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Home My WebLink AboutBuilding Permit #060 - 29 PADDOCK LANE 7/31/2006 L TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION 04 1"D #6.14,, 6 O to Date Received— Date eceived Permit NO: '� '9A o_..._K.„'• � Date Issued: ,+e � ��SSACHUs��h i IMPORTANT: Applicant must complete all items on this page LOCATION Of 7 fiqw--ac Z L _ Print PROPERTY OWNER Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ r�[01 �NewBuilding MPROVEMENT PROPOSED USE Residential Non-Residential .J One 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 ,�C�10�� .�sTru�- �iSl7h�`?�or� • Identification Please Type or Print Clearly)/2 /� (� � Phone: 92 7C�% i-7 OWNER: Name: //� e [ C � Address: lTl`t CONTRACTOR Name: ( a Phone: Address: ,� �1 —,�T /` —fir an Supervisor's Construction License: ( � Exp. Date: Home Improvement License: Exp. Date: � / " ay— ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. 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, L�DD x12.00=FEE:$ Check No.: 6 Receipt No.:A 41� :7— Page I of 4 r J I TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ Tobacco Sales Well [� Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. L`�' Electric Meter location to project NOTE: Persons contracting w' unregi red contractors do not have access to the guar fund Signature of Agent/Owne Signature of contracto a- -�� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped 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 HEALTH ❑ ❑ 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— Fire Department signature/date I Building Setback (ft.) Front Yard Side Yard Rear Yard Re uired Provided Required Provides Required Provided I 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 I i I I I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1MC.Jan1006 r J 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 1 paaP 4 of 4 Location =21 No. Date NORTIy TOWN OF NORTH ANDOVER Of�•••o : ',yG 3? 0 F A • ; ; Certificate of Occupancy $ J t Building/Frame Permit Fee $ s�cHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 ' Building Inspector a ,.10 R T1.1 Town of Andover L.. . ...... No. e6 C,odovet Mass., LA IF I� COCHICHEWICK y�• 7,p ADRATED S BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D 0"1"44 � BUILDING INSPECTOR I THIS CERTIFIES THAT......................................................... � I ................ ............... . . Foundation . .............. ......... . . . . has permission to erect........................................ buildings o ♦... ....... ...g. O..�CW........ ...�.......................... Rough to be occupied aS1 #110.0 ........... �. � Chimnev .............. . ...............:.............................. 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. i PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 3 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU N STARTS Rough i 0 ............................................:.. Service BUIL ECTOR 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. "IN Department Commonwealth of Massachusetts Department of Inditstrial.lecidents Office of Investigations ti I i 600 Washington Street Boston, A14 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers replicant Information / Please Print Legibly Name(l�usincsstOrganiialitmllndividual►: OL/-Jss/c Q� 's ;address: 470 f •�'/t / /v� - `i—�� _ — City:State/Zip: �/ Phone 4. 2?Yl �S t� K��o G ,kre you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction mployees(full and/or part-tithe).* have hired the sub-contractors 2 1 am a sole proprietor or partner- listed on the attached sheet. ' ®'Retmodeling ship and have no employees These sub-contractors have 3. ❑ Demolition working for me in any capacity. workers' comp. insurance. y. ❑ 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 ME].❑ Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] employees. [No workers' comp. insurance required.] 13T1 Other —_ `Any applicant that checks box,41 must also fill out the section below showing their workers'compensation policy information. +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 mane of the sub-contractors and theirworkers'comp.policy information. I am tin employer that is providing workers'compensation insurance for my emplgyeec. Below is the policy and job site information. Insurance Company Name:___—_ - --------__-- --- --- Policy :'or Self-ins. Lic. `?: ---__ Expiration Date:_—____ —_ lob 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 tine up to$1,500.00 and/or one-year imprisonment,as well as civ it penalties in the form of a STOP bN ORK ORDER and a tine 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 DLA for insurance coverage verification. I do hereby cer ' ' + Fer th ions and penalties of perjure that the information provided above is true and correct. `i nature. nate: !)/ficial ase only. 1)o!wt write in this urea,to be completed by v t)-or town,,�fico ll City or Town: ;Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk t. Electrical Inspector 3. f lumbing Inspector 6.Other C r)nt3ct Person: Phone#: Jauolsslwwo3 Izsl.o Vw 'aaozlxoe ON IIIH SNAVS VLZ xf1omoH a I3VHOIW 01 :pa;ola;saa OJ 1.1,L :ou LOOZ/1,0/40 :saildx3 0961,/V040 MBP4V19 £61.090 SO :jegwnN NOSIAU3dflS NouonalSNOO :asuaal-1 SNouvi s3a Waiine dO awo8 v�drm�✓r�vr�/�a ��nanzoox�viuoni ax�� Board of Building Regulations and Standards _ One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 107835 Type: DBA Expiration: 8/7/2008 CLASSIC CONSTRUCTION CO. Michael Robidoux 27A BAYNS HILL RD BOXFORD, MA 01921 Update Address and return card.Mark reason for change. DPS-CA1 is 50td-05/06-PC8490 Address Renewal Employment ❑ Lost Card �/ic Lan��za�uaea� a��a:�sczc�ivaelta Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 107835 One Ashburton Place Rm 1301 Expiration: 8/7/2008 Boston,Ma.02108 Type: DBA CLASSIC CONSTRUCTION CO. Michael Robidoux 27A BAYNS HILL RD �o •� _ - BOXFORD,MA 01921 Deputy Administrator Not valid without signature J)raposal Page No. of Pages CLASSIC CONSTRUCTION CO. ANDOVER, MA (978) 475-5033 PROPOSAL SUBMITTED Tj PHONE_ 79A�l'C/�^� DATE STREET JOBNAME CITY,STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: v:/N.O...........�T�"sc�S.: i .G......... 3 /z' .....4 . ../ 'G/4_<. ........../°GU/n, rt� -.............. ...__........... "'00V ?/ (.L / / ,, 1--�/G :7r 1. .I.... 1.T�-/ ......... . Gci4L �. .......... .... .. // = G-?, E � r� / 9vJ �- � % / �� "�/2 ............ `7-1467, . vii /% c .......... !/ �.. .. .......is ✓ ' ' ..... ................ ............. ....._...r, . ..�s.........._�:� . � / .%= ...... ......... ...........D ,1. .T .. . 'm. /..rv ✓ Z,... �....................... .. ............LL W ...... ....0 `....._'..... OiL J......�// i v1../... �........lGl� tii j.........f-%(/G6�7 Amo................................................. ................................................................................................................ ..........V/ c��s"...............<�L �c�................................................................................................................ ................................... .. .............. ....�..............-.... z e/s' .. :c . F>........................................----........................................................................... ......... ................................ .................................. ... ............. . .. ...................................................... / ao 06/ <vc L v,dzs4 We proPOSe hereby to furnish material and labor—complete in accordance with above specifications, ^for �the sum of: dollars($ Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed 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 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. i Arrrptaure of Proposal —The above prices, specifications 1 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: /` f1,�� Signature To Reorder Cell