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HomeMy WebLinkAboutBuilding Permit #136-11 - 26 LAVENDER CIRCLE 8/18/2010 BUILDING-PERMIT cF OORT#t ry�StI.E D, 6*6"YO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ' Permit NO: SP Date Received ass Date Issued: 'z ®f gCHus IMPORTANT:Applicant must complete all items on this page r �,'''",,.- r. of tyt'-z-'' G"^.t _!•-,1 t- y +s Z-'. r y .f. ,i p a� tc,-rn �_ rtr� r-s..t ....a� - [-{� �•'� Tf'di, �t ° �` ' ^=Y.�L, •r-.c'�k?�''e eE 'e ��-'Yr5R - +�•, z,,., q I•' i. r.J.+ ''v' Yvl. i �-l. "Nae_�2�1 F f�l 2-t)C 12_l 4� �' t4 �t dr 1 S x5✓"Jee,'rd-4i- 'i. x-J y c .a. 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Ym-` ..4.3+.. ��-i;r�`�.�T' �`t��.�r'`..^3��;.,��,��w,�f-'��-r;���'�'��i _ x�.,. ���•,�.� �fw s 7 ��ct r .;�.��� ,E .;.r`a`"'r,sr"'�� ��,v-,��t � L }a i� �•' 1 't at tizt � - _ rv�,ry - �_;r r,. ;z',s}2::.��t��+`!t. �.r; r .,x'k �• lH_��.,L/ .�� 3a911T c ti}r "rr` �t4i4.�`,�+rr;�"�C.- ...S.,CJ�H'+f`.ial'e-.7��. �r��'�,.�SY•.'�:�r�."�_�a :��'z�f+�T',`5.� ARCHITECT/ENGINEER Phone: Address: �. Reg. No. S FEE SCHEDULE.-BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $-J a , FEE: $_Z Y a Check No.: y Receipt No.: 0 J NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund f S fuse of,;Agent/O nuu r - - aefo Sinature�ofcor� r x I Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans } TYPE OF SEWERAGE DISPOSAL I 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 . I DATE REJECTED DATE APPROVED' PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature , (DO Ml EENTS t HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafer $ Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: t Located 384 Osgood Street a m R 2�E '3ME �er ��Dr sterr� srte des BB`c atedf � lainSfree# y �p� fi ti i i ono —cs L IF�re0epacnen s� nire/date , -Lr�-r C i I { Dimension ' j Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area, sq. ft.: i ELECTRICAL: Movement of Meter location, mast or service droprequires j Electrical Inspector Yes approval of No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.s100-$1000 fine NOTES and DATA— (For department use) ) ❑ Notified for pickup - Date Doe.Buiiding 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 ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses f ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work n, ❑ 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 I ❑ 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 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 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:Building Permit Revised 2008 Page No. / of � Pagt proposal �OUvk po�1e jz ROBERT LANGEMIN BUILDING AND REMODELING ), L C 795 Dale Street NORTH ANDOVER, MASSACHUSETTS 01845 (978) 686.3607 PROPO AL SUBMITTED TO 1 PHONE DATE R STREET JOB NAME CITY,STATE and ZIP CODE ,q JOB LOCATION l�� l�G�i'�r 1'�✓ 1 �1�� r -U'i'OJ�I'� ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: ..._�..6-164A.�.' ".......... ..........r �<,c_gt,��.,.N .._.._ ................. /...n1......... ._............................ tv....................................... -_ . .........�._r ..► .... ........._�°.t'................................................ R...._.................................................................................................................................................................. .... ... .. .. ... V W ...... ...... ................L .................. .......... .......... ......._.._.. . � _ .........._........... -__ ..............................--..................................... '.............. , '' - - '/ _ .......... '. _1 ................. ............................._...................... r -L-..................._ .__1...._.. ................U1 ................._ _........... .r._► .............................................................. . l �9 . 9.� 1 ............ ................. ....... .. ...... � -....1_ _G's........... s......................................... ................................................ ................. ................_".:... ................._ ...............5................ .. _ F��............. ... /1................................................................................. ........................ .a..................../ a� ' ..........._.-L� - '1. ............ ...�....... .............��..._V ./. 5;�......._�`r'..........................................lQ, 5....... . .................................................................:...... ........... T.......-P............ C _5...j s`...................W.r` .......................lQf ._r' .........._r _J .. ............................................................. _e._V c.............. J-._rl.. _ ''s........................................ .... .................. R ct n4 4c96D5 o--t-j :57-F—P-5 rapUgP hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: - ci 1 C�l�? `'>dollars($ Pay m nt to b/e made as follows: All material is guaranteed to be as specified. All work to be cdmpleted in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders,and will become an extra Signature t` ti—S•� charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. Arreptaurr of Proposal —The above prices,specificll�ons jJ�-N t and conditions are satisfactory and are hereby accepted. You are authorized Signature 1 to do the work-as specified. Payment will be made,as outlined above. ,; Date of Acceptance: Signature V I Page No. � of � Pagt ROBERT LANCEVIN BUILDING AND REMODELING )-4 C 795 Dale Street 'M A sA NORTH ANDOVER, MASSACHUSETTS 01845 t`C ( a (978) 686-3607 PROPO AL SUBMITTEDTONE DATE ( rS' �' 7rj`t3 �' rG)r gyp ) Q STREET JOB NAME CITY,STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: / .............................. ........................... ......._ ._ _r_ ........ ��,G, �... ................. J1 ,� ,ti .................... fir. ... ii li 4 .................... ............................. ................................................................................................... (A /AjDeW ..................................................................... . --------------- L� .......................................... ........................................ _......,..__ .._.._. .._,._..__...._................__. ................ ...................................................................... .. Com- . 4 ................................................... PP.................................. - . .._......... ---- '......... _ ..............:. _.. " f N ........... -........... 2a . � �. � .s .- , ..........._.................S_..............G ........... '--s......... _........................... ....... ........................ .........................�f .................1-MA t!'71t?"fiF. :5......................... ..................................................................... ......................_ a..............._... /� ............._L=. �� 5............ ! ............. .....�" /tiS .._.... T "........../g 1�s........ ..........................................-..............................................................................................p...................�......-5...................C.t . ........... ...............................1..`.�.................. _r- ............r-.................................... ............................ .............................. ........................................................................_P Kc..............00.0k.k ._r el..p_6's................................................................................................................................................................................................................................................. -- -PA,4cE n4A.4ecA--M- 66.D 5 )3rd ctl� s7-F-P5 ,,___W*- ruP09P hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: crao '>© �Ye c ',dollars($ Pay m nt to be made as follows: 1� T All material is guaranteed to be as specified. All work to be c mpleted in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorizedinvolving extra costs will be executed only upon written orders,and will become an extra Signature 4:74 charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. _ r �1PCPptFIYILF D. Proposal —The above prices,specificatlo fl4-� � A-j k and conditions are satisfactory and are hereby accepted. You are authorized Signature f I to do the work-as specified. Payment will be made as outlined above. i If ('J ly Date of Acceptance: Signature i -- �� The C'omnionweQith of Massachusetts Department o f Iradustrial Accidents Office ofrnvestigations 600 Washinvon Street Boston, M4 02111 ki ww►v.masS.g0-V1&a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aa Iieant Information Please Print Legibly Name (Business/Organizatil Individual). �� ��D �f �'IE'D►1o�i� � N 4 L 4C Address: 'j ��' City/State/Zip: V6 _ p,5 D� 11/1 �' Phone#: tS ��3�, p Are you an employer?Check the appropriate box: l•❑ I am a employer with 4. ❑ I am a Q„ Type of project(required): employees(full and/or part-time).* have hired contractor and I the sub-contractors 6- ❑New construction 2�I am a sole proprietor or partner- listed on the attached sheet x 7• ship and have no employees A �emo`it�g These subs-contactors have working for me in any capacity. workers' c 8• ❑Demolition [No workers' com . ' omp,insurance. P insurance 5. ❑ We are a corporation and its 9' Buil edition 3.❑ regdired.] officers have exercised their 10 0 Electrical r I am a homeowner doing all work riv t of„ epi or additions m sel£ gh "Xemption Per MGL I l.❑Plumbing repairs or additions Y [No workers' comp. �,§I e no insurance required-] t c. 15 (4) and we havem to 12•❑Roof ees. P Y [No worke repairs rs' comp.Inst'-ance required.] 13 ❑ Other -a} =^pliccaa±tha±chicks box ? must`so tui cu! ti:c sece� I4omeowners who submit this affidavit indite ! ,.v = .^=r wer:ws'com���. ;: .Y - indicating thf.��ar✓....W-ai. Gini anQ r......�„_r-�-� �.-bon. 'Conttactozs that ch=ii ""m:h- outside cont*actms i o submit a new amdavit indicating such. this bo.*.Wust atta_ an additional sheet showing the name of the I am an employer that isproviding workers'compensation inssub con 'actors and their workers'comp.poiicy information. information, urance for my employees. Below is the policy and job site 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 ) fine up to$1,500.00 and/or one-year imprisonment,as well as c=vi1 penalties of a of up to$250.00 a day against the violator. Be advised that a co penalties m the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. FY of statement may be forwarded to the Office of I do hereby c fy un r the pains and p trees o er fP Imy th¢t the information.provided ab a is true a correct Signature: Phone#: � 7 !� ��� 3db-2 FFth only. Do not write in this area, to be completed bJ'city or town ofjzciaL n: Permit/License# hority(circle one): Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.PIumbinR b Inspector son: Phone r: Information anx d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,associaLtion, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apar=t eIItr and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not be.cause of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing a-ency shall withhold the issuance or renewal of a license or permit to operate a business or to Construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co:'Mpliiance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work ut1ttil acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability partnerships(LLP)with no employees other than the members or partners,are not reWiied to carry workers'comp tsation insurance. If an LLC or LLP does have employees,a policy is requim& Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be dare to sign and date the affidavit:. The affidavit should be mt tamed to the city or town that the amplication for the perrait or lice--se is,being ✓quested,not the of Industrial Accidents. Should you have any questions reg-*dir g the law or if you art required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. 'Ile Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of lm�estigations has to contact you regarding the applicant, Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under`.`Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit_ The Office ofInvestigations would I&e to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone.and.:fax number..._.. The Co nmonwealtiz of Massachusetts Department of Industrial Accidents Office of I yestibations 600 Washington Street Boston,M-A 0.2111 Tel. n 617-72.7-4900 ext*06 or 1-8 7-NLASS AFE Revised f-26-05 Fam m 6.17-72.7-7749 VrV7W.mass._gov/dia. NORTH o Of over _ = o lover, Mass., Y O ~ LAK I. If, COC HIC EWICK V /? TEpPa`�5 BOARD OF HEALTH PERMIT -T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... .... .. :.............................................................. """"""""""' Foundation has permission to erect..&ccinj buildings on ... .......16.00...-.::.. .................... ..............e.......... Rough t0 be occupied as. Chimney ......... ..... ...... .. ......... ............................................................................................. provided that the personthis 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 MONTHS UNLESS CONSTRU 24M�� TARTS ELECTRICAL INSPECTOR Rough ............................ ..... Service .. G INSPECTOR 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. Location / No. Date NORTH TOWN OF NORTH ANDOVER Fr Certificate of Occupancy $ Building/Frame Permit Fee $ s�CMus Foundation Permit Fee $ Other Permit Fee $ coo TOTAL $ Check # 2 `�'^ a Building Inspector