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Home My WebLink AboutBuilding Permit #345-11 - 23 LYMAN ROAD 10/25/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 2,3 M .i *, Print - PROPERTY OWNER 1�: ��.J e45r (IJ Print MAP NO:014 Q PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPQaED USE sidential Non- Residential El Building Elne amity ❑A it ❑Two or more family ❑ Industrial # No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other q`Septic ❑ 1Vell i�;Floodplain `�Wetlands ❑ Watershed District. . Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: n Jam✓ 1< -I-ca *_J e -J Identification J Identification Please Type or Print Clearly) OWNER: Name: << % k-J ;IV 1J Phone: Address: JN1 1� kJ �. CONTRACTOR Name: Phone: rr II Address: � 7 IL ere vy f < W A Cc_ C, CA 0A Supervisor's Construction License: O i R -3 Exp. Date: Z ( # Home Improvement License: l # Q Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 0 ® FEE: $ Check No.: 2— Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th guara ty fund ' -}Si natureof�cont_r`_actK_ _:; rt >.' 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 o 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 MOTE: All dumpster permits require sign off from q g 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 Doe: Doc.Building Permit Revised 2008mi i I 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: 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 ® Notified for pickup - Date Doc:.Building Permit Revised 2008 I Location �� No. `y Date f �oRTM TOWN OF NORTH ANDOVER o � c ►. w Certificate of Occupancy $ 9 NuBuilding/Frame/Frame Permit Fee $ s,ksE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #113 23557 Building Inspector NORTH Town of _ over O -oCl over, Mass., LAKE COCHICHEWICK V d AERATED � .S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR 0 �.�J 14��_ THIS CERTIFIES THAT............................................................................................................................................................... Foundation ...................... buildings on Q�s......... y .fr.. .........!�.�......................... Rough has permission to erect..............:. / to be occupied as.... } Chimney ....... .......... ............ �everyresp .... . .........................................................................:.. provided that the person accepting this permit shall�int conform to the terms of the application on file m 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTN S TSRough .................................................................... Service BUILDING INSPECTOR 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. Board of Building Regulatro sand Standar s HOME IMPROVEMENT CONTRACTOR r Registration; 112998 Exptrti n 5/y11/2011 Tr# 283102 Type DBP.' L. F �1 { RICH ROOFING CO—W-, JOSEPH RICH JRA 27 CHESTNUT ST` Administrator WAKEFIELD,MA 01880 Y Mass achusEtts= " Dei�artment oi-A Board of ' Buil Public sat'eti ` Construction'Supervisor r and Standar-ds"i 19939 License: CS Aervisoand Restricted to: 00 I JOSEPH F RICH 27 CHESTNUT STS WAKEFIELD ; - , MA 01880 c C'umminer� EXPirdtion: 8/ _._. 2/201.1 j Tr#: 205 i 1� 1a1 t� 1 �� ✓� �' Contract Joseph Rich RICH ROOFING COMPANY ROOFING 781-245-1664 SEAMLESS GUTTERS 27 Chestnut Street • Wakefield, MA 01880 CARPENTRY ~� EXTERIOR REPAIRS Name __. k Address r I we,the owner(s)of the premises mentioned above,hereby contract with and authorize you as contractor,to furnish all necessary materials labor and workmanship,to install,construct and place an improvement according to the following specifications,terms and conditions,on premises above described. AGREED WORK: No work shall be done,except as herein specified and expressly agreed to in writing by the contractor, including incidental repair work. Contractor hereby propose to furnish the materials and perform the labor for the completion of: ff i, -s "I"'i A 4 y ra 4 f' i S i s t T i l.}� } f In consideration of the said work, materials and services to be furnished by the contractor,the owner agrees to pay the contractor the sum of 3 (,o,) Dollars down and the balance to be paid in full upon completion.$ ?1This agreement constitutes the entire agreement between the parties and owner agreed that the contractor has made no statements,promises, commitments or representations not contained herein.Additional charges are made for all work ordered by owner,if any,not specified in this contract. Additional work must be specified in a written change or new contract. Contractor will do all said work set forth in the Job Specifications in a good workmanlike manner.THERE ARE NO OTHER WARRANTIES,EXPRESSED OR IMPLIED. Installed equipment and materials carry only the warranty,if any, made by the manufacturers.10 year guarantee on workmanship only. Owner hereby acknowledges receipt of a copy of this contract and certifies that he has read this agreement.Contract becomes valid upon written acceptance by contractor and property owner. In Witness Whereof,the parties have:hereunto signed their names this day of :`X 20/1) Accepted: — 0 _.r Signed LGH-ROOFINGt CO. ;' OWNER' The Commonwealth of Massachusetts Department ofIndustrial.Accidents Office ofInvestigations 600 Washington Street Boston,MA. 02111 www mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectricianslPlumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): `� e— t `e' Address: City/Stat e/Zip:l. -4 - Phone#: �r �` 66 y Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. (]New construction �,g employees full and/or part-time).* have hired the sub-contractors ( p ) '1. [-]Remodeling 2.&am a sole proprietor or partner- listed on the attached sheet.t ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]Building addition [No workers'comp.insurance S. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their right of exemption per MGL 11.❑Plumbing repairs or additions 3.El am a homeowner doing all work g p p myself. [No workers'comp. c. 152,§1(4),and we have no 12.[Roof repairs employees. [No workers' insurance required.]t 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an 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.#: Expiration Date: Job Site Address: City/State/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 statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify un r th ains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: 1(S 6 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.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: