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Home My WebLink AboutBuilding Permit #638-16 - 25 FERNCROFT CIRCLE 11/23/2015 (3)Permit No#: Date Issued: J BUILDING PERMIT . TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page WRR f �PROPER4TY ®INNER Pnn s100`Year Structure yE s no) �FIMF AP.iP/�RISTRI`Histone+®isfrct TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r p°.Sept c �'�Well ��=_..s. �-��'LL�D�Floodplain� �,�Wetlands..y� -~�� 010+ Wa erste trictf. ' .z DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Address: IISTI SIM r , AM Supervisor�'ks C®nstructi®n €L'cense b ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE; BULDING PERMIT.'$1Z00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $, Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,babY0 Locatio,a� 6,(A— v N o. Date Check 323-3 719 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ Building Inspector 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. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature_ 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: Conservation Decision: Comments Comments Water & Sower Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: �';F R �D PEPE A'Rd METMET NTn _ ;t _., =` Located fie �8n4o- Osgood.0on.. Street OR- Tm®'umpterfontsite! iyes .. _ ;Lo atedfiatfi12,4in re:0Department1s1ignature/date, _ I i COMMENTS;_ _ t 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 e U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature. Reviewed on Signature Reviewed on Signature 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 {IFIREliMENIT Temp;Dumpster� onsite° yes -,-----Located v� _ no � __. p r a Located at X1244 s Fir�e`Departmentlsignatu_ re/date �� y.. • s � a.... .:... �. v. ��.e cs z _ .__.__��...--ar...�..._ �___�_�a.r..-mom® _ t G 1 COMMENTS_ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art E]g Swimming Pools ❑ Well Tobacco Sales ❑ Food Packaging/Sales El❑ Private ❑ Permanent Dumpster on Site ❑ (septic tank, etc. Electric Meter location to project NU 11N:: Persons contract- with unregistered contractors go not have access to the guaranty fund Signature of Agent/Owne Signature of contractor �~ Plans Submitted ❑ Plans Waived ❑ Certi Plot Plan ❑ St ped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATIONEl COMMENTS HEALTH COMMENTS Zoning Board 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 DATE REJECTED U Comments Comments no DATE APPROVED DATE APPROVED DATE APPROVED Water & Sewer connection/Signature & Date Driveway Permit Temp Dumpster on site yes_no_ Fire Department signature/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 ®ANGER ZONE LITERATURE: lyes MGL Chapter 166 Section 21A —F and G min.$10o-$1000 fine M Doc.Building Permit Revised 2014 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 DOTE: 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/Cross Section/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 TOTE: 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 ❑ 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 OTE: 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 Clerics 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: Building Permit Revised 2014 r J Q W LL Dz Q m a) ,+u_� o o E ? u a ai In p W d Z m C: O -a C: o LL c tw o W c t U LL O d Z J 4 t °° oo K LL 0 d Z Q W W t °° n U ai Ln LL O a Z Q ° o W ro S LL Z CWC G W W LL =3LL m O Z ~ vE N Y o y mma a`) a. N -_ U) N C M m LO C .O N O t O Z O a J O O W a Cl) z �m a' 0 m t0O — z �— C) W z X0 UJ U �N W LLJ -j CL z The Commonwealth of Massachusetts Department of 1`ndustrial Accidents Office of Investigations !=' 600 Washington Street Boston, MA 02111 �.� www. mass - goy/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): (�(Q� On) Sk)n- - Address: Log J�— City/State/Zip:C ►'t2t Z� h% P 4 "3 ( Phone #: 7E)—_3 8 %' 7' !� 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 employees (full and/or part-time). have hired the sub -contractors 2M 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' n insurace.; 9. E] Building addition [No workers' comp. insurance required.] comp. 5.E] We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12,�Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' I3. [� Other coma. insurance reouired.l *Any applicant that checks box #1 roust 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 am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy 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 $250.00a day against a violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the for i7frartce, coverage verification. I do hereby c : fy u pains and penalties of perjury that the information provided above is true and correct S' e Date: / l 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 #• Gregg Keniston 40-4 Mulberry St Concord, NH 03301 781-389-4485 Client Address: chip mcailister 25 Ferncroft Cir North Andover, MA 01845 Job Description: Complete roofing with lifetime arch. Shingles, ice and water shields, 8" aluminum drip -edge, 51b. felt paper, ridge vent. For the Amount of: sio,000 Contractor J' Client , a 0 O C) n z m m Z� CO O C �I �1 p x nQy. aro 7 z�z z xm�o 'at°•3� r _XCj) m m wtoO O Z= a'@ ° 3 3 e o Zi Z n\�, maf uNi y1� v, .. 5y C1 to < g O W @ �-� •o N _IA 3 .s cQ co m w y = 3 NQ n _ ` Q R°Az! O. 0 I r ' V1 Cc A ,a a O m .� _ Orn rh 0 A -� f < Q ;u�,:� c 72 m Z Q ro 1 o ° O 0 to df �