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Home My WebLink AboutBuilding Permit #354 - 29 MAGNOLIA DRIVE 11/1/2006 I . TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION . o Permit N O: s Date Receivede r yy Date Issued: ?� ssCMUS IMPORTANT: Applicant must complete all items on this page li LOCATION L1 hulk&Ay1D L4 & bQ l v\4& kOR-7)4 q6'DDVi4 JUA-. 01?fig PROPERTY OWNER_/41UdU y �print L �( SCL�rel�O Print MAP NO.: 66 PARCEL: !6 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSEDS U E Residential Non- Residential New Building X One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration. No.of units: C Repair, replacement ❑ Assessory Bldg ❑Commercial Demolition,- Movin (relocation) ❑ Other ❑ Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED Glitn E L AS S` �-S Identification Please Type or Print Clearlyf OWNER: Name: n- k0n y O K k ala+ Se-a-maa Phone: 6? 17 49 S'l- Address:_ 2� MA(zsNIOLAA 'NO-we, k/0 47/W 4,n -6DV A MA ©f `— CONTRACTOR Name: Phone: Address: E50 ?a Kz f;�-r� l �r� !. 9 Supervisor's Construction License: nto` S Exp. Dater — Home Improvement License: I++ Exp. Date: I I 12 — b ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 5125.00 PER&F. Total Project Cost :$ !f5;60D FEES S .dk> Check No.:��Receipt No.: C � � • i 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 16 uilding Permit Application Workers Comp Affidavit hoto 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 o 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 Dnc:INSPH TIO.NAL SERVICES DEPARTMEN'rMFORM05 Page 4 of 4 i 1 TYPE OF SEWERAGE DISPOS L Swimming Pools G Tanning%Massage/Body Art Public Sewer Well Tobacco Sales Food Packaging/Sales C Permanent Dumpster on Site Private(septic tank,etc. J Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Ow=4 Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ St meed Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY I INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ j COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS i FIRE DEPARTMENT - Temp Dumpster on site yes no i n Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection/Sienature& Date Driveway Permit Building Setback ( Front Yard Side Yard Rear Yard Required 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:131'FORM05 Crcaied JMC Jan 2006 1 Location No. Date < <� +06A, 35�{ NORTH TOWN OF NORTH ANDOVER 3?0�,•`,o I•,hOL 10jaidgiliKy l Certificate of Occupancy $ �'�s''•°'E<�' Building/Frame Permit Fee $ �ACNUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # LT_— 19755 �' Building Inspector NORTH Town of t _ 4 over o _ :..r_. W ., No. W - - _ Im W z- A dover, Mass., ' COCHICMEWICK y1. %a ADRA'rE D S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... ~ �.... .� ... +�.......... ..........................c r.................................................... Foundation has permission to erect........................................ buildings on .011.........�.O. ...04.6..Lt.M......P.60.... Rough to be occupied as. T........ .............to."X........................................................................................................................... Chmn y ie provided that the person accepting this permit shall in every respect conform to the terms of the application on filo 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 S PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU t� ELECTRICAL INSPECTOR Rough .............. ......... Service .. ..... ... . . ............... S BUILDING IN TOR Final Occupancy Permit Required to Omtpy 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. bJ� W � ANI / l ----------------2 t a ` 410 11' 1 uto� 0858£0 HiS aNOd 05 iauol$$Iw FId-asc 4 77� Iva 80� s�J[d �C151:13b�- :ou'al ; 99 L5£9Z g96615L19� �.-` M; t. i g50S90 � esueol'1F SNOD .. , dns i4omon2�1O GwO9 dOSIOIa -a Za ol!114'll(19 71. �o,,�nwauoea o�✓�/laaaac/zuaPlta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 144756 lug Expiration: 11/2/2008 Tr# 124408 Type: Individual JOSEPH R.ENAIRE JOSEPH ENAIRE 50 POND ST NEWTON,NH 03858 Administrator CONTRACTORS INVOICE ' 0-625 5S WORK PERFORMED AT: TO: '2-.J HALNOUAF � • �LfAA 0 15 DATE YOUR WORK ORDER NO. OUR BID NO. 1 • • e •• •• • S G + t p k- ?ew,- i - C .t� 11ATAIJ I . WoAc- II t t v4::7 45;= DQU APS � I �-- 10131166, All Material is guaranteed to be as specified, and the above work was performed in accordance with the drawings and specifications provided for the above work and was completed in a substantial workmanlike manner for the agreed sum of 1 Dollars($ ). This is a ❑ Partial ❑ Full invoice due and payable by: Month Day Year in accordance with our ❑Agreement ❑ Proposal No. Dated Month Day Year NC3822 CONTRACTORS INVOICE AV/J1/GVvv iv:at raA OUJov.9tvly isavr s.tc roar Ijvvi CERTIFIC IA I E OF LIABILITY I SUIZ4I�C h =attwl P"DUCER (503)382-559f AX I nsur ante Express.coat 1 nc. (603}38Z-1852 THS CERTIFICATE 18 ISE.IED AS A MATTER of INfORMATION S PI ai at ow road HOLLIXIL THIS CEAND RTIM No!1F WE8 NOIGWS T AMMO.EX EM OR LW t C47, ALAE COvERAOE/`�61RDED 8Y THE POLfC1E8 BELOW. PI el at os NH nal r e MURERS AFFORDING Co,,MGE mwRreo Joseph Eelat re FINACq 50 Fond St INSMIRA Preferred M t.lalWW mi., Nfi 03858 Iata 24 INSURER c: a £�&►GE8 �e THE!POUC16S OF INSURANCE LISTED BEU W FIAMIA REEVE N ISSUEO TO TI$INSURED NAMED ANY REQUIREl�NY,TERM OR CONp ym T ANY CONTRACTOR OTHER A80YE FOR THE Pi JCY PE MOD INDICATED.NOTIMINSTAEXMNG MAY PERTAIN,AG RE INSURANCE ARFORDBC 8Y TT{E POLICIES DESCRIBED HEREIN IS� T TO ALL IERRESPECT TO CTHSI:S,EYa U�S10NS AND MAY BE ISSM OF Sur POLtaES.AGGREGATE OMITS SHOWN MA•HAVE BEEN REM)=sY PAID CEAIMS. 7GGhrLA=rCATEU"TAppUFSpFjt TYPEDFIWURANCE� POL=tllmm pmICrfrbM CPQ 0120 57 72 32 1110212006 11/02/2007 +;II accvRRe X C RGALG�ALLIAR3ILft 500,000 ctAIMs wADE I X occuR Rem ARE °�EsoIW •) S 100,00 AICA"orn(A"amgvma4z 500! 'ERSONAL 4 AOV INJURY z 500,00 2ORAL AGGIMATE Is 1,D00,0000 41 7ucY 1 , Loc 'RO�JCNP s-COrOPAGG s 1,'000,000 AUTDpO UABIUTY J ANY AWO 1 r�Ea SINGLE LUT ! ALL OWNGO AMOS f B WOULEDAUTOE Wp RNRjRy 8 HIRED AUTW NONzWNED AUTO$ 901311.1'INJURY :�otkrideng i YGAMAGE OARAOE LIABILITY — _ I� S ANY AUTO 'tR0 ONLY•FA ACCIDENT S MCE :1'HER THAN CA ACC S ftV�t@ItELLA LIABILITY VTOONLr: AGG s �OGCUR I �CLMMSMADE :404 CCUR7 WE :GR1aA?E y OFDUCrIBLE _ WORKMS CO ATION AND _... T� � S EL'AiOYR9I$LIABRLRTy �70r1Y l�MTg I I0 ANY PROPRIOMPARTNEROunm,VE Im I L EACtIACCt y OFFtCBiJMEMBER DQRtlDE09 9 Pdaleftwww BPROM 051 Ns pebw i DISEASE•!:A EMPZ f E _OI$Ejl4E•pmla uwt 5 �DRIPTIDNOFOP®tATiDNSIL0rATIp I FJICLUSIOIYS ADD®BY IXOORSEMEpT/s ECKL F7I01Asli .�EttTIFiCA HOlL3ER �" CANC ISIlWEDANYDFTlIEABOVCO$SCRR bili P011CIpS�'CA86FORETHE EIUGiATRON DATE THEREOF,TiIE)Sy Qi G 06UTM WILL SWEAVOR TO MAIL 1LDAYS WRRTEN NOTICE'TO n i'-MMICATE NDLOM RAMTO TIS W". Ant ho* Scaraggi BUTFAIURRETO 29 MlWm l i a Or I ve �ePosE NOoBLwATwn ORLUBILIsr N6Dr t h Andover, IVA 01645 or -wmwwvmm _�oENrs�REPRESMATPI & ATM _... ACORD ze(Za I=) ` 0ACOROCCIRPORATION 1982 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): _ 16 � AJ Q, Address: 50 City/State/Zip: 6 l; QA N. t2; Phone#: 63 - ?2 Z�Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.X I am a sole proprietor or partner- listed on the attached sheet. + ?• E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also till 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my 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$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$250.00 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 ceqifi,under the pains and penalties of perjury that the information provided above is true and correct Q Si nature: Date: 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#: