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HomeMy WebLinkAboutBuilding Permit #325 - 365 MASSACHUSETTS AVENUE 10/23/2006 TOWN OF NORTH ANDOVER r►ORTF1 APPLICATION FOR PLAN EXAMINATION o0""D '6. - �O t A Permit NO: 2,20' Date Received /lJ r yam}z? Date Issued: 61' �/v—0i �9 q'R4no SSAC HU`+� IMPORTANT: Applicant must complete all items on this page LOCATION Pri t PROPERTY OWNER Print MAP NO.:6 V(3-, /Y PARCEL: ©d�ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non-Residential ❑New Building 4216ne family ❑ Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: T'IFepair, replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Z�S w i ti D6A� s dentification Please Type or Print Clearly) OWNER: Name: 6G01K6;E- Phone:Z 0 o 77Y9 ti Address: 3 6� yA&-,S 5 Ay- f CONTRACTOR Name: � l G1 Phone: Address: 7T�-t=— IU4 (J C&J G-,Q\ J� Supervisor's Construction License: OCA 2 Exp. Date: CZJ 2 Y I D Home Improvement License: A � �� Exp. Date: � �� � ARCHITECT/ENGINEER �— Name: Phone: — Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$�'y ery FEE:$ . i Check No.: 7734 Receipt No.: Z Z Page I of 4 TYPE OF SEWERAGE DISPOSAL Public Sewer F1Tanning/MaTanning/Massage/Body Art ❑ Swimming Pools ❑ Well 11Tobacco Sales ❑ Food Packaging/Sales El ❑ Permanent Dumpster on Site F1Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS a DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 1 • COMMENTS /FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date / / per /4 al J —o,6 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 Building Setback (ft.) Front Yard Side Yard Rear Yard Re uired Provided Re uired Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created IMC.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 DEPARTMENT:BPFORM05 Page 4 of 4 ' N2 2 5 �Co 1 Date....19,11 W........ NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING CHU This certifies that ......J.k. C4........ ................................. has permission to perform ........ ......... �'`4.............................. wiring in the building of.......... ................................................ at..............IV e. ..... ........... ........... dqorth And ver,,Mw�r Fee........ ........ Li c.No"..iew............... . . . .............. ELECTRICAL INSPECTOR**** Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Location '�Z �.v� No. Date �- - NORTN TOWN OF NORTH ANDOVER O A }�a Certificate of Occupancy $ s�cNUS Building/Frame/Frame Permit Fee $ sE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 ` 19722 Building Inspe t t4ORTH Town of : tAndover No. 43 4;S y =LAK dower, Mass. b 2OZ C T COC MIC KE WICK V 7 ADRATE D BOARD OF HEALTH PERM T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT. .. ...�...........................eings ..................................................................... ............................. Foundation has permission to erect........................................ b on ..................................... ............................... Rough 6to be occupied a �... aA�l�. .. .. ...... ......Nwp=-- . . .. .....r............. Chimney provided that the p on accepting thi perm hall in every reap conform to the terms of the application on file in Final this office, and to )iPe of the Code and By-Laws relati 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 UNLESS CONS S TS ELECTRICAL INSPECTOR 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 Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massaehuselts Department of Industrial Accidents Office of Investigations 1500 Washington Street Boston, AM 02111 tet : www.mass.gov/din Workers' Compensation Insurance affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` r Please Print Legibly Name It}usincss.(hganiialiam fndi�iJuall: � 1 tJ Address: LY City,State;Zip: Phone 7 Are you an employer?Check the appropriate box: Type of project(required): I.❑ I ata a employer with 4. El am a general contractor and l 6. E] New construction employees(full and'or part-time).* have hired the sub-contractors FW � a sole proprietor or partner- listed on the attached sheet. ' 'C�tetnodeling ship and have no employees These sub-contractors have 3. ❑ Demolition working for me in any capacity. workers' comp. insurance. q. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.0 Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] — 'Any,applicant that checks box rt I must also fill out the section below showing their workers compensation policy information. L Homeowners who submit this affidavit indicating Ihey are doing all work and then hire outside contractors must submit anew affidavit indicating such. Contractors that check this box must:attached an additional sheet showing the name of the suh-contractors and their workers'comp.policy information. I am an employer titin is providing workers'compensation insurance for my emphglvees. Below is the policy and job site information. Insurance Company Name:—_.--- _ __--_ —__--- --- __-- Policy 't or Self-ins. Lic. .`t: --._—_ -- 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 NIGL c. 152 can lead to the imposition of criminal penalties of a Fine up to 51,500.00 and,%or one-year imprisonment,as well as civil penalties in the form of STOP NVORK ORDER and a fine Of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of lnvcstigations of the DIA for insurance coverage verification. I do hereby ce y rtt er the pains and penalties q/*perjury that the information provided above is true and correct. tiinnture: nate: , -3— Phone d)/jic•iud use oily. !)u alit aurone in tlti.�• arra, fo be�'nrnp/ctetl b).'riO,��r tntwt,�jficial. City or TwAn: Permit/License 4 Issuing,Authority(circle one): 1. Board of Health 2. Building Department „Z.City/T,)wn Clerk 4. E.'.ectrical Inspector 3. plumbing inspector 6.Other Crntact BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR i Number: CS 002685 i Birthdate: 02/24/1947 Expires: 02/24/2008 Tr.no: 15095 Restricted: 00 ROBERT M LANGEVIN 795 DALE ST i N ANDOVER, MA 01845 Commissioner Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registratl6rn 1.11990 Eipiratimn: 2/11/2007 Type. bRk i ROBERT LANGEVIN BLDG&REAOLDING ROBERT LANGEV1W 704.n®I F CT /.��� ((�� }}..��.�, Office Use OnlyC�• 9 V4P �'iIIIlII1tDn111EEtl � asgar4iusefts Permit No. ado Mepartment of Publit -AnfEtg Occupancy&Fee Checked T BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town ofyt 1d/Fllie2 To the In pector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) -34-5- 71-14e , eiie- +rx� Owner or Tenant i Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No ,®. (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps _� Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters .n Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work � o t, , a , V No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges I No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals I No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW Local [] Municipal []Other Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO ✓ 1 have submitted valid proof of same to the Office. YES i NO C If you have checked YES, please indicate the type of coverage by checking the appropriate box. T INSURANCE X BOND ❑ OTHER ❑ (Please Specify) /�/✓�G����S 7/1I S, Estimated Value of Electrical Work$ (Ex4iration Date) Work to Start Inspection Date Requested: Rough Final Gni✓ Signed under the Penalties of perjury: --��-- FIRM NAME -__ G /P�� C� cmc _LIC. NO. S JS Licensee S. A'. `✓URA .T2 Signature LIC. NO.-A593 3 Address .� Ctiialee lyc- ✓C o V, ��✓nn lift O As i It. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner I Agent (Please check one) Telephone No.-PERMIT FEE$ (Signature of Owner or Agent) x-6565