The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #188 - 352 FOSTER STREET 9/7/2007 APPROVED -4""T-wORTH ANDOVER pORTM APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 4 tea, 4 { aF OPA C 1^41K. Gq PP` Date Issued: r _'.T 9SSACHf1`�� 5 IMPORTANT: Applicant must complete all items on this page LOCATION 3-!;7 Print PROPERTY OWNER ,S \4 LN vQ A I- --s Print MAP NO.: / 24�7 RCEL: C� ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑j ew Building ❑One family Addition ❑Two or more family ❑ Industrial WAlteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED `sv c'Lxo s Z� Vic.U Identification Please Type or Print Clearly) / OWNER: Name: o).A . . `w t, -S �A Phone: a 5�,3 6 6k t Address: '� s� \2 S'.'. , v W. V2. CONTRACTOR Name: C�s-,-n --s- c o� s FIs-r E�r�n ��- ,Phone: Address: 2�, c=a ks la�,N \Z., 4 Q is AN"I IL-c_Ge tl� u Supervisor's Construction License: s ®s` co Exp. Date: Home Improvement License: Exp. Date: �� 1 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ (Q S o �.� FEE:$, aK �� Check No. Receipt No.: �^ Page Iof4 Location 3i�2-- No. Date NORTIy TOWN OF NORTH ANDOVER 10,: • • Lp ' Certificate of Occupancy $ ,SSACHUSEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2051 Building Inspector i TYPE OF SEWERAGE DISPOSAL ySwimmin Pools ❑ Tanning/Massage/Body Art E] Swimming Public Sewer ❑ Well F1Tobacco Sales ElFood Packaging/Sales El Permanent Dumpster on Site ❑ Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered con actors do not have access to the guaranty fund Signature o"genwne Signature.of contracto &' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS ATE REJECTED DATE APPROVED CONSERVATI COMMENTS fnO t SDA REJE`TSE DAT PROVED 4 ' HEALTH COMMENTS11fz v ' ✓ /Z V;' 5 '4� FIRfDEPARTMENT -Temp Dumpster on site yes no Fire Department signature/date 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 I I Building Setback(ft.) Front Yard Side Yard Rear Yard —Required Provided Required Provides Required Provided / 1 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES a TA— For department use) !'age 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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 DEPARTMENTMFORM05 Page 4 of 4 I ELIZABETH G R A D Y JOHN P.WALSH PRESIDENT 222 BOSTON AVENUE,MEDFORD,MA 02155 (781)960-0112 (781)391-7828 FAX johnwalsh@elizabethgrady.com www.elizabethgrady.com V4 RT#q T v own of Andover No. v dover, Mass., O C OCHICHEWICK oRA r E D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT y. � ............ Ae...(sk....................... BUILDING INSPECTOR ............................................................................... Foundation has permission to erect........................................ buildings on ....05.s.;� ..... ...... ... ........... Rough ..... ... ...... F" t 000400% Chimney to be occupied as....... . .. ..............; .........1�.....L... . ON ............ ......1? 4 i provided that the person accepting this permit shall in every respect conform to the terms of t6 �i�pu..L on file 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 PERMIT EXPIRES IN 6 MONTHSFinal ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO p�JTTS Rough ....................... ...... .......... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE __Jl Smoke Det. _ � o I ?,t y `f F OD i ii j ` r 1 - - --- - - ! -- -- _. ----------- &22P- ---- r ' l i - F. . Y4<{, , _.._ EmSTING WILLIAM BALKUS ASSOCIATES )*C[KrEM TEKSOUrHMAINSTREErTOPSFiaDMA01983 WMBALKUSASSOC@AOLCOM TEL 978 887 3351 FAX 978 887 9290 WHLSH FESID- ENEE NORTH ANDOVER , MASSACHUSETTS The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 5. www.mass.gov/di a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / 'A ' /[ Please Print Legibly Name (Business/Organization/Individual): y H ty P V V R l—s Address: 36 02 Fo :5 City/State/Zip: 1N' h/vb Q vE 2 Phone #: 79' - 0 3 —66 y/ 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 I 6. ❑ New 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. E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its ,required.] officers have exercised their 10.❑ Electrical repairs or additions 3.UZ t am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](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#I must also fill out the section below showing their workers'compensation policy information. t 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/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 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 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 herebyce un the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: ( 7 O 7 Phone#: 7 f( - Official use only. Do not write in this area,to be completed by city or town offteiaL 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#: NORTH TOWN OF NORTH ANDOVER ° • o '•�" OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 1ss�crw5�� Gerald A Brown Telephone(978)688-9545 Fax (978)688-9542 Inspector of Buildings HOMEOWNER LICENSE EXEMPTION Please print DATE:- 9 ,7 ,- 6-7 _ JOB LOCATION: r-0 S Number Street Address MapUt HOMEOWNER J a/ Name Home Phone Work Phone PRESENT MAILING ADDRESS 3 o7 L S ✓ / /y - &Ibo vklz- f1/(9 6i Sys City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which helshe resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that heishe understands the Town of North Andover Building Department minimum inspection procedures and and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Foam Homeowners Exemption BOARD OF XPPE:U.S6` --9511 CO.NSERV.VRON633-9530 ITE.u:I'H693-95.30 PLLVVING6"-9535 i _ t 76 W R L S H R E S I D E N C E NORTH AND�6-AVER , MASSACHUSETTS 3 . l/ "-o s ✓ r _ �I : i l h.11� T- El L-__- EXISTING rFFI� } `Opp W R L S H R E S I D E N C E NORTH ANDO V E R M ASS A C H US ET T S 1 I I II 1 _MEl r flu i -El i IyV P47V FMJ I I i t 17th LEH r'E-- 1H- ; W W A L S H R E S I D E N C E - L. LV N ANDOVER M A A C H U S E T T S -- - NORTH T H S S : _ 1 - I i vv T�- j77 prit�' F; - : �,'-oc �G W R L S H R E S I D E N C E NORTH AND OVER , M A S S A C H U SE T T S -- -- I — - -- - ._ - -__ -- - 1 : w L ; �e a TEL-fi 77 4. - cod, WRhS RESIDENCE S Ut.�VA�'flb�) NORTH AND OVER , MASSA CHUS ETT .i i I 4 .. 4 - r 11 el"I tj 7,7 Y 77j}7} I: 0 a y WRLSH RES IDEN_ CE NORTH ANDOVER , MASSACHUSETTS y � / i _ W R L S H RES I DENCE NORTH ANDOVER , MASSACHUSETTS , J- Hall :1 • - FFMI J Ej 7M- [10FIF MOM I F t- rh n � �:-" •� QI�OC1d =_ 1 -- - - T-1 L W fl L S H RES DEN C E ASSAC NORTH. ANDOVER , MHUSETTS A .0 � C