C.�f............................. ... Foundation has permission to erect........................................ buildings on ��!. :.!' / Rough . . . ..................... to be occupied as................... eVls�permit /..�•. .�` �"/ � �. �!.��' ................................................................ Chimney provided that the person accepting 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 LESS CONS V CTION ST TS Rough Service BUILDING PECTOR 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 'Mall To Be Done FIR_ E.DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Ir SEE REVERSE SIDE , Smoke Det. PG ll� r, Ll µ i f .`4 ! X Jx t I i � r I t i j i y i i' .. : : f .tF- „-. -Vl a(I \ UtoX111 1- V Ar>�rsen Andersen Windows-Abbreviated Quote Report Project Name:08-BRILEY-082911 ..�. . Quote M 4409 Print Date: 08MOU011 Quote Date: 0292011 IQ Version: 11.1 Dealer. — Customer ` BEV Address: Phone: Fax Sates Rep: Tim Gorman Com CSR Name: II _ Itarn Qty Nam size(Operation) Location — -- -- Unit Price _Ext Price 0001 1 C25-C2S (LR-LR-LR) : 231231 S 2312.31 PlUtUil ROSim=1ro3X-Wxso31rH Unit3Iz*a12'0114^W:4.11rfVH Composite Unit,Whitefaear Pine.High Perronnance LOW-E4 Le&RghYHigh Performance Low-E4 Left-Right High Performance Law-64 Left-Right Giess, Removable Interior Grille Left-RW*Removable Interior Grille Left-Right'Removable Interior Grille Left-Right,6 SM6'Gear Plane Complete Unit Job Site, Mulling Location.Factory(Disci),Mug Type:Narrow Mull,Mug Priority:Vertical Grille,interior,Removable,Wh'de/Msple,Colonial,2WSH,34.Roman Ogee insect Screen,Stone Hardware Pads.PSC,Andersen Classic Series-Stone DCT JAMB,6 9116 WALL PR DCT JAMB,6 9M6 WALL Suomi 2 312.31 _ Total Load Factor Tax(6250%) 144. Customer Signature -- -- -- — 0.960 Grand Total Dealer Signature All graphics viewed from the exterior -Rough opening dimensions are minimums and may need to be Increased to aliaw for rase of building vuraps or flashings or sill perming or brackets or fasteners or other items. Quote t. 4409 Print Date: 08/302011 Page 1 Of 2 IQ Version: 11.1 µoRTH TOWN OF NORTH ANDOVER ��t�gllo y6"11rO . 0 #0 OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 "vsSAHusNorth Andover,Massachusetts 01845 c Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXE1vMPTION BUIDING PERMIT APPLICATION Please Print DATE: j f JOB LOCATION: r Number YStreet Address Map/Lot 130MEOWNER ,X'07r e C.e� c17c/ Name Home Phone Work Phone PRESENT MAILING ADDRESS_ Sem-e City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who Awns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will co ply with,said procedures and requirements. HOMEOWNERS SIGNATURE , APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption M1 BOARD OF APPEALS 688-9541 CONSERVATION 685-9530 HEALTH 688-9540 PLANNING 685-9535 r� The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA. 021X.1 WD www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/JElectricians/Plumbers Applicant Information Please Print Le0bly Name(Business/Organization/Individual): G Address: City/State/Zip: Aloe- J9 nd QU(A 0 M14. _ Phone#: �'7�'— 3D Y- �Oy� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. [Remodeling . 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. ❑ We are a corporation and its ,{required.] officers have exercised their 10.F1 Electrical repairs or additions 3.LACI 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' 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 check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lain 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.Lie.#: 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 ce�urt th epains andpe Valfies ofperjury that the information pro videdabove is true andcorrect. Date: Si ature: y Phone#: Dy Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectricaI Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: