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HomeMy WebLinkAboutBuilding Permit #538-15 - 35 FERNVIEW AVENUE 12/10/2015Permit No#: �, / Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received = IMPORTANT: Applicant must complete all items on this page I LOCATION �1G„t,¢T' " �" � �rn �'�ew �e 4c2 Print PROPERTY OWNER C"4-rA, 2h,*,D Print 100 Year Structure yes no MAP L4 PARCEL: 35 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition P,wo or more fa ly 11 Industrial El Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: :29)ntl C&_k an zo.no Phone: 9'76-69S-1-t7Yl Address: iew V4"o , _-11- Contractor Name:&yil1_(�rrfi,ro Phone: 76(43a4- 1o4;1 - Address: rV Si ©3 Supervisor's Construction License: 7q S-7.2 Exp. Date: 4'a Home Improvement License: 16 o lyo ARCHITECT/ENGINEER Address: Date: Phone: 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: $ i� J $ $ ,1 S FEE: $ �36 — 0R 20 5-7g6 Check No.: $�� �o Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guar, Signature of Agent/Owner CIASignature of contractor Location No. — Date / TOWN OF NORTH ANDOVER Certificate of Occupancy $ ' Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ '(Z Building Inspector 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 PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS s HEALTH COMMENTS Reviewed on Signature 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: 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU I tJ and UA I A — (1 -or department use ❑ Notified for pickup Call Ema Date Time Contact Name Doc.Building Permit Revised 2014 No 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 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 In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals treat 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 W, V, W r O O O O O D Q Q � Q 0 a a 0 u E V LL Q L � ZZ Z w �� d+ 0 C` E L CM = tn cr. O Z Z Q U Z w 'a O J > • M L O Q W y __ a O co c q: y d a m J U W1 C7 cc Q I= N c Ul c d W L Q CL U Y N N O v crow . ..: Z +� a L) o s cu _ s s ,L to = O F v O 0 c7. a)C 7cu LL U 7 c 7 7 f6 N O N t LL N .� mOV OC U LL w LL C ul LL LL m N In r O w CLZ CDZ m V� T z Q O �O A z V W O W O � U d c W J m a= LO as _ 0 N O t O Z O J O , O C4) d� w O O O O Q � Q O 0 : E V Q L � .F+ �� d+ 0 C` E L CM = J 'a > • M L O �: = Qi > y __ a O :a q: y d a ti E C Z r V; Q I= O N O t An = = o0 L Q CL (i crow . ..: _ CM a a ~O CL as N V m N O LU = O +�-' O O LL ea v V U O (n G1 '> C= N N t -0 O = F— .� mOV O w CLZ CDZ m V� T z Q O �O A z V W O W O � U d c W J m a= LO as _ 0 N O t O Z O J O , O C4) d� w www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �` Please Print LeL3ibly Name (Business/Organization/Individual): Kevin C%{ itYt Address: A S;vi' , 9A Ci 63T � Phone#: 7$1--831-1Dq;, Are you an employer? Cheik the appropriate box: The Commonwealth of Massachusetts 4• ❑ I am a general contractor and I Department of Industrial Accidents Office of Investigations " I Congress Street, Suite 100 listed on the attached sheet. Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �` Please Print LeL3ibly Name (Business/Organization/Individual): Kevin C%{ itYt Address: A S;vi' , 9A Ci 63T � Phone#: 7$1--831-1Dq;, Are you an employer? Cheik the appropriate box: 1. 1am a employer with 1_ 4• ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 ant a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub contractors have working for me in any capacity. employees and have workers' (No workers' comp, insurance comp. insurance. required.] 5. E]We are a corporation and its 3. ❑ I ant a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.]' c. 152, §1(4), and we have no employees. [No workers' comp. insurance reouired.] Type of project (required): 6. ❑ Ncw construction 7. ❑ Remodeling S. [-1 Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other Anyapplicant that checks hos r 1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. 1f the sub -contractors have cmplo}res, they must provide their wrirkers' comp. policy number. I ant an cmployer that fs providing workers' compensation insurance for mer employees. I3e101%1 is the police, and job site information. Insurance. Company Wi t r I Policy # or Self -ins. Lic. Expiration Date..— JobSitcAddress: 3$ cMttiQw P`4, City/State/Zip: Il #,rA 4 4&AC tM& btjos Attach a cope of the workers' compensation police 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 tip 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 certif} t er t1?* pain ?and pe alties of perjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town of�tcial. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/i'own Clerk 4. Electrical Inspector a. Plumbing Inspector 6. Other Contact Person: Phone 2014-10-15 14:45 isoprt75.1979 1 >> isoprt75 P 1/2 !'�fg �ri+fl��:r:it:•yr/1/ �1'�!"'=��ir•1.r'ec-%rUe/!, �- Office of Consumer Affairs & Business Regulation h ME IMPROVEMENT C014TRACTOR. gistration: 160140 Type: xpiration: 6125.,f2016 DBA KEVIN CARREIRO CONSTRUCTION KEVIN CA.RREIRO 2 SIMES RD."l KINGSTON, NH 03848 Undersecretary Massachusetts - Department of Public Safety Board of St:ilding Regulations and Sta ndprds 0)nstruction Supen'isor License: CS -074572 KEVIN C CARREJkO ` 2 SMES RD V ECL3ITG&lt ON ZNH WW 'xpiration Commissioner 091kJW16 CIL 0 U cc ,,0 V/ _O U U Q Z ir 00 0 NU O � N } Z 00000 0 O cD T N = M covo Z p O co O O O E- W W W c w CL 0- cD cc U) U) o co U) co N co M N u W Ir 0 U) 0) = Z QQ � Lu QQ o Q M: O C/) co = U Z o� Cn Z) >w O0 w > J O W 3 0 J N a3 m° C: a)co •� Q U U w � L N U a) 3J a° � N (DE �a N J U c6 O' a o Cts O a> C Y CZ C N N N E a O C U ns -a C7 rn Z °: Z >.L a3 N c� W N cc a -a O LL LU O Z c F- cuU p v O E U L) N m p N E c Z -080 a Q) LD L L O C � FI- N N = ° E W c -°a ~ 0.0— Z cn :c 0 p j0a)J a)Z 0) O Z rn° _cF- cC°� Z O a) L W y a) y U U a) p O >1 y UJ E:�=u� OC a) 2 (D �•�- 8EZ Q) .0 W °ONfA ca O L — :3 -- ° p fCf � c W a) CC 0 N a) LU CD L J F- E o a co LO M co It O cD LO Z_ w U - U) U J J d vi Z L a) O a)0 U L C o O = v y � N � 3 O 0J J a)co0 a 3 Z T ai 0 O Z d U_ V J = L Q ) U O J U J O O C � U N � � 2 N 3 (D 0 0 J J 0 o� 0 M M N }~U' M % w O O Q w (n ~ w � Cc D (D 0 v 0 z a cr o 0 N D T 0 d } d w J 0 LL } z O U) Z_ QJ W > 0 W U) M M Cc a 0 0 0 co 0 ^ 0 C)m CO LO O cm j Q U :it a. 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