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HomeMy WebLinkAboutBuilding Permit #542 - 3 IRONWOOD ROAD 2/21/2006NORTH Of ��• .•71.0 p TOWN OF NORTH ANDOVER �' •' APPLICATION FOR PLAN EXAMINATION Ss US . Permit NO: �%� Date Received: Date Issued:�% IMPORTANT: Applicant must complete all items on this page LOCATION 1) I; d _ Print PROPERTY OWNER 'D cRv - a L:%^ G 2.J 6 e- 2 Print MAP NO.: 104 C PARCEL: 144 ZONING DISTRICT: (C I TYPE AND USE OF BUILDING UKTORIC MgTRICT VTC fl TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ✓One family ❑ Addition ❑ Two or more family ❑ Industrial WAlteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition C Moving (relocation) ❑ Other ❑ Others: El Foundation onl ULNUKIF 11UN UP W UKK I U BE FFLE URMED _.— S �1 aim 2ov..ia P-0%J"i �.�,� w�A\l5 4145} wJa11 Identification Please Type or Print Clearly) OWNER: Name: � A14e (?,2,J.5QA Phone: 'i G19'9 S`I00 Signature Address: 3 -T Tz- o ff CONTRACTOR Name: 54yY, Phone7$'- Address: S cA P p',P- "ti 5 'T- Supervisor's r Supervisor's Construction License: C S O 5,-( 1 $ Exp. Date: taoaq�. Home Improvement License:1-e5*�A TS� I -v9 Date: kt I'T aGo'1 ARCHITECT/ENGINEF,R Name: Phone: .Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $12.5. 00 PER S.F. Total Project Cost :$ a-)/ y 6 a x10.00=FEE:$ 7f Check No.: ;; 9 Receipt No.: %4r�" 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 ❑ Debris Removal Form ❑ 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 ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Form ❑ 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 ❑ Form U ❑ 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 DEPARTMEN"rMFORN105 TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art Swimmin- Pools Public Sewer Tobacco Sales Food Packaging/Sales ❑ Well Permanent Dumpster on Site LJ Private (septic tank, etc. Fj NOTE: Persons contracting with unregistered contractors clip not have access to the guaranty fund Signature of Agent/Owner _f Coy q?n e"� Signature of Contractor 0 a —J -,o __9� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS DATE REJECTED DATE APPROVED ❑ Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED DATE APPROVED 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 Temp Dumpster on site yes—no 4, Fire Department signature/date ti Building Permit Approved and Issued by: Building Setback( Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 1J 11111'J1 141 0 "11 Number of Stories: Total land area, sq. ft.: IVV 11'.S ana DA A — (For department use) Total square feet of floor area, based on Exterior dimensions. Um: INSPLCC I ION Al., SLIMCLS ULPAK FMLN I :Li1'PUKM05 Created 1MC Jen._000 r— Location 7 No. "�2� Date .2 s/ NORTiq TOWN OF NORTH ANDOVER i. • SOL t 9 Certificate of Occupancy $ Building/Frame Permit Fee $ sACNusi Foundation Permit Fee $ Other Permit Fee $ / TOTAL $ 2 �S Check # `i8985 /Building Inspector m m m x CA VI m Fm y C O CD s Z y CD .2. CL Cl C CZ 5 CO) aUm -0 =Nq C CD CD O Q CD Sr CD O Cp C D 3 �C � =0 CDy CD O I O C ? = O m 2 -•vi0a FE, CD N to EDoa m m ® N C7 O. H 3 P. Z • . � o OT n O Er Co n � tv m N y m o O f CD m p o a > > N O -1 O A0. 00 p z:SO N. 7d CO! : C ? N d S am : CL mo , ? =rCD O O N CD cc C a CD O N � N C =r C O N cu N CA `u Cos m cd t: O W� 7 CD O !f C34 ...F m O# Z a. Wim: ;w H CD d 0 CD dd: CL off: 0 m � H 0 Lft'N- 04 o� po m n or d 7d H 0 Lft'N- 04 rc V y`1 d � O Z \L 02 , 3 1� .y J -0 d f Q. r Q � f A V) d QD LL-cp 3 ? � � � s 3 a mac► /,./ 1111711'1 1) 111 IU l' U atll 1ti :lull ,lt:1111 :1 r(S � t'`�' `�i� %'�'»1/I/2OIl.GJB[LlG/T. G 61,(lQ}l7filllQEw[p BOARD OF BUILDING REGULATIONS HOME IMPROVEMENT CONTRACTOR License: CONSTRUCTION SUPERVISOR _i. Number: CS 054718 _ Registration: 120296 .� l Expiration: 11/19/2007` } *.i Birthdate. 06/08/1965 Type: DBA Expires< 06/08/2006 Tr. no: 26693 I i TESTA BUILDING & REMODELING Restricted; 00 JAMES TESTA f JAMES M TESTA, # 5 APPLETON STREET. 5 APPLETON ST R, MA 01845•- Administrator c t N.ANDOVER, MA 01845 N ANDOVER, Commissioner } r 00 - 35,000 cf enclosed space (MGL C.112 S.60L) License or registration valid for individul use only 1A - Masonry only 1G - 1 & 2 Family Homes before the expiration date. if found return to: { t Failure to possess a current edition of the Board of Building Regulations and Standards 1 Massachusetts State Building Code One Ashburton Place Rm 1301 is cause for revocation of this license. Boston, Ma. 02108 1 O�/�ry(,�/J i DIG SAFE CALL CENTER: (888) 344-7233 vot valid without signature (q �jjyt F i$ 6 y y'\ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations :1 600 Washington Street Boston, MA 02111 www.mass.gov/dia t: Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/t)rganization/Indivi(Iual):d?Sr§`e� J Address: �- City/State/Zip: +V, Phone #: cl-A, (,'4-7 Are you an employer? Check the appropriate box: i. ❑ I am a employer with 4. ❑ 1 am a general contractor and l employees (full and/or part -tithe).* 2. [` 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance 5. ❑ required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] ' have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction T. [ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I I.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # 1 mist also fill out the section below showing their workers' compensation policy information. I lomeowners 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 4 or Self -ins. Lic. #: Job Site Address: Expiration Date: 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 tip to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the forth of a STOP WORK 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 DIA for insurance coverage verification. I do hereby certify under the porins and penalties of perjury thin the in/ormation provided above is true and correct. Phone It 011icial use only. Do not write in this area, to be completed by city or town offrcial 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 #: Building and Remodeling (978) 682 2023 FAX / PHONE Proposal Submitted To: Dave & Lisa Gruber 3 Ironwood Rd North Andover, MA 01845 Job: Finished storage space. Proposal Revised February 16, 2006 Job Description: Home Phone: (978) 685-2548 Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. CONSTRUCTION: Frame basement as per discussed . Using pressure treated lumber on the floor and KD lumber to frame the walls. A wall around perimeter of basement to include closets and a A finance charge of 1112% per month (18% per year) will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection, including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of: $ 27,469 Twenty Seven Thousand Four Hundred Sixty Nine Dollars One third to start one third after insulation one third upon completion Authorized signature I reserve the right to cancel this contract ifnot accepted —30_ days Signature Signature ELECTRICAL: INSULATION: PLASTER: CEILING: FINISH TRIM: Proposal Z Wire basement to code. There will be New sub panel outlets to code 1 cable jacks 1 phone jack Insulate the basement with R- 13 Kraft face insulation Hang Y2 blue board and plaster all the new walls. Drop ceiling will be hung in the finish basement and the closets. 2X2 recessed . All molding and doors will match the existing. * NOTE There is no allowance for painting , staining , or floor covering.