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HomeMy WebLinkAboutBuilding Permit #780-11 - 212 ANDOVER STREET 5/19/2011Permit NO: -??) �/ Date Issued: h 1/7/0 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Rece o•tt�ec �6'•N�\ VL FMYORTANT: Applicant must complete all items on this page LOCATION: a-t..;;L>_ _4-4106VC- .0 115-R 0 P-, ti RTY WNER 'Punt hhr_ yes. MAP NO Q_PARCEL_ Ab ZONINGFDISTRICT: Historic District `Machine _Shop Village wes ,no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building P-Gne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ,L�air, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Septic El!,Well ❑ Floodplain ❑.Wetlands p 04itershecl=District ❑'.Water/.Sewer. ...._,.y. DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: i i - Phone: ��?�'� �-Wo2L Address: 'ZLo-' 'i7,400ve2 ,GONTAACTOR Name: i 1 NtcL1,S-Phone:�lQ,-L�S-�_��5- �eGl�o�.-s FAddre5s: '-C.S f=or•b r r�.� ���� �'� �.-.max.-, o4ir3 �- . _.,.. _.. _ . _�� _ Supervisof's'Constr. ion License: _ � �1- �� N.Exp: fliomeilmpro_yernent;License: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $7f,01 t96 ©— FEE: $ 6 Check No.: ii 4?�:, -7 Receipt No.: 2`1I 6'6 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sgnatureof AgentLOwner�_ f _ - Signature:of^contractor�A -4,(. �..---- Location %1�-Z - /i Date 3 No. %E( �ORTM TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ sAENUs t�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #- j� 2 ► 6 Building Inspector 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 PLANNING & DEVELOPMENT COMMENTS DATE APPROVED 11 CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Panning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMENT -Temp Dumpster on site yes_ _ano Located�at �124fMan Street .._..._ . _ �. _..- Fire Departmentsignatureldate CO_MME 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 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 ❑ 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 w . ° z ° 0 HH. a a aco z aa - o u w Cf)nn Or- 45 `3o co o cij w rQ 0 c o c ol 43 rA P O H uiCOD W LL. H ae W LLC.D .co �o �m c o : o = C N O C c O :vV CLc cv ev m c :r o 0Cc m v4 c _ E ts cm 0 O CL= \' N O c m L Nay CD NC Co \V` m �mo 0-Cma 03 % i Z L O mC C C Q N dC= cc c CLCD o CD :ago H cc=w m •y '_ Z C •C �E ca .0 ama N m ®� C d0,0 mGo m O� Acm L h �O _ s mem d. N s N s N C O m L m C _ m 0 m c 'c N m t O Z 0 cm lip F,-r, 0 E CD c i O O V Z CD C. O CO) G C Ico gm 0:5 O �— O O O �ECDow m m � � ccm O 0 0 CD ca o C Q Co .1-9 c v cc -J 00 ca CD C.3 ca O C C cc CO2 cmY The Commonwealth of Massachusegs Department of Industrial Accidenis Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print I,edb-!Y Name (Business/Organizadontbdividual):_ A54& khy00i:y S -o-- ,00 p r. j C Address: -4 S- Forior- rzo l t 3 2— Phone M 9" 1 Are you an employer? Check the appropriate boa: 1. ®'F am a employer with . Z Y 4. ®. I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet ship and have no employees working for me in any capacity. (No workers' comp. insurance required.] 3.0 I am a homeowner doing all work myself. (No wool ers' comp. insurance required.] .I These sub -contractors have employees and have workers' comp, insurance # S. E] We are a corporation and its officers have exercised their right of exettsption per MGL c. 152, § 1(4), and we have no employees. (No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Memodeling 8. ❑ Demolition 9. ® Building addition ME] Electrical repairs or additions I I Q Plumbing repairs or additions 12.%] Roof repair . 13.0 Other *Any applicant that checks box #1 mistalso till out the section below showing their workers' conipensaton policy tnf lmdon. I Homeowners who submit this affidavit indicating 4icy are doing all work and then hue outside eontraefors must subadt anew affidavit indicating such. tContractors that check this box must attached on additional sheet showing the name of the sub -contractors -and state whether or not those entities bave employees. If the sub -contractor; have.employees, they must provide their workers' comp. policy number. I ant an employer that. is providiacg workers' compensation. insurance f or my e4.toyges. Below is the policywnd job site information, Insurance Company Name: `-_a C e-4 "`at -&A V -- ff�� Policy # or Self -ins. Lie. #: � L0&JLS -7 4 a-' Expiration Date: "7 Job Site Address: CitylState/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 MGL 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 fine of up to $250.00 a day against the violator. Be advised that a copy of this statementmay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above iv true and correct Signature: //k-1 J . A Date: Phone #: `"0 7"to cit Official use only. Do not write in this area, to be completed by city or town official City or 'sown: 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 li Contact Person:- _--_- --- Phone � IDOrrrm AC®RD.. CERTIFICATE OF LIABILITY INSURANCE DAT20100:50 07/0212010 09:50 PRODUCER (800) 225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C. Church, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAOR TE HDER. THIS CERTIFICATE DOES 41 Wellman Street AT ER THE COVERAGE AFFORDED BY THE POLICES BELOW Lowell, MA 01851 800-225-1865NAIC # INSURERS AFFORDING COVERAGE INSURED INSURER A: Citizens Insurance Company of America New England Window & Door LLC I INSURERS: Wausau Underwriters Insurance Company 45 Fondi Road Haverhill, MA 01832-1302 INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIUM t:U. NU I VVI I MCI r IMIJ11 a ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS 5HUTA?N NIAT -P.vm occre Mlm�w =+ 4 r - -- ••�• — POLICYEMion VI POLICYEXPIR4TION LIMITS ILSR OD' TYPE OF INSURANCE POLICY NUMBER DATE OD D E MOD 1000,000 EACH OCCURRENCE $ GENERAL LIABILITY DAMAGE TO RENTED 100,000 $ X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurencs $ 10,000 j� CLAIMS MADE - OCCUR MED EXP (Anyone person) I i ZBN8161407 7/1/2010 7/112011 PERSONAL INJURY $ 1,000,000 A GENERAL AGGREGATE $ 2,000,000 RROCL'CTS-COPrP/OPP.GG a 2,000,1-00 GEN'L AGGREGATE LIMIT APPLIES PER: ' POLICYFXI PR0- LOC AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO I I I ALL OWNED AUTOS BODILY INJURY $ (Per person) A SCHEDULED AUTOS ADN8162169 1/1/2010 7/112011 X HIRED AUTOS BODILY INJURY $ (per accident) i X NON -OWNED AUTOS i PROPERTY DAMAGE $ (Per accident) AUTONLY-EA ACCIDENT $ O GARAGE LIABILITY r EAACC $ ANY AUTO OTHER THAN j i AUTO ONLY: AGG $ EACH OCCURRENCE $ y;JOU,L'OU $ 9,000,000 EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE AGGREGATE lJ 7/1/2010 71112011 $ A UHN8167305 -I $ I DEDUCTIBLE S X RETENTION $ X I WC STATU- 0TH• WORKERS COMPENSATION AND $ 500,000 B EMPLOYERS' LIABILITY ANY PROPMETOR1PARTNEWEXECUTIVE I bt'CCZl1259957010 E! .EACH ACCIDENT ?/112010 7/U2611 500,000 E.L. DISEASE • P EMPLOYEE $ OFFICER/MEMBEREXCLUDED7 500,000 If yes, describe under E.L. DISEASE -POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Proof of insurance 1 I A•ru%ru CERTIFICATE HOLDER .,......____..___ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF: THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN few England Window & Door LLC NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL .5 Fondi Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR laverhill, MA 01830 REPRESENTATIVES. 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'Q L-> i C E N c�.- Rf �O U cn O•C UO O n O> Q al c6 E O Lir O (6 Q" C C '-�= a) a)E N ONcvi c c«�- L BEY lacca (u�'- o L O O N-0 N E U a) - c = C -O O CA .c y "� , a r� aj O i i C CO '6 i V ,((`` N O O ,o O U) %n j, O` O C: — O V O ` X N -O ,(.a a) .O N CLO N U O �"'�+ O E c E x E Y v vac ro:�o(cn(�n ctooaD--u ami o ns me(n— m �.s(D ""co O o v 4.1 E — — , 0 �O — N > O Q).2 N -C A~ R� cz 4 c LL C O X U- N X ? is • o •.� (n in Cn c ®1Z O O O 'ttf N C p C Eo v L c s M +u a) N> O— O �` 'C U cc3 O — b> in N O Co C cn Al N oo to Ln ao n to Cl Io M r P cp to V N ni (D b m N 2V N Eh A V N c (!} I EH (f} ffl 49 O V 0 L fll (Q CoC e+ -Cs co m I 0 o A z ' e tw U) �-° 0_ N (0 0 11 i u N L NOTICE OF CANCELLATION Customer Name: /7' (Please print) Date of transaction: 7 '3 l / You may cancel this transaction, without any penalty or obligation, within three business days fi-om the above date. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement; or you may if you wish, comply with the instructions ofthe seller regarding the return shipment of the goods at the sellers expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. if you fail to make the goods available to the seller, or if you agree to return the goods to the seller- and fail to do so, then you remain liable :for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a 'telegram to Pella Windows and Doors, at 45 Fondi Rd., Haverhill, MA 01.832 not .later than midnight of 11 (three business days from the date of transaction above). 1 hereby cancel this transaction. (Date) (Buyer's signature) DISPUTES C Job Name( at G-r� Date L-/ '2 THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS CONTRACT, PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE :EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATiONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH A.RBITRA N AS PROVIDED IN M.G.L.c. 142A Contractor Home yy Zcr NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER NER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. i PELLA WINDOWS AND DOORS CONTRACT 1. TE RMS AND CONDITIONS These Terms and Conditions are an integral part of the contract set forth on the Product Order (the "Contract") between New England Window and Door LLC dba Pella Windows & Doors. Inc. ("Pella") and the person(s) identified on the Product Order- ("Owner") to Supply the products (the"Products"), and perform Ole work (the "Work") described or referred to in such Contract. For Product Only purchases, a signed "Product Only Addenduni' is a required part of the connect. 2. OWNER Pella is tint responsible liter any existing security systems. Owner shall remove all shades; verticals, blinds, curtains, drapes or window mounted air conditioners, prior to the installation of the Products. Pella's installers are not responsible for the removal or installation of these types of items. Pella is not responsible for pre-existing window coverings fitting on newly installed Pella windows. The Owner Shall provide complete access to the work site between the hours of 7:00 a.m. and 6:00 pxa, (Monday flirough Friday) for Pella's installers to deliver the Products and perform the Work. 3. PELLA JPella will be responsible for and have control over construction means, methods, techniques, sequences and procedures and for coordinating all portions of the Work. Pella will be responsible for the Work of its Pella Contractors who will install the Products. Unless provided otherwise in the Work description, Pella will provide and pay for all labor, materials, equipment, tools and machinery, tntnsporialion. and Other facilities and services necessary for the proper execution and completion of the Work. The materials and equipment furnished ander the Contact will be. good quality and new Unless otherwise required or permitted, the Work will be free troll defects not inherent in the quality required or permitted, and the Work confomt with the requirements of this Contract.. Pella shall not be responsible fol damages nr defects caused by abuse, modifications not. executed by Pella, inhproper or insufficient maintenance, improper operation or normal wear and tear. Pella will keep (he premises and surrounding arca free front accumulation of waste materials or rubbish caused by perl'ortnance of tbe. Work. C H!iNG E15 The Owner may older in wriiing ehanges in Lite Work consisting of additions, Ndcletions, or modifications ("Change Ordcr" ). Any Change Order Shall include an actiusumnit to The Price anti the Substantial Completion Date, as detcnninecf by Pella. Pella reserves the right to approve or disapprove any Change Order and any such Change Order must be signed by both Owner and Pella to be effective. SUBSTANTIAL COMPLETION Owner understands and agrees that the Substantial Completion Date is an estimatu only and thatthe actual dale on which the Work is conhpleted may be extended to allow lot. Change Orders rcyucsled by Owner or if lite time to complcle the Work is affected by conduct of the Owner, weather, labor disputes, availability of subcontractors. acts ot'God, fire no other causes reasonably beyond Pella's canard(. If fihr any reason the Work is not fully co ipleted by the Sul•(<U:nti:l Complefion Date (including any extensions contanplaicd above). but is subshmtially cnnlpletcd by such date, i.c.. the Product has been installed, but minor parts Or components are missing or need iu be replaced or icpairud. a !hold back proportionate to the. cost ofremaining pails or work to be completed is acceptable. However, the holdback will not exceed the amount of the completion costs or 10 N of the remaining unpaid balance of the Price, whichever is less. Ir INANC:I NG If payment (,['the Price is financed with a financial institution through fella. all / financing paperwork nuns( be completed upon signing Of this Contract and the requisite approvals and authori-rations Iiir the full amount of the requested financim, shall have been received front the financial ins!.itttion. PAYMENTS Pella shall be entitled to stop the Work upon written notice to Owner for any material default or failure by Owner, including but not limited to, the Owner -s failure to pay Pella the amount due within seven days alta• the date payment is clue. CORRECTION OF \YORK Pella shall correct installation Work not in conformance with the requirements of the Contract, if not.i Pied in writing by the Owner within two years after the Completion Date or, if carlicr. the date on which the Work is substantially completed and payment of the Purchase Price made subject to it holdback as provided above Correction of Work as herein provided shall be Owner's sole remedy for defective workmanship, and is provided in lieu of any and all other remedies. Pella's Obligation lO correct Work is conditioned on Pella's prior receipt of all payments then due. LIMITED PRODUCT WARRANTY Pella shall warrant all Pella products, but only in accordance with the. Pella Windows & Doors Linhited Warranty. THIS LIMITED WARRANTY SHALL BET"FIE SOLE WARRANTY WITf 1 RESPECT TO THE PRODUCTS AND PELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES, EXPRESS OR IMPLIED. WRITTEN OR ORAL (INCLUDING WiTHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE). 10. NO CONSEQUENTIAL DAMAGES UNDER NO CIRCUMSTANCES SHALL PELLA BE LIABLE FOR C0NSEQQIJFNT!AI_, INCIDENTAL. INDIRECT, OR SPECIAL DANIACF,S. WHfFTHER FORESEEN OR UNFORESEEN. 1 L HOME 1NIPRO:'EMENT CONTRACTORS All home improvement contractors and subcontacloas shall be registered with the director of the Home Improvement Contractor Registration Program jadministered by the Board Of Building Regulations. and Standards. Pella and any of its subcontractors identified in this agreement have beat registered. Any inquires about Pella or any of its subcontractors relating to registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place. Boston, !NA 02108, 617-727-11598 12, PERMITS (MA customers only) P,Ila is 011igct}cd LO and will obtain the following permits for this project: tin ni F . _ . tloniemvncrs who secure their own permits will be 1 excluded front the guaranty fund provisions of Massachusetts Genial Lavis, chapter 142A. In addition to the r ights and rrtrantics .^muttcrated in this agreement, ycu may have additional rights under Massachusetts Genera! Laws, chapter 142A and 780 Code of Massachusetts Regulations R6. 13. NOTICE OF CANCELLATION You may cancel this agreement ilii has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notify the seller in wvriting at his main office or branch by ordinary mail posted, by telegram sent or by delivery, .not later than midni;lit of the third business day following the signing of this agreement. See the attached Notice of Cancellation for an explanation of this rirrht. Do not sign this contract if there are any Blank spaces. CtSm.'ner sig,itll e'/ ! / Date 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 Doc.Building Permit Revised 2008 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Sw"nm'ng 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 PLANNING & DEVELOPMENT COMMENTS DATE REJECTED ❑■ DATE APPROVED CONSERVATION Reviewed on Sionature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes E Planning Board Decision: Comments Conservation Decision: Com Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street 'FIRE DEPARTMENT _ Temp `DLimpster on site yes no - Located,at 124(M6in Street Fire;Departmerit�signature/date _._._ ---- - - -� - COMMENTS 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) o 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