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HomeMy WebLinkAboutBuilding Permit #270 - 295 BRENTWOOD CIRCLE 10/11/2007 t3U1LV114t7 rCRlvn i 3?-b•t; ,oc TOWN OF NORTH ANDOVER i APPLICATION FOR PLAN EXAMINATION Date Received "'AreG� 4� Permit N0:a 9SSACHuS�� Date lssu d) '- I PORTANT:Applicant must compl11 ete all items on this page €'�. �,/'..�..- ## d�� �� � � "°"' N " Sir `i.L � - ...r '��' a�'�' L � Y,• ' ' �. a � a � J _ •r�n�� ,- � zm 1+ � rye` £ } "n#,. ,,�°€<�„�1�t���,g`�'i��t'� a� ,,. � TYPE OF IMPROVEMENT PROPOSED USE Residential Nan-Residential ❑ New Building ❑ One family ❑Two or more family 0 Industrial ❑ Addition p Commercial ❑ Alteration No. of units: ❑ Repair, replacement A AssessoryBldg Shed 0 Others: [IDemolition ❑ Other i l�� rt Yk s , DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) Phone: 6 �� OWNER: Name: f,�i Iain m ��� �4.c Q!I 5 n+ �0 i`rcke l�© YI bier 0�� Address: w �x ,: .. ,. .:. k. . . ,,. 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: $ �. FEE: $ Receipt No.: Check No.: NOTE: Persons contra ting with unregistered contractors do not have access to the guaranty fund ,. f. fi Si '�r�eJ �,__a Location No. Date NaRTM TOWN OF NORTH ANDOVER h p ' Certificate of Occupancy $ ,s •° E<� Building/Frame Permit Fee $ JAGMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 206 ' v Building Inspector ,� f Plans Submitted I I Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ 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 DATE REJECTED DATE APPROVED. `p CONSERVATION ❑ . [ /"�� 17 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 Located at 384 Osgood Street fu�� A E�� X �I eta p to bta stt� +" : +3^"�i"- W-11151 Lo��ed i# 4ne �� ���. ������ � ..,�•�r '�.sy �{r._ '?,.�,'�'�-^+.�,rs, +3'7'7�• � �� � 19na`luTw is t a+� _S''. .,. r_st' c ._.:F J: :; �+• 'r..a- »s,,.».:.., � so � �,.. -x<'r'`sr�.a'M&s��,`.'_,�. � s #� -' 0Y��.,?�t' Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21 A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) 0 Notified for pickup - Date Doc.Building Permit Revised 2007 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 a 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 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) a 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) a Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit a 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 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 2014 96{05(2007 12:32 FAX 9784754575 CBRB-ANOOVER 1@002/002 7,3 L Q L L. c-) I -74741. frY,s,G 't -7FOR yr41 LOT , Lam% T �.. r... .10 x 10 i i' roo ' i - t M .. _. i II A 'I �� - r � t7 � 80 AMERICAN SURVEYING ('o I ' OF BOSTON, INC. mp I ,n)IIN S J AUR 'A 1 171 r 3264 MAIN STREET WALTHANf, AiASS. 02451 A REGISTCIiED LAND CiuAvFvOR, PHONE (!UI) 09.1-$477 Y'AX (7$t) ng -,7091 00 H1;r4EP,Y CER'Ilf'Y 'THAI' 'iF; ABOVE VORTGAGi INSPECTION . PLAN WAS PREPARED FOR MORTGAGE iNsp 'C'TION PRL-Q TetV & I•fI»RNpON L!.P DATt: 5/ —�.^..`, Y...� r y CLIENT: r IN R:,CORDE() AT - tN BONN EF.• C it iNIC-RIG-ACE,', A D 7U OE A I.NDEOANL) J-0, � „ � � [)RAWN f' U_; ij R�.C`= 1P REF�CTIO�' WtTFI T-` flCj6F,(� W Lr uE CRRFNC.I„ PACE�Alll 4ffH�a C^NFr _ �!D t NUT IN'I CLIENr >? �..., CS $URVC NO HE ---,....,_ a, TUY1N pR t�kOPER IY .� THE t,CsCnYInN Or ORIGuvgt, �.In,a CORNERS YvCP: SFT, RN IT OWL'LLING S!I()Wty rfEAEC1N (_ETFlEf1 �ADC)R�SS- __.PARC!Lj/:___......—�_.D rl.)•-- CANNOT PE tAED PPR WAS IN COMPLIANCE WITH LGCAt APPUCAB�5TASLISMNG QNCl, HEaGE, rLE xfINlNrBYLAWS INt:` F€CT WHEN CONSTRucl-EOR R/ILDSNGLINES. TH7 LAD t3-C-1—Rrf_I�,W_(R..,.:_ti..D•RnEiCG YMAM,,,HA_,rN 1F_� ---.._.... H RESPECT SHAWN HERkON IS 8A5EC (JN To �(4MZONrAu, j(:f.fE�tT FU�t�;IMHF_, nIMF;'NSIONAL t'14UIR[1.IENr fjNT•Y), ".._•,, .,"„”. ( INFORM ATION, APlly tisAY BEOR 1'4'EXEMP7 LA1'1(afv 1 5ue.if cT r{y FUrZTH Ci � 1, CHAP, , 40A, P2 Mh2a 7yc CUr.,J CT l)WELLINA LIES IN E��D N°L'RAtLt F I OL;7-SALES' TAKINGS, EASMFNTS, UNLESSLrt7Il' CH AF, a A, ST(.? r DL) 27VE aN0 R1GMt'i., OF WA1. NU SHAWN Flr,F�g(N.A coNFl.0 CR 45 �HC1WN t�N THE NATIONAL .I N ORCEUruT ACTION G NSLtRANC,t FLOOD RAVE A `__ f R4$I`Ory'3iE3rLrY fS ExT"ENt7Ep INSTRUMENT SI.IkV:I' IS nnF � f �A�Et �� UATEU4,fi.122- F C) CC)P�MI)NITY #--yM-� Q4 .......... HEY7CIt� 1'0 THE LAND lJNn1ER OR t4 IT STRUCYURES ARE STrc7Wsr _! I`ijr f1RA 1 t.:H� Elk Ef �— � '- -yrs..-�`_.� ,,....._...... OCCUPANT. IT IS NOV INTENDED Lf:aS THAN I' FROM PROPER Y ,r{ 8Y! 1 rj TO B- 1zECORpEp,,, Rk�UIRELI YONING 5£TBACIt t,INF.4 DATE; :T CAI�` NORT'►y - Town of 0 "A ..No. - Z '70- pow* o �` dover, Mass. o T—� I� COCMICMEWICK y1. ORATED PV C7 1 G BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT......... .��.J..��i�.......I* Af. . .............. .........................................`..... Foundation has permission to erect........................................ buildings on .� .. ...... ..�► 40 ....rw.A... Rough � to be occupied as....lajeI.Z........-SA4.w................................................ ........................................................ 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 PERMIT' EXPIRES IN 6 MOS UNLESS CONS TR 0 T TS ELECTRICAL INSPECTOR Rough ... ........... ......... ............................................ Service BUILDING ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Yo No Lathing or Dry Wall To Be Done I FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner- Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of'Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 u4p www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): hot SlIM Mar Address: �4_ a5 'Brenf wood (r,tGk, City/State/Zip: A Q "4tff t4A ()11#-6 Phone #: g71-g75-/05c;� Are you an employer?Check the appropriate box: Type of project(required): I.❑ 1 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ 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/Id.I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions V myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.jQ Other Sh comp.insurance required.] *Any applicant that checks box#I must also fill 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 c rtify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: &L Date: /0 lb oth 7 Phone#: 1 7L0 . 6 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#: xeeas Perry meas ana gazebos -uait enoto battery :: Nerving tsoston Nati,marc... rage i or t Ain, 9 1(�)( I Home Sheds Gazebos Services "Note:Scroll over the smaller images to view them at a larger size �.Ai•L- a 4 ® �a t j � EVi 3 Industrial Drive Hudson,NH 03051 Phone:888-857-4337 Fax:603-882-9566 ©Copyright 2005 Reeds Ferry All Rights Reserved.Powered by SilverTech.Inc. http://www.reedsferry.com/sheds/photos.asp 10/11/2007