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Home My WebLink AboutBuilding Permit #365-16 - 333 CANDLESTICK ROAD 9/21/2015 BUILDING PERMIT of"°DT b qti TOWN OF NORTH ANDOVER24yti`'`- ` " �° ° APPLICATION FOR PLAN EXAMINATION Permit No#: ' Date Received ��' �gSSgcHLis�i�y Date Issued: I ORTANT: Applicant must complete all items on this page �*I,s..+«�y-�..# 'i.�',•,; "` "t -'i� ,.fs"�L`8rf' j�.. 7 r�A es' r^'�r a r'f,3.Y"� :""p ;L'OGAT IONy 3sern.. ; y . PROPERTY OWNER' �` ?'t! �a t ->�»-' �,�s' aw R //jj tPnnt 100 Year Structu e" es' ZONING DISTRICT tl4UlHistoric Districts yes o Ys. � + .. c �i -�" t arr •-s�+ �. Avv 'Y +`ec r t it n+ c«.- =:= :MachineFS,op Vilfage m, y4(n9 0_ Na 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 11Eh eptic�'❑Well #; r l }:❑ Floodplain �, Wetlands r t ;; ,❑'VVatersfied District F ';' ;£x i- t, -- 5 c"��7r•t�s .g 'GY�.'- va.l'. ... r �ry»��' ❑1Nater"/.Sewer .rte _ :. a _s4. _ � #Y, �r mss] i y d rgr Ykv e� .r.. _... ': -:�+..,.tre+rFs<:,S S.,'.3 c ra. i `"r«. 3... _L.m :+' ,•a, DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Z+Vrza4-.,J ►- g4z'sWw" Phone: g76 y7 14- Address: JV7. 1J- ±!SJ 7&V&—C- :?z� ti - r yr i r -.5 �� `t `L �^+: ��r,,,� 'r��'Si'a3�ri.y�qr a.•ap�.. .fit:�„� { :Z r �"� '� _ 'z, ,'f"�,:,,, 5 �f ..., ,i!X e frl. r {a i ^ mak✓ ''1 *_ .r> + ;Y+;.', 1 t�3ts"E,r--¢ R � k abs 'i t As �Contractor�Name� � TT � . �� kPhone , aZ6hr,� x �x= d L rti.`e�' �^'i,,, :.. "aYLr F.�M'*rs°•v 'FY ve a -e 4, - �� Email �Tl�-!J ut� sn .a 5i'* .--h<'C=, x fr-+,.^h".�v x r�a�:Aa� ...�v,..'► r�� is �;r.-"•w � ",�.t�. i � � +-.-rr;�*�->j Address �—tom 11yw t !�`P _ •x« ll'-t� a _1 .} 1 r4L.',�i: Paxxu Ti -"�-4 '^u'r. ..r...+rr Yt s 4 +r .7t. � r}ems �a�._ a y, .«+y� yicyi,�'� .�„* " .' i�;T� ski"3�, � . � �L*�:' c- �'.afro'•i=n -a� n. A3 k g .{ ls j r'�rxy �-t: �Supervisor,s ConstructionLicense .s'�''`" �M-�n!'m.�£;fa"�:.,5�'`�. ..�a'ic�s i�3+r:y • a�� P �`tY' x°rt'�'� e;*x',�r � �__ �r`.r.�� .+,�Q -�:y•�o-� - �-'J 6..., q �'i� ?.. ..4��V'7�a 1. .ua L,e.n. eN..�+Z";•u�n ..' .4.t+,a«Sr.<.r...�n+.�'.,r.'..' ,Y .i,.'I7"".` �'.tii�."�` Y d w'rt 4 �a--q i�^y.a-r� �y:i�" a ,�. a� r. �, �' a•t-.. ^rt � - r � � #� r'=-- •-�-=: HomeImproyementyLicense ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST ASED ON$125.00/PER S.F. Total Project Cost: $ .188, -- FEE: $ W 12, Check No.: /C ys�y Receipt No.: C�5 3 yy NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature,. of contractor =- - - M _ I. -, :. . --. - ._ . . . ,... ,. . - -- . .11 _ . . . . - .. 1. :: 1. . 1 X r� . J. 1. - b . :... , Y P J -1 ..a :. r' .:'.-..-.. v: x . Location . � = _ ti : No. /� �� - / Dat kff e ..1 . . � _ :-_ . . : . - .'.. , _-. • TOWN OF NORTH ANDOVER IS lis . • _ -.. .-,, • , Y _ Certificate of Occupancy $ Building/Frame Permit FeeW�t: .�--__ .�' /� .. Foundation Permit Fee a $ Other Permit Fee TOTAL $ (�/� 2 � � , Check X9 J V - f .. ... _._,.� , _.,__ _.. ---- -- . . Building Inspector - �' . .: -= ;: - - - .:, - _ .. .; .,.tee...-' -r...: - x . k . .. .... �. _.. ... J _. - _ _ _ T :. .._.... .... ..' -.. .. .- _ ..: .,._-._. _ - ,.. .. - _..._ __ ..._ - - _ - .i-:..:-..r. .. ..... r - __ _ �- .` - 4 r - - .:.. ., ,. ,..- — : ,. . , .. . . .- . .., . ..,. 11 - % . .,:: _ .. ,,.. .—: .. ..: . , :: : '..' . .. . - - - , '':*,- . — . :.' : - .:-' —: :'�' — 11 ..:. .:-' ,:, -- . .. - ' s. ". . — .:.� - : - . . .:---; .. I ... .... .- .. .. I 1.... .. . . I ,. ��-. ..:.�:.*.:...-.:.......*--:.-.�. I � .1 - ::: *�: �"��,: �:- � - 1. - '. � , - . l' - ,.:.: - - - --" - ,. �- ---,-.. ... I ''. . - .1 — 1 . . �,,�.,.-. �,', �-�.�---....--.�L..--,�.�.�-.,,�,�,-.,,.��,7.�� qs -�.-.� - W. , -,,,',,..,' ... . ..,. .... "'.- �.- . ..� . - I . ��%:: ...: I L 4 - �. 11 � ,. � � ,,:��. �'..-.:,�...�i..��,,-,::�, :��., . ��-:�� . ... .. I :� ' . . ��:*:�.- :,." .. - '; '." -'.::i'-'.'---.;' -..::�.;:'..,;_' �-w :: :� " . - !::�' . ': -. I...- .- - -'--- -1-t,'.- :.- - . - -'.. I ... - I I. 7 .: � . - .. V -.7-: - -: . . I. .. - - I -1- -1. '-� �, . ''.". � �",;,.7��.�r�,,��:, ..�..,.'i�.-, ':...' -- - ,:-,. '�-0--:-1-- � � --' _. - C� . �— . � �.1. .0 "_- .,...,:,� � :. : :r -1 �'. - - . , I .;.'��'�":.:',.:�,�'.!""'�":n.-"','.,-�'r.-,.,...-��-*..."'�'i-1*'.:��"-�4'�..,�'-.�-71� ..' 7-�—: ::,..:., :. ', -- - - .:-�.:�,:� - :.-�,-.1 - � I - I .1 � - . . . I . - . .,�... . i%:--- -� —, . y ,; V Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEA, LYH Reviewed on Signature COMMENTS 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: Located 384 Osgood Street j124. �saF .1-t`.5. 4 fi .a, Lo"cated at Main Street 4; a 4 w,_r '�;?`>>."ter,,�'R r'g�i:-f'_�""us-'1[ f C+� '�roS »� �.�.i i� y"4... ..i�+Q0..t,��fi'��F�d Ly�•* t*y��'a�:`'.�s.�.�fi � � a7 '4!..''�i {FireDelfartmentisirynature/date k �; €�h p,p w f".x �t g w .. 3.,:J .r' 'P.«'.,"'a.F.'*,,k t,E ^a .la u .``•-.5r....$�J�u fa • �'�' 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— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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/Cross Section/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 I' NOTE: All dumpster permits require sign offrom Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan i c3 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:Building Permit Revised 2014 NORTf-f Town of t ndover No. % i ver, Mass, coc",c„.WK« A04ATED ►Pa��y S u BOARD OF HEALTH LD Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT .................... .. ....L&OnjAaa-. AA. .. . ....................................... BUILDING INSPECTOR ... � • Foundation has permission to erect .......................... buildings on .............. . p �. �� • Rough t0 be occupied as ... .. Ar......., ,... .. �. ..... ..... ........ Chimney provided that the pe on actin this ermit shall in eve respect conform totieerm f h ip p p g p ry ps o t e appl cation 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. PLUMBING INSPECTOR VIOLA ON of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 ONT ELECTRICAL INSPECTOR UNLESS CONSTRUCT ST Rough Service ............... ......... ........ ..................................... Final l BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to OccupyBuildinn 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. I I The Commonwealth of Massachusetts Department of IndustrialAccidents r I Congress Sheet, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): ELEEK;�z Address: l6 17PUjgX- fkw rq,-- additions additions I such. gve b site t date). 00.00 50.00 a rance Dr � T i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi•confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or pen-nit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia - --- — --- ��e�¢nzrren.nsaea�t�i a�C�/��cdiccc�tcvetLi _ - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ,fIOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 118501 Type: Office of Consumer Affairs and Business Regulation Expiration: 3/27/2017 Individual 10 Park Plaza-Suite 5170 � y Boston,MA 02116 KENNETH J DIAMOND KENNETH DIAMOND 10 DOVER HILL RD TOPSFIELD,MA 01983 Undersecretary Not va id without signature Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Superri icor License: CS-019192 KENNETH J DIAI�AO , 10 DOVER HILL-2D;i� ~_ TOPSFIELD MA70198 W Expiration Commissioner 01/13/2016