HomeMy WebLinkAboutBuilding Permit #98 - 1845 TURNPIKE STREET 8/3/2009BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR. PLAN EXAMINATION
Permit NO: Date Received
Date Issued: --k
IMPORTANT: Applicant must complete all items on this Daize
LOCATION
PROPERTY OWNE]
MAP NO: 1607 � P
I
Print'
ZONING 6iiTRICT: Historic District yes
Machine Shop Village yes,
1 0
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
(0- n e f a m i lv-'�
— -----------
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacemen
Assessory Bldg
Others:
Demolition
Other
Septic Well
J
Floodplain Wetlands
Watershed District
Water/Sewer
UhSURIPTION OF WORK TO BE PREFORMED:
I
enti icati n Pl6ase Type or Print Clearly)
OWNER: Name: 4 �e P h o n e: >c, �-
Address:,/45&-5 <
CONTRACTOR Name
M
19P
Supervisor's Construction License: Exp.
Home Improvement License:
ARCH ITECT/ENG I NEER
— 16S,4ell Exr). Date: 411*1
Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON$
Total Project Cost: $ FEE: $ '71 4�
Check No.: Receipt No.: 59W
NOTE: Persons �ontracting i registered contractors do not have acc'e'-ssto 11)
8-i-g--nafd�e—of'A -ge n-t—/O-w- n -e- tor
Simature o _ f contra bto
1>
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
Well
Tobacco Sales
Food Packaging/Saleess
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
Zonfing Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/signature & Date Driveway Permit
DPW Town Engineer: Signature:
LOcatea 664 USg00C btreet
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signatureldate
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
MGL Chapter 166 Section 21 A —F and G min.$100-$l C505 fine
No
NOTES and DATA — (For department use)
j 0
11 Notified for pickup- Date
..... . .......... . .................... . . . . ....................... . . . . . ....................... . . ......... . .............. . .. . .... . ................... . .... . ................... . . . . . ............. . .... . . ............. . ... . ............................................
Doc.Building Permit Revised 2009
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
Ei Building Permit Application
u Workers Comp Affidavit
ci Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Ei Copy of Contract
Li Floor Plan Or Proposed Interior Work
13 Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Li Building Permit Application
Li Certified Surveyed Plot Plan
• Workers Comp Affidavit
• Photo Copy of H.I.C. And C.S.L. Licenses
• Copy Of Contract
Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if -Applicable)
"C
, . ompliande R606h (If Abplicable)!
o Mass check Energy
u 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
Ei Photo of H.I.C. And C.S.L. Licenses
Li Workers Comp Affidavit
u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li Copy of Contract
Li Mass check Energy Compliance Report
u 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
Locationz �ew Tllf�v --.1
No. Date
1,40*Th A TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
3 CwUS*,
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 7
2 2 2 , u
Building Inspector
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03/05/2009 10:01 9787948570 TA SULLIVAN PAGE 02/03
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SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE "KCAED BOOM THE WIRATION
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Boston, M4 62111
Werkers� compematio be)dia
A nficant Informat.10 11 Insurance Affidavit. j3unclers/Co
1�"ae (3's'rl--ss/Drg=izebon/Lndi,id..]): Please Print Lembiv
f
City/StELL-/Zip: Z, e", -*�2
000,
Aj�r, �yon phone
hapioYer? Check the appropriate box:
8 employer with _4!0_0000, 4. lam Type Of p
MPIOY roject (required):
_S (full and/or part-tirne).* h 'neml con&dctor and I .
am a sole proprietor or partner- ave hired the sub-DOnt-dctors New Construction
listed
sh� and have no employees These am the attached sheet .7. 17 R-Modelin 'o;
working forme m any cap=ty. sL'�`-Ont*actors have
work=, comp. insurance, Demolition
No workers'. comp. insurance 5. We art., cO 9. 13
required.] Tporation and its U11ding addition
Officen have CxCrcised.their Electrical MoPairs or add
an a homeowner doing all work right of e)c-
g m itions
myself [No.work='com ption per MOL Pluinbing repain or additions,
insmmc-, require P. c. IS2, § 1(4), and we have no
employees, 12.0 R00f rep
[No workers, _a
1Akv jLppji=nt.thw r Comp. insu
.heclu box ranct requirecLI 13.516h;_���
F4DrnCoWjj= W11(j SU6111ji.filis 'M= a1"0'ffl1 out the sectionbalow shoring 6mir wrk -
_G;:.---U_Sj 'O'r� =' Compensation Pojicy infbmtioll.
ro"davil indicari116 af" art u
2COnU=tot; that chca. this b Mzcched an Iddinional sfi= shov(j.
.wdirio �,Lee, i�,,;
__-Lars od
-the
of tht =�,_Gr
lonim . Qt,,, and th�r workets' camp,
Z#rP101YM_ that &Droviding -oa, P1111r,31 �i'D�fcyrmafioti..
4fformatio& P_ P01ir
rance
insurance CompanyNamc: J Jarnrempioyem Bejp"'.is thcPOR,:�, andjoh site
Policy #or Selfins. Lic. #:
Datae:
Job -Sift Addr= r— I-1
Attacb a capy ojm the work� City/state/Zip-
M, ro4sation,policy deciaration 011<
- (ghowill: 6e P, I
Failure to = Acy z4nber and expiration �Cj�
c"re' oo'v--' "age as required under Section 25A Of M GL c. 152 can lead to 2te�.
fine. up to S1,500.00 and/or one-year imprisonment as well as i,,jj the imposition of crim-
Of UP to S"50-00 a daY agai= the violator. Beadv' penalties in the form of a STop mal penalties of a
ised that a copy of this WDRK ORDER and a fine
Investigations ofthe DIA for insurance cov-7ge, ve -f
_n Icatic)ZI. Statement ma3, be forwarded to the Office, of
I do hereby cerg6� u ................
.. .. .. .. . .. . .. . .. .
P 0
th'zr the informafioppl"OVid& above true and Corr=
:'hont 9:
Off'Cial Oni
.P. Do not Write h7 fidS Ica, 40 be congpiez,,d.b., or to w)7 offLciaL
City or Tow1r:
ISS:Uiav Authoril�y (circle one): Perroft/Licefts,
I. Boar� of He . altb 2. Rufidin- DepartInent 3. CitylTowla
6. Other Clerk 4. E'ectrical Inspector
Iftspmtor
'Contact Person:
Phone j�-.
iuLivi LaaLivu 9::KJLIU JUINU-MAIURS
Mass=husatts General Laws chapter 152 requires all enP.10yers to provide workers' compensation for thei� employ--ts.
Pursuant to this swutt, an employee is defined. as 11...evMT—Y person in the service of another under any contrad of h ire,
express or implied., oral or writtm"
,kn employer is defined as "an individual, partnembip, La-'—Or_iation, Corpo M -tion or other legal entity, Or any tWD 07 More
of the foregoing engaged in &joint enterprise, and includ--iTlo, the lenj representatives of a deceased -employer, or the
rer.miver or trtister, of an individual, partnership
,, assOciati <Dn or other legal entity, employ g ploye*
owner of a dwelling house.having not more than three apzirtrn in = ca. H ow -.v -.r the
ents and who resides thermin� or the occupant of tim
dwe�ling house of another who employs persons to do ME11-iritzriance, construction or repair work on such dwtil�g house
or on the grounds or building appurt-nnant th=--to sWl,nc>t because
of such _mployrn --nt lr-. dee-med to be an =ploym."
MOL chapter 15-1, §25C(6) also states that "every state ca. r local . ficeming agency shaU withhold th'e issuance or
.renewiLlofaiieensearperinit,toopemteabtL§iftes�Or- to constmat buildings in the commonweaft for any
applicant who has not produced acceptable evidence ci.-,f compiiance Wftb the insurance coveragge required."
Additionally, MOL chapter 152, g25C(7) =itts "Neither ithe commonwealth nor any of its political subdivisions shall
.enter into any centract for the performancz of public worl< until acc:eptable evidence of
compliance, with the insuance
requirments; of this chapter have, b=n presented to the ��ntrazting
aufhority.",
AppJicgLntS
PICIM, e fill DUf the workers' rompensafion affidavit cOMPI-etely, by checking tbt boxes that apply to yolz gituabon and, if
ne=ssary, supply sub�cbntractor(s) namc(s), address(es) am. d phone number(s) along with their cercificate(s) of
insurance. Limited Liability Companies (LLC) Or Limht;� Liability Partnerships (LLP) with no employees oth
er than the
members or partners, are not required to cw-Ty work
erg c: c:)mpe-nsation insurance. If an LLC -or LLP does have
employem, a policy is required. Be advised th& tiiis RACI-avit: may -be submrtb-,d to the Departm=t of Industrial
Accidents for confirmation of insuranot coverage. Also ]be sure to sign and date the Rffi&vit. The—affidavitshouid
be returned to the city or town that the application for the permit or liccrise is being requested, not the Department of
industrial kczidents. Should Vou,have, any ti
clues Ons rCg-,--_rdin the -imv or. if you
am requir--d to Obtain a worl='
call the Department at the nUxnb=r,li&_-e below. Self-insurcd companies should enter their
.comp nsation rbliqv, ple:
selif�rsuranc-_ license nurnbcr an t I he appropriate line.
City or Town Officiais
Picast be S= f�af tii�affida�itis complete and print -,d 6�iblv. The Departm=t has provided a spare at the botorn
of the affidavit f0ryDU to fill bw in the event the Office OF Investira s contact you. regarding the, appli=t.
c tions ha to
Pleamt be sure to fill in. the permitfficenst nuTnb--r which be used as a reference number. In addition, an applicant
-that must submit multiple perznitnicezue applicationsmi arty given year, need. only submit one, affidavit indicating current
policy information (if necessaTy) and under "Job Site AdA."resE" the applic - "ELI] locations in
ant should writJ. _(city or
town)." A copy of the affidavit that has been officially 9'a-rnpe:d or marked by the city or town may be pr'ovided to the
applicant as proof fiu� a valid affidavit is on file for future, Permits or lice-wes. A new affidavit must be filled out =h
year. VA= B home owner Dr cftiz--r is obtaining a liaem— or permit not related to any business or commercial ventur-e
(i.e. a, dog license or permit to burnlmaves etc.) said P"-Mln is NOT required to complete this affidavit -
The Office of Investigations would like tothank you. in ad-vance for your Moperafion and should you have any questions,
please do not hesitate to give us a call.
7ht Department's address, telephone and fay, number
T"he Cc)mmonwtalth Of M=a,:.
hustts
Dcpartment Of lmdmtrial Acc�d='ts.
Office of 1[mvestig
ations
600 Wash�= ste:et
BOSt011, MA G-21 I I
Ttl. 617-727-4900 co= 406 cr 1-9. 777-MASSAFE
Rvviscd 5-2645 FaX 4 61 '7-7-7-7749
WWW-Mam. crov/dia
Vincent Greco
Clean Guys ILLC
We provide the following listed services as described in a professional &
business like manner.
• Replace FHA Furnace
• All insulation as described by code
• Repair sheetrock
Repair all electrical
• Service as described and agreed with electrician
• Replace hardwood flooring: to be provided by the customer
• Repaint complete interior: walls — ceilings — doors — trim
• Replace all ornate trim — as original
• Power wash house
• Repair walks and retaining
• Rebuild lamp post with 8' brick column
• Install granite kitchen floor: provided by customer
• Install kitchen cabinets: cabinets provided by customer
• Provide sufficient base for granite flooring
• Reset all plumbing fixtures as needed
Customer Signature:
Customer Printed Ne
Contractor Signature
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