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Home My WebLink AboutBuilding Permit #490 - 3, 5, 7, 9 Ciderpress Way 1/21/2010Permit NO: 41 / L9 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION "ie� YesS+1 rnd�3 PROPER. TY OWNER t � 1 , not L. LC Print - MAP NO: lOgC PARCEL: 31 ZONING DISTRICT: I Historic District yes no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building One family on Two or more f mily Industrial Alteration No. of units: Commercial Others: Repair, replacement Assessory Bldg Demolition Other 5 ell Floodplain Wetlands Watershed District Water/Sewe LO wiv,vr vvumn 1 U *r- r'tKrUKMtU: Iden ' kation Please Type or Print Clearly) OWNER: Name: I Phone:R—)'?'68 -Z 3Y Address:_L/-,5- r*e- CONTRACTOR Name, ldrn lec,., Phoned '166 7Z Address: f/ Gcr- r 4�4-0 / Supervisor's Construction License. 02-57rel Exr .Date: tom' Home Improvement License: Exp:. Date: ARCHITECT/ENGINEER,/)Sui/(I,., I l %3 Phone:_ Address: S . ( d) Reg. No. 60%d FEE SCHEDULE: BOLDING PERMIT: $1 P0110 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S. F. to6'{Z s f a 10,'6 ba Total Project Cost: $ 7713A►Zs - ),I" x V */SF FEE: $ 100 0,1JZA-rTVW Check No.: - 12-36 Receipt No.: 2. NOTE: Persons contracting with unregistered c ntractors do not have access to the va ar my and Signature of Agent/Owner Signature of contract Location ?- �. r✓r�,� sr�s� No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ ' Building/Frame Permit Fee $ w�MUs Foundation Permit Fee $ f0o f Check # Other Permit Fee $ TOTAL $ ° Building Inspector �Submitftte Plans Waived Certified Plot Plan Stamped Plans 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 PIA, Z -M COO -B CONSERVATION Reviewed on / COMMENTS -.DEP 2'(Z— It 14 HEALTH COMMENTS o Reviewed 61 0 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments r Conservation Decision: Z qZ -1 try Comments Water & Sewer Connection/Si natur t drivewa ermit NO �4101 DPW Town Engineer: Signature:YAO l Located 364 Usgood Street FIRE DEPARTMENT - Temp Dum.pster on site yes ✓ no Located at 124 Main Street Fire Department signature/date COMMENTS P/-7/ C-> Dimension / Number of Stories: 2 Total square feet of floor area, based on Exterior dimensions. 6 �� Total land area, sq. ft.: 30 •Z A(�. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No y. DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc:.Bui]ding Permit Revised 2008 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ 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 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: Doc.Building Permit Revised 2008 Eq--* P7 w x a ua c O w v V) w z C p w O c� ,� U co q w O w p w C w �+ U a u v w p rs v cn C w AG ` � c� G w Z w x cq o cn v 0 cn C 0 : o 0 C H V V .dCD K \: ; C tC O o CD CD H Ea fy .fit.) j= W \: m F Z Y Ju`E5 f! Q 0 CD m c a:r m `a L C O y OCD ce E . a L � � cm V V m L O r o iA � p � m tO.i N O LO :O>Z O r C Cs Cf L C_ ~ m H m C •C 3 N O ~ 0 y 4D.2 H m y C WLi O � r.+ C �r 0 .coo atZ m 5 oc E caCc,.y o V o qm c Vi a m ; O CL= eyp m i y O C t ar�..m I, U O O v .T34 04 0 uj ul U) W W W N The Commonwealth of Massachusetts ^, s Department of Industrial Accidents Dice of Investigations '� r 600 Washington Street ,.�`= f°Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name r- Addressd i K- Ca A flpU ps. G /State/Zi . h' p: � . � R --,Q clM A juf J Phone #:q -) x- a 7-z6 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part time).* have hired the sub -contractors 2.,4 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance S. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right o€exemption per MGL myself_ [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. 12 New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I l.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks boxfl t must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing A 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 fire policy and job site information. Insurance Company 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 vArification. I do hereby certify under thh airs and penal of perjury float floe information provided a�W v is true and correct. Official ase only. Do not write in this area, to be completed by city or town official. City or Towa: Permit;License # Issuing Authority (circle sone): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact' Person: son: Phone #: PROP. INLET PROTECTION 11 • J •N . ,S. / RIM=144.34 INVOUT=140.66 G/ SUMP-136 'RCP 148 148.50 6 % .........y, 2 CP ' 1' CBE es— ry '40 "`!".':.... Rim 144.33 ••/ / \ PEI 1NV.ouT=1 .03 4 J �' _,,. •'.'.'.. ,� � / INV.OUT=140.8 SUMP=136.73 150 / /pµ14112FF-151.50 f' R1M=]44. ' ! GF= 49.50 vd I .;N=14O (CB#8F-14250 MV.iN=140.5() 150.80 jNV.0L7=140.54 1M.P=14p.O7 O kRIM=144.7E FF=153.50- g, SHELF=1 ' • ' , GF=151.50 � BF=144.50 y 152.3u_ . �4,155,50 GF=353.50 0 \ BF=146.50 / FF=157.50 i BF=148 50 / \f' i PROP.000F 1 INFIL TIO I srsr (n'P) I SEEEDETAIL � I