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Home My WebLink AboutBuilding Permit #357 - 27 FURBER AVENUE 11/24/2008 BUILDING PERMIT of"O oT"q� TOWN OF NORTH ANDOVER c? 4 ..''.- o°^, APPLICATION FOR PLAN EXAMINATION Permit NO: J —2, Date Received 'fs,9 w°Nwre°►PP,�(5 SSACHUS� Date Issued: .�') "0? IMPORTANT:Applicant must complete all items on this page LOCATION 7 ' Y Print PROPERTY OWNER`S L I Print MAP NO:0( 7. 0 PARCEL;(JQ ! ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 Septic Well floodplain Wetlands Watershed District Water/Sewer DESCRIPTIO OF WORK TO BE PREFORMED: �t d �9WI AW l,`t Q 002 Identification Please Type or Print Clearly) OWNER: Name: 7fWMA - AlAfrlA Phone: 4 Address: CONTRACTOR Name: 1.-)0,J 1(a t Phone: 67-"M 04 5 Address: '7 I-U( c Supervisor's Construction License: 6 3 c) Exp. Date: 101 /o Home Improvement License:- 4 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ , �� FEE: $ � i Check No.: Receipt No.: I NOTE: Persons contracting with unregi tered c tractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Locationr -- /- No. Ste'" Date NORTH TOWN OF NORTH ANDOVER 9 ` Certificate of Occupancy $ Building/Frame Permit Fee $ �a �cwus — -+� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �a 2 . 7 � 'i 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. 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 w 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 Dumpster 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 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 Application Revised 2.2008 �i i s :7 1 J 75 I Dan Gobeil Home Implrovement LLC 80 Munroe Street Haverhill, MA, 01830 508 451.-0493 C.S. 063220 CONTRACT RE113. 1.32182 CUSTOMER: Carrie Lynch HATE: November 23, 2008 27 Ferber St.,No.Andover,MA 01845 PLAN: Remodel portions of bath THE.TOB WILL INCLUDE THE FOLLDWING: '� PRICE • Demo 22rtion.of b ceal.in s and walls u to rub. Remove Radiator. _ • Insulate,drywall Wath "moisture.resistant drywall",mud,tape and sand.Painting to be done by others. Create smaller window opening in existing window opening for an Anderson double huns window."to be supplied by homeowner,''. Re-trim and vinyl side to match as close as p2ssible on exterior.Re lade all trim on the interior of window. _ Reverse entty door to opcn out,which will re uim a new jamb. • Lay Bardi-Backer to accept floor tile. Tile floor,supplied by homeowner.Apply y remaini: trim. _ • Install new vanity,toilet and add now ceiling fan,"all to be supplied by hom.eownewr". _ TOTAL MATERIAL AND LABOR y $4,460.00 • Electrleal to be done by others • Supplied Items by Homeowner $774.12 • Electrical F": u $350.00 • Plumbing free: _ $900.00 Permit fee: $200.00 I • DEBRIS REMOVAL: _ $200X _ I Anytl*above and beyond said,work willbe donne on a time and material basis at a rate of$50.00 an hour. TOTAL MATERIAL AND LABOR $6,884.12 ACC ED& AGREE BY: ;r Carrie Lynchaniel Gobeil `� 1 DATE. DATE: ll The Commonwealth of Massachusetts Department of Industrial Accidents Office Of Investigations 11 LIM ,'. 600 Washington Street Boston, MA 02111 Mm. a 17'taSS.b OV1dla Workers' Compensation Insurance. P Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Leaibiv Name (Business/Organization/Individual): Address: /,(044 -� City/State/Zip: I t. Ic,afn.,` / Phone Are you an employer?Check the appropriate box: 1.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 Type of project(required): .6. ❑New construction 2Xemployees(full and/or part-time).* have hired the sub-contractors 'Iant a sole proprietor or partner- listed on, the attached sheet. $ ?• ❑ Remodeling `` ship and have no employees These sub-contractors have 8. [] Demolition working for me in any capacity. workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a corporation and its 9• ❑ Building addition required.] officers have exercised.their 10:❑Electrical repairs or additions 3.❑ 1 an a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself. [No.workers' comp. c. 152, §1(4),and we have no insurance required.] t employees. [No workers' 12.7 Roof repairs comp. insurance required_] 13 Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating uie) aft uuiit'�'vfork et�d then hire outside cuniraciurssubmii a new am—davit indicating ssuch,rtmst zContr3ctors that check this box must attached an additional sheet showing the name of the sub-con.:actors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for n9'employees. Below is the policy 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 51,500.00 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 cert' under th ains n pe es of perjury tfzat the information provided above is true and correct Si-mature: d� Date: Phone 9: — —� Official use only. Dn not write in.this area,to be completed by city or town officiaL City or Town: Permit/License# Issuinft g 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# 0266 032 DRIVER'S LICENSE d wr DAM Of ORTH WSS REST HDGm Sa 0131.1966 D 546 M 01 31 .2009 GOBEIL DANIEL L eo MUNROE ST HAVERHILL,MA 0193304635 ------------ B o uai Ing cgu ati®6s Construction Supervisor License License: CS 63220 v_ Expiration. 163162D10 Tr# 15704 -ra Restriction: 00 DANIEL L GOBEII 80 MONROE ST HAVERHILL,MA 01830 Commissioner ��ie 1ii�nn�Turea "00✓�aoatcciaelt�a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 132182 Expiraoin: 1163612008 Type: DAN GOBEIL CONTRACTING DANIEL,GOBEIL 80 MONROE ST. HAVERHILL,MA 01630 Administrator