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HomeMy WebLinkAboutBuilding Permit #032 - 2211 TURNPIKE STREET 7/15/2008 N BUILDING PERMIT o` ORTN o .TOWN OF NORTH ANDOVER 0244e;. APPLICATION FOR PLAN EXAMINATION e D9 Permit NO: Date Received A7lp 010, y �SSACHU`+�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION I r � q Print s PRQPERTYIOWNER �:. j z°SU°S Print MAP NO /� :PARCEL. . ZONING DISTRICT_ Historic.District� =yes= � no,, T w �NlaeFirae Shop Village yeses °no 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 Others: Demolition Other Septic V1/e�l floodplain w = `.We'tlands Water5hed•District-'-ro Water/Sewer - _ : _ DESCRIPTION OF WORK TO BE PREFORMED: ra Identification Please Type or Print Clearly) OWNER: Name: ,rC'�C�/2�10 � j,�.7,PS'GS Phone?—ff Address: —CONTRACTOR—Name— ' mit/c /� �' Phoneme Address: Sy`'� Supervisor's Construction License. Exp. Date ` ®_ - Horne°Improvement.License . /�/ d. _ Exp.P Date: } .? a 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: $ s`� FEE: $ �� Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fud r 7-7 ��gnature ofi. #gent/Ownerr+ Signature"of contracto 1 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 14EALTH 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 f"TREE DEPARTMENT -jempIDurnpster.on site yes no Locatedl at=324'Main Street "Fire Department signatureldate w "COMMS--NTS 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) - l IIS ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 I 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 I ' ❑ 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 9 9 9 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 22 No. O�2 Date d 6� �oRTM TOWN OF NORTH ANDOVER 3? ' °c F 9 # Certificate of Occupancy $ Building/Frame Permit Fee $ g wcHus z Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # `a 2 13 2 4Building Inspector FORTH TO" * of No. 3 cz oL N dover, Mass., r 0 LA I� ACOCMICMEWICK ,, T DRATED P' C:) `s E BOARD OF HEALTH a PERMIT T D Food/Kitchen Septic System 5 BUILDING INSPECTOR UI NG FSu5 THIS CERTIFIES THAT........ .... :....:.. . .... ............... ......................... ....................................................................................... Foundation has permission to erect........................................ buildings on .�2.j.......� �' ./.d� ... � ................ Rough ... . . ................. .. to be occupied as.......:...:..:............ ... r ...' ..... ......�o.c)... .................. Chimney provided that the person accepting this permit shall in every respect conform 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 Buildings in the Town of North Andover. 'PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids,this Permit. Rough Final i PERMU EVItZES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough ................... Service ................ ...... ................... • BUILDING IN ECTOR Final Occupancy Permit Required to Occupy .wilding GAS INSPECTOR Rough Display in a Conspicuous .Place on the Premises — Do Not Remove Final No Lathing or Dry (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner j Street No. SEE REVERSE SIDE Smoke Det. QUALITY ROOFING RESIDENTIAL by LARRY HILDEBRAND ROOFING CONTRACT 30 Sheridan Street Woburn, MA 01801 Owner's Name: �� 'Owner's Address 781.789.9711 c 7-' eTej a S `� /� ; 6 CS090389 Owner's City Owner's Zip Code Owner's Home Phone Owner's Wo hone Ter larryhildebrand@verizon.net Project Address r Project City ProjectZip Code Project Phone Date ME,the Owner(s)of the premises described above authorize Quality Roofing by Larry Hildebrand,hereinafter referred to as"Contractor",to furnish all materials and labor necessary to roof and/or improve these premises in a good,workmanlike and substantial manner according to the following ten-ns,specifications and provisions: a.Description of the work and the materials to be used: _ NQS rf. f �d �' 5 . ``'f. ,L i/ ............................. .............. 1 -X-- 7 _ f Or . ..._ ............. r.. ,r t .: �- ....... .............. .................... ........ ... r7 r .......... zr ..._.. c_ rs .... .... .. _ ...- _ _ . .. ... .__ ....... .._ ........ ......... _ ...._. ......... . _ . ___ ............... ......_ ......... _.......... ............................................. ........... ........ ........ . ........ ........ ............ . __ .._...._....... ......... .......... ........ ............... __ ...... ...... b.Description of any areas that will NOT be worked on ..,.,..._ _ ...............................---.............. ......... ... . .................................................... ... ............... ......... . ............................... ......... __............ _.._ . ......._.. . This list of specifications maybe continued on subsequent pages(seepage number below). c.Payment:Contractor proposes'to e f`o�he above work,(subject to any additions and/or deductions pursuant t uthorized change orderWforheTotal Sum of$ �V J v Q Down Payment(if any)$ )rT�00-00 PAYMENT DUE WH AMOUNT PAYMENTS TO BE MADE IN INSTALLMENTS AS FOLLO �. 6llqu � � oN_ ��1��� �'���D_o_o .........._- ............ ._ _ J04,00 a. .................................. .......... _ _ _ _ _.........._.......... _ .............. . _ _...................___........_... - 3. 4. .....................:............................................................................._........._._........_.........._........................................................................................._... ._............... d. Commencement and Completion of Work: Substantial commencement of work shall mean either the physical delivery of materials onto the premises or the performance of any labor and shall be subject to any permissible delays as per provision(5)on the reverse side. Approximate Start Date: Approximate Completion Date: e.Acceptance:This contract is approved and accepted.I(we)understand there are no oral agreements or understandings between the parties of this agreement.The written terns,provisions,plans(if any)and specifications in this contract is the entire agreement between the parties.Changes in this'agreement shall be done by written change order only and with the express approval of both parties.Changes may incur additional charges. Additional Provisions Of This Contract Are On The Reverse Side And May Be Continued On Subsequent Pages (see page number below). Read "Arbitration of Disputes"provision on page two(2),provision 13 and the NOTICE following this provision.If you agree to arbitration,initial on the line below the NOTICE where indicated.Also,initial in the same place on EACH COPY of this contract. 7�d©� DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES approved and accepted er) d e You,the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this approve nd accept ( e tWdat ansaction. See the attached Notice of Cancellation form for explanation of this right. 7TE: This proposal may be withdrawn after_days from if approved(contractor) not approved and signed by both parties. Form RC3-C Copyright©1996-2006 ACT Contractors Forms(800)820-5656 www.calform.com Page one of Total Pages I Board of Building gegulations and Standards RegluHOME IMPROVEMENT CONTRACTOR g istration 148422 Tr# 133270 pirat�on `912212009 =Type.f:Individual LAWRENCE HILDEBRAND' LAWRENCE HILOI RAND;. 30 SHERIDAN ST. Administrator WOBURN,MA 01801 iVlassachusems-Depatrtnient of Puh]ic Satictc Beard of;Buil(l;in.!� Rclacil<ttion and Standar6 coostructibn.Supervisor License Ltcense: C9 90389 Restricted to 00. r: LAWRENCE HILDEBRAN'D -30 SHERIDAN'ST VV0BUR-N MA-01801 )x U4CENSE Expiration: 5/24/2010 t'uinnu.vi„nci~ Tr#: 25739 r d The Commonwealth of Massachusetts t l Department of Industrial Accidents r Office of Investigations 600 Washington Street Boston, MA 02111 ` �I www.mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Etectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization individual):_ Z4 Address:- p�.1J✓�(°�o�.��y S'f City/State/Zip: a,241 y/,1-f MA 6/4161 Phone #: -?,f J�'ZC/ Are you an employer?Check the appropriate box: Type of project(required): 1. VII am a employer with_ 1._ 4. ❑ I am a general contractor and 1 6. []New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.i E]Remodeling ship and.have no employees These sub-contractors have 8. []Demolition. working for me in any capacity. workers' comp.insurance. g, n,Building addition [No workers'comp.insurance S. ❑ We are a corporation and its l0❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 1 1.F Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ hoof repairs insurance required.]t employees.[No workers' f 3.0 Other comp.insurance required.) *Any applicant that checks bo)t#1 must also fill out the section below showing their workers'compensation policy information. t Homeowneq who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infuttnation. I am an employer that is providing workers'compensation insurance for nay employees. Below Is the policy tread job site information. Insurance Company Name:_ Policy#or Self-ins.Lic.#: /J G a 2 s'1'f Expiration Date: �/s 4,? Job Site Address: Z z 1! City/State/Zip:_/�/✓4�l/c%v�/' /YI4 0/8 Y 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 statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do hereby certify under thepains andp'en/afttles ofpedury that the information provided above is true and correct Signature: Date., s-;v�d- Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# issuing Authority(circle one): 1. on of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: - � m }... � � ✓ - •" Y � _......w� � .. ... ..+.-i+�.v��«.-..—mss..=.. _..� CER Sow=�� k: ^.'�� �`�� ��=�' � alb i� � ¢, r t 1 a E?r ask al ml z: � 1 P � " '� =a"` <•, CADWA. rCot ^.4v` V #est? OR.cn-ts #�=,? 'rt trwNA —9 3744304 HOLDER �?� •�<'�'""�€ ,�,� �ti.�==� :. was�- c� .::�_�'�: 4�� �f