HomeMy WebLinkAboutBuilding Permit #188 - 21 HIGH STREET 9/15/2008 i
BUILDING PERMIT pFNORrN
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TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION `
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0ermit NO: Date Received �,9`�RAtee
SSACHU`��
Date Issued:
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg s:
Demolition te-C Other
1etstncteptix �
z17Uter�SEa�ver
DESCRIPTION OF WORK TO BE PREFORMED:
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Ide 'fication Please Type or Print Clearly)
OWNER: Name: L-LC- �.�� ��1.Fr��ti, Phone: Q-?
Address:
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ARCHITECT/ENGINEER Phone:
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Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ G/�, 60 n . o 0 FEE: $ 5-70-
Check
-7OCheck No.: Receipt No.:
NOTE: Persons contracting with unr gistered contractors do not have access to the guaranty fund
e:,
gnature`of1 ent/ lwrner_. k Sa nurse oficonfrac`tor
- - - 9
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public 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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Sionature
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
; a�E EPA 1•M 1T TVW,P19wMgPster-in IE yes
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Old. t
L�ocated��I��4�7Jam Street.. ,
COd1'7I
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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.s100-s1000 fine
NOTES and DATA— For department use
❑ Notified for pickup - Date
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Doc.Building Permit Revised 2008
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/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)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ 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)
❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
1
Location 0` h 5 T '" l % it I
No. � � Date
TOWN OF NORTH ANDOVER
H • oy
i
Certificate of Occupancy $
;�s'• a�� Building/Frame Permit Fee $
�cHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 3%
2 : 569 -"-
E' Building Inspector
� � 036954 Joseph S.Savil*Inc. Contractors Reg.# 135743
jtiofing&Gutter Contractor
i
40 Canal St.
Medford,MA 02155
(781)395-3954 Fax(781)393-4926
CONTRACT
Juane 24,2008
RCG LLC
Attn: Skip Rose
17 Ivaloo St.
Suite 100
Sotijexvi,lle,MA 02143
Faxi 617-625-8345 -
Job\Address: East Mill,21,High St.,North,Andover,MA.
SWNGLE ROOF
Remove shingles from roof to sound board.
Re-sheath deck with 1/2"plywood over entire roof with screws.
Install ice and water on perimeters and valleys-
. •
b1stadl 15 lb. felt om remainder. ti i.
r Itastall$" driped$e an all edges.; ,
InsrtaU GAF 30 year Arcbiteaft r SbWes on roof(weaving on valleys).
Remove all job related debris.
Price includes all labor,materials and staging.
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.: :, :. �,-c�.� c°..at�s? �4t I�.R-�-4•�^a"t� pal s cc, r.4�t.�f
Toto$47,500.00 Termsto be discussed if awarded job
Thank you,
o Ph S.Sa
IAORTH
® of
No.
dower, 1Viass. '
I� COCHICHEWICK V
%ADRATED p' C:)
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT......:. ... .Q1S ......rn l.l ....................................... Foundation
... ............................ ..................................
has permission to erect........................................ buildings on .,a ......... ...... .........................: Rough
s
� Chimney
to be occupied as.........�. .....Ti ......... ......... ........ o.a.�.....�............. .
provided that the person accept! this permit shal in every re a nform to the terms of the application tfil�ecl� 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 b MONTHS
UNLESS CONSTRU STARTS ELECTRICAL INSPECTOR
Rough
Service
BUILDING R
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.
ti ilff
x� 'r,�+„h�?�� y✓r„:t` r .fir• ,.r ,4d�t?�'i�'�J ..
e`f-,09 Yea'10 Mag useits
``.: .
partmeiit of M,dustrlal Aecldlents' `
4: Of,�lce ofblvestigations
.600 Waslthigion Street
Boston, MA 02111
www.ntass.gov/d1a
Workers!,Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please`Print Legibly
Name (Bus iness/organization,'lndividual): ' -k'TLcnh
Address:
t
City/State/Zip-_ 4s `.. Phone #: B} 251-5, �Sq
Are yn�tnployer?..C]teck the appropKIate box: Type of.proJect (required):
r 1: ! am e'em lo'er with`�t'� 't' l`' ”"' ' 4:i ❑'1'8m.a general contractor and,l,
1 P Y 6: New construction
em to ees'(full'add7or' art=time + have hired the sub-contractors :. ❑
P Y P ) 7. ❑ Remodeling
:,2:❑ [=4 sole proprietor.or partner~
listed on the attached sheet. .
,_..;;..;.:.ship and have no employee
These sub-contractors have 8. ❑ Demolition
working for mein any•capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' co
mp:� insurance 5. ❑.We are a corporation and its
10.❑Electrical repairs or additions
required.) ` ' officers have exercised their
8 i right.of exemption per MGL' 11.❑ Plumbing repairs or additions
3.❑ [ am a liorrteowner doin al. work,, :..., . ,.:.;,
` m self. o workrs'.comp, c. 1.52, 1 4 ,and we have no
• Y LN .,�, . P, �:-: :: . . § O l2.❑ Roofrepairs
M ; insurance"required.].t employees. [No workers'-
comp. insurance`required.] 13.�ther C
*Any applicant that checks box f!1 must also fill out the section below showing their•workers'compensation policy information
t Homeo%ners'who sabmlt'this affidavit indicating they,are doing all work and then hire outside contractors must submit a new affidavit indicating such.
i tContractors that check this box must,attadied'an addltlonal sheet showing the name of the sub-contractors and their workers'comp:policy information.
I am an employer that!s providing worktrs'eompensatlon lnsurpneefor my employees. Below Is the policy and job site
In
.: .
Insdratice Company Name:'.' ��.,C,orz-SGP
Policy or#or Self-ins. I;ic: #:` Expiration Date: is
,., .... ... ..m�a.� [Jori-f�
Job Site Address: ham r N City/State/Zip: �i
Attach a copy of the workers' compensation policy'declarations the policy number 11-expiration d
aaate).
y.,.
Failure to secure coverage as required under:.Section 25A of MGL.c. 152 pan.lead to theJmposition`of criminal penalties of a
fine up to$1,500:00 and/or one-year imppsonmeht 1i well as civil penalties.in the form of a STOP WORK ORDER and a fin,
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 ofthe DIN'for insurance coverage verification:
1 do hereby certify under'the pi lns and penalties of perjury that the Information provided a oye:is:(rue dnd correct.,
Signature: •• . . _. .•.. ._. .. .. _.. - ,.. ..._ ....,.....,.. ' Date: ., . .. :..
Phone#:
Offlcial use only. Do not write/it 1111s area,to be.contpleted by'c/V or fo)utt ofj7cial.
City or Town: PermIt/License#
Issuing Authority(circle one):
1.Board of Health '2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other.
jLBoard of Building Regulations and Standards
Constructop Supervisor License
License:, CS 38954
RIqPd its 7%2211955
F,.pl,rm on: 7/ 2/2009 Tr# 17487
Resti� ed6w.-do.
JOSEPH S SAVINI
84 RAVINE RD 4—
MEDFORD,MA 02155 Commissioner
��&mmmwvaU�✓�"GGfO0�Q7u0Rf0 Y �•--" ___..._�.,__�____.__.._
lS��•.\\ Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMP OVEMENT CONTRACTOR before the expiration date. If found return to:
gL
RegistrQ. 135743 Board of Building Regulations and Standards
010 Tr# 266057 One Ashburton Place Rm 1301
_ Boston,Ma.02108
JOSEPH S.SAV _ CO.
JOSEPH SAVINI _
40 CANAL ST Cu^�
MEDFORD,MA 02155 V Administrator NqKvalid ho gnature
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.,t ti'r^ `i''^ .7.:�.' '.'�+��•.• .� .�rZ.��.1.R Vis.,:l'..,L. �, • �••rr �A, • • 4It: 1 !k J••�'_
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trot 'i .�,i• •• '313 S' `
HOME IMPROVEMENT CONTRACTOR LAW
!I �; Supplement to Permit Application
K ` ivtGL 142A irquire that the t +struon alteration renovation revair. modctnization,covering imyrovcrncnt, irmoval.
demolition of corismcdon of.in Wdidon to am adstina owner-Qocuoied building containing at least one but not marc than
four dwelling units or structur=which arc adaccnt tb such mid=cc ar buildings be dont by rostered watra=m with
=min=cpaocrsy along.with Qd =Tt
i•.'—t:'%-fir,,
Location of Property: m,I we r.
Owner Name and Address: o, r � a
Daze of Pernit Application: 9/15&B JEst!Cost: GZ-?51212,12 C�
Type of Work: v4y,�'a sr_ V-P —V-�
I hereby certify that:
REGISTRATION IS NOT REQUIRED FOR THE FOLLOWING REASONS:
work=luded.by law
job under S1,000
building not owner-occupied
Owner(('PuIImB own permit
wNiotice is hereby given that
OWNERS PULLING T MIR OWN PERMrr OR DEALING '7iTITE UNREGISTERED
CONTRACTORS FOR APKICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND MGL c.'142A
Signed under penalties of perjury, I hereby apply for a permit as the agent of the owner:
S@t4;
;, :•_<: Contract r Name tint Daze
Q . ..
(pLt)
Contractor Si Registration Number
OR. • S" 3 --� 0
Nprwithstmding the above notice, I hereby apply for a permit as the owner of the above property:
I
Owner Name (print) Date
Owner S i�mature
08/16/2006 20:27 17816485967 FELLSIDE PAGE 03
07/29/20U. 12:56 7813.934526 JMEPH SAYINIINC rpm e3
,AL=a CERTIFICATE CSF LIABILITY INSURANCE 10/29/2007
•*00UCER (600)333-7234 7H1 CER11FICATE 13163UEP AS A MATTER OF INFORMATION
Eastern Insurance Group. LLC ON.CYAND CONF..ER8.80RIQKT8UPON TM.EGERnFICATE-
HOLDER.THIS CERTIFICATE.DOES NOT AMEND,EXTENOOR
233 West Central Street - ALTER THf,924MOR AFFORD$b BY THE POLICIES BLOW.
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