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Home My WebLink AboutBuilding Permit #129 - 247 OSGOOD STREET 8/20/2008 BUILDING PERMITo`No DT 6"tio TOWN OF NORTH ANDOVER <': '` - °� APPLICATION FOR PLAN EXAMINATION e" Permit NO: 100191 Date Received ��SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Prin PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Res' Non- Residential New Building Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPT2Q"F WORK T BE PREFORMED: Ate 17� entifi�c�at�i�pType or Print Clearly) OWNER: Name: 12�il[ 't1�1 1 7t�.' Phone Address: 14 \p CONTRACTOR Name:-- 07 �+ -- Phone: IF Address: ? �1fi 14 pl 1 "7 Supervisor's Construction License: Exp., Date: Home Improvement License:___ Exp. Date; 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: $_ FEE: $_ Check No.: oZ 7 F5;1 Receipt No.: l 3/ NOTE: Persons contracting with unregistered contractors do not have access toMarfund ___ __� . ignature of Agent/Owner Signature of contract w r 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 Dempster 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 sig-n 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 DEPARTMENTMFORM07 Revised 2.2008 Location IR No. Date )pl;;2 /� j NORTH TOWN OF NORTH ANDOVER 3Z � . 0A s • ; ; Certificate of Occupancy $ �'�s'•^°'t<� Building/Frame Permit Fee $ �� :"us Foundation Permit Fee $ Other Permit Fee $ ? TOTAL $ Check # 3 75X 2 I 4, 3 ,i J./ ,Building Inspector d NORTH I � i ® ® G Andover No. / ca o dover, Mass., rl a O co LA 7� ADRATED `S BOARD OF HEALTH Food/Kitchen PERMIT T D i Septic System - BUILDING INSPECTOR I THIS CERTIFIES THAT ..... . ..a:JG',�S'........................................................... :: Foundation has permission to erect.............. a..,................,... buildings on . .?........�,S�r.A� ....... ............................... Rough ............................... c to be occupied as........................ . . .r�........�..�.. .C�`�. .. bZ�o/....:.............................................. . Chimney h' e provided that the person accepting this permit shall inevery 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough { i + Service ...................... ...... .. . ..... ... .... BUILDIN PECTOR 11 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. Bumer Street No. SEE REVERSE SIDE smoke Det. -ORD Cp ss i-4114.115 •iReu f T:fls C501MCATE 1s MWED AJ A KATTSA OF I?4FaRWnCiq I rts,, Zne. ONCY AN13 CONFERS Ni a RIGHTS UPON THE CERTIFIC.AT; 14001M Trus CERTIFICA c OCES NOT AMEND, EXT-Caro GR poe.cests.4u.aC3sa-'sh.c0r1 ALT_R THE COVERAGE AFFORDED aY 'rXi PUL.`CIES BE aw. tied iout Ad DTII. Spits 1100 X. Ga 30103 {INSUF: RS AFFdAtaIHG CCNERAGiE MAIC 0 L31 1411-4901 f pm,r3e.adtast Zns Co 1330t epo- C.S.A.. rac. owmaturich ]Amasieaa Ins Co 13313 - is 00-pot, Ino. pCZllinois 2fs:7. Ias CC 33417 .. Ic.s 74z--f load. .- .._. 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'' ' � � E,1,�.rat,ICru�r 11.oQo,aoa - :< ac!-442117117 tint 113/61(04 0]/0 /OS yauszsnes/!Il- 23X/31{ aylaya" 1�rss q/o2/44 a2/oi/o1 . :ssa bovemiti°a 1229739 (9811.;o .cao.easeioa 192175,8 Ila, lo, lnr. m� : .ul6zta6 0 /04/03 W��11pIgI1pCA7RR14r ncoet��srao6inDrDrt rfr4aA�►Ro+�•+ Comm MY . • - CAt�ICEtLAT1GI�t • -ATE HOLDER aANror tAacvs4Esau�s0c�sa�QAe�4u.4a4a�ou�ttWMA + DAM T1Nmp.TM==a W&WAR 11tt O1,w"V011 i0 MAR. DAIs Val 7 7 111 i oxim, 17IC• A071Ca1 TO 1!R ClIlT09CA71<HOtAdIMI 7921114 ltrT.OtiT�AS.Y114 TO 00!0 lt1ALL • 4/014 in a{mum an UAW=or Afr am WKW TM KWJRM 60 AWO oR. suru m CA .ernsar.7n,4s. _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations > 600 Washington Street Boston, DMA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElPease Print Le ibIv 1103plicant information Name(Business/Orgmizadon/Individual): d l Address: oZ 7irr� .^ �"� ?� — phone.#: -� � city/State/Zip: Are y an employer?Check the appropriate bon. Type of project(required): er with ,�`-� 4. ❑ I am a general contractor and I 6• New construction 1.N� 1 am a employ _1�—* have hired the sub-contractors employees(full and/or part tune)• listed on the-attached sheet. 7. []Remodeling 2.❑ 1 am a•sole proprietor or partner- These sub-contractors have g• ❑Demolition ship and have no employees empto have workers' working for me in any capacity. Y comp.insurance.ees and ht. 9. ❑Buz7ding addition (No workers'.comp.insurance 5 ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] . officers have exercised their 11.❑Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work right df exemption per MGL 12•❑rther4 myself [No workers'COMP- c.152;§1(4),and we have no insurance required.]t employees.(No workers' 13 comp.insurance required.] • applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Any app are doing all work and then hire outside contractors must submit a new affidavit indicating such t Homeowners who submit this off davit indicating they g _of the *Contractors that check this box must attached an additional steo g workers'comp subcontractors nrber mid state whether or not those entities have employees. if the subcontractors have employees,they provide 1 am an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site information: ---"S Insurance Company Name: Policy#or Self-ins.Lic.#: .Expiration Date:• City/State/Zip: Job Site Address: Attach a copy of the workers' compens 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 as well as civil penalties in the form of a STOP WORK ORDER and a fine _ eaz imprisonment, 500.00 and/or one y fine up to$1, be forwarded to the Office of of up to$250.00 a day against the violator. Be advised that a copy of this statement may Investi ations of the for insurance covers a verification I do hereb cern and r p sand penalties of perjury that the information provided bov is and correct: Y • Date: Si afore: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityrTo�vn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.other . Contact Person: ,Phone#: �/ze vrommoouuea�i o ./�Cuaaclzuaell2 \ Board of Building Regulation's and Standards lugHOME IMPROVEMENT CONTRACTOR Registratr 126893 Ezplrattcsk 813/2010 �3p �Ype Sapp lement Card lit, 41 The Home Depo=! #8ome Setrvi RICHARD FALLONE � rj 3200 COBB GA LLl21:A'P!IWY"/#20. ATLANTA,GA 30339 Administrator