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HomeMy WebLinkAboutBuilding Permit #160-11 - 200 CANDLESTICK ROAD 8/3/2010 X10 R TF1 BUILDING PERMIT ] OF�t�ec ,e'�ti TOWN OF NORTH ANDOVER o » w Z. APPLICATION FOR PLAN EXAMINATION # ,� Permit NO: t Date Received �SSACHUSE� Date issued: IMPORTANT:Applicant must complete all items on this page �,..., YtN r.�- 'sE-4 -x i f `y"7'J' a _ 7,�•a'�'.t,y i'! �- .. ";1 �. '.y- i: fx r6-'.r M-t. s- .ti ^"a s' '- �..rN•"., ''�Jx<• i m ,� a .7E r y r i^+t' a � r s`� r :.. 3 i.t'q.,'"`-a,• :`gt's ���'jlh3t .71x ai. r yr^�"`".- - - ^w -4>sYri *yRISE-,eskPyaS-�T�N A'.I`» �� y �:.r,'�. glsz f.ti�' x- --�.n•s+ D�• �a�.-- �a, i.�.x:qac. -e' �..r`Yv.kr '.mak_ ^'"^5n 5+ �-r.].•d.1f�1L 9,e� x�xiS 'N 1t' „.cL. ,-af' -c4�.,r�. -r y3, aS' -+'„rv''; �., Pm�i t '. sr E ^3-r- -m_ s:' .. 'E•.[•3zkf�•��*.ra,. 1'al.'M'-�C ;" ow 7 s- •r�_.3:-r,• s'/,ti - ti s: � .. r.�, °� .� -+`'r rr ,.:er„t� s rte'"r. 7 ?r ".w•.'�'^{!3 �4 q a`���� 3 '�`_f,.sr,`.t-'Y'dF[ Y sc�'',� aY .�{y - _.. �� i,F'� ' "�`. ' °"e-�. � ;�y.-r.w•.h^._�.r..�+ _,ki++ �`��i,r,� _� ro� . ,�'� M.�a� ���]�� t '�'T�"f�h� ..rfT}�i�- �(' �t�� `� u-_-si,�n��'�re,����?�.�`'d�'- ��•, �� �5i�^ �.� c`�"`v�� i��- yip:..{ � �.�� a���c,��• ��!�' D 2 e��t�5� ... �.1�ES� �'�'�5Y!l�r£�^9'::...`.'�-1'�y.".�`'ii•.ST'*%IY+..�d�JY+ �£.�''µW Y' 1'�t"<;fG�/T.�., _ .,Yq„. at.w:-'E:h ".f^xi{��..i16��S".A T4s TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Two or more family Industrial Ad • n No. of units: Commercial Iteration Assessory Bldg Re air, replacement Others: " Demolition Other Y;AY '--v r . DESCRIPTION OF WORK TO BE PREFORMED: a I1 roll d o `� (Ac boards a s aeeo�ed b, -o rz a►'-n-h n Identification Please Type or Print Clearly) e: NI t G H L M R G u i(,E Phone: q 7 a-g 75, a q OWNER: Nam k �bo Cf�Nd t,E �l cic 2o�,p � rU I � Address' Na ► � � oov�R �� o �'i� Offi r - tr 4� o! �. ���... `a• Ynx' �' _ r -+rr�.. � .tom '�,�.' .il - 7H ' do 4y`' _�n�' t N'.;r..-i ,r= ,4- lr v� 'j y:��,t"'�L•u7S * £ i ff �' a $, _ '?�".3"-..• sd n... Ss .i„R__ ...:.iG= .rIX x tl'_ +r �Jw- le � �Y jaat.,� •� �� r? r _ - .. dy �6, ily �• w'' tom•_ w, 40-i� 1F.....�� ARCHITECT/ENGINEER Phone: Address: Reg. No. SCHEDUL-E.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$i ER S.F FEE ^ Total Project Cost' $ FEE: $ Check No.: Receipt No.: NOTE: Persons contra ting with unregistered contractors do not have access to the guaranty fund �r�n iilrE f= �.Ell'f/OwneT / S 1latur'.6 CLOT _ Y I Locationr/© Gl/? .GGt G�C No 42 Date NpRTN TOWN OF NORTH ANDOVER f O L F R 9 Certificate of Occupancy $ s�CNUs Building/Frame Permit Fee $ �Q�r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23218 _ Building Inspector i Plans Submitted Plans Waived Certified Plot Plan Stamped Plans FPublic E OF SEWERAGE DISPOSAL Swimming pools Sewer Tanning/Massage/Body Art i Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOL LOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Si nature + COMMEN I S HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Comments Planning Board Decision: Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street .„ .„P, +� 4-'' ` Ou steT' rarts - bets i Y vx -.:. _ILzocated�f"��4�Ylam�tr�at + �- _ i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I 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 i NOTES and DATA— For department use) i i 1 ❑ Notified for pickup - Date Doc.Bnilding Permit Revised 2010 I'i i 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 D 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 o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract n 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) f o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include_ Sprinkler Plan And Hydraulic Calculations (If Applicable) El 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. P The applicant must then get this recorded at the Regis of Deeds. One co and roof of recording a �'Y PY p must be submitted with the building application Doc:Building Permit Revised 2008 NORTH TOANM of _ Andover No. �` = o dover, Mass., T O t+ LAKE IfsCOCMICKEWICK V DRATED F?a��Cl BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT I�z �/' /... ..3�. ...Z!/�'' - --- Foundation ............../,/...I "••••........... ... ......................................... A has permission to erect..... .......:. g �... .. ............... Rough buildings . .. �f,7...... �P. ... ..........J.. ......��.... c i Chimney to be occupied as............... :. ...�� '... . .. .�`a .......................................................................................................... y provided that the person accepting this permit shall th 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 CONSTRUCTI ST TS Rough .............. ........... .................................... .................................. Service BUILDT4C' NSPECTOR 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 Wall To Be Done FIRE DEPARTMENT ' Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwe¢ith of Massachusetts Department o f Industrial_,accidents Office of Investigations ..600 Washington Street Boston, Aq 02111 Workers' Compensation Insurance Affidavit: Builders/Co Av licant Information ntractors/Electricians/Plumbers Please Priv t Legibly Name (Business/Organization/Individuai): /11 C 14,4 Address: 0?40 CND L�STIC llIV AN OvV�f Z City/State/Zip:_ /VOl2? ASV�O�ER MR d incl s Phone#: 17$-q1 Are you an employer?Check the appropriate box: ❑ Iamao 1.❑ I am a employer with_ 4. F7. 0 project(required}: employees(full and/or part-time).* have hired the contractor and I the sub-contractorsew construction •❑ I am a sole proprietor or partner_ listed on the attached sheet t emodelingship and have no employees Thesesutrcontractors haveworking for me in any capacity. workers c emolition[No workers' comp. insurancej omp.insurance. uil' Q❑ We are a corporation and itso�addition 3/41 required] officers have exercised their 10❑Electrical repairs or additions myself enption per MGL 11.❑Plumbing repairs or additions Y [No workers'comp, c. 152,§I(4),and we have no insurance required.] t employees. 1 ❑Roof repairs [No workers comp.insurance required. I� ❑ Other `-=-Y�pIicant that checks box.t! MUS!also tui ce! ] Fiomeown ccc aeras_beiov „�4.n9 . gas who submit this affidavit indicating th7'a.�dciug aL'-Ara:e and w ie out cOtnr =eL T: .. +Contractors* r:- tttell hire i]tliSidE GOntTEct..t•.-a• a:tib �t hi't""bo,mus"a=c,-ed shed an additioaai sheet showing the lhuii!a new n name of the sub-con �da"n indicating such. tractors and their workers'comp_policy mformation. lam¢n employer that is providing workerscompensation insurance for my employees Below is the information. Policy andjob site Insurance Y ComP an Name: Policy#or Self-ins.Lic. : Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration pane(showing lite otic ntun' Failure to secure coverage as required under Section 2Policy per and expiration date). fine up to$1,500.00 and/or One-yrar im SA of c. 152 can lead to the imposition of criminal penalties of a prisonment,as well as civil penalties in the form of a STOP VJORj{ORD Of up to$250.00 a day against the violator. Be advised that a copy of to the O statement maybe forwarded a one Investigations of the DIA for insurance coverage verification face of I do hereby certify under the pains and penalties o er fP .%zoy that the information.provided above is true andcorrect Si�ature: Phone 4 9.75,- q 2.5--2 e/2 6 Official use only. Do not write in this area, to be completed by cam,or tonin offccwl City or Town: Issuing Authority(circle one): Permit/License# I. Board of Health 2. Buildinb Department 3. City/Town 6. Other Clerk 4. Electric al Inspector 5.PI umbiab Inspector Contact person: Yhone #: I Information an_ d Instructions Massachusetts General Laws chapter 152 requires all employes to provide workers'compensation for their employees. Pursuant to this statuL,an employee is defined as"...every peon in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including tie Iegal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association oy-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartmLents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintexiance,construction or repair work on such dwelling house or on the grounds or building appurt nanf thereto shall not bL-cause of such,employment be deemed to be an employer." MGL chapter 152, §256(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to a`onstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of colinpliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the.performance of public work um-til acceptable evidence of compliance with the insairauce requirements of this chapter have been presented to the contracting authority," Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC) or Limited L' tyPartnerships (LLP)with no employees other than the members or partners,are not required to carry workers' comp c:nsation finzance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be store to sig and date the affidavit. The affidavit should ~i3e ivt'viued tG the vitt'or tLlinri thatt.the ap'u%iCauOE,for the permit'or 1rCerse LR being,,b ai,e 2ng,. quested,not -D--n .L W rt.of Industrial Accidents. Should you have any questions regardi,^_-_g.�e law or if you are treq ired to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license member which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under`.`Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephonic and.,fagnumber:_._. Tic Commonwealth of Massachusetts Depar cmc of Industrial Accidents Office cif Inrestriaatfons 600 Washiagtan Street Boston,M—A 02111 Tel. # 617-727-4900 m t 406 or 1-9 77-NL4SSA.FE Revised 5-26-05 Fax ##6.17-72.7-7749 Wvm'.Mass..lgov/dia. INVOICE NO. JERRY CROTEAU ra CARPENTRY & HOME IMPROVEMENTS Name: I %./`rr� l /e �;v r(ill 4V, 1LLC C �, INTERIOR/EXTERIOR Address: �� c� I� %f /� r ' „ no job too small /f�i. .!y�c�a✓cr/ AL JERRY CROTEALI 603-893-9474 Telephone: 9 LEDGE ROAD PELHAM, NH 03076 DATE ORDERED DESCRIPTION AMOUNT � J J -L7 yr 1 st Deposit Miscellaneous DATE COMPLETED: Balance Material ' 2nd Deposit Labor f f CUSTOMER SIGNATURE: Balance Labor & Material 3rd Deposit TOTAL + Balance Additional fee to remove old material Checks Payable To: Jerry Croteau NORTH TOWN OF NORTH ANDOVER + OFFICE OF y 9 BUILDING DEPARTMENT . 1600 Osgood Street Building 20, Suite 2-36 North Andover'Massachusetts 01845 SSacNUS'�< I Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: 31 o JOB LOCATION: a00 CA N D LE S-tj C(< (LOA Number Street Address Map/Lot IiOMEOWNER MICHAEL MA6v12C q?B-�7S-2�a�, 17?-37Y- 57oL Name Home Phone Work Phone PRESENT MAILING ADDRESS a00 CAVO LE$Tl C(< fZoft C) City Town 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 owns 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"homeowner certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption i BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 i �.1ORTH T0VM Of over No. o A K E o dover, Mass., COCMICHEWICK RATED PPa,t�CC7 1 ` BOARD OF HEALTH PERMIT T D 'Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT a �! �� "' Foundation has permission to erect..... .......:......................... buildings on . ........ 1�.r?. ............. ..... .. ..... Rough to be occupied as............... .7ep�tilng s��. ... . ..�. Chimney Chi e provided that the person ac this permit shall n 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 CONSTRUCTI ST TS Rough Service BUILD SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough j Display in a Conspicuous Place on the Premises — Do Not Remove Final No LathingD Wall To Be Done or � FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner { Street No. SEE REVERSE SIDE Smoke Det.