HomeMy WebLinkAboutBuilding Permit #138 - 230 LACY STREET 8/8/2011 O�
BUILDING PERMIT NORrN
,�tteo 6�4.
TOWN OF NORTH ANDOVER 02t" ;•`- .6 0
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received 1ssAr
10 /l go
US
Date Issued:
IMPORTANT:Applicant must com Tete all items on this page
LOCATION a t f
not -
PROPERTY OWNER Y Yc � - 1pej
Print
MAP 2- 16'/04'
10!//U G PARCEL:30 ZONING DISTRICT Historic District yeso
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One fam'
Addition Two or more family Industrial
Altaration No. of units: Commercial
re laceme Assessory Bldg Others:
Demolition Other
Septic VI/ell Floodplain Wetlands Watershed District- .
Water/Sewer
�ESCRIP � OF WORK E R�ORME : �
x, U�
1 �
Id ntification t Please Type or Print Clearly)
OWNER: Name: f St t�i�rPs Phone: y ����67
Address:
CONTRACTOR Name. ( Q�7�� �/- �c�1� Phone:
Addr -ess: 0_
Supervisor's Construction License: 7o2 Exp. Date:
Home Improvement License: fV Goc�__ Exp: Date: aZ Wil -,
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ! FEE: $ 1
Check No.: �3y - Receipt_No.: �Z
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owrier '- T -Signature of-contracto
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 Siqnature
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 DEP.ART-M_8A Tem Dtarn ster on site; es -no
}Located atx124.Main Street
[..�� }it- Y"'s iSx�.�} '`''i.�'s:- ``'Cgk:. iY-- - 1... _k.., .,.a...., �, �-.�{�'#•T,
°Fore D
•-• e artment s� nature
_g
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
❑ Notified for pickup - Date
Doc.Building Permit Revised 2010
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
o .Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
Or
o Floor Plan O 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
o 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)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
a Copy of.Contract
o 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
I
Doc:Building Permit Revised 2008
Location
No. —��'�12 Date
�o�TM TOWN OF NORTH ANDOVER
s Certificate of Occupancy $
;�s"'•''��' Building/Frame Permit Fee $
s,Kaust
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
24 ,462
Building Inspector
NORTH
0VM of
No. 26- _ ..
�( o dower, Mass.,
Y` Q ' LAKE '
COCHICMEWICK ��
S RATEO p? C:)
BOARD OF HEALTH
Food/Kitchen
Septic System
. ..PERM IT T D
BUILDING INSPECTOR
.r Ot. Z
THIS CERTIFIES THA .................
Tum......tl.............................................................. Foundation
has.permission to erect........................................ buildingson ..� ........ .W,...........46.....a.................... Rough
to be occupied as 6444%m �� ._.... Chimney
a.h........ ......... ....... ...........................
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
PERMIT EXPIRES IN 6 M S ELECTRICAL INSPECTOR
LJNLESS CONSTRUCT Rough
ug
...................... .........................................................7`�EC***0R***
Service
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 Regulaions and„oda ji1,tn,cnt of Public
- ROI N"ss.tehusctts- Dc1
Board of Bu►►dinl�Rc`�ulutions and Standards
One Ashburton Placeervisor License
Construction Sup
Boston. Massachusetts ( �S $5173
Home Improvemet t-COntractol t.icense:
WILLIAM T FOSTER
65 COAC DR iL
01826
COTE & FOSTER CONT. DRACUT,
MA Expiration-,--11110!2012
Steven Cote i. Tr#; 5316
20 Aegean Dr Unit 15
Methuen, MA 01844
Update Address and return card.Mark reason for change.
Address Renewal � Employment � Lost Card
DPS-CA1 Cr 50M-07/07.PC8490
✓fie t�amrr�a�zu�rc�r� o�✓�aaaac�uaeCCa
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Registration: 107602 One Ashburton Place Rm 1301 ?�
Expiration: 8/5/2010 Tr# 272878 Boston,Ma.02108 `i
Type: Private Corporation
COTE&FOSTER CONT.
Steven Cote _
20 Aegean Dr Unit 15 `"`Q"' Not valid without signature
Methuen,MA 01844 Administrator
-1 W-410
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JI,C�
LE
41
7-1 le
The Conrnoiwealth of Massachusetts
F Department of Industrial Accidents
l.a
Office of Investigations
l.; 600 Washington Street
Boston, MA 02111
www.nnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
90c, �
Name (Business/Organization/Individual):I e g /
Address: 20e y, d Cil!I
City/State/Zip: G � 0,1Phone #:
Are you an employer? Check the appropriate box: Type of project(required):
I am a employer with 4• ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New constriction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g_ ❑ Demolition
working for me in any capacity. employees and have workers'
' [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition
5. We are a oration and its 10.0 Electrical repairs or additions
required.] ❑ corporation
3.❑ I am a homeowner doing all work officers have exercised their I Ln Plumbing repairs or additions
myself No workers' com right of exemption per MGL
Y [ P• 12.❑ Roof repairs
insurance required.] t c. 152, 51(4), and we have no
employees. [No workers' 131-1 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t 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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I ant an employer that is providing workers'compensation insurance for rrny employees. Below is the policy and job site
information. ,
Insurance Company Name: at
Policy#or Self-ins. Licc.#:�� c� �� � Expiration Date: ,2, A4
Job Site Address: City/State/Zip: Mcy-�r� �
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.
I do hereby certify iinr the ut penalties of perjury that the information provided ab ve is �ue and correct.
Si natti Date: �G 11
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. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
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` AUC. i6. 2011 10:53AM VSEA N0. 345. P. 5/i
�It& o Y
Total cost to complete-S17,730-00
T#wk you for the opportunxty to quote your project. Should you Dave any questions
or would like to take your Project to the next step,please contact us.
Sincerely,
Stevea M.Cote and'WM=T.Foster
Cote and Foster