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HomeMy WebLinkAboutBuilding Permit #863-13 - 315 SOUTH BRADFORD STREET 5/1/2018 I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page A¢¢ _ LOCATIO.Nt -_ _ - r P,[int9 f PF201?ERTI((®1NNEFZ� - Pnnt� 100,YearQldStructure,+ yes3 nox. MAPNO:' . CPARCEL` �ZONI,NG ©ISTrRICT Histonc,Distnet+ yes no;) .__ - : _ 'I Machine Shop.rVillage, yesa 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 Z Others: ❑ Demolition ❑ Other T�tiT ❑`Septic3 :❑Well t ❑?Floodplaint-= ❑1Netland's� �' ` D WatershedDistrct I. - • 01Nater/Sewers - DESCRIPTION OF WORK TO BE PERFORMED: !' iDxtoD --c--` 'r& [SP �'5-O GeV A -7�r1 /Z�tirayry �/P,T_ I l3Cs�O� Oue h A n/D Identification Please Type or Print Clearly) OWNER: Name: 3�f�ls -i. 6A&v -Y Phone: &3 Address: 16 CZ-t /-(713 IJ wry aJ� 0'3&S't FCONTRACT®R Namd: A. Phone ,(c03�_3�2 .177 Address -f'a t3bx 4(75. titYL Nf-t a3$S — r� up ervisoP's Constructions Li'eense.'. ._._ _ _ _ Ex- e ®ate s . - Home,,ImP.rovernentjLicense' w: ARCHITECT/ENGINEER Phone: I ' Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. ° i Total Project Cost: $ V-?,a FEE: $ 35`� Check No.: � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I SignatureofAgent/Owner£*t=0 re;of c tractor` Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Plans Submitted ❑ 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit ' q, DPW Towo ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main.IStreet Fire Department si9hatute/date`' COMMENTS 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 DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use i I I B Notified for pickup - Date E Doc.Building Permit Revised 2010 r Building Department The foll.�'Owing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, 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 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 ❑ Building Permit Application . ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract a 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 i 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 app.-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application I Doc: Doc.Buiiding Permit Revised 2012 I Location No. , 67 - 1 Date • - TOWN OF NORTH ANDOVER • b Certificate of Occupancy $ Building/Frame Permit Fee $ 3 oQ Y� Foundation Permit Fee $ Other Permit Fee $ a TOTAL $ Check# 2.6505 `Building Inspector NORT11 e Town of : ndover o h , ver, Mass, 6 cocKICKlwICK �1. RATEo U BOARD OF HEALTH Food/KitchenPERMIT T D - Septic System A BUILDING INSPECTORTHIS CERTIFIES THAT ...... . 4 . iq.t /�................................................... ��G Or S' Foundation has permission to erect.......................... buildings on .JZ: ....... .........,.: f. ....r ..... ..................... � � Rough to be occupied as .... ... ff ..V.�.' ..�yl..l ..1 .............................1�:.�G.' ...................... Chimney provided that the person accepting this permit shall in ev ry respect conform to the terms of the application Final on file in 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. PLUM BING.INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service ....... ...... .. .... .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done, FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE r 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 Applicant Information Please Print Legibly Name(Business/Organization/Individual): 4PeX "Q0-T- AC-FrAL Address: -u 6bx `x`7(0 City/State/Zip: NP 03%9 Phone#: (7-77 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 22 I am a sole proprietor or partner- listed on the attached sheet. ❑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. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.ElI am a homeowner doing all work right of exemption per MGL 11.E]Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.©Other Tem comp.insurance required.] *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 Lire 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. lam 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 certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: 6-11? 0 2-/Y"? Phone#: �D�- 68 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#: fO rJ?m�nrPE nr��ncr_r rr�r lJrJ�cJ�r�rJ��fiUMPORTANT DOC U M �I T�Pc1r�cnu�r�cPr��rrPrl�rent nlnrrJ� O 5 rtf i. �. 5 (Fla Res �c 5 5 5 REGISTRATION ISSUED BY 5 APPLICATION ' _ Date of Shipment S 5 2/26/2007 NUMBER �. NDUSTRIE INC. S5 v 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 1=t 40.1 oP MANUFACTURERS OF THE FINISHED 04446377 S TENT PRODUCTS DESCRIBED HEREIN 5 5 5 This is to certify that the materials described have been flame-retardant treated S (or are inherently noninflammable) and were supplied to: 5 5 76556 5 5 7 COTEVIAPEX LRENTAL 5LE RD 5 5 5 LONDONDERRY NH 03053 5 S S S 5 5 5 5 SCertification is hereby made that: 5 SThe articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done in conformance with California 5 CS Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAs 84, ULC 109. S Serial # 8150501 (1) 5 5 Description of item certified. 5 5 CENTURY MIDDLE 50WX30 W'Lil'FE C SNYDER VINYL-SINGLE POLE: 5 5 Marne Retardant Process useWill Not B d e Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 SSNYDER MFG NEV PHILADE LPH 1A.OI-1 signed: 5 �j Name of Applicator of Flame Resistant FinishANCHOR INDUSTRIES INC. C®] r�cPc1�tJJ?lel,�c!c,17rPc!r�clrnr�rJr�clr�r fr fc tc l?r 1�s t�PtJcl�l7cicir�r lir Ir Pr�cl�c tc1cncnnrlr�-----�cPr�rJ�rJ�rJ7�l�c��c f�ttJ�t131crcl�r�r�rnr3PC.r( o ul=n�rmirmin�r�?�n�ncr�r O O R T T 5 U MNT7 5 Certificate o Res" s 5 REGISTRATION ISSUED BY �� eC 5 5 APPLICATION a Date of Shipment 5 5 2/26/2007 5 5 NUMBER INDUSTRIE INC. 5 S EVANSVILL.E, INDIANA 47725 Tent Identification 5 F]a0.i MANUFACTURERS OF THE FINISHED 04446377 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant 5 (or are inherently noninflammable) and were Supplied to: treated 5 5 76556 APEX TENT RENTAL S SN 7 COTEVILLE RD 5 5 5 5 LONDONDERRY NH 03053 5 5 5 S 5 5 5 S Certification is hereby made that: 5 S The articles described on this Certificate have been treated with a flame-retardant approved S chemical and that the application of said chemical was done in conformance with CaliforniaS S Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, !JLC 109. S Serial # 8150701 (l) 5 5 5 5 Description of item certified° 5 CL:NTURY LOOP END 50W\20 WHITE 5 SNYDER BLOCKOUT SINGLE POLE 5S Flame Retardant Process Used Will Not Be Removed By 5 Washing And is Effective For The Life ®f The 5 5 e Fabric 5 SNYDER MFG NEW PIiILADELPiIIA,OfI 5 Name of Ap licator of Flame Resistant Finish Siq—ed r!?t[�i[P�rPr1:P[Ps P[Ir�PrJ�f trJ��.ltJ�r�[tr��cPrJ�[1or�cf]d7t1[P[ lrf[lrJ7[lcPr l�cJ�[!r l�r��LP[J[lticJ�[PrPcP[I7rJ7rJ�1_Pr�rr�tJ�r_Jr�fcP[f[�.f�clo[P[dr�J� O OMPORTANT DOCUMENT- 101 5 REGISTRATION ISSUED BY S APPLICATION a ' Date of Shipment 5 [� 2/26/2007 S NUMBER �� NDUSTRIE INC� 5 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 S 1:140.1 MANUFACTURERS OF THE FINISHED 04446377 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 0 5 76556 APEX TENT RENTAL S 5 5 7 COTEVILLE RD 5 5 5 LONDONDERRY NH 03053 5 5 S S 5 5 0 S5 0 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 r5S Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. S SSerial # 8150601 (l) 5 c5 5 Description of item certified: 5 SCENTURY I-IOC.E ENI)50\\X20 WII(T[: S 5 SNYDER BLOCKOUT SINGLE POLE 5 Flame Retardant Process Used Will Not Be Removed By 5 5 5 Washing And 6s Effective For The Life Of The Fabric 5 5 SNYDER MFG NF:W I'I IILADELPI-IIA,OH Signed: Pj Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. fj D c iPctr;dr lrJePclr��7r Prime fel7l7J7c1�rJ��c frnr��Pr�etrJ�c�r l��Pr�r�rJ7rJ�ef�P�PcJ7r�r�r�t��1�lr lePtP�e!,cP�l7tJ�ctePr��r f 7�rnrJ�r l7cPtP�PrJ�orJ01000 5 C�7 rnrJ�cPctctEP�PcPr�cPrJ�rlr�rJ��r.��.fi O t P®jam►� � DOCUMENT�(planper.i+��� I! u ,t 5 ' ISSUED BY e's1-s t "Cc S S REGISTRATION J� 4/1/2008 Date of Shipment 5 5 �.s �j'®$� 5 5 NUMBER �NOUs FRIES INC.� 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 5 F140.1 '�' MANUFACTURERS OF THE FINISHED 04595788 5 TENT PRODUCTS DESCRIBED HEREIN 5 SThis is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: S Cj 76556 5 S APEX TENT RENTAL 5 5 7 COTEVILLE RD 5 5 5 5 LONDONDERRY NH3053 5 5 5 5 5 5 5 5 5 5 Certification is hereby made that: S S5 The articles described on this Certificate have been treated with a flame-retardant a roved 5 chemical and that the application of said chemical was done in conformance with Calilaforni S 5 hre Marshal Code. All fabric has been tested and passes NPPA 701-99, CPAI 84, ULC 109. S Serial # 5 5 8uo5ol X11 5 S5 5 Description of item certified: C5 SCENTURY MIDDLE 50WX30 WHITE 5 5 SNYDER VINYL-SINGLE POLE 5 5 5 Flame Retardant Process used Will Not Be Removed E 5 Washing And Is Effective For The Life Of The Fabric � 5 5 1 "" 5 5 NYDER MFG NEW PHILADELPHIA,OH �n Y�� /� ' Cj Name of Applicator of Flame Resistant Finish Signed: 1 t/ 5 @1C r�r.n�nr..rGr-u�rJ�cPrJ�r.�>:.r�r-tJ�r�C.rr.�rPr�cnr�t.rc.rcl�nr.Pcii�l�u��r�r��.rcl-cPrPl�r�u-rJ�cPr�r�rJ'i_ncPcPc�IJ�r���r..ru��r.Pcl�>si�ct�r��r..�u-� 5 uPfPr_PC0r�L17LTI�LnLfu� cI