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Home My WebLink AboutBuilding Permit #234-16 - 19 KARA DRIVE 8/26/2015 �.. NORTH (� BUILDING PERMIT °��%oR TOWN OF NORTH ANDOVER 3 APPLICATION FOR PLAN EXAMINATION 1 Permit No#: _ � � Date Received �4'°R,TEo�Qy SS US Date Issued: 1 IMPORTANT: Applicant must complete all items on this page j LOCATION I _ Print PROPERTY OWNER K G SOX l Print 100 Year Structure yes no MAP�PARCEL:-7/-I.. ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition [I Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 0 Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic D Well ❑ Floodplain O Wetlands 0 Watershed,District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: _ f Com - `)n G2 Identification- Please Type or Print Clearly 6 02 �o�g OWNER: Name: a Phone: If Address: /5 /< !q r/-{ Contractor Name: R1c NA--D 6 4 6t-,�a N Phone: S Y 3 5-541,6 Email: Address: 7� 011401Soni Aui:-:- eZASS - Supervisor's Construction License: ( 3 6-d Exp. Date: Home Improvement License: // 5 5O(71 Exp. Date: / ARCHITECT/ENGINEER )VQ U 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: $ Z J, '7 -FEE: $ Check N ` �/ Receipt No.. NOTE: Persons contracting with unregistered contractors do not have access t the gu an fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tauning/Massage/Body Art ❑ Swimming Pools El 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENT'S WEALTH 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: Located 384 Osgood Street FIREIDEPARTMENT - Temp�Dumpster en•site _ ion t Lo`cated�at;124�MamtSt�eet - - ` : - f •wiz �-- Fire Departmentsignatti /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, 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.$1o0-$1000 fine NOTES and DATA— (For department use) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 4. 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4- Building Permit Application 4. Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) * Building Permit Application 4 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 2014 Location N . ,� Date . - TOWN OF NORTH ANDOVER . x Certificate of Occupancy $ '. .� �► � Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# �� r. ' uilding Inspector NORTH Town Of .. It E ._'. .nover 0% No. .� — Z� * t - y � _ h ver, Mass, C OC NIC t4a WICK �,95 R�rEo ►`Pa,��(5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT D.{. O BUILDING INSPECTOR ............... ......... ... ........ .................................... ....... ..................... tt Foundation has permission to er ct .......................... buildings on ..L. ....... .r .......... ........................ Rough to be occupied as . �Olr61 y . . .. ........�.. ....... ........ .... .................................... Chimney provided that the person accepting this permit shall in every respect con orm to the terms of the application Final on file in 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 S VIOLATION of the Zoning or Building Regulations Voids this Permit. __ Rough Final PERMIT EXPIRES I MO T S ELECTRICAL INSPECTOR UNLESS CONSTRU T Rough Service ......... ............ . ............................................. final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Smoke Det. KITCHEN INSTALLATION ESTIMATE WORKSHEET - USA score: Ke rrwiaer: 2694 R.J.CONSTRUCTION. —Mle Olson 7111/2015 Gato BrO.akdovwrn Demo and Haul Away $1,877.00 Electrical $1,275.00 Plumbing $1,340.00 Tile $0.00 DrywallfRepair $1,340.00 Cabinetry/Appliances $2,701.00 Additional Charges f Permits $650.00 Grand Total 9.183.00 �Z / Customer Signature: Date: Associate Signature: Dater GC Signature: �" Date: . L'd 9990LLZ9L6 uoslpeiN paeyoly d8Z:909L LL Inf 70;" 61?" 9" 1301" ., 34,143" 22!96" 41:" 29:" 2614 Kyle Olson 26:" 30" 14:" W -4 C'' m "+ « A N A A Fe�LnLL w ., to rn U+ wy / N Ut Co W `p F Q AC/Heat vent —I N m - a u /a. 1 5a.. tQ N W 02 VOR O 24" 14x„ , 1. Sink centered 11.75"off the left wall, no disposal 2. No appliances. 3. Ceiling height 97.5" 12;" 25, 4. Drain the same as the sink goes into the wall.. 3$z., Soffit starts 65.5"off the 109.75"wall, 56"w x 10.25"deep Small vent in the ceiling, heat/Ac, starts 12.5"off the 109.75" wall, centered 70.5"off the left wall , 12 x 12. All dimensions size designations ' This is an original design and must !Designed: 6/28/2015 i given are subject to verification on not be released or copied unless Printed: 6/28/2015 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. f^ t I G� 62803,62e.kit _ ___ i'All Dravving//: 1 No Scale. The Commonwealth of Mlass�chusetts z . Department oflndlustrlalACcidents r w 1 Congress Street,Suite 100 ' Boston,MA.02114-2017 www mass gov/dia Sy. Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED VVITH THE PERMITTING AUTHORITY. Aptilicant Information Please Print LegHb Name(Business/Organization/Individual): Q I G �•` 04,)14 Ga/1 .Address: A b l S 41l /� U E City/State/Zip: G/-o u 4:: G/I-I)�/D k195�5 Phone#: Are yo2'1-lployervith ployer?Check&e appropriate box: Type of project(rEquired): 1. . •./., employees(full and/or part time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. emodelirig any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself,[No workers'comp.insurance required.]t 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12..[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insrrance.t 6.❑We are a corporation and its officers have exercised their right of exemption perMGL G. 14.Q Other 152,§1(4),and we have no er;mployees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. i 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 state whether or not those entities have employees. If the sub-contractors fiave employees,they must provide their workers'comp.policy number. lam an employer that is pioviding workers'compensation insurance for my employees',below is the policy and job site information. Insurance Company Name: Policy#or S elf-ins,Lie.#: O G ce U tet/ U 6 6 Expiration Date: 5- 36 -1? Job Site Address: A City/State/Zip: Attach a copy of the workers'compepsation policy declaration page(showing the policy number and expiration elate). Failure to secure coverage as required under MGL c.1.52,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Iuvestigatlons of the DIA for insurance coverage verification. Ido hereby certi under the pai an enalties of perjury that the information provided above is true and correct. signature: Date: - e� �/5— 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): i 1.Board of Health 2.BuildingDepartment 3.City/'Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �po�rrir�co�rr�r�ea�� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration-date. If•found return to: egistration: 1:18509 Type: Office of Consumer Affairs and Business Regulation -- Expiration: 3/29/2017 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 R.J. CONSTRUCTION RICHARD MADISON 3 MADISON AVE GROVELAND, MA 01834 ut signatreUndersecretarY Not.,ali thou l _ Massachusetts Department of Public Safety Board of Building Regulations and Standards _ License: CS-030000 Construction Supervisor 41 RICHARD J MADISON 3 MADISON AVE GROVELAND MA 01834 Expiration: Commissioner `Y 07/21/2017