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Home My WebLink AboutBuilding Permit #009-2011 - 27 PARKER STREET 7/1/2010 BUILDING PERMIT of "°RTf t(LED i TOWN OF NORTH ANDOVER II - APPLICATION FOR PLAN EXAMINATION - '' ~ �( r 1 Permit NO: " s�®�� Date Received �� f� ' � A .9 �RAtEO IJ Date Issued: , AcHuf IMPORTANT:Applicant must complete all items on this page rf a� i1r"'..�.F��t �' ':pl i1�S`�-C L� '- ,• j-` �.. � `! - 'i Si €, :cam t _ c ''z r - I -t i 4 �••.F - } 'P- 'f !.� r.,i.�.y Print!" 4. ,fPROPERT r"j. +`{ Kr!4� � t '.`" Yr t...K'�f` 'nl ! a �2�� I�t'�`. 1� � r'r.. � '�"'-�j''t� 'i�} • � `may+ f. ,� r r� �aii i=i j' MAP210�`z:'_ PARCEL: ' F ZONING'DISI"RICTG, Historic D�t�strictlj a7' - ii � Y Machiiiet�hop4Village '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 Welly wlFloodplam H Wetlands �r �s Watershad D{strct l' Water/Sewerr ,.,x r �:� , ,` .• r S # �, DESCRIPTION OF WORK TO BE PREFORMED: - f Identification Please Type or Print Clearly) OWNER: Name: V I - Phone: 52 �� 6 Address: T ri✓ Y 1�Y f77 r. !_ -{ ti e. - , 4_CONy"'3-j.,OR Name / X41 k=/ ( i/, =jW :Phone '•" '. ,3�' Z f i- y 5 � �Adtlress �r ��,�,�tTh�' ,r �.�;�' �"� �'`��y"�i��1��•.' ,�� '�� ,�'�-�,.y'.;u-; .. ss "A. Ng-," Ng Su Er�isoon_strucfion;License _�,s ;�� { �P iC � .. r - � ARCHITECT/ENGINEER Phone: Address: Reg. No. a FEE SCHEDULE;BULDING PERMIT.,$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ f j � D` FEE: $ Check No.: Receipt No.: �u oc�'J'' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of_Agent/Owner . = g of contractor = Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerSwimming Pools Tannin /Massa elBody Art g g 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 Durn pster on s7te yes no �. Located at24 Main Street Fire Departmen t�sjgnature/date � :+ �. L t�k a�y t .t c.»t. r �7 ; aYK "?•..-'� kez_l �� t.. � �� '_ � +' .;*� ...tr - COMMENTS :�.�_.� ��':�..__: :�_ rt.._: -, : .:,_ .. � , ��:. r�_,,• �> <• ar.� .w�. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land.area, sq. ft.: ELECTRICAL: Movement ofMeter 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 2010 Building Department artment 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) o 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) a Copy of Contract ❑ Mass check Energy- Compliance Report ❑ Engineering Affidavits for Engineered products N 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 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 ORTI, oWn 0 _ Aindover No. �.� -' LAK O dover, Mass., COCHICHEWICK ADRATED S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System �� THIS CERTIFIES THAT............. KO V1Y 6 BUILDING INSPECTOR.. J c Foundation has permission to erect.........:.......:...................... buildings on �� ' rJ ............................................................................................. Rough to be occupied as................. .c`„-7"? . `° {•t•••t•• � �/.e.. .... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final 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 CONSTRUCTION STAIFS ELECTRICAL INSPECTOR Rough .............................. .......... ................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Display in a Conspicuous Place on the- Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. 7641" ATTACH TEP2490f1.5 (increased depth 29) Legend 1: TEP2490F1.5-WD 2: BWC6 3: 3DB15 9�' 4: TEP2490F1.5-WD 7 5: F330 6: 2XF330 8 2 6 7: 2XF336 8: W361824 _ u'�1 9: F336 INCREACED DEPTH 10: W2736 TO PANELS. BUILD 11: BEP-WD W361834 OUT FROM TURN FILLER ON S DE, ` c�;I� Ir �p 12: BEP-WD WALL FLUSH FACE. FINISHED SIDE OUT. 13: W336BCFP 3/4"OR TRIM TO FIT. - 14: W336BCFP 15: 2DB21 SS TRIM ALL FILLERS AS 16: F330 NEEDED. cn = 17: SSS36L 18: W3018 19: 2XF330 ATTACH 20: 2XF336 WMC1236R 21: DW362424L 27 22: SB36STS ° 23: W1 236R - 24: W1536L 24.DISHW 25: W1236L h 26: F336 ATTACH 3TWT4 21 0 29 28 °O 27: F330 and BBM8 to 28: W936L FD241224s to ma e - - - 29: W2136R window seat 30: WMC1236R ° 31: B(243412)FH 05 " 6;" 7," 32: FD241224 6 33: FD241224 34: 3TWT4821 102.21"- 01 22"0 Ll a- All dimensions_size designations This is an original design and must Designed:4/25/2010 given are subject to verification on not be released or copied unless Printed:6/24/2010 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 4250FE39.kit All Drawing i#: 1 9 1/ 16 �� -//12 "/- 15"7/12 24 1 ti 0 2XF336 236NV1536W12;F3 DW362424L i LO M ` Lr O O O � CO 0 M LO E2XF330=1DB21 S;F3 SSS36L 0 LA ITT ILL 21 ' 36" 1028 ' 2�4 " XL W3 1_31 4 1 7 1 1 21 16 v 2 316 3 2 ' 13 -2 All dimensions_size designations This is an original design and must Designed:4/25/2010 given are subject to verification on not be released or copied unless Printed:6/24/2010 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 4250FE39.kit JEII Drawing#: 1 764 F336 W361824 00 ` W2736 2XF336 00 00 TEP249 1 .5-WD 36REF-2D - 530 CD M `" -RANGE1 d' C'7 0 F330 BWC6 3DB15 2XF330 2 2 All dimensions_size designations This is an original design and must Designed:4/25/2010 given are subject to verification on not be released or copied unless Printed:6/24/2010 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 4250FE39.kit El 2 Drawing#: 1 2 3 it 4W16 816 a*� r co W3018 _ o0 _ r 33 W33 CFP3 _ Lf) 1CO Ir- r LO MW.HOOD o LO � o h _ N (D@0 @ (D@ r r-, 00 LO r N A3EP 30-RANGFB-E 2XF330 M H_ 30 2 lit 83 ww w06 ti 16 4 16 1 13w 8 4 if) 1 it 3 8 16 16 All dimensions_size designations This is an original design and must Designed:4/25/2010 given are subject to verification on not be released or copied unless Printed:6/24/2010 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 4250FE39.kit JE13 Drawing#: 1 102 2" 24" 9 .1 4316„ 21 „ -4 E o 104 DW362424L V936L W21 WM 236R lf) IN M N 104 In = In Ho ° �I r �IC4 — U,(0 ° �o �°° Cfl Lr) N �IN M M SSS36L F330 SB36STS 24.DIEB 24 H N M I� W3 36 3 2 " 1 .. 3 v� 3,94 •• 3 it 3011 31 616 16 1 16 All dimensions size designations This is an original design and must Designed:4/25/2010 given are subject to verification on not be released or copied unless Printed:6/24/2010 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 4250FE39.kit JE14 Drawing#: 1 75 3 4 a- - CO � CV - L LO _ _ 3TWT4821 2 2F r� F D241224 F D241224 24" 24" -24 " 9 il 1 8 16 Iz- 24 1 11 - 35111 36 3 vi _ 2 0i 8 4 8 All dimensions_size designations This is an original design and must Designed:4/25/2010 given are subject to verification on not be released or copied unless Printed:6/24/2010 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 4250FE39.kit El 5 Drawing#: 1 Page 10 of 11 No. 2685-173677 Home Improvement Agreement PLEASE READ THIS Important additi nal information regarding Customer's rights may be contained in an attached State Supplement. I ' Scope: This " greemenf' consists of this page, the following General Terms and Conditions, the Invoice, the State i Supplement if al pficable, and any drawings or Change Orders expressly made a part of this Agreement. The Agreement Is between the Cu tomer identified on the Invoice and Home Depot U.S.A., Inc. ("The Home Depot" or "Home Depot"). Any installation services provided under this Agreement shall be performed by a licensed and insured third party Authorized Service dwe li gse or other Home s ructuepot d es. The Home Depotoes not perform and r is Authorized engineeringal or Sery cel Provider wces, nor illsit e perform structural chinstallation ch g services in acco ance with a licable law. Payment Schad le: Payment is required as indicated baro .�a' --1 Please initial here to opt to pay the total amount of the sale now;Customer h s the option of paying less as further specified in the State Supplement. Payment: $_ 10 47. 1 Due in full immediately. Sales Tax: $ Don If applicable. Total Amount of Sale: $ 1 247-21 Includes all applicable discounts,rebates,and taxes.Excludes finance charges.* *Any interest pay ents or other finance charges will be determined by Customer's separate cardholder or loan agreement,to which The Home Depot is N OT a party,and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the ardholder or loan agreement,as applicable. No funds should be made payable to Authorized Service Provider; however,Authorized Service Provider may collect Customer's payment(s)made payable to The Home Depot. Antfcf a'ted Defi very!Installation Schedule Derive Date: . BD Start Date: 04/25/2010 Finish Date: 05/25/2010 Acca tance a d Authorization: Customer authorizes The Home Depot to order and arrange for the delivery of all goods and services i cluded on the Invoice. Customer further agrees and understands that this Agreement is the entire agreement be een Customer and The Home Depot with regard to said goods and services and supersedes all prior discussions anJ agreements, either oral or written relating to said goods and services. This Agreement can not be assigned ora 'ended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer ias read, understands, voluntarily accepts the terms of and is entitled to and has received a complete copy J of this Agreement at the time Customer signs the Agreement. Do not sign if blank or incomplete. Electronic Si nature: The parties to the Agreement agree that the digital signatures of the parties included in this Agreement are intended to authenticate this writing and to have the same force and effect as the use of manual signatures. Customer ackr owledges that he or she is the person named on The Home Depot contract number identified on the point of sale device. CANCELL ION: CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGqAN BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRDNESS DAY AFTER SIGNING THIS AGREEMENT. Under such circumstances, Customer's P e returned within ten(10)business days after The Home Depot's receipt of Customer's notice. Accepte04/25/2010 x Date Customee Authorized Servic Provider's Full Business/Trade Name,Address and Associate's/ thorize Service Provider's un Sign ture License No. or Ni (s).,as applicable: Date Associate: Please print your salesperson's license number,if applicable. I License No(s). Authorized Servi'e Provider's Tel.No. uestions? f The Home Depot store and Authorized Service Provider are unable to answer Customer's questions, Customer may contact The Home Depot Customer Care Department at 1-800-553-3199 or use the address below. Home Depot U.S.A.Inc.,2455 Paces Ferry Road,N.W.,Bldg B.3,Atlanta,Georgia 30339 112010 Page 10 of 11 I o. 2685-173677 73677 Store Copy I ' Massachusetts- Department of Public Safet. Board of Buildinl- Rel-ulations and''Standards Construction Supervisor License License: CS 30000 Restricted.to: 00ry RICHARD J MADISON 3 MADISON AVE GROVELAND, MA 01834 ;j,� ti _1,}�1 Expiration: 7/21/20.14.C" ` ('onnni�si nei'` Tr#: 17764 GTS -+°a�ni�w � Board of Building Regulatio sand Standards j HOME IMPROVEMENT CONTRACTOR d. RegistratioW 118509 Expir.ation 3/29/2011 Tr# 281414 t� Type DBA. MJ)CONSTRUCTION, RICHARD MADISONk 3 MADISON AVEr GROVELAND,MA 01$34 , Administrator The Cornnzonwe&r&h of Massachusetts i Department o frjzdustrial_4ccidents Office ofd" Ues2i ations 60.0 ffashilzgion Street Bostvrz, MA 0111 ' 'Rrorkers' Compensation Insurance'AM did •aid guilders A licant Informa{i.on /Contractors/Electricians/Plumbers . PIease Print L.eoibiv Name(Business/Organization/lndividual): ((� Address: City/State/Zip:Gly )f- l �c _ . �.�:�� Phone#: Ji (j �� F n oyer?Check the appropriate box: a employer with ' 4. Type of project(required):' ❑ I am a.en e-ral contractor and I loyees(full and/or—part-time).* have hired the sub-contractors 6. ❑Nev,construction a sole proprietor or partner- listed on the:attached sheet.� 7• ❑Remodeling anal have no employees These sub...contractors have ing for me in any capacity. . workers' com .ins 8• ❑Demolition p urdnce.orkers'comp:insurance 5. ❑ We are&-coporation and its 9. ❑Buikding addition red] of5eershave exercised their 1Q•❑Electrical repairs or additionsa homeowner doingallworkn t of eemotion perMGL I l.❑Plumbing repairs or additions lf. [lJo workers'comp, a 152, I(4) and we have no ncerequired_]t ' employees. 12•❑Roof repairs -ns -Llrc n- comp.insur-awn a enquired.] 13.[]Other Romeo �i `=ksbox-#i must=sU M-10-It thesecrirn a_ot* =^oa:r r� _. wneas who submit oris affidavit indicating they z=dein^ail•ao.n anti R cn.Ms'comp...mon^^ e . E 1_ Y :c, =ion +Contractors that check this bax&rust a ched an a ��hire outside contractor mLt,sub ddifie�al sheet show' t a n��affidavit incii:ating such. the same of fl,e g,_i.•e uu-. . -tam and their workers'comp.policy infm..E au. -ram an employer that is providing workers'compensadon in information. srrrance for my employees Below is the policy and job site Insurance Company Name: C I /� ( � l'• ' Policy#or Self-ins._Lic.#:_�/, /�- 6146' Expiration Date:-. 5--- 3C3 — Job Site Address:Q�j f"JW /4---r 5T City/State/Zip: Attach a copy of the workers'compensation policy declaration page(show—in- number and expiration date). the policy Failure.to secure coverage as required under Section 25A ofA4GL c. 152 can lead to the imposition of criminal fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WOK pemaities of a Of np to$250.00 a day against the violator. Be advised that a co RDER and a fine Investigations of the D1A for insurance coverage verification. Py of statement may be forwarded to the office of Ido hereby c un Cr the p ' s aenah ies of periur3r thrxz the information.provided above is true and correct: Signature: / • ' Date:-_�.�._�_�'• / Phone Of-ficial use only. Do not write in this area, to be completed bJ'city or town offer City or Town: P.ermitucense )<ssuing Authority(circle one); I. Board of Health 2.Euildinb Department.3.City/T own Clerk 4.EIectricaI Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: ' I Luformation an- d'Instructions Massachusetts General Laves chapter 152 requires all.employc--rs-to provide workmrs'compensation for their•employees. Pursuant to this statute,an employee is defined as"...every prison in the service of another underany contract of hire, express or implied,oral or.written" An employer is defined as"an individual,partnership,-associaItion,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including tibe Iegal representatives of a deceased employer, or the receivtrr or trustee of an individual,partnership,association Dag other legal entity,employing employees. However the owner of a dwelling house having notmore than three aparfnz� ��who resides therein,or the occupant of the dwelling house of another who employs persons to do maintt:mauce,construction or repair work on such-dwelling house or on the grounds or building appurtenant thereto shall not be:c--ause of such employment be deemed to be,an employer." MGL chapter 152,§25C(6)also states that"every state or 10.cal licensing'agency 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 ca39upliance 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.perfonnance of public work intim acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contra cling 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),address(es)and phone numbr(s)along with their cmtificate(s) of insurance. Limited Liability Companies(LLC)or.Limited Liability Partnerships(LLP)with no employees other than the Members or partners,.are not required to carry workers'comp=sation in Trance. If an LLC or LLP does have- employees,apolicy is required. Be advised that this affidavit- may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be gva to siggn and date the affidavit. The affidavit should lie i�tuiied to the cis or iC1KJri jih�s`the S ._ '-the T, e�„�e h 'y aui,uca�on'- r'�ait-oi h � eing requested,not tae.Departmn"t of Industrial Accidents. Should you have any questions regardin ge lawor?f ycne required to obtain a workers' compensationpoucy,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 Offl als Please be sufe.tbit the affidavit is complete and printed legibly. The Department has provided a ace at the bottom In space, of the affidavit for you to fill out in the event the Office of Inuestiations has to contact you e g y regarding the applicant. Please be sure to fill in the permit/lice' nse 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 stampe=d or marked by fhe city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or license&. 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 burn leaves e'fc.) said person is NOT required to complete this affidivit The Office oflnvestigations woWd.like to than y_ou in advance for your cooperation and should you have any questions, please.do not hesitate to give us a call The Department's address,telephane.and,fax numbers---- _ - The Commonwmlth- Gf Massachusefts. Department of bdustrial Accidents Office.of h esti at ions 600 WEA��_Iton Street Boston,MA 02111 Tel. # 617-777-4910 ml 406 or 1-9 77MAS.SAFE Fax 4 6.17-727-7749 Revised 5-26-05 mmR7 miam.-mov/cha Location O7 7 G/I S�— No. ��c1_ a0// Date �ORTM TOWN OF NORTH ANDOVER N p ' Certificate of Occupancy $ • i � ;�s',••°•Eta' Building/Frame Permit Fee $ ' s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 0- 2 3' 2 ' 04 Building Inspector Dateq-d(l--.qo�' 04 41 TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING SACHUS This certifies that . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . plumbing in.the buildings of . . 116--In--�- . . . . . . . . . . . . . . . a t C�V'?-7. . . . . . . . . . . . . . . . . North Andover, Mass. Fee�. . . . .Lic. No.. . . . . . . . . . . . PLUM BOG SPECTOR Check # jM 7854