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Home My WebLink AboutBuilding Permit #026-2015 - 2 JOHNSON STREET 7/6/2015 l� BUILDING PERMIT o� NoerN q TOWN OF NORTH ANDOVER o '6'a C do a.: r ]� APPLICATION FOR PLAN EXAMINATION '' s V2-G- 2o 1 ` J � O Permit No#: Date Received Date Issued: A : US IMPORTANT: Applicant must complete all items on this page _. LOCATION j Prim PROPERTY OWNERO Print; µ-` 100 Year 5tructu`re es ` no MAP ® PARCELpo ZONING DISTRICT: Historic Districtes no _ .. Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑AJteration No. of units: ieCommercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic .Q Well ❑ Floodplain ❑Wetlands i1 Watershed District Waterj$ewer 11 DESCRIPTION OF WORK TO BE PERFORMED: S1ecP I�KrJ P.e��+¢Cl� �'3�fI��>�- SV►i�C*�.eS Identification- Please Typ or Print Clearly' -S.. OWNER: Name: C"e s e fie, ay TIPS.F Phone: 48 Address: 1 • e S7L o e h !/p� 1i1� 1� m �c�s Contractor Name:f.&:2f-0d0 Phone: s^o —,3a$ --5�G�3 0 Address: Cp'7 i f� 1� -+r #.,�- + t� I�.1449v 104eW1417 Supervisor's Construction License C S a 7 30 Exp. Date: Homplrnprovement license: _. Exp. Dade: u. 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: $ GSE FEE: $ Check No.: Receipt No.: NOT - Persons co cting with�eg eyed contractors do not access to the guar fund - re Signatur of Agent/Ow r Signature o ntracto.r w�7 Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ F YPET F SEWERAGE DISPOSAL p,,t, Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ 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 COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments e Conservation Decision: Comments Water & Sewer Con nection/si nature& Date Driveway g e ay 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 i 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 Call Email 3 Date Time Contact Name _ 3 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 ❑ 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/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 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:Building Permit Revised 2014 to Location Q V ^ No. (:)2_Lo—201 Date I is • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ - � Foundation Permit Fee $ Other Permit Fee $ i TOTAL $ t ` A Check# i v 4 ti r, ; Building Inspector r , NORTH : :. .c .E ver o - No. — �' .K 0 _C) 2,( h ver, Mass, 2d T O LAKE 1• /J- CO[HIC Hl w1CH NIV S V BOARD OF HEALTH Food/Kitchen PERMI T L D Septic System (� l THIS CERTIFIES THAT �2 ' .. ....... -� BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ............................. ........................................... AIZ .. ..................................................................................... Rough to be occupied as ....... :�..... ..!Z.�.v.aT Chimney provided that the person accepting this permit shall in every respect conform 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough . Final Service .... f2�" % „ ...... .. . .................... ........... BUILDING. . . INSPECTOR. GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. c Qut o�Pu s�ardae�s p pa�sa cs and - "- users' Rc�uiat�a assau� ui\a��g d o{6 ti°.i 5u� 5302 Bea` rts�r`�� `Jr,ense BE O,a;gvlwv e 1401.0 EXPO�Zp16 69 i I INFORMATION PAGE Associated Eniployors insurance Company 64 Third Avenue, Buriin8ton,Massachusetts 01 B 976 (8€0)87&-2765 NCCt NO 40955 POLICY NO. I WCC-500-5W75811-264A PRIOR NO. I WCC-5oo-soo7581 013A ITEM 1. The Insured: 'Key Lime Inc °r"�c3Hing addrt3ss: 10 LI^cpc�tica Ddve FEIN:'*-r**!218 ;North Andover.NIA 01 845 Legal Entity Type- Corooration Other workplaces not shown above: 2. Tl policy period is from 09/15/2014 to 09/1512015 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the siates listed here: IMA S. Employers'Liability Insurance:Part Twe of tate policy applies to work in each state listed in item 3.A. � o limits of :ab-y under Pat;Two a-a: Bodily injury by A=--:dent $ 1,01)0,000 each a cldent On,61yIniury by ttisease — _ 1_000'.000 policy ll:eeil Bodily,Injury,by Diseass $ - 1,000.000 each emptoyce C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 D. This Policy includes these'Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy wit!be"tearnined by our Manuals of Ruies,Classifications,Hates and Hating pians. All Information or,and change by audit. classifications ---- Premium Basis -- - _Rates - Cade Estimate T_Per$(100 ! FSL+!s**ad No. � Total Annual Of Annual Remuneration Remuneration Premium INTRA 2€5896 INTER SEE CLASS CODE SCHEDULE i Minimum Premium 0575 Total Estimated Annual Premium $4,217 GOV GOV Deposit Premium $1,086 STATE CLAS NIA 5645 MA A.sse-m9ment C'hg. $3,778.00x3.4000% IV28 - �-�� - This policy,including all endorsements,is hereby counfersigned by - `- " 07/31/2014 --- — Aulhoriieo 3�nature — mate Service Office: M P Roberts Insurance Agency 54 Third Avenue 1060 Osuood Street Burlington tvtA 01805 North Andover, 01645 WC-100 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation insursnos, used mth 416 tzar:iscoGn.