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HomeMy WebLinkAboutBuilding Permit #586-14 - 291 MASSACHUSETTS AVENUE 2/12/2014 NORTH q BUILDING PERMIT TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION - Permit NO: - 4ILI op ea Date Received Date Issued: SSACHUS� 7" NP6RTANT:Applicant must complete all items on this page f LOCATION � 17ROPERTY rint OWNER G �l3 Print MAP NO: PARCEL: (�D ZONING DISTRICT: Historic Distrct+rl yes Machine Shop Village yes w TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building t�r-One family ❑Addition ❑Two or more family ❑ Industrial ..Alteration No. of units: ❑ Commercial b4-Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0-Septic Q Well El Floodplain 0 Wetlands, 0 UV itershed'District (&Water/Sewer PC�HIo / -tic M"54 EMIT h"%/ �jln%�yoo{ff, 1yc�d�,- Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR. Name:yL,. Phone: ,.- Address, 170 ' A Q3a l/ Stapervisor's.Construction Li ens - Exp. . )ate;_ f . Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 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: $ a2 000, coo FEE: $ Check No.: {1 r J C,- Receipt No.: NOTE: Person ontr c g with unregistered contractors do not have access to the guaranty fund igrtature of Agent[Owne_r fSignature of contractor a '` � _ .. ' I .. � f i _ ` ii h ,� I i < r 4 o. �✓ i i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page NIT LOCATION -- - - - - .. - P"nrjt. PROPERTY OWNER: -_� - - --_ Print T 100 Year Old Structure yes. no MAP NO _ .. _.- S,PARCEL: __ ZONING.DISTRICT: _.. -Historic District yes ino _ ..�_� Machine Shop Village yes Eno. -. _.�. .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 _ r# T µ D Septic. ❑Well ❑ Floodplain ❑Wetlands p. V1latershed Qistnct U Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: I I I Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: LCONTRACTOR Address: — n Su=.ery so -s Construction License: _ ._._ _- _ -;Exp. 'Date: . P M Home Impvem roent License: _. _ _ rExp. 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: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund it - Plans Submitted LJ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The foi",wing is=a.list of the required.forms to be filled out for:the appropriate.permit to.be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Btailding Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o 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 apuaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Buil Jing Permit Revised 2012 r Plans Submitted ❑ Plans Waived ❑ . '..Certified Plot Plan ❑ Stamped Plans ❑ Public Sewer ❑ Tanning/MassageBodyArt ❑. . Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Too_dPackaging/Sales ❑ Private(septic tank, etc..: ❑-- - Permanent Dumpster on Site ❑ :THE.FOLLOWING . SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ",DATE REJECTED DATE.APPR-OVED _ PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS i e I HEALTH Reviewed on Signature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_ , . Planning Board Decision: Comments Conservation Decision: Comments Water & Sealer Connectionisignature& Date Driveway Permit I DINN. Tow 2 Engineer: Signature: - 84 Located 3 Osgood Street FIRE DEPARTII�►=;NT Temp Dumpster on itees no Located at 1244MairStreet 5`` `• Y - - - Fire Departure►it"signature/date ' :. COMMENTS '-'4" :-Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. :Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, rust or service drop requires approval of Electrical Inspector Yes No DANGER ONE LITERATURE: Yes No MGL-Chapter-166 Section 21A-F and G min.$100-$1000.fine i NOTES and DATA— (For department use I I ® Notified for pickup - Date F d Doe.Building Permit Revised 2010 1 Location-21 _AJ No. Date • • TOWN OF NORTH ANDOVER • • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $_ Other Permit Fee $ TOTAL $ t Check#L-2. 27291 Building Inspector Enter construction cost for fee cal - --North Andover Fee Calculation Construction Cost $ 265000.00 m $ - $ 312.00 Plumbing Fee —$ 39.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 39.00 Total fees collected $ 490.00 291 Mass Ave 586-14 on 2/12/2014 Remodel Master and 1/2 Bath i NORTty Town of ndover O ";"' ~" to No. CIO;N-4 h , ver, Mass, L COCHICKIWICK S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System .. .. �•-w"r�— THIS CERTIFIES THAT ................. ............. ........... ........... ......................................... BUILDING INSPECTOR �Q Foundation has permission to erect buildings on ...�.I �... ........................ .�............. _ Rough .. . ................ . to be occupied as .... .�►'�........ .4r...T9.P.0 0 11w........ . ... ..... .. .......... Chimney provided that the persatracEepting this permit shall-in every respect conform to the terms of the application Final on file in 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR �, • UNLESS CONSTRUCT. S RTS Rough Service ............. .... .... .. ............. ........................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. aI 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: ��o //'/� Address 7 /%// R City: �?k�< �/7� Phone#: Insurance Co. Policv# 60IS1 7j07 Company name: Address City: Phone#• Insurance Co. Policy# 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 underthepains and penalties of perjury that the information provided above is true and correct. Signature /% rJ� Date-;7 Print name /��4411'/ Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept F1 Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone#: Health Department Other FORM WORKMAN'S COMPENSATION 1182" 2 21 7 12" 21" 54" 13" 9 q 14 382,. 46,' 18" TT —24" 15" 2 "— 522" C �V7VIL 1:7J -c VIVIG�.�J� 0 0 S 12 Lo 0 � N V 4VDB153 V 1 ;(° rn 0 CO cn Cf) 1 4 Drawer Base = CO CO - / --- m 0) $3 2" i rn SFA. FA CET _.--- - N 5 e" �. TOILET-1 - 8 '�iN c0 1 � N Cf) 4 8' -�------ w� 2 TT 17" z 24" " 34-" 2 All dimensions-size designations20 70 j`�, This is an original design and must Designed: 11/26/2013 given are subject to verification on TECHNOLOGIES not be released or copied unless Printed: 1/13/2014 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Backman Full Bath 3 All I Drawing#: 1 T-5 3/4"-� 1'-5 1/8'11,1'-6 1'-0 7/8" 1640DH Lv110 r- cf) in M r 2668 LIVING AREA 35 sq ft 1 iVlassachuseiis -Departmentof?ublic Sa ery �Vf Board of Building Regulations and Standards Cmistruction SuPcrvisnr License: CS-081670 ftly NUCHAELF GOOpWIN 7 HOLT RD Epping NH 03042 , OIsaii3r; Commissioner 0810812015 -, Office of Consumer Affairs&Busifiess Regulation(' License or registration valid for individul use only ROME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: `e istmtlon: ' , 9 .105029 Type: Office of Consumer Affairs and Business Regulation r 7 i xplratian: 7/96/2014 individual 10 Park Plaza-Suite 5170 Boston,MA 02116 MICHAEL F.GOODWIN JR. Michael Goodwin Jr 7 HOLT.RD. EPPING,NH 03042 Undersecretary Not valid without signature TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building"be done by registered contractors, with certain exception, along with other requirements)el/ . Type of Work: 941,100 Rew P,r Est. Cost ;Z x'00 7 Address of Work,�__9� f?g.Sf ,44/vAd©ycr Owner Name Cm, / f / al�J�ti ,P,-c-�niz/7 Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Permit No. Job under$1,000 Date Building not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name