HomeMy WebLinkAboutBuilding Permit #Exception - 2 UNION STREET 9/12/2016BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
0
4L _4
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Date Received
Permit No#: 4AYED
Date Issued: IM[PORTANT: Applicant must complete all items on this page
LOCATION
P�*C L/
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PROPERTY OWNER /-�-V Al ow
MAP Iq PARCEL: _V -7 Print V 100 Year Structure yes no
ZONING DISTRICT: Historic District yes no
Machine. Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
El New Building
11 Addition
n"A'Iteration
0 One family
El Two or more family
No. of units:
us r
[I Indus rial
q1nd
El Com ercial
Com e
0 Repair, replacement
El Demolition
El Assessory Bld
[I Other
0 Othe
S, eptic, 0 Well
0 Water/Sewer'
El Floodplai
o Wqtp edDistric
DESUKIP I 1UN Ut-
Al-e- L -J woet-e.
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let
Identification - Plea e
A6 0�aA�l
OWNER: Name
V
Address: ol Ok,,'VA/
Contractor Name:
Address:
Supervisor's Construction LNcense:
Home Improvement License:
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Phone:
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ARCH ITECT/ENGINEER )4va�,Cew Aallze,�iSz�e/0 Phone: �rlvZ olt'T V L -P
Address: 77�/1041 '711" &Wdq0k-Z1(he4 /WA 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: $ /0 ac -O.- dp_<D FEE: $
Check No.: Receipt No.:
NOTE: Persons contractine with unregistered contractors do not have access to the guarantyfund
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Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $—
Building/Frame Permit Fee s--7-7-
Foundation Permit Fee
Other Permit Fee
TOTAL
Check # (,ol
�tuil&6)—nspector
Commonwealth of M assachusetts
Sheet Metal Permit
0 Permit #
Date —N—Z
-' C' ' 7 7.
Estimatedd Job Cos Permit Fee: $
Plans Submitted: YES — NO
Business License # �9� 6
Business information:
Name: � C (20kA-k- + �
Street: �-Ko e, d
City/Town:
Telephone: (7161
Plans Reviewed: YES NO
Applicant License # -- 39f �
Property Owner / Job Location Information:
Name: 60"'doo,
jStreet:
City/ToIAM: A/0 ri� O�O Ve f
Telephone: &P �1-� S?31 -*
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Building Type:
Residential: 1-2 family V Multi -family Condo / Townhouses
Commercial: Office Retail - Industrial Educational — institutional
Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft.
Sheet metal work to be completed: New Work: Renovation:
HVACV Metal Roofmg — Kitchen -Exhaust System — Chimney / Vents
Provide brief description I k to be done:
OTZ +
C14
CWbA �60
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes[-] Non
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy k, Other type of indemnity F1 Bond
OWNER'S INSURANGE WAIVER: I am aware that the licensee does not have the insurance coverage required by Ghapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
owner El Agent n
Signature of Owner or Owner's Agent
By checking this box[], I hereby certify that all of the details and information I have submitted (or entered) regarding 'this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application Will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Date
Progress Inspections
Comments
nspector Signature of Permit Approval
Sir
Final Inspection
Date
Comments
2ype of License:
-a'ster
By
Title
El Master-RestriGted
City/Town
Eliourneyperson
Signature of Ucensee
PermIt
Dioumeyperson-Restricted
I Fee $
License Number.
Check at www.mass._qov1dpI
nspector Signature of Permit Approval
Sheet Metal Commercial Guidelines I Life Safety / Critical Systems
Nspection Checkhst
Yes No N/A
Set of stamped engineering documents and detailed description of
mechanical system to be installed has been provided
V_ All workers performing shoat metalwork onsite has valid Massachusetts sheet metal
license
V/_ All sheet metalwork being p orformed with proper journeyperson-to-apprentice, ratios
Fire dampers with across door properly installed and checked for operation
Smoke and combination fire / smoke dampofs with access doors properly installed -
actuator checked for proper operation (May also be. verified by fire department during
fire alarm testing)
Duct smoke detectors with access doors properly located
(May also be verified by fire department during fire alarm testing)
Smoke / atrium exhaust systems installed and operation verified
(May also be verified by fire department during fire alarm testing)
Stair pressurization systems installed (where required) and operation verified (May also
be verified by fire department during fire alarm testing)
C-acase / kitchen hood exhaust system installed with all scams and connections welded
airtight with prop orly lo cated cleanouts. Proper cle,�Yanwoes, f ire rated enclosures and
pressure testing required..
s -.-a i inst -d' h ant and d1utv.,);r�-
6 afl &;,E oka 6 reqpjrc;..o 'eq i`
lilpm.
Duct penetrations in fire'rdtDji-,!aIl.-3,and flQ*6rs sealb(T
Metal roofing systems installed watertight bsingproper materials and fasteners
Flexible duct runs installed 6'-0" maximum length
Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle
iron
Ductwork I plenum connections scaled substantially airtight
Ductwork insulated by means of external covering or internal Ruing
Volume dampers installed for each supply air branch duct
New/clean - properly sized filters installed (final inspection)
Testing and Balancing report complete (fiiial sign -off)
Sheet Metal Residential Guidelines / Jnspection Checklist
Yes No N/A
V Detailed description and sketch of sheet metal system to be installed has
been provided
All workers performing sheet metal work onsite has valid Massachusetts
sheet metal license
All sheet metal work being performed with proper journeyperson-to-
apprentice ratios
Equipment sized per heating / cooling load calculations
Duct work sized per manual "D" calculations
VBath / shower room's contain mechanical exhaust fan vented outdoors
VElectric dryer exh aust properly installed maximum total ran 35'-0",
maximum flexible run 8'-0"
Flexible *duct runs installe d 14'-0" maximum length
V Volume dampers installed for each supply air branch duct
VDuctwork installed using proper gauges and hangers
V_ Ductwork / plenum connections scaled substantially airtight
Ductwork insulated by means of external covering or internal lining
New/clean - properly sized filter installed (final . inspection)
Testing and Balancing report complete (final sign -off)
n8 Commoniveafth qfMass�chuseffs
Depaltment OfIndustrialAceldents
-1 Congress Sfteet, Suite 100
Boston, HA 02114-2017
www-mass.go-PIdIa
'Workers' Compe'nsa-aoilinmranceATJ�a-davit: )3uUclers/Contractors)FIqqt�iciamiTlignbers-
TO BE FffXD Wffff TEE 23MAR7TING AUTHORM'
Name pusiness/C)xgaiiizatiovludividaal): -
% tLuk i
Areyou an employer? mer'kt& apprloprlatebox;
r
% r V" --t- Iq k
Phone #: � 1 -1
oraployarvdffa_-:,�l0Y0I-s (M andImpait Lima).*
I am a Sole propdBtD3�-partoamhip andhavo no amploYeas-WOIId� fOrmeirt
any caparity. [No wojicers' c G]nP- insurance requirrd-I
IE] !arn a homeowaeldoiU.94 w0lk-Ysalt . LNO walkers' comP- 'Usurance required -I
4-F] I am ahomeo-marandvO bohiring- contractorsto conduct all -WDIk OumyPrDPM'Y- will
ensure tl� an coiataLjors aitherhave wo3kars' compensation justranca or are sole
pr6brieturs -WnaO B3$�IOYe�S-
5.FJ I am a gonaral contactcr and I have hired the sab-contractors listed on Iho attached shoat
Die�a g�b-.onfractors �, ai� ph�I.Tjs andh6- wc�drs' ..I�P-
6.EJ We area coiporatiom pnd#q qffi�prs have exerGisedtheirright ofax-Fdon Perm&, 0.
152. § 1 (4). W;P'h�-V- 110.�M , ldms� Mo workers I comp. insurance required-]
I 15� �
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Type of project (T�qmx�
7.- Now co&tructlon
8. Remo deag
Demolition
10 Ruil#g addition
11.�j Electrical xapairs or additions
i 1
12 airs
pl=bing rep ' or add itions
14.Ej Other
noli � �.
rvinfonnaffom
z-�Any applicaut-that chedrsbox--ftl must also -ta, 0mrse B—Lull 'Jul— --6 stsubmit auew affidavfiindicatiag such-
T:Ecencovmars who sabhiitt�ff aE.ddavlt andicatingthey are domg all work aadthonlare Oumde, cOntactDIS MU I- -VG
cc�p:�t showingtaongm of the snb-coiCtactors and State whether ornotthose entities hEL
tc,nfractors�ffidche .4�aqhad p�L a�ddi�onal sho6t
, 3 kcfDISLaV6��plcge'
employees. Ifthe sub -cm US,
_T ailt at, e7hvloyep & 4t is Tj0I;Idfizg IV 0rkLI,8 -' comp ewadon hmuran cefo y enpfl�yees.' BdoV is t7jeFolicy andjo
lasurancD Company Tame
PORGY 4 or Self -his. lia. 4: EiTiration.Date: —
Job Site Address: �,4 �,�o (,A city/StateMP:
Attach a popy of theyvorkers' - c . ompep4ation p oRcy declaxation. page (showing the poRey number and expiratim date).
FaHure to scuare, cov&aga as raqidreduadarMGL a. 152, §25A is a criminal violation punishable by a fine up to $1,500-00
and/or oneyear hnprisomment, as well as oivilpenaltles in-flio form of a STOP WORK ORDHR and afma ofup to $250-00 a
day against the violator- A, ropy of f -ds statement may b a forwarded to the Offic a of Iavestigafl6ns of the DIA fox h=anG(,-
coverage Verifloatioru —Z
I do b ereby cerfify u2ideT ffz e
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