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Home My WebLink AboutBuilding Permit #374-12 - 32 ANDREW CIRCLE 10/26/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: EUPORTANT:Applicant must complete all items on this page LOCATION O u / `3 � rmt PROPERTY OWNER 6t�/ , (/ C1 it# Print J �` MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 3 100 year-old structure ye no TYPE OF IMPROVEMENT ROPOSED USE Residential Non- Residential ❑New Building .ne family urv1,JS 11 Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial "epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ Septic-'i®:We11 -f i * Flooclpl'ain� ; ,� Wetlaricls' ', � ,p� Watershed District ' ciOtWater/Sewer�t.. : '.:` • ._a I._.,_ '� `�h� iJ rJ �� " y . s - ( �•, .: l:� � "!. DESCRIPTION OF WORK TO BE PERFORMED: - i } Imo/ p R1z.9 /Z 4o® /`S 4NLM On/ (Identification Please Type or Print Clearly) ,WNER: Name:_ ;,n77_ 121 e Phone: 1� ddress: I ONTRACTOR Name: 11Vi�/ ti� � �r.?S i61�t one: ?oma_ U a' ddress: 226 602a/��r 5'1 lr// AP?A t tpervisor's Construction License: G .p Exp. Date: /Z )me Improvement License: Exp. Date: '2 — 2- - iCHITECT/ENGINEER Phone: (dress: Reg. No. FEE SCHEDULE:BULDING PEA�R''MIT.•$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER SF, tal Project Cost: $ fes, 1'12-6 FEE: eck No.: �3 25(,=> Receipt No.:_S�H ns c fritting with unregistered eolntrirctoirs do not have access to the guaranty fund na ure.-o .aen Owner_..,_ ..;:..... -. ,_.: ., _.. . .:clnnafrr�. ,�{•�;_ -- ,�;, �:_ . - -:-: - .-. -- . t4ORTI, 04 ....t . �y . 0 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLkN EXAMINATION SA St PCI-111it NO: Date Recei\_d:-0( 610 Date 1SSLJed: (6 j 111 "ORTANT: App11Cdllt 111LISt complete all items Oil this pilgc I LOCATION_ 4vdAwel C_ie,, e- Prim 1 PROPERTY ONVNIT, I gol Print MAP NO.: 0411-0- PARCEL: Of" ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES El TYPE OF IMPROVEMENT PROPOSED USE Residential Non-—Residential Nev%, Building i XOne family Addition Two or more farn i 13, Industrial Alteration No. of units: XRcpareplacement Assessory Bldg Commercial Ir, ii Demolition I'vloving(relocation) Other Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED ZaWA ee_ 414- )gee, �11 Identitecation Please Type or Print Clem-ly) OWNER: Name:' tt_)� - Signature Phone: f1f Address: CONTRACTOR Name:_W4�1 Phone: e Addrcss:__,o7,6 Supervisor's Construction License: Exp. Date: Mollie fill pro,.enlen t Liccilse: Exp. Date: 3 R Cl i I'll.C'F I'N(i I N F1'R Name: Phone: address: Reg. NO. FEESCHEDULE:BULDING PERMIT:.4111.110 PER 51000.00OF THE TOTAL ESTIMATED COST BASED ON 51 25.00 PER S.F. Total Project Cost oa _.� e� I've, x 10.00: FEE:$ 30 Check No.: 44�� 1 � t Receipt No.: t r Location ' No. c G� Date s J � �oRTM TOWN OF NORTH ANDOVER r ? •. •• i Certificate of Occupancy $ ` s��N�s�� Building/Frame Permit Fee $ w^ t Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ Check # r � . Building Inspector i II TYPE OF SEk4 ARGE DISPOSAL I Sw immin, Pools Tanning'hlassa e Bode girt Public Sewer — Tobacco Sales - Food Packagings Sales «'ell . Permanent Dempster on Site 1 Prig ate (septic tank, etc. NOTE: Peh•sons contracting, with unregistered ccohrtructors do not have aecess to the attaran(rfilnd nature of ContractorL4�,A449�Signature. of Agentr'Owner - - l,lblllttted Plat V Submitted aived P1 Certified Plot Plan J1 Stamped Plans 1_. THE FOLLOIWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit I --i Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS— _- DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: -,FZ.onim,Dccision:'reccipt submitted ves �•Plannim, Board Decision: Conservation Decision:_ _._ —Comments. ---- — — \Vatrr& ScNcr connection si,nature& date _— — --- - no Fire Department sinature'date Temp Dempster on site yes_— — — -----------.--.--- 131.lildin�. Permit approved and Issued by: Building Setback (ft.) , Front Yard i Side Yard Rear Yard Required I Provided ReqUircd Pro-vides Required Provided DIMENSION Number of Stories: Total square feet of floor area. based on Exterior dimensions._ Total land area.sq. NOTES and ivk 1*,,\—wor department use) 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 ., Debi-is Removal Form ❑ NVorkers 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 Pian And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) o 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 FnerQy 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:I\SPL(`rIONAL SERV K ES DEPART\ILC\'f:BPPORVOS C NORTIy � Town of And 0 ........ No. k3 * = Y O dover, Mass., /f, 0& COC MICMEWICK ADRATED PPS\ S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... h►...... ......................................................................................... Foundation has permission to erect........................................ buildings on .........32.......1. ....&>iG..&............ Rough to be occupied as................ �r.....'r..... ...... .. ................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough ...... ....... ........... ......... Service LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 6� &/7 i G�l Dm"61.4 1 u . I bwmd cq Kw C � /6� ''*ex" `1 �� Fr. PROPOSAL PROPOSALNO,. SHEET NO. DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME ADDRESS ADDRESS : DATE OF PLANS PHONE NO. y � ARCHITECT We hereby pro ose to,furnish the materials and perform the labornecessary.for Oe completion of le 0 If alwioga r .,xege � _, ,5 44"d : ,- Xe ` ✓ tl T : ', r ""` fes € � ! . :`9,� c y ;* *" All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifi- cations submitted fora ove work and comp ted to a sub antial workmanlike manner for the sum of P — Tao ' �`' , E Dollars ($ ) with payments to be made as follows. Respectfully submitted Any alteration or deviation from above spermcations involving extra costs 1,, will be executed only upon written order, and will become an extra charge Per ••,j over and above the estimate. All agreements contingent upon strikes, ac cidents,or delays beyond our control. Note—This proposal maybe 'hdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to 'do the work as specified. Payments will be made as outlined above. Signature Date Signature ' 't1, 381850 MA PROPOSAL MADE IN USAA i ��ie �Parurr�omulecz� �,�aac�zuaP,l�a _ Board of Building Regulations and Standards � 41" HOME IMPROVEMENT CONTRACTOR k Registration: 142227 `' Expiration: 3/23/2008 Type: Private Corporation AJ DESIGNS,INC. ANTHONY PETRAITIS III 25 JOSEPHINE AVE:' ✓ METHUEN,MA 01844 Administrator f._ 1 r ✓1ze �an�noozeuea,�lJz a��/laaaaetivaeC2a �i ' BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 086613 Birthdate: 09/29/1971 ' Expires: 09/29/2007 Tr.no: 86613 i i Restricted: 00 ANTHONY J PETRAITIS III 25 JOSEPHINE AVE.. l.fi•«moi— j METHUEN, MA 01844 'Ad+tiinistrator The Commonwealth of Massachuselts c Department of Industrial:accidents Office of Investigations 600 Washington Street �. N Boston, MA 02111 www.mass.gov/lin Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kpplicant Information Maw Print Legibly NameA—Y+ Address: :ae o 4s! _-- City/State/zip:1 L� G D/g�� Phone #: q7:e—ol0 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 1 6. ❑ Ne construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. ? 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. orkers' comp. insurance. q. E] Building addition [No workers' comp. insurance 5. We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL I Q-1 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' 13.0 Other comp. insurance required.] 'Any applicant that checks box 01 must also lilt out the section below showing their workers'compensation policy information. +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. /am nn eniployer tlttit is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy !I or Self-ins. Lic..4: --- Expiration Date:_ Job Site Address: CityiState/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 IvIGL c. 152 can lead to the imposition of criminal penalties of a tine Lip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form 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 tit pains and pe alties of perjury that the information provided above is true and correct. Si!mnature: 4 nate: _ Dlfic•ial use only. Do not write in this arca,to be cv,ntlrteted by ca)!nr town offteiat. 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#: