HomeMy WebLinkAboutBuilding Permit #499 - 305 BOSTON STREET 12/22/2011TOWN OF NORTH ANDOVER
r APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT: APPlicant must complete all items on this page
LOCATION J10
Print
PROPERTY OWNER /6O1eZ� i i5=D a e-_ 11r1`9 Unit #
-, &0-5, Print
MAP NO: f d �� PARCEL: ZONING DISTRICT: If -,2, Historic District yes no
Machine Shop Village s o
100 year-old structure yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
I No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
emolition
❑ Other
®peptic ®Well T
D 1 Water /Sewers .�.� � �..�°°'14
..® Flood$laiu. O We Ian_ s ' '
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DESCRIPTION OF WORK TO BE PERFORMED:
(Identification Please Type or Print Clearly)
OWNER: Name: logia Gr��611, Phone:
Address:
�CG
CONTRACTOR Name: �TrlG�i����� i�
Phone:
Address: / 7 fir-
a
Supervisor's Construction License: ,� % d Exp. Date:
Home Improvement License:
Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDINC PERMIT. $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ _ /D O®c7
� "� FEE: $
Check No.: No.: c 1)q Z Receipt No.: 2 ` �
NOTE: Persons contracting•wi h unregister�ors do not have access to the
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Plans Submitted ❑ Plans Waived ❑
Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/MassageBody 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
�r CONSERVATION
COMMENTS
�a�d '
HEALTH
COMMENTS
Reviewed on //�,' '��,41;;l
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
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Located 384 Osgood Street
no
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 21A —F and G min.$100-$1000 fine
NOTES and DATA — (1 -or department use
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
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
o Building Permit Application
o Workers Comp Affidavit
o Photo Copy of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
o 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
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o Engineering Affidavits for Engineered products
MOTE: 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
Li Workers Comp Affidavit
o 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
o 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 2008mi
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual):
City/State/Zip:
Phone #: ��od 3 - 75%7 - %O s8
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. t
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. [N We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of 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. ❑ New construction
7. ❑ Remodeling
8. (Demolition
9./❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13. ❑ Other
*Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information.
i 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 N
Policy # or Self -ins. Lic. #:
Job Site
Expiration
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
the pins andyW lties of perjury that the information provided
S,
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/License #
,els true and correct.
A0
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
nationalrgrid
40 Sylvan Rd
Waltham MA 02451
December 15, 2011
Al Demaio
305 Boston St
North Andover, MA
RE: Service Removal for Building Demolition.
Dear Mr. Demaio,
This letter is to confirm that, per your request, National Grid has confirmed that
there is no electrical service going to 305 Boston St North Andover, MA as of
12/14/11. If you have any questions or need further assistance, please feel free
to contact me at (508) 357-4519.
Si rely,
#ngelic Butler
Order Processing Representative
Customer Order Fulfillment
ph # 508-357-4519
fax # 315-460-9149
angelic.butier@us.ngrid.com
Town of North Andover NORTH
Building Department- 'r O� '-ED 06 quo
1600 Osgood Street Bldg 20, Suite 2-36 .�'� y�`�t'- 61 O�
North Andover NIA 01845 t '�
Tel: 978-688-9545 Rix: 978-688-9542
DEMOLITION OF BUILDING AFFIDAVIT °�A cocLAKEIocw
rE® &PP
DATE 4Z f / . - 9SSAC HUS��
OWNER'S NAME & ADDRESS:
Wy
LOCATION OF PROPERTY TO DEMOLISH _3D
DESCRIPTION:
CONTRACTOR'S NAME &ADDRESS:
4-7
DEP
DEPT. OF PUBLIC WORKS - WATER: -
DEPT. OF CONSERVATION
HEALTH DEPT:
HISTORIC COMMISSION
F'6-) PLANNING
GAS
FI F[ TRI('
T SIGN -OFF
V2 , J-2,/ Q- t l
SEPTIC V WELL
EXTERMINATOR: + / •. �, e 114 / /�y.��` czjj xc
DUMPSTER — O �STREE DIG SAFE NUMBER
BUILDING INSPECTOR:
I
4
.- . V
Town of North Andover
Building Department
1600 Osgood Street Bldg 20, Suite 2-36
North Andover MA 01845
Tel: 978-688-9545 Fax: 978-688-9542
DEMOLITION OF BUILDING AFFIDAVIT
DATE
OWNER'S NAME & ADDRESS:
�� /fah' eT ���r�% .g-�✓Do�
LOCATION OF PROPERTY TO DEMOLISH -305"- �e),5,
DESCRIPTION: �cs%®"''`��� '� de-74c%e�' �!'
CONTRACTOR'S NAME & ADDRESS: /o �z 1-.cA-tcr65/4
DEPT. OF PUBLIC WORKS - WATEI
r
DEPT. OF CONSERVATION
HEALTH DEPT: %'
% HISTORIC COMMISSIONj.
'
PLANNING
GAS
ELECTRIC
TELE
CAB
TAXI
POL
FIRE
EXTERMINATOR:
DUMPSTER - O O=STREE
BUILDING INSPECTOR:
DEPARTMENT SIGN -OFF
SEPTIC
NO R TFi
0.fL,R Ib��
L m"
A-COCMICMlwtC It
Ab
ATED
SSACHUS�
WELL
DIG SAFE NUMBER �?,IIISeo3lS2-