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HomeMy WebLinkAboutBuilding Permit #700 - 308 CAMPBELL ROAD 6/15/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ,!�v Date Issued: / - ' 09 IMPORTANT: Date Received must complete all items on this LOCATION 308 Cuw%T�b"\ (•d 13� ��.-,d©yt2ri MA © 1 %49- Pdnt PROPERTY OWNER ���e�v �. `C—G 5 Print 'MAP NO: 10.6 • PARCEL: - 2 2... ZONING 'DISTRICT. _ Historic District yes -no Machine Shoo Villaae, ves no 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 Septic Well Floodplain Wetlands_ Watershed Distfict Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: i.e.) W S •6 Identification Please Type or Print Clearly) OWNER: Name: T-e__ss lav— Phone: q -I - £s- & &I- -�-?ay Address: Z O 6- Cc,-vti IQe l t Qg2 , 1y . i ado v ev- ._1,A A © 1 'CONTRACTOR 'Name o07,,,: &�e�vv e: 'Phone: I : - 3 S 7)3 .Address: 10 D AAk •Supervisor's Construction,.License:. - to 1-? C_ q � _ Exp. Date: 404 �.._� �.0 4 Home fLmprovemer t License l oZ g S_ ?� . 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: $ 15 g 6 7 FEE: $ Z Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 'tip Location 2e5 8 - v -e5 9 No. Date NaRTM TOWN OF NORTH ANDOVER � • OG 9 Certificate of Occupancy $ ��s'•^° t<� Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# O a 9�S•S' Plans Submitted. Plans Waived Certified Plot Plan --- _ _ _ -- - __j 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature { COMMENTS t. Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp D--m.pster on side' yes no "Located at 1.24 Main -Street _ - Fire Department signature/date 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 Inspector Yes No Ins Electrical p 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.Building Permit Revised 2008. e 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 L3 Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o 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) o Mass check Energy Compliance Report (If Applicable) o 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 o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 N m m 4 m �o m CA F2 m _v, F d C � d CA Cl) 10 0 CD OZ y CLO RC2 O CL rA CD o p CD O CL c � =r CD cc CD C CD y. _. CD av y �■ O CO CD I S- CA O 1 Z CD .O� o CD 0 CD d 0 CD dGO) � H C C =0 0. d = C 77O H 0 (IQ N O Q N n ,z "17 O rL O n y 0 (n C/)x "I O CS 0 S o"oy =�1 0 o 0 m n z N CD P.* c �' ' S -c N =r CL o m �i.=r CD0 o y N o CD`oo zO CD CC',oCD V / 1 O l 1 CD O o .�. �-► N fl. c cn {. N cn CD N _m .r CCD V O CD O z Ca N CD cn CD ■`+. o� .� N CD on = CD 'o C=L n'o N O �. l J : C O C d 0 CD dGO) � H p M y 7d C 77O H 0 (IQ r H z n ,z "17 O rL O n y 0 (n C/)x "I O W Od O Ov CD ✓/Ze �omrna�zueai� ��✓l�crJuz xeme& _`- Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:. 102957 Expiration -.-.%713/2010 Tr# 271114 Type: Private Corporation GREENE INSTACLATION.CO ;INC. Ronald Greene 165 Bow Street Everett, MA 02149 Administrator Boar o w in e u ati s and tandards Construction Supervisor License License: CS 61719 Birthdate: 10/27/1944 E4 -.-a,1011.:-10/27/2009 t Tr# 4892 Restriction:' 1G RONALD A GREENE 10 RITA DRIVE --G— �� MEDFORD, MA 02155 Commissioner NaMe (ktusinu�t 0rgunitatMNl L&.t.UUI The COmfl a wealth of Manac ktae is rDepathww of induVrid Ac idena 01 rM of lavestrgations 600 Washington Street Boston, MA 02111 www.nraxb.goplaa Insurance Affidavit: Builders/Contrgketar/Electrician&Tlamben Address: t ` City/State/Zip: M (K . nal UgPhone- ii - Are ou an em(itwyer? Check fire appropriate box: ' 1 ami, employer with 4. C] I am a general contractor and x employees (hall and/or part-time). 2. I am a sole propriftr or par'ttaer- bave hired the sub -contractors listed oxn the: attached sheet. Ship mid have no cruployees These sub -contractors have working for me in any capacity. employees and have workt s' [No workers' c)tnp. insurance comp. Insurance! required, t 5. We are a corporation and its 3. i am a homeowner doing all work officer's have cxercised their myself (No workers' comp, right of exemption per MGI. insurance required.] t c.152, §1(41 and we have no employees. [No workers' comp. insurance requires] Type of project (required); 6. El New cotmuc:tion 7. 0 Remodeling 8. Demolition 9. (] wilding tddiuop 10.0 Electrical repairs or additions I I.❑ Plumbing, repairs or additicros 12.® Roof repairs 13.0 Other -.». , Lumt also Till 011E IIIc st:outat below &Nowfng dMk WQe, t - a�rrqusrtwdion policy inforttmtion. f tomcowncr t who Nuhn it this aliidavit ip odins tky 6rc doing all work anti then hire outside contmctom must submit anew illydavlt iftdicating such -(',reilr ees- that check on box attactaF9d tm ati�tionai shtxu showing the tutme nl'thc sub�'Unfra IM wet Auto whether or not thoot ctiti6eq harp t n,ployee If the sub-oontractt►ts tic oycM gwy must wide their worbers' comp, policy number. I am ala empltryV that 1F JrrmMing warkerrr' compensation ebnSumme for my eArIvy6m Rdow & !'lee prrlt"cy mrdlob sure lrxforntatiner. d. It1SleranCL' Company Name Policy # pr Uf lns. Lie. W)Ib`]'�-fao _ Expiration Date: !ab Site Address: _ City/State/Zip: Attach a copy o[ lute workers' compensation p41ic+ declarMtion page (sltaowitlg tltn Polley nnmbW and expiration date). . Failure to secure coverage as required under SoctiQn 25A of MGL C. 152 can lead to the itnpositien or w iminal penalties of a fine up to $1,500,00 and/or one-year imprisonment, as well ss civil Penalties in the form of a STOP WOR K ORDER and a fine Of up to S29,00 a day against the violator. De advised that a cagy of this stn meM may be forwarded to the Office of to - tions of the MA for lose co a verification. I do hereby -gel ur r the ons peas"les ofpenury t4at the Uafnrnrrrtkin proovided dbvre hr trace. and terra'!, Signature Date.- 0 ate:tftele only. 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