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Home My WebLink AboutBuilding Permit #117 - 247 MIDDLESEX STREET 8/15/2007 OF BUILDING PERMIT NORTH �t�ae �b�ti0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIONAcA .1 _ r a Permit NO: Date Received 74p0 Too �SSAGHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page m IN W- 111 OR +f''"'�' '. 70 � ' w �a-A a s 11 . '> r H �„� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Add' 'on ❑ Two or more family ❑ Industrial DAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg 0 Others: ❑ Demolition ❑ Other 0201 im AN 9 M 1 �s �. DESCRIPTION OF WORK TO BE PREFORD ED' IdentificaYi n P>< seType or Print Clearly) OWNER: Name: ��Ly �-- Phone: Address: '/7 AWhel-e ss- S/ >a. f € � ::: ,��`'`"�� atis k"; `'�:yaer",.. ✓" ri v W r.— -- g c r s 77" c` '' MI �` "tea Cc.mac- -.�,w�g "R'i t3 - i 4 MW ARCHITECT/ENGINEER Phone: Address: Reg. No, FEE SCHEDULE:BULDING PERI $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ g�� FEE: $ 'T Check No.: 1 Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �/J/44ignature of contractor Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit o 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 Addition Or Decks o 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 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 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 2.2007 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY i INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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 ❑ F 4Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/Si-qnature& Date Drivewav Permit Located at 384 Osgood Street SIR tE"08 ERe 10L0cate at212JlairtSfreeF flre3eparmen sEgnat�re/date �. � � 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 i NOTES and DATA— For department use ❑ Notified for pickup - Date Location r't + No. Date 4 004— NORM TOWN OF NORTH ANDOVER 0 s A Certificate of Occupancy $ cMustt� Building/Frame Permit Fee $ -- 1 , r Foundation Permit Fee $ t Other Permit Fee $ TOTAL $ Check # 20490 Building Inspector NORTiy Town o t over 0 dover, Mass., 60 LAK �t �. COG MIC ME WICK V ADRATED `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................C../'r / u' .................................................................... Foundation ................................. .. has permission to erect........................................ buildings on ....a;q... ..... ........... . Rough V Chimney to be occupied as.........5 ....... ........f........................ . .................................................................................. provided that the person accepting this permit shall in every ect 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU T S Rough .............. ..... ....................................... .............. ........... Service BUILDING INSP Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Pae# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh $ Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted T: ,. Job Name Job# Address Job Loca_tion-t 4� Date vy O Date of Plans Phone# F6# r Architect We hereby submit specifications and estimates for: 4-6 4,44 I ........_..... d. _ _ a _? _-___-_- _ _......_-..........._..... ......... - _ _ txr_. G - - ____ We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: $ � Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully `� �/ � executed only upon written order, and willbecomean extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. acceptance of Propo.0111 The above prices,specifications and conditions are�satisfactory and are mature / .� 4� 4� hereby accepted.You are authorized to do the work as specified. "0000– A" Payments will be made as outlined above. l/ Date of Acceptance Signature - � t �" A Yv 1- �w�i� i• {4 .d t f I f r.;'^�Ali' •� • F I �� •4idCN �y�#j. N•. t}44�� .it„1: ��,+1 i �/ •1�T x �Il k d ;11 3 � Ik d1, ,;UI-:iil♦:' i! "V� �t�;ksi�,i.; .,► Aid fi _ 3 ,5;. 3 •'!'- " -- • dA_�1 -k ti�.t ,. Sri IFIL`W .i '•'„'•: +1• k: Walsh&S ..1 'i'1` 55 Pleasant I North Andover, 01845 .tl� is f ;F' 1- � T, 'Oi,kS:�: t k. kc ::/ t 41:5' ti� .' ;) t 't: t :ys k'Is :•e' f' 1- a ";i•T't D US f � CI• • ' .A. YT t :ef 1 ,i. :k' • S.R' Ir` !f • ' Ik# f' • Ftt: •.• F' • "!'I'•I :l;t.: M;1' 'E' :i; f; :If f :t' _ 1: ees •.:i' a"r► ,5;� • af'_ 1:a, i�aik :k• ;ill -i °i: J• ;F-. G+' • �f Mi.-! '• i” '• F: F C, •' r' :ta' J!-.,ft7t Fe - 1 '!. t�1n• r�Y �.a . �> 1 k �'.� r. ._:k.. icy i• q,st:;a;: s��i�� r11N / ,i'rt I � _ k EP��u _ fi 't'' is - - - _ _t•.. — e .0111 10 pa xrt 5 s x °n'I'„``?1i' Ix e: t. 'e=i''T i, ,:t aT''.nd:`.`.;""i�Y"►"T :Yi ala l,,Q 9 !li 'Y !kl x �. 'r •• t :1 i i - •a '• The Commonwealth of Massachusetts Department of Industrial Accidents Dfce of Investigations 600 Washington Street Boston, MA 02111 i Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers u des/Con A licant Information tractors/Electricians/Plumbers Please Print Le ibl Name(Business/Organization/Individual): J � ` �S Address: City/State/Zip: NO '010boe K /��Phone#: �� Are you an employer?Check the appropriatei7am 1.❑ I am a employer with 4. general contractor and I Type of project(required): 2.❑ employees(full and/or part-time),* have hired the sub-contractors 6 ❑New construction I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity, workers'com . ' g• ❑Demolition [No workers'com . ' p insurance. g_ ❑Building addition p insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10•❑Electrical repairs or additions 3.❑ I am a if doing all work right of exemptibti per MGL 11.0 Plu myself.[No workers'comp. right ht 1 4 repairs or additions c.insurance required]t , ( ),and we have no employees. [No workers' 12 Roof repairs comp.insurance required.] 13.0Other *Any applicant that checks box#I must also fill out the section below showing their workers'co t Homeowners who submit this affidavit indicating they are doing all work and then mpensation policy information. tContractors that check this box must attached an additional sheet showing the name of the sub contractors and en hire outside contractors must submit a new affidavit indicating such. I am an employer that is providing workers'compensation insurance for my employe their workers'comp,polio,information. information. eS Belowl� is the Policy andjob site Insurance Company Name: IV /)YS C� Policy#or Self-ins. Lic.#: 2'0 2 D 7 l / Expiration Date: D 7 Job Site Address: G.e y�T9- x Attach a copy of the workers'compensation policy declaration page City/State/Zip: �� /�"�l�el�u� /yJ/�— Failure to secure coverage as required under Section 25A of MGL . 52 can led tohthe pimposition licy bof and d expiration date). Failure fine up to$1,500.00 and/or one-year imprisonment,as well as civil criminal penalties of a Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded o the ofof a STOP WORK fice ORDER and a fine Investigations of the DIA for insurance coverage verification. e of Ido un 6aroM. under y der the pains d enalttes of, ry that the information provided above fS true and correct Si na e• �� true Da 1 7 p OJ)lcial use only. Do not write in this area,to be completed by city or town gdlcia[ City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other P Contact Person: Phone#: I IIS , ' l Fzm� soaRp oF�Bu�cpucen": CONSTROCTIoM - 022680 I' t dirt 39. Tr.00i 28249 �rr��1f1A�R ,.• ./�.1 4 . Board of Buijili Itiiijlations and Standards HOMEIMP VEMENTCONTRACTOR sp Regis �'• tl�tibp�.. —_ 3 3 i� 58 ji'l T . �tj �� 0 8 J e, Pri r Corporation A: WA J: G��SH&'S0f ArtnurQshJr:,