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Home My WebLink AboutBuilding Permit #291 - 374 CHESTNUT STREET 10/13/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: e� ! / Date Received Date Issued /3 IMPORTANT:Applicant must complete all items on this page LOCATION 3 Print PROPERTY OWNER Print MAP NO: PARCEL: Z NING DISTRICT: Historic District yes Machine Shop Village yes n 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 PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: e CONTRACTOR Name: ",AfJ 'Phone: q 7 Address: Supervisor's Construction License: Exp. Date: ��Ilo Home Improvement License: Exp. Date: 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: $ E;> Z 00 FEE: $ �� Check No.: o� Receipt No.: L93`_!^ 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 Location _;? ,/� r✓✓T�'�1 No. � v Date v i hQRTy TOWN OF NORTH ANDOVER 131' •. '. • pD r ' Certificate of Occupancy $ " sAcMusBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r 22520 Building Inspector 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes � Planning Board Decision: Comments a is 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 no Located at 124 Main Street Fire Department signatureldate 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 Permit 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 Permit Application, o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract u Floor Plan Or Proposed Interior Work u 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 Li Certified Surveyed Plot Plan u Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) u 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) u Building Permit Application u Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract o Mass check Energy Compliance Report u 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 Doe: Doc.Building Permit Revised 2008 NORT1y Town of over . No. 62 9/ - z SAKE dover, Mass., COCHIC KE WICK �� DRATED BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ................. ......#*Pole..... ............................................ ......... ........................................... Foundation Y....... has permission to erect...... .................. ...... buildings on ...� ... Rough t0be occupied as............ ............. ...... ..........................:........................................................................ Chimney provided that the person accepting thisAjit 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR �1_ 3 ST 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 BeDone FIRE DEPARTMENT Until Inspected and Approved, by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. TRAVELERS JW ooesi -L2 TRAVELERS SERVICE CENTER Notice of P.O. BOX 1564 ELMIRA, NY 14902-1564 Estimated Audit Premium Account No. 4624N3106 Policy No. 624213353 680 Pol. Eff. Date: 12/15/07-12/15/08 . CP 01 6640 G6640LKQ 09047 00561 P1 Issue Date: 02/17/09 RAYMOND BERUBE 361 CHICKERING WAY NORTH ANDOVER MA 01845 Agent: TD BANKNORTH INS AGENCY Insuring Company: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT This bill includes new additional premium that is due as a result of a recent ESTIMATED .audit that was processed for policy number 624233353 680 effective 12/15/07 - 12/15/08. The audit premium for $373.00 is due and payable upon receipt of this bill . You were recently contacted in order to arrange a visit by a Travelers representative or requested to provide information via a Policyholders Report. To date we. have not received the Policyholder's Report as requested or our representative has not been successful in arranging a visit. As a result, we have ESTIMATED the audit premium for Your prior term coverage. Please contact your Travelers Premium Audit representative at 1-800-842-4271 to make arrangements to provide the requested information. The ESTIMATED audit is due and payable upon receipt and will be adjusted upon completion of the Policyholder's Report or the visit by our representative. Failure to pay this ESTIMATED audit may result in CANCELLATION OF YOUR CURRENT TERM COVERAGE. This statement provides billing information about thisspecific policy and DOES NOT replace your most recent bill. Please detach the return ctuh pnr►tnat7 in,ifh unur nnumAnf i„fhc Board of Ullildu^�R� ul.^Unns:nul tii ruil;n dr 1dOfvlE INiPROVEtitEW COt.'TRACI'Cf2 Re4isira �urlry105523 Trr# 2707 s E�;�iratron_7^17!2010 f x r:fz f ,dual :r P ZF rtviC?:DV_.BERU 1; yn,0116 Borube r RdIl r o r*•-- i� rj 016+5 Iv Board of$pildJng Reguf�tio attspdaTds co nstruC11 iiDn S.uper�iisor Lfne` J Lic&nsp� cS 35867 f ERat 1.5/2009 Tr# 8995 RAYMOND V BEIB �} -{ r 361.CHICKERING 01, N ANDOVER MA Q1.845 i omm^gsio.ner i .; Page# of pages 4a Proposal Submitted To: Job Name Job# T Address Job Location , P ALd S <•, Date Date of Plans i G Phone`# /—f Fax#' ;.t ; ; Architects r (We hereby submit specifications and estimates for: r rd.o a r✓ �,r U e �l y ✓— L .F tt S (e c C /Al fD ��:1-,c�.�...�� C L7�� t� � C r t 1 n, sti.F cf 5 � ,- •-` -• - ��- - -, -"� - - j G r-r-s !.piZ - i I We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: $ � GU Dollars with payments to be made as follows:-Dao _ M . .4►-�-� t� �at,..,60 , Any alteration or deviation from above specifications involving extra costs will Respectfully be executed only upon written order,and will become an extra charge over and S bmitted� +- above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note-this proposal may'a withdrawn by us if not accepted within days. Arcep#anre of JJxuposaxl The above prices,specifications and conditions are satisfactory and are / hereby accepted.You are authorized to do the work as specified. Signature Payments will be made as outlined above. �y Date of Acceptance id OrVII S" 2,V ( Signature NC3819 I