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HomeMy WebLinkAboutBuilding Permit #671 - 22 BRIGHTWOOD AVENUE 2/29/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION F?_ b_ ~'•Y�i y Permit N0: 6--7-1 Date Received Date Issued: C IMPORTANT: Applicant must complete all items on this page LOCATION` �1G" t _1,M}.0 �'P,�- Print ` J ;PROPERTY OWNER Pp - r Print =MAP NO:PARCEL: Z ZONIN_G`DISTRI.CT Historic District yes r4� Macf7ine:Shop Village :yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne fa ' Addition Two or more family Industrial teration No. of units: Commercial Re air re lacemen Assessory Bldg Others: j Demolition Other Se tic : , `Vllell _ P Floodplain -'-Wetlands Watershed District lnlater/Sewer, ... D SCRIPTION OF WORK T BE PREFM;1 : 2�'1GUe ,4ce j Tc7rL�✓ ��-r's S A entification lease Type or Print Clearly) OWNER: Name: APAi`"tic Phone: C7 Address: �'�? f vo. xk _- z �' CONTRACTOR Name.._ s_(� 'Phone: Address..oYv/� Su,pervasor s Construction dLicenseExp Date: II — — c 6m .1 _ C6b , l 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: $ o�2 G `� FEE: $ 2 Z-- 'Check No.: 0,1 36 1 Receipt No.: NOTE: Persons contracting wit# unregistered contractors do not have access to Oe guaranty fund 'Signature of Agent/~Owner ��� Signature of contractor_. i I� I Location No. Date • �S.. ©j.-- NORTq - TOWN OF NORTH ANDOVER oft,..o ,•,�c • ; ; Certificate of Occupancy $ ;,ssACMUSEt� Building/Frame Permit Fee $2-- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ I Check # t �� i by �� 2 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 DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS 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: 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 ❑ Notified for pickup - Date 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: Doc.Building Permit Revised 2008 I ---------------� I � , , LO I , I NI l W O' � I z� 1 l O I I ol , I I O� C � I NI p11 l � I O I dL---------- I - --- _--J U) N 0a 0)0) V �a O °0 C N L: C ? m M NA W o�.cnoc O F- U) V W w_j00 W Iz->o 5— Z J a_ ODN LU V co CL ui CO in ays-d 100'd EIZ-1 -woad wvsz:ol so-ea-inr MN st O OilY 0�t0 O ndIt 00 It MLn cD 1�. 00 Oi p oo Rt en 0 M 00 It OAn- -U). 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X M u, iA iA - P All ditnenajotu .ej2e desi lfl[jOiLF givctt OrTit 7lus is nn vrigtnat acait5�� and mw.t r.�t be !?=�g.+ed: 6/3/10011 subject to vorifieation On job Site and ecteaa� er copied %ml P aPPlic;.Wc Cee has Printed: 7/19/20OR acjjuot*+-ent to fit job conditions. been d Orjeb ordtf head. 5t00e218.kit fp 1 Drawing h_7 Board of Building Regula ons and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Construction Supervisor License IRA G MALKIN 180 DAYTON ST DANVERS, MA 01923 ITS-CA1 Co 5OM-05/06-PC8490 s License CS: 20014 Restriction: 00 Birthdate: 7/31/1955 Expiration: 7/31/2009 Tr# 15631 Update Address and return card. Mark reason for change. Address Renewal Lost Card Jk Board of Building Regula ons and tand"s/ One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration IRA G. MALKIN Ira Malkin 180 Dayton St Danvers, MA 01923 DPS-CA1 0 5OM-07/07-PC8490 Registration: 100654 Type: Individual Expiration: 6/22/2010 Tr# 267871 Update Address and return card. Mark reason for change. Address ❑ Renewal F Employment J Lost Card 7lae �an��zauveall� o�J/iaaoaclucaeCta Board of Building Regulations and Standards Construction Supervisor License License: CS 20014 Birtldale` 7/31/1955 uplrat on 71-31/2009 Tr# 15631 Restriction: 00 IRA G MALKIN 180 DAYTON 'ST DANVERS, MA 01923 Commissioner f aco>a� CERFIGATE O LIABILI DAT.IMM/DGI/YYYO X01 " E'7 2. '08 PRODUCER THIS CERTIFICAM MMUEP: )i3O INFORMAMON ONLYAND C ERERT John JT Walsh Ins Agency, Inc � HOW R."I`H ;' f N6OR P 0 apx 407 ALTER THE ?!7 may., + 7�,� 0.7 :'>� �"{,�. � ::�• j t�% t �t.„'� « � t"'0. � � ti "` ¢ S �! �v � +1FY� ;. ,y4�f.,.'; _ >' t .. + y;Y '4�, .r$�b:oe �`ap'J sf .i. t«; ' ,•.<, , Phone.: 98,-,7,45-3300".,$axs97S-75-9557 INBE18��IN , , 1iI�EC INSURED .� i - t • c'g1 INStIR R C _ r 7 .. . 1. r•' C� r AP`s Z 11E INSiJFtE.Ii, D: :1- COVERAGE THE POLICIESOF INSURANCE',LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NQTWrrHpr (DING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 0EFC11PICATE MAY BE ISSUED-OR MAY PERTAiK.-,THE INSURANCEAr-pom6h BY THE POLICIES bESCRIBED HEFI91N IS SUBJECTTO ALL THETERMS, EXCLUSIONS AND CONDITIONS OF S CH" POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN,REDUCM BY PAID CLAIMS. LTR NSTYPE OF INSURANCE POLICY NUMBER DATE MWDR DAT! MMIICY EFFSOTIVE DD TION LIMITS pip alASluri�: ;;�AGM:O' 'a• .s 10)00'00'0 . 1,. =':' ccs ur,E: •;: A X CQMMF.RCIALgFNERA4LIABIL7 NC70.3488 PREMISES (Ea o curenc. S 50'.0.00 15 . '0 10/03/07 10/03/08 PEiSOiVALBAo INJURY $ 1000000 'S' 2.0�0.0'Q'0 . G AAr I4MAYE' IMITAP81 �5Pk 'QR So lc� ,aPAo $:2;' 00:00.. POLICY'C�f' LOC S :$• :1!..''.'!. A M061LEL,rl i :'0' .. •'c ,:.. ; 0 8i!YED I E IIF .• 5 AUTO e l `OWNEDAUTOS. ::i ;�nLILY•tNJ� S' ' IKEb AUTOS i }'' • ` P fid t ON-01NN(=0'AIiT03. � '.'� �.,.. �.. PRO G E:LIO8IFITY AU7O;OIYC. :E f1CGt0ENTi,$' ANYA4TO AUTObN • r . DCR9'IA. 'EAG��H���G__CCI�?R� OCCL1Fi Cial mi DE; i1GgrtC s; !f,' :S l ori ... s G •, .'3; ;; .:� EMPLOY L1A8 B. wA MP ga7io,; 7PJ08-203x968-2-07 08%31/0 08/31/08 6L: EACH AMT-CI'EKf I 510'00 . NAND r:!' �'• ANY P 0 EWEXve OFFIC EXCLUDED?. E.LiDiEPt�� Ehdpj 0� 3 1OjA'O:O:Q.. . If yes .d undo. SPEG�IAL• OVISIONS hefau ISEA�Er' L1trrY:LIM1R T S' S GO;00' E,ID SS f I. DESCRIPTION OF OPERATIONS /LOCATIONS 1 VEMCLES / EXCLUSIONS ADDED BY ENDORSEMCNT' 1 SPECUIL PROVISIONS ' i I CERTIFICATE HOLDER CANCELLATION ..:,.L..:. .:.. . SHOULD ANY OF THE ABOVE DESCRIBER:0ouadt CANCELLEDBEFORETHE EXPIRATION OOo1003 :. •. DATE THEREOF, THE ISSUING INSURER WILL ENDER RTO MAIL 3 O DAYS vvRITTEN NOTICE TO THE CERTBZCATE HOLDER NAMED TO:TH LEFT, BUT FAILURE TO DO SO SHALL Adam Rupp IMPOSE NO OBLIGATION OR LMILFTY OFiAkY IOND ON,TFIE mSURER ITS AGMS OR' 22 Brightwood Ave :Korth Andover' KA 01845 REPRESENTATNES- • ki- AUTHORIZED REPRESENTAT . John a. Walsh In ACORb 25 (2001108) CORPORATION 1988 ZO'd ZS:El 800Z VZ Inf LSS69bL8L6:x8A 30Nv8nSNI HSIVM NHOP The Coninronwealth of Massachusetts Department of Inditstrial Accidents Office of Investigations 600 tMashington Street Boston, MA 02111 " www tnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 1)6tJ' RYY S 7 City/State/Zip: 0#*i ueQ S /Y►�. Of r , phone tl: • r j 77*Q Fa Are you an employer? Check the appropriate box: 1. VI am a'employer with _� 4. ❑ 1 ata 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. t ship and have no employees working for me in any capacity. [No workers' cornp. insurance required] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition l0.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12,0 Roof repairs 13.❑ Other -arty appncanr tnat cnecKs box n i must also till out the section below showing their workers' compensation policy information: t llonteowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' cornp, policy information. I am ars employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: 7 P3'06 -,3x96 B — a. —0 7 Expiration Date: Job Site Address: V e, City/State/Zip: Attach a copy or 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 statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the paiys and penalties of pe►jury that the information provided above is true and correct. Oficial use only. Do not write in this area, to be completed by cite or town official. City or Town: Perrnit/License # Issuing Authority (circle one): 1. Board of [Health 2. Building Department 3. Cityrrown Clerk 4. Electrical Inspector 5. Plutttbing Inspector 6. Other Contact Person: Phone Al: E 0 C w O O F=4 a Q o CQ G u O w Op aJ cn v cn cz o z " a C ° p w O w v �C U m C w" aa 0 U p C2 ie C ii 0 w � U W p w v V) c C - w p U W.Itow p w r w w w a C fn cn v 'a ° cn W � c o c N C.) co •:,ago ;ac :earn * a :moo i O E a X Z oLU c� 1'Y' JZ H O ca r� :gym 0 CM 66 CL= cC m m � CD H M � H W c co •�cm CA Cc = _ • N O � W E m CD A :o c.t� L m - m ' y cr. Of V • r r.+ � C .�. C H P -4O p � m C3 H Z c� cc c •� o ..: ' Ito c ~ t1 1L�'mc •o ` o CD CL. m Cl) N.! v = L 1 _MD c �- ».. .y dL W C Z uj uj E ca c o • c*m o� c 7O CLv� a O y O m�p� �-i O d = m ? F-4 u it V) 7 0 u C!) �1 N O ai � L O v z CL O h C I Com_ COD 0 mm CL 1. = O � coCL L CL CMa ca c o B � cv � V J •p CL 0 CD c z ai 0 CL V H O C C C m CO2 0 uj 0 v/ uj W a W. ujW U) Permit NO: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received "• O •ti t� * 0- a TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOnefamil Addition Two or more family Industrial era ion No. of units: Commercial Others: e , —replacement Assessory Bldg Demolition Other Se tic.., Wel# p Floodplarn' �IVetlan�l 11i1a#erste `fisc# q s k .� DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: _f)0PrM ROM Phone: 97''687"485 Address:_cv ARCHITECT/ENGINEER Phone: 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: $ 10, o�a�% 00 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature, of Agnilbwner _ Signature of contractor