Loading...
HomeMy WebLinkAboutBuilding Permit #2362 - 366 FOREST STREET 4/9/2008 BUILDING PERMIT pORTIf 0 -quSD 06qq, TOWN OF NORTH ANDOVER 3� b`"`- `- ' *° �y- APPLICATION FOR PLAN EXAMINATION ° : � Permit NO: Q Date Received �SSA:HUS���� Date Issued: - •0 IMPORTANT:Applicant must complete all items on this page LOCATION 3LOIe f!04e A 0, "" -c` 4,- Y-�A u PROPERTY OWNER - ' s� Print Pri Print MAP NO: PARCEL: ZONINGDISTRICT: Historic District yes 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 Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: C( 12 X I t...P Identification Please Type or Print Clearly) OWNER: Name: � �e� I �J Phone: Address: .3LA O res }- n,A-,A6I•I�ver YYA of �Lls CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3 o SL `b FEE: $ .-36 Check No.: 23L-R? Receipt No.: 9 �y Co Z NOTE: Persons contracting with unregis red contractors do not have access to the guaranty fund Pigpature of Agent/Owner- Signature of contractor Location �ta� f-7 rL.-7 7— S�� No. 5ee9 - Date d TOWN OF NORTH ANDOVER • Certificate of Occupancy $ HuBuilding/Frame Permit Fee $ - G� ncs ✓ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �-3 266 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerTanning/MassageBody 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 l7�CONSERVATION Reviewed on Signature COMMENTS N-b G ' -4(9,l P V4 rA HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 4 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 Perrnit Revised 2008 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 PP 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 2.2008 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): L Orem Address: 3 �tD-Q�'k City/State/Zip: n.A-vioff.-dVR—,- Phone#: k- BC.9—L.v 22 t 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9, E] Building addition [No workers' comp. insurance 5. El We are a corporation and its equired.] officers have exercised their 10.❑ Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.❑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' 1311 Other comp. insurance required.] *Any applicant that checks box#1 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 hereby;cer ;under the pai and penalties of perjury that the information provided above is true and correct. Si nature: Date: Phone#: q 7i-C oho- LP,1 1 Official use only. Do not write in 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF NORTH ANDOVER o '"•� OFFICE OF BUILDING DEPARTMENT • + 1600 Osgood Street Building 20, Suite 2-36 �'"+,..:•�r4ty# North Andover,Massachusetts 01845 1sswcN>ntt Gerald A.Brown ` Telephone(978)688-9545 Insp%Vr of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please p iii DATE: 4 q�o �. JOB LOCATION: 3Lo l,'F-DYeS � �- , �1, -y�GQm A b 1 k y s Number Street Address IvlapJt,ot HOMEOWNER JOAA✓e� �Q.� 0)7F - 1PE-L-P - og93 Name Home Phone Work Phone PRESENT MAILING ADDRESS ?>L -e FOrP 8a- �} . 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 motion 108.3.5.1) DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which hetshe 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 shatl 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 he/she understands the Town of North Andover Building Departnumt minimum inspection procedures and requirements and that heJ with said comply procedures and I Uiremems. HOMEOWNERS SIGNATURE —*",e'— APPROVAL OF BUff DING OFFICIAL xevied 10.2005 Form Homeowners Exewfion BOARD OF \,PPE:ILS 683-9541 CO.\CERv.moN- 638-9530 ITE.ILTIT 698-9540 PL.INVI�G 688-9535 V40RTH Oo � _ Andover T " f No. i7 4L 0 dover, Mass., 0 0 -z-z-"- L. COCHICHEWICK � ORA T E D VSC BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....(A440040%=......i) ............................................................................................ ................. Foundation has permission to erect........................................ buildings on .*?&&...!Mvw%M7......;17.......... Rough tobe occupied as....40.. ............. ......................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in 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 Final 36 � PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S ARTS 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 SIDEl Smoke Det. f r _ s O:: t r ra s y,,. i',C y _ro ,y "t"• a p i L s. �` M '� � � Ili �*^ Y •; r Y � � � s.� -. i ���' y x` �T..:B e *�,r, t..y g.-.: � a ,#_� �'�•` ` � 'e f..° k - l s 5 • .. v :q �} x f ,,.kk 2� i ,. r ,r,l.,; +R.t t'" a •'1 `a 31� Y_+ �' ,.t. .- '�.;�� � :pT!`i�... `�,� .f, v' :*. .i �� �+� '¢q, y%+, t. ��,'' �-i ''S. k1� Y o .ate.-itis .t,. _�`� a,;;-�r�i..-. .,st t,��"".k. ..� ,� e k,r^ t•. VINYL 1001 MAINTENANCE FREE ®PINE , KILN DRIED AND SMOOTH... WITH YOUR CHOICE OF 9 COLORS READY FOR PAINT OR STAIN •CEDAR -,,DURABLE AND STABLE...NATURALLY INSECT AND WEATHER RESISTANT •SIZES RANGING FROM 6' X 8' T0 12' x 20' 1 Z� � Af •i :r't ef" - ..'t'�3 iz +, -.f .e •k3 s �- '@� t s. ,�. �"': h:,, �� h�^} R AW 71 JA t ',-,-� �., 1 � .r ,� -r�'v�Q .mgr y ^• '"i i—`- -br +� r,Iti 8'X 10'VINYL' 10'X 12'PINE 12'X 16'PINE WITH _ ROLL-UP DOOR -�--.acre."+� ,t'� � 't "tr' - n .:�, � ':� i•e' ,k. •L.,,�y r se*ti . AA fi ' yy� • �u ,¢ # u i `sem , r "'"_"�.a " ;" 4i ``,s �i �� Y ni z I � f s I, 8'X 12'VINYL 10'X 16'VINYL 12'X 20'VINYL WITH ROLL-UP DOOR 3• r P. QUALITY45 YEARS TION _ w� ONSTRUC n �+ a ,K OF EXPERIE'NCE BUILT ON SITE �" ` a 7 b � , Price includes -- ' Photos shown delivery and installation t may include to most areas. 8'X 14'VINYL 10' X 20'VINYL options. `�ad r � .r # v:.-... i.`-�'.•+- t� s fi•t *) '�.,t SE. kAF " � #�a" �. , e .-@ ! a' �:h � "�•.1 ie a v! �°'.�� :et � � .,,f �x»-� r Tsr ,��`-r•}�,.a� T 4 i M1r R'. 0 C @ J: ' ,i *'• @ 0 @)A 'l +F'� y� a qy_5 T/.d uy�' ��'� . @ ® e @ @ @ �@ �_ T ,�,�%� - a�`.<� C �,#fit• �, .•yah• r ,� � ,� 41 rive DAN RE '?n - 3051 ''' I} 85. �_ •136: CHAPIN'S id OOD PRODUCTS, INC. S T '`� fATEZIP 1-956 Sheds • Gazebos • Yard Accessories Redwood Playsets • Playhouses ORDER DATE ry.c0 Route 1,80 Washington St. :LIVERY DATE Other Location P.O.Box 1823,Plainville,MA,02762 WHITMAN ( ) C ) IEL L�H STORIC COLONIAL ' �AMS Tel 508 699-8268 Fax 508 699-2913 r - www.chapinswoodproducts.com r PiNL _ SIZL 'x „_ $ _ r Door----------------------------------------------------------------------------QTY. x $ 50.00 ea. $ - r Door------------------------------------------------------------------- -------QTY. x $ 75.00 ea. $ Door-----------------------------------------------------------------------------QTY. x $ 100.00 ea. $ II-Up Door-----------------------------------------------------------------------QTY. x $ 125.00 ea. $ lywood Flooring Per Sq.Ft.of Floor--------------NO.OF SQ. FT. x $ 2.00 ea. $ ----------------------------------------------------------------------------------------QTY. x $ 75.00 ea. $ ---------------------------------------------------------------------------------------QTY. x $ 100.00 ea $ 01-----------------------------------------------------------------------------------QTY. x $ 125.00 ea. $ 2t------------------------------------------------------------------------------------QTY. x $ 150.00 ea. $ -----------------------------------------------------------------------NO.OF SQ.FT. x $ -(1.00)ea. $ )e Per Lin. Ft.-------------------------------------------NO.OF LINEAR FT. x $ 5.00 ea. $ 1yl/Cedar Per Lin. Ft.-_-------__------___-___--_NO.OF LINEAR FT. x $ 6.00 ea. $ w(S)"---------------------------------------------------------------------------------QTY. x $ 80.00 ea. $ low(s)*-----------------------------------------------------------------------------QTY. x $ 135.00 ea. $ Window to Large--------------------------------------------------------------QTY. x $ 65.00 ea. $ x---------------------------------------------------------------------------------------QTY, x $ 25.00 ea. $ -----------------------------------------------------------------------------------------QTY. x $ 35.00 ea. $ HeldDoor-------------------------------------------------------------------------QTY. x $ 200.00 ea. $ fieldDoor-------------------------------------------------------------------------QTY. x $ 250.00 ea. $ fieldDoor------------------------------------------------------------------------QTY, x $ 300.00 ea. $ Door---------------------------------------------------------------------------------QTY. x $ 50.00 ea. $ t U .,. .,.. _ _. . oll-Up Door-------------- ---------------- -----------------------------------QTY. x $ 350.00 ea. $ Additional T Steel Roll-Up Door___-----_-_-------------------- - QTY. x $ 400.00 ea. $ _ To.Change 5' Finishshleld Door to 5' Roll-Up Door-------------------------------------------QTY. x $ 200.00 ea. $ To Change 5' Finishshield Door to 7' Roll-Up Door-------------------------------------------QTY. x $ 250.00 ea. $ Loft4'x 8-----------------------------------------------------------------------------------------------------------QTY. x $ t0.00 ea. $ Loft4'x 10'----------------------------------------------------------------------------------------------------QTY. x $ 80.00 ea. $ Loft4'x 12'--------------------------------------------------------------------------------------------------------QTY. x $ 100.00 ea. $ t, SolarShed Light Kit-------------------------------------------------------------------------------------------QTY. x $ 135.00 ea. $ Architectural Roof Shingles (Not Available on Gambrel Style)---------NO,OF SQ. FT. x $ 1.00 ea. $ *Shutters included on all Windows SUB TOTAL $ ROOF COLOR Standard Q White Q Lt.Brown W*Gray ❑Black ❑Dk.Brown Q Weathered Wood SALESTAX $ = =' Y TOTAL $ <:. Optional Q Gray Architectural Q Lt.Brown Architectural LESS 15%, DEPOSIT $(-) Q Black Architectural Q Weathered Wood Architectural s' SHUTTER COLOR Q Almond Q Black Q Blue Q Clay Q White TOTAL AMOUNT DUE Q Red Q Gray Q Green D Brown Q Burgundy " t3PON DELIVERY$ -v- VINYL COLOR Q Frost White Q Wicker Beige Q Victorian Slate D Sunny Maize Q Adobe Clay Q Warm Sandlewood Q Vintage Sage Q Classic Sand Q Harbor Stone Q Charcoal Gray Q New Linen PLACEMENT OF DOOR(S)AND WINDOW(S) DEALER BACK Chapin's Wood Products 80 Washington Street Plainville,biota 02762 LEFT' RIGHT SIDE ; 3 SIDE SALESPERSON; " ! ' AMOUNT RECEIVED$ FRONT L3 CREDIT CARD ❑CHECK Q CASH ❑TYPE SKETCH IN THE APPROPRIATE SYMBOLS N0. WINDOW � DOOR DOUBLE ©OOR ;,. ,� •�`. J, -bate CUSTOMER SIGNATURE:, ; w -