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HomeMy WebLinkAboutBuilding Permit #712 - 23 WILLIAM STREET 5/7/2006Of PORT a AN O - 9 5 �,SSACMUSEt4 Permit NO: -7-12, Date Issued: 5 7 16 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received: 5 6 11 If IMPORTANT: Applicant must complete all items on this page LOCATION '-�- 3 PROPERTY OWNER Print A �-eeAct rl Print MAP NO PARCEL: 'r[7DTi A V-11 TJQ1V n17 RTTTT ."YNG ZONING DISTRICT: HISTORIC DISTRICT YES ❑ 1 11 l:J AiL v TYPE OF IMPROVEMENT - - PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition F1 Two or more family ❑Industrial Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED, r1eAqo01�e/ kiishE^ t Bq"A I OWNER: Address: Identification Please Type or Print Clearly) Name: A/? fle eyla Phone: 9 7 7 E7 7 /M) 23 w[/lrQMs s-�-, /v, C e.— CONTRACTOR Name: %'C 4a c ( 4v CIO t r_ Phone: q 7,V -3 Address: S 7 S'gr'r /4 (-- n d vle_� H a& erk'1 % M 14 Supervisor's Construction License: GS G617<,?,/ Home Improvement License: I z-1-7 q yC Exp. Date: s/a o -Z o© S Exp. Date: ��� 3 / D% ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$_�,� �%D O x10.00=FEE:$ Check No.: Receipt No.: Page I of 4 TYPE OF SEWARGE DISPOSAL r Tanning/Massage/Body Art 11g { Swimmin Pools El Public Sewer Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ Electric Meter location to project NOTE: Persons contracting with unreg stered contractors do not have access to the guaranty fund Signature of Agent/Owner �e�.-e— Signature of Contractor % Plans Submitted ❑ P ns Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS rA HEALTH COMMENTS Lonmg hoard of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: DATE REJECTED ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED 11 DATE REJECTED Ll Comments Comments u DATE APPROVED DATE APPROVED DATE APPROVED Water & Sewer connection signature & date /� Temp Dumpster on site yes no_ Fire Department signature/date �/ h.>' Weg Building Permit Approved and Issued by: Page 2 of 4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DEVILINSION Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. NOTES and DATA - (For department use) Page 3 of 4 Doc: INSPECTIONAL SERVICES DFPAR9'MFNT RPFORMo5 Created JMC Jan2006 No, 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Page 4 of 4 Location No. Date 1% TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ CHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � Check # 7-5 Q 19 71 Building lnspj�ct& m m m m m d � d 'O O CD az y a.O =� r CO CUc CL y 0 CD CDCL O Q d CD CSo C CD y� �. CD �O y O I to CD S v CO) O 'v Z CD � o CD 0 CD C c��o VOR ° =cO °� Q dos• to y Cil n T O a C! ym.+C 3 � � �� O� , ,r .d.► a ? d�+ O TI =rm •-► O y ,_,► y CD N ro Cl c, � OO cm o M ca 31A.� .CD C =r aoto CL CDL C i=q ar C h C W a N m m .w mH F y � CD go CA w ="oll\: al CD CA o m ;w CA O CD �d h �C dd CL's. n CS C. �o sem: 70 s W °� z w Cil n w A r � � �� A. "� ro n ro c, � �' n o M �t H 0 9 0 c y The Commonwealth of Alassachuselts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, ,VU 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �y Q __ Please Print Legibly ',�allle ll3usinessith•gauiialitm�lndivi�lual): 1 " ►�C �ae � /►UCIQ/!— ;address: �% - FR ill /0 w7 1qc,-e-- City., Stater Zip: G%4�`���ff M ��Phone#: �P7S -?7�1 :are you an employer? Check the appropriate box: i . ❑ I am a employer with 4. ❑ 1 am a general contractor and employees (full andlor part-time).* 2. (� 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. 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 ?. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.[] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other '.any applicant that checks box ;41 must also fill out the section below showing their workers compensation policy information. y 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 um an employer that is providing workers' compensation insurance for my emphwees. Below is the policy and job site injarmation. Insurance Company Name: Policy 't or Self -ins. Lic..=E:------_ _ Expiration Date:__ lob 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 NIGL c. 153 can lead to the imposition of criminal penalties of a Fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP 1k ORK ORDER and a tine Of up to $250.00 a day against the violator. Be adv iced that a copy of this statement may be forwarded to the Office of Invcstigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the injarmation provided above is true and correct. tii�nahue: Date: S/9-/oC Phone ' Olfichd use only. Do ltut write in this area, to be completed by crly nr town official City or Town: Permit/License # Issuing ,authority (circle one): 1. Hoard of Health 2. Building Department 3. City/Town Clerk T. Electrical Inspector 3. Flumbing Inspector 6. Other Contact Per -,on: Phone #: � r :a, = �` s �'!ie �anvr�wruve�:�i o� /�aaaaclzuaelta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number ,CS 064781 + 't ,I BIrthdete ,i05/20/1970 Expires 05/20/2006 Tr. no: 25065 ' Restricted JG I MICHAEL W AUG LAIR .; PO BOX 1481 ; HAVERHILL, -MA 01831 1 Commissioner 1 . � ✓ d 1 L+Y ���� °y �,aaaczc�u�ae�i Boar o m in a ulatio sand Standards HOME IMPROVEMENT CONTRACTOR a PPgistration: 147946 Expiration: 8/23/2007 . ,T,We: Individual MICHAEL AUCLAIR . MICHAEL AUCLAIR ' 57 FAIRLAWN AVE HAVERHILL, MA 01830 Administrator 3 4/26/06 Patti & John Heenan 23 William st. North Andover Michael Auclair General Contractor (978)374-4004 Project: Remodel existing kitchen and bath on first floor Cost: $26,400.00 Description: - Remove existing cabinets, appliances, and fixtures in the kitchen and bathroom. - Remove sheetrock and flooring in - Insulate exterior walls - Board and plaster kitchen, bath, other rooms on the first floor. - Install new cabinets and fixtures - Add recessed lights in kitchen the two rooms. and ceilings in three - Install two doors and woodwork to match the rest of the house - Add vented fan in bathroom - Tile floor in kithen and bath - paint all new applicable surfaces Contractor will be responsible for removing all debris. Also contractor will supply all materials required to complete the project excluding the appliances which will be the customers responsibility. C.S. # 064781 H. I . C # 147946 Az-a� Lftohn Heenan (customer) '�"" '-w _ atricia Heenan (customer) a C�- Michael Auclair (contractor)