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HomeMy WebLinkAboutBuilding Permit #433-2017 - 351 WILLOW STREET 10/24/2016 0* ORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * Permit NO: Date Received ire*0 Date Issued: CH IMPORTANT: Applicant must complete all items on this page 13", 415 5, i PROPERTY' 'AffNrif ........... n wjkjpN ......... PRO Q A TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Industrial ix Addition parking lot Two or more family I . i Alteration No. of units: _IX.Commercial i_ Bldg. t.-: Oth Repair, replacement Assessoi-y ers: t-.Demolition Other 6 Project consists of the construction of a new auto parking area and associated site work to accommodate a new building expansion at 351 Willow Street South, North Andover, MA. Identification Please Type or Print Clearly) OWNER: Name: Bake N Joy Phone: 800-666-4937 Address: 351 Willow Street South, North Andover, MA 01845 Roift (111""& 'd 'NTF60 0-T + 0 � :0 C 7_ 't SP su'per'\Asos d1bh1"W' -''1QqJ'qni "h 2 554 ­�.............. Horne Tt ARCH ITECT/ENG I NEER The Morin-,Cameron Group, Inc Phone: (978) 887-8586 ' P', Address: 447 Boston St# 12, Topsfield, MA 01983 Reg. No. Civil No. 39836 FEE SCHEDULE:BULGING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125 OPER S.F, C Total Project Cost: $ Q) —FEE. $ AA Check No.: ---Receipt No. NOTE: Persons contractitkq;vith unregistered contractors do not have access to the guar fund, f A 00�thi<eP"," cvo(z Bq I/zr r �- %AORTH i BUILDING PERMIT oF�tLED ,bq�o TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION 'Y� T H Permit No#: Date Received �qss ATED rs��c5 ACHY Date Issued: � jTWORTANT: Applicant must complete all items on this page LOCATION. Print PROPERTY OWNER.- __ _ _.., _ -- ___- -- r 90:O;YearStruct6re yes. no MAP- PARCEL:.. . ZONING DISTRIC,T. _Hisonc Distract yesr no -- - Machine.Shop Village yes 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 [IAssessory Bldg [I Others: j ❑ Demolition ❑ Other __ _�_ trict Septic 1Nell Flbodpfain l]Wetlands L] Watershed Dis J - E]-Water/Sewer. DESCRIPTION OF WORK TO BE PERFORMED: I I j Identification- Please Type or Print Clearly Phone: OWNER: Name: Address: Contractor'Name . - _-. _ Email`: - -_ - - Address-. ._ - _ Date: Supervi'sor's: Constructon,License: - -- - - Horne=Improvement License:_ _ - - - Exp ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ent/Owner ,S nature of A Signature of contractor g_ _ �€._g Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plane ❑ 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 Siqnature COMMENTS a HEALTH Reviewed on Siqnature 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 FIRE DEPARTMENT -.Temp►DumpSter.on site ;yes Locatetla`t`124�MaintSt�eet ,.. - � -' -� - -- -,---� • --- -- - -- Fire Department,si natbre/date _ COMMENTS,. - 1 , 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) I ❑ 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. 4 Roofing, Siding, Interior Rehabilitation Permits I o Building Permit Application Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses f o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 Location . /.� —��= r No. �� � Date /() ZI- WIA5 • - TOWN OF NORTH ANDOVER . ' j, Certificate of Occupancy $ Building/Frame Permit Fee s-4 1019.40 - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# T � / f rBuilding Inspectors NORTH - W1. . _ _ t 0. .c . _ ve" '* o - �+ No. 3 . y 3 � Z h ver, Mass, ° COCMM IC .WKK y1. �•9 R�reo �Pa��S S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........�2../.:a.....�� BUILDING INSPECTOR . ..................................................................... . has permission to erect .......... build' s on .. .?�...�....�W-*4 fl4T.... ...� Foundation Rough tobe occupied as .. ..............trg .. . . ..y.................................................................. Chimney provided that the person accepting this permit shall in every 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST S Rough Service ;;ION .. ...... ..... ........ .... Final BUILDING 1 CTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of'Investigations 600 Washington Street Boston, MA 0211.1 www.M4ss.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): ' ('�' �y • t!, _ Address:: � --���� �-�,�t 1��t Vf City/State/Zip: Pharie#: Are you an employer? Check th appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 T am a general.co'ntractor and T employees.(full and/orpart-time). �w have hired the sub-contractors t. 0 New construction 2.[ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, F-1 Demolition working .for me in any capacity. employees and have workers' 9. F� Building addition [No workers' comp. insurance comp, insurance.t 5. We are a corporation and its 10.E] Electrical repairs or additions required.] officers have exercised their 3.El am a homeowner doing all work. 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.2 Other: parking lot comp. insurance required.] "Any applicant that checks box#1 must also fill out die section below showing their workers'compensation policy information. 1 lomcowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit new affidavit indicating such. =Contractors 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. If the sub-contractors.have employees,they must provide their workers'comp.policy number. I art an emploYer that is providing workers'compensation insurance far my employees. Below is the policy and job site in1brrnation. Insurance Company Name: tlalosl Policy#or Self-ins.Lie.#: We 4., i 12U 2L1401 i'l Expiration Date: ( ��--1 351 Willow Job Site Address:_ „_ Street South_ Ciry(State/Zip: North Andover, MA 01845 .Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). T*ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine 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 clay against the violator. Be advised that a copy of this statement.may be forwarded to the Office of Investigations of the.DTA for insurance coverage verification. i do hereby certify a er the pa" s and penalties of vesjury that the inj©rmation provided above is true and correct.; Signature: 6 y. Date: , October 21, 2016 Phone#: 6/- 3-2r. _7T Official use only. Do not write its 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 Cleric 4..ElectricaT Inspector 5. Plumbing.inspector 6. Other Contact Person: Phone#: Massachusetts Department of Public Safety Board of Building Regulations and Standards. License: CS-094656 Construction Supervisor KAREN F CURRAN 70 UNION ST ' MARSHFIELD MA 0 Expiration: Commissioner 10/09/2017 U