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Home My WebLink AboutBuilding Permit #176 - 27 MEADOW LANE 9/6/2006 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o�' No oTti quo Permit NO: Date Received qq cxmt-1. y1� 7eD Date Issued: ' Q S' s us IMPORTANT: Applicant must complete all items on this page LOCATION -)9 1 /1�CtC�Uuj IU Print PROPERTY OWNER k,-i r i Ili fah N}-1-,o A Print MAP NO.: PARCEL: ZONING DISTRICT: j i TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑New Building ne family ❑ Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED , r�Pf�lac4L t' �tv�Sr�eS c��r.� r�+x�t,res iti 2>ti.5-�.na �c-�hr�y I V Q Ct%a'^U{( +0 -t 1 co! 4 1 d O -- v Identification Please Type or Print Clearly) OWNER: Name: ka r c iv Pa ruil Ig oYy Phone:��' l 1 ZS-5'513 Address:� MPcJcaw f aive-, Y CONTRACTOR Name: Phone: '?,)F 6F�-S,03.6 Address: YS + bc-46,-n Supervisor's Construction License: [< 0'7 4{y '7 Sf Exp. Date: J Home Improvement License: 1`(S O q-L Exp. Date: 12 - 2--0�> ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING ERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 360 FEE:$ >�D Check No.: 4 � u �� Receipt No.: bel .- Page 1 of 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ Well Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ ❑ Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to th guarantyfund Signature of Agent/Owner Signature of contra i 0� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Uped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED 14EALTH ❑ ❑ 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 Temp Dumpster on site yes_no-1 Fire Department signature/date Building Setback(ft.) Front Yard Side Yard Rear Yard RequireC Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Pane 4 of 4 Location r>1 V)l j!!e/10 ii � f -7 No. ) 7l/ Date -Olo OORT" TOWN OF NORTH ANDOVER ro- n { Certificate of Occupancy $ Ss E< Building/Frame Permit Fee $ cMus Foundation Permit Fee $ f Other Permit Fee $ TOTAL $ Check # _ 19552 Building Inspector NORTf-r own of t L Andover ft rO L A E - over, Mass COCMICMEWICK V %A0RA7ED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT......... ......... ...ontIe.A.. .................................................................................... Foundation has permission to erect........................................ buildin s on .. .. ......... I... .....A...................... Rough to be occupied as.....,4A �l..O.Gt>h!►.......... .. �►/7'1�1. .................................................................... Chimney provided that the person accepting this 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 916 IT PERMEXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough ` .............. Service .................. .............. ........... ........................................... BUILDING 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. 153 Maple Street • Methuen,MA 01844 • Office 978.688-5036 • Fax 978.688.4098 O o e o MV LOGLZ Construction Contract A. Date of Execution August 8,2006 B. Parties Contractor: Steeplechase Builders, Inc. 153 Maple Street Methuen,MA 01844 (978)688-5036 MA Home Improvement Contractor Registration# 145042 Federal Identification#20-1906118 Contract executed by: Christopher D. Smith Joseph M. Clementi Principal, Director of Planning Principal, Production Manager Steeplechase Builders, Inc. Steeplechase Builders, Inc. Homeowner: Karin Pantleon 27 Meadow Lane North Andover,MA (978)725-5513 C. Project Address 27 Meadow Lane,North Andover,Mass. D. Proiect Summary Gut and remodel existing bathroom with no modification to existing floor plan E. Proiect Cost $26,300.00 X qn�\,. )� . pa6kee� 08 og 200 Homeowner Signature(s) Date Conc-16rSignatures Date MA Home Improvement Contractor Registration#145042 MA Construction Supervisors License#CS 074478, CS 089253 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone F-1 am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone#: Insurance Co. Policv# Company name: ee p)e 61= L A J J c i t --rive— Address I S nor,ole 5�- City: Phone#: �►S�'l 13 G+ Insurance Co. Policv# C( �} Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature In Date 9- 6 --04, Print name .Tse v CL ems ;-, Phone# 34� Official use only do not write in this area to be completed by city or town official' F-1 Building Dept []Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone#: C] Health Department Other FORM WORKMAN'S COMPENSATION NOTES: 1 . NO CHANGE TO EXISTING FLOOR PLAN O 2. REPLACE ALL f N 151-1 E5 AN D FIXTU RES j 0 3. REPLACE BATHROOM WINDOW 0 o O CV O — 0 U 7-3 112" SCALE: 3/8" = 1 ' 0" Drawn by:Chris Smith Date:July 28,2006 Steeplechase Builders,Inc. Pantleon Residence ❑ This drawing is the property of Steeplechase Builders,Inc. Steeplechase 153 Maple Street 27 Meadow Lane,North Andover,Mass. Any use of this drawing without the written permission of B U l L D E R S Methuen,MA 01844 ❑ Steeplechase Builders,Inc. is expressly prohibited. Inc. (978)688-5036 BATH ROOM FLOOR PLAN oseph "Tay" Clementi Steeplechase Builders, Inc. �\ ✓1GG 7/JNJli4)LlJY2C!/P.CLl�12U ✓,'r!rUaed'.3 �/ � --^ - `1 � TP -�a,JVJJea�u . o�✓G�dar..�f;rae�b BOARD OF BUILDING REGULATIONS SN—\ Board of Building Regulations and Standards License: CONSTRUCTION SUPERVISOR W HOME IMPROVEMENT CONTRACTOR Number: CS 074478 Registration: 145042 Birthdate: 01!24/1964 Expiration: 12/2/2006 Expires: 01/24/2007 Tr.no: 6264.0i Type: Supplement Card Restricted: 00 i STEEPLE CHASE BUILDERS,INC. JOSEPH M CLEMENTI JOSEPH CLEMENT 153 MAPLE ST /tel METHUEN, MA 01844 �_— / 153 MAPLE ST fir. ' *✓ Commissioner METHUEN,MA 01844 Administrator CS license (front) Contractor registration (front) 00-35,000 cf enclosed space (MGL C.112 S.60L) 1A-Masonry only 1 G-1&2 Family Homes Failure to possess a current edition of the License or registration valid for individul use only Massachusetts State Building Code before the expiration date. If found return to: is cause for revocation of this license. I Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 '— DIG SAFE CALL CENTER: (888)344-7233 Not valid without signature CS license (back) Contractor registration (back)