HomeMy WebLinkAboutBuilding Permit #827 - 201 OSGOOD STREET 6/19/2006OF NORTH 1ti
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Permit NO 27
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
APPROVED
Date Issued:
IMPORTANT: Applicant must comply
LOCATION 7-C) l O S u as O ST
Date Received:
all items on this
Print
PROPERTY OWNER M R d S ZY ; KA
Print
MAP NO.: , 5-r PARCEL: Q ZONING DISTRICT:
TYPE AND USE OF BUILDING
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
0
Exp. Date:
Residential
Non- Residential
❑ New Building
❑ Addition
❑ Alteration
❑ One family
❑ Two or more family
No. of units:
❑ Industrial
['Repair, replacement
❑ Demolition
[rAssessoryBldg $ A O
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED R ) c, W Z W oob J ►� j N s
3 5 DCi5 f!'JES tr 3 ACK 1 1Z C- VI -o) CLb P dot RD
tQ STnLc- \�FhA,
Identification Please Type or Print Clearly)
OWNER: Name: 'KA-, k u 'z. S V-A Phone: 1'1 $ - G 3 - SS 36
Address: Z0 S Gzc D
�Ec.c q 1 8 - 3'7S`-7 -7 qv L
CONTRACTOR Name: T D)*i k AT 5"o +) Phone: q1 8 6 9 f t 1!")O
Address: 3 E-DGer-e,R-C. "RD I3Dt4 �I`i `aIg6`t iyo IK4
Supervisor's Construction License:
0 Z-2- \-1
0
Exp. Date:
r 1 Z Z
O I
1
Home Improvement License:
i 1 O
Exp. Date:
1-0 /-z, oz
D 6
ARCHITECT/ENGINEER Name: Phone:
Address:
Reg. No
FEE SCHEDULE. BULDING PERMIT. $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COIT BASED ON $125.00 PER S. F.
Total Project Cost :$ 2..`7 O iw> x10.00=FEE:$ Z% Q
Check No.: Z-7 o 9 Receipt No.: y!�
Page I of 4
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Public Sewer ❑
Well F1Tobacco
Sales ❑
Food Packaging/Sales [I
Private ❑
Permanent Dumpster on Site ❑
(septic tank, etc.
Electric Meter location to
project
NU It: Persons contracting with unregistered co tractors do not have access to the guaranty fund
1
Signature of Agent/Owner - ignature of
Contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
i COMMENTS
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTMENTMFORM05
Created 1MC. Jan.2006
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Q
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
711
DATE REJECTED
DATE REJECTED
C
DATE APPROVED
DATE APPROVED
DATE APPROVED
Planning Board Decision- Cnmmentc
Building Setback (ft.)
Front Yard Side Yard Rear Yard
Required Provided Required
Provides Requir
Provided
/ 4-ed
/4
vation Decision:
Comments
Water & Sewer connection signature & date
Temp Dumpster on site yes—no— Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
DIMENSION
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
INV I r.S ana UA I A —
Page 3 of 4
Doc: INSPECTIONA
Created 1MC. Jan.2006
C
0
n
s
e
r
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
Addition Or Decks
❑ Building Permit Application
❑ Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan
And Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
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
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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
i
Page 4 of 4
d
Usk
Location,
/
No. 9.2 - Date % O
NORTq
TOWN OF NORTH
ANDOVER
• O9
f
s
;
Certificate of Occupancy
$
�'�s',•°' E
SACMUS
Building/Frame Permit Fee
$ 7�
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check #
i
Building Inspector
I:
John H. Watson
June 16, 2006
Kathy Szyska
201 Osgood Street
North Andover, MA 01845
Ref: Barn at 201 Osgood Street
Post Office Box 414
North Reading, MA 01864-0414
Telephone 978-664-3510
The Gothic Carpenter
The following work is to install new siding on the rear and two sides of the barn
at 201 Os ood Street, North Andover, Ma. Existing clapboards will be
removed; ' i, Mill be repaired and renailed as needed, windows will be
reflashed trim will be repaired and renailed. Typar Housewrap will be
installed. New #1 red cedar shingles (rejointed and rebutted) will be installed at
7 inch exposure. All debris will be removed and properly disposed of.
Stock will be delivered and work will begin June 19, 2006.
Labor & materials: $27,250
Payment due: $9,000
14,
Please call with any questions. Thank you.
The Commonwealth of Massaehuselts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, ,V.4 02111
t ; www.mass.gvv/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
,kpplicant Information Please Print Legibly
Name musiness/organisation/Indkiduall: 6 A 5--0I 1
Address: c x i I �-I C0 (le, r- e v-,&10 —
c
C ity,'StaterZip: �) ,, (Rr- ,6 h ai 6 - Phone #: g J S'
Are you an employer? Check the appropriate box: '
i. ❑ I atn a employer with
4. ❑ 1 am a general contractor and
�ployces (full and/or part-time).*
have hired the sub -contractors
2.elm a sole proprietor or partner-
listed on the attached sheet. x
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. [1 We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
$. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
I I.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
*,\ny ,applicant that checks box N 1 must also fill out the section below showing their workers' compensation policy information.
+ homeowners who submit this aff idavit 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 none of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance fur my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy �? or Self -ins. Lic. i#:
Expiration Date:
Job Site Address: City/'State,/Zip:
,attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of ,",IGL c. 152 can lead to the imposition of criminal penalties of 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 tine
Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do Hereby cep* un4er the Niins atfl penalties gl'perjury that the information provided above is true and correct.
�ignahtrc: � In/��
Q
C<cL aF 3J5 7702 —
Olficiul use only. Du not write in this areas, to he completed b4 ei(p or town official.
City or Town:
Permit/License #
Issuing authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk -t. Electrical inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
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I.oard of lf;iildin" ltcgii;a;iotn .vsd
r — ?OF iE ? ':I=ROVE*�1E31T C:?i+7.� -.'
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Registration: 110493
txpr ac'cn: 10/20/2006
Type: Private Carl orai'.cn
GOTfi'C CAR=ENT_R It..
j0H.N WATSON
LEDGEMERC RD
READING, t:•'A 01864
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BOARD OF BUILDING REGULATIONS
=_
License: CONSTRUCTION SUPERVISOR
Number: CS 022409
Birthdate: 09/22/1946
Expires: 09/2212007 Tr. no: 5730.0
Restricted: 0r
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