HomeMy WebLinkAboutBuilding Permit #533 - 350 SUMMER STREET 3/21/2008BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 5-3 Date Received 13 C;
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0 � 7
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TYPE OF IMPROVEMENT
PROPOSED USE
Res'
Non- Residential
New Building
One family
Addition
-eramily
Industrial
Alteration
No. of units:
Commercial
epair, replacement
Assessory Bldg
Others:.
Demolition
Other
Septic ll ell
to dela nW", K]ands a#ersi
�C
�d 3rs r,�c#
ESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: /t/}/VCK Phone: 97� X81=48��
Address: 3 '® sv�-rA4EA -�1
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COTRATOR�ai� 1�wai
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SupervasorsCnstt�aont.ces�
7-7
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: $_ FEE: $ o �-
Check No.: Receipt No.: a 10 ()S._
NOTE: Persons contracting with unregistered .contractors do not have access to the guaranty fund
r€
Signatures ofjAgen#Over- 5gnatu a of �onfacto�.. ,ate
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
DATE REJECTED DATE APPROVED
CONSERVATION
•uu
DATE REJECTED DATE APPROVED --
HEALTH
COMMENTS
4
i
M
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
Located at 384 Osgood Street
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 - Date
Doc.Building Permit Revised 2007
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/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
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 2.2007
Location s-7--
� t �I
No. ,- Date ' / O r
Check # ay
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ "
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
2 i 0 0 5 Building Inspector
T/.
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registry 129774
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PELLA WINDOWrimS��@;l
WILLIAM NICHOL,S'UF = wb
45 FONDI RD.
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Departmenl.of Industrid Accidents
Offset ofInvesdga(ions
600 Washington Street
Boston, MA 01111
www.massgov/dia
WorkersCompensation Insurance Affidavit: )tuilders/Contractors/Elcctriciaus/Plumvers
laII1C(Business/Organizationdodividual): Pel' LJ, 4-o j-5 em IL
,ity/Statc/Zip: •}�,0.N�'�'Li�� /V�14 O�Q3'Z #� l ��ii%��r �� ��y2�.Sr•i2SS
re you an employer. Checkthe appropriate box: -T
Type of Protect (reggictd):
a I am a employer with 2-
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•sub-4ontrwaors
6, ❑ New construction
employees (full and%r Qart-iime). •
] I'am a sole proprietor or partner-
have hired t[ie
listed on the a&ath6d shed_:
1, 0 Remodeling_
ship and hive no employees
Uist: sub-contrutots'havc
8_ ❑Demolition;
working for me in any opacity.
workers' comp. insurance.
9. -0 Building addition
(No workers' comp. imurance.
S- ❑ �Ve are a corporation and its
10 ❑ Electrical repairs or additions
requited:] -
I aa' a homeowner doing all.work
officers -have exercised their
right of exemptn per MGL
repain additions
11.❑ pivrnb'mg P .
myself [No workers' comp. "
='q 152. §1(d), d -we have -no
12.❑ Roof.te;paus
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employees., (No workeis'
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iy VOliclilt 1 schedo box#1 mustslso fill outtbe sectioabdow aha 4o7��atWW
want �bomPeNatia�' Po. submit a new a�rdavit indicating svKh.
at�eow ca •rho submit tris attidayd indiadug t Ki an doiaz alt waste aid dbM kite ,outside oontraclats Must
evacton ow dwck Ws box must attached an W&tiooal street showing theRum dlbe sub-coolsac ms sad that+ra�. O01°P yollry intoaastioa
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�at�isprovidinr.worlrirs' eonptntotion tntr;gnee fo�irty sn�plo�'tes�- B.eiow i$ die po1uY artd jo6.00. '
uraacc Cote any Name: �r` AGI Ci�1 V r C.
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licy * or Self -ins. Lic. IK : D 8 w 4 N �..5 7 y Z _ Expiration Date:
b Site Address: 3'Sc7v. e 2 s T-
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of the workers' tom ssatioo be declaration a o (sLowingthe poGciti+°°ice'°a rip'T'uo° aatcj.
Nsid t copy P1 Q° y . Q ,
Overage as required under Section 25A of MGL c. -152. caa lead do the •imposition of eriat'MI penalties
Iffi;rttosecurtcof a `
meup to '51.500.00 ynd/oi one-year imprisonment; -as well. as cival pecnalties in the form of a STOP V�IORK ORDER. f i fine:
`up 10 $250.00 z day against the violator: Be. advised that co*,' j his stitetaent may ba forwarded b the Office of
kveitigations of the; DIA for insurance coverage verification -
do hereby-eerew un&r thepchwawd peneUki.. of pul!r►y-tkot dire Ltforrna&R provided above is.trut mid coned
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