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HomeMy WebLinkAboutBuilding Permit #319 - 21 NORMAN ROAD 11/10/2008 NORTH BUILDING PERMIT bgtio TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION * ,� Permit NO: Ar Date Received gSSNGH►1`�� Date Issued: — 19 c IMPORTANT: Applicant must complete all items on this page LOCATION 2 I J! /Yl Q P V /y, 47 Print PROPERTY OWNER J OC. 1-�----► c fzo— -' Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration V No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer f ESCRIPTI N OF WORK TO BE PREFORMED: r- Identification Please Type or Print Clearly) OWNER: Name: JOc-Tr;cL-?=4 Phone: Address: ex Sf /V qnC) I*q CONTRACTOR Name: Address: Y�i`tOC e ire t Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 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: $ ��y FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 5-ignature of Agent/Owner Signature of contractor ► _ ,K,� 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 i HEALTH Reviewed on Signature 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located.at 124 Main Street Fire Department signature/date COMMENTS 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 I I I ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Y 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 i ❑ 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 i Addition Or Decks ❑ BuildingPermit Application ppllcatlon ❑ 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 ❑ 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 Location e�k No. Date r �aR�M TOWN OF NORTH ANDOVER 3: • O f w + Certificate of Occupancy $ , ,s<� Building/Frame Permit Fee $ , Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /? a3 Building Inspector �l' ,p �/te {OJo7�rreo�uuea Board of Building Regulations and Standards Massachusetts.- Department of Public Safet.N HOME IMPROVEMENT CONTRACTOR ..Board of Buildin<- Re-ulatiims and Standards' ' . Construction Supervisor Specialty License Regis 122385. 14900M]26/201 0 Tr# 274007. License: CS SL 99685 ire btf/ Restricted to: RF J&D WEATHtR' M ' ; JAMES DEBRECENI JAMES DEBRE �,_ � 2 TANAGER WAY 2 TANAGER WAY'=>� �, "` LONDONDERRY, NH 03053 LONDQNDERRY,-NH 03Q3 Administrator Expiration: 1Z/6/201'1 CJAInmi..i4,ncr. TO': 99685 License or registration valid for individul use only Restricted to: RF before the expiration date. If found return to: IA- Masonry only. Board of Building Regulations and Standards RF- Roof Covering One Ashburton Place Rm 1301 WS-Windows and Siding Boston,Ma.02108 SF- Solid Fuel Burning Devices DM-Demolition only ti Failure to possess a current edition of the — Massachusetts State Building Code - _ — is cause for revocation of this license. Not valid without signature Refer to: WWW. Mass.Gov/DPS AL FOURNIER JAMES DEBRECENI Family Roofers & Painters 168 MAPLE STREET METHUEN, MA 01844 973-5127 EXTERIOR PAINTING — CARPENTRY— ROOFING FREE ESTIMATES Date: NEW ROOF STRIP LAYOVER Install 8" 5" Drip Edge Entire Perimeter Install 3ftC/'/ 6"ft 7of Ice & Watershield at Eaves Install Ice & Watershield at Valleys & Chimney Install 151b Felt Paper rest of Roof Install Vent Pipe langes Install 30yr 40yr 50yr Architectural Shingles Install Ridge Vents RUBBER ROOF Install '/�" Insulation o r Install Drip Ed E i imeter Install Fully dh e 0 ubber Install Cover Tape Install Neoprene Around All Protrusions TOTAL � v ON ACCEPTANCE WHEN STARTED HALF COMPLETE BALANCE WHEN COMPLETE All Workmanship guaranteed 10 years All checks paid to James Debreceni or Albert Fournier 11111**4J:1 1A GRANITE STATE INSURANCE COMPANY 71593-0000 WC 742-78-59 13102 ------------------ -------------------------- -66-0508-00 JAMES EI N I 2 TANAGGERR WAY Member Companies of WA LONDONDERRY, NH 03053-0000 041American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 I.D# MA UI#h Of Will'I 1XII 01111:i nEGNAN INSURANCE AGENCY WORKERS COMPENSATION AND EMPLOYERS 85 SALEM ST LIABILITY POLICY INFORMATION PAGE LAWRENCE, MA 01843-1619 INSURED IS PREVIOUS POLICY NUMBER INDIVIDUAL RENEWAL 002359957 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 05/11/o8 TO 05/11/09 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500.000 policy limit Bodily Injury by Disease $ 100.000 each employee C. Other States Insurance: Part Three of.the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A D. This policy includes these SEE EXTENSION OF ITEM 3.0. OF THE INFORMATION PAGE - WC990612 ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Classifications Code Number Remuneration $100 OF Re- Premium ❑X Annual ❑3 Year muneration rLA-IJ Annual El 3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $163 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $318 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $3,294 If indicated below, interim adjustments of premium shall be made: ElSemi-Annually El Quarterly Monthly DEPOSIT PREMIUM 05/12/08 ASSIGNED RISK 66 Issue Date Issuing Office Authorized Represent ive WC 00 00 01 39967 (Rev'd 04/08) INSURED'S COPY tAORTH Andover ® o _ __ ; TO o .,.¢y�• tiw,4. 1 No. / 9 = � _ 3 - _ C, © dover, Mass., I T O LA A. COCHIC HEWICK V AD PQ�t� y 9�S RATED G BOARD OF HEALTH Food/.Kitchen Septic System PERMITBUILDING INSPECTOR r' .. ........................................ Foundation THIS CERTIFIES THAT.......1,0.t............... UC,-.. ........ . ....................................................., . . has permission to eroCt.. ►.. ..41..K�-. buildings on ........ ......Y.i.Q. k!�Ig �J �' Rough P ... Chimney to be occupied as.... provided that the person acc ing t s every respect orm 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 PLUMBING INSPECTOR Buildings in the Town of North Andover. VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S S Rough Service UILDING INSPECTOR Final Occupancy Permit Required to Occ uPY Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises. — Do Not Remove Final No Lathing or Dry Wall To Be Done FBurner DEPARTMENT Until Inspected and Approved by the Building Inspector. SEEREVERSE SIDE Smoke Det.