Loading...
HomeMy WebLinkAboutBuilding Permit #818-2016 - 39 HEWITT AVENUE 1/20/2016-a1�1 C.rrr L�, BUILDING PERMIT v t TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#:n--*� Date Received Date Issued: � ` PORTANT: Applicant must complete all items on this 1 LUCATION-77 � PROPERTY 'Pant 100 Year S#���t� MAP PARCEL ZONING DI$TR1CT: HistorC Dist i Machine Sh`c TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition )?qlwo or more family ❑ Industrial ;E Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other U Septic ❑ 1Nell D Floodplain 11 Wetlands ❑Watershed D�stnct 0 Water/Sewer DESCRIPTION OF WORD TO BE P RFORIYIPDr' (n A or Print Clearly OWNER: Name: Address: -!59 Contractor ,Name: 0 , t �. r"L t ,Phone:__ -7- Ad 6 _Adtl Supervisor's C"Onstru -tion. License - ` aExp. Date . Home Improvement;,License: ARCHITECT/ENGINEER Phone: X —OJJ�; Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST�BcSED ON $125.00 PER S.F. J Total Project Cost: $ FEE: $ 4f --- Check No.: l /(d Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature Reviewed on Signature Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r--- 1 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: 84 LFII -E DEPARTMENT tTemp{D^umpster ons site Eyes TA _� " Located Osgood Street �LocatedOt 1,24�tMai- kWre'et F�rtieiDepaartment.sTMgnature/d�a`te_ _ _e__ r 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Nu i is and UA I A — wor deeartment use ❑ Notified for pickup Call Ema I Date Time Contact Name Doc.Building Permit Revised 2014 No 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 ❑ Engineering Affidavits for Engineered products VOTE: 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products DOTE: 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 COTE: 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: Building Permit Revised 2014 Location5l -4 No.—S 1S- " 2e l � Date. ` U Check # rl J:i+:3rJ TOWN OF NORTH ANDOVER Certificate of Occupancy $-44:.:- Building/Frame Permit Fee $ Foundation Permit Fee $ k Other Permit Fee $ R TOTAL $ { e)4b-,-_ Building Inspector n rA I---1 Q 2 u. pZ o m •�u_+ Y "a O LL ? N A) N FO W W H Z Z_ p . m • O O U- CIA O N O L U O LL 0 of Z m g J bD O W O LL 0 W N Z Q _V W W to O W O VGD>c L {n _ LL oC O u a Z a (j 'o K C LL Z W W W LL L m O z N i) (% ++ Al cu Y O {n 7T 7m7O C O O . O O LU coZ Q O iv Q D m Cl) O-, N v Q z L N w � 5O G� �S O E c, z H L = cl) L W V v N M CL J X. W U F- � C C O O N � N > > 0 O � V C N E�0 o �;mz CLM� :�-3 �0 o L Q N . V - yr - 0 Q � O C C L CL O m N "r = O O - O O W V O LL. -� N . Cc N C � � � 0 w E v v v N Q. o O -> C T N m O . aov O LU coZ Z D m Cl) �. z E - 5O G� O z H cl) M W lIL Cl) z X. W U F- W az I ,,,PA 7- /07 ' r Federal lD#OSOe06629 RISE Engineering Fd Canbactor Registration No SIN E A division of Thietseh Engineering CTContractorRegisbudontloS20120 RJS EPIGWEF�IdG . 60 3hswmn4 Garcon, i►zA 02021 CONTRACT 339,502.6197 FAX339�S02.6345 ' t-----� PROGRAM nos coNnwr is uaaraam aero surw»u wsa ng�71 CMA M are os aemnMcugta®tcaaw�tas Wuuj seaw, datum Z= nate cums wowcanom Sebastian Pafane N (978)729-8533 12/042015 424819 00002 senors sumer t1 p eaLm ataEET 39 Hewitt Avenue E -J 39 Hewitt Avenue cv saxnce O snuma err,smre.aa . Not Andover, MA 0184 t� J North Andover, MA 01845 Q OB DESCUMON AIR SEALINQ Provide labor and mate ials to seal areas of your home against wastcK excess air leakage. Thk wodc will be pcdmncd m . concert with the use of special took and diagnostic tests to assure that your home will be left with a heathtiil level of air exchange and indoor air gaality_ Materials to be used to seal your home can include caulks, foams and olbarproducts. Primary rices for sealing indade air leakage to aWcs, basemorN attadied garages and other unheated am (windows are not generally add sed.) This will require (8) waiting haus. A reduction in cubic feet per aimne (cfm) of air iosltration will oo=, but the actual number of c8n is not gaaramead. At the completion ofthe weatherizefion work, and at no additional cost to the homeowner, a final blower door and/or combustion safety analysis will be conducted by the subtoatractor to ensue the safety of the indoor air quality. $680.00 AIR MAIZ40 ADDER: (2) woddag hours. $170.00 AT11C FLAT: Provide labor and materials to install a 6" layer of R-21 Class 1 Cellulose added to (920) square feet of ticored attic sp= $1,637.60 ATTIC FLAT: Provide labor and materials to install a 12" layer ofR-42 Class 1 Ceiluloso added to (328) square feet ofopen attic space. $574.80 AMC ACCESS: Provide labor and materials to insulate the back ofthe attic door with 2" rigid Tbesmnc board and seal die doe's edge with weatherst<ippiugto resbict air lewm8c. $7391 VENTILATION: Provide labor and materials to install ventilation chutes in (54) rafter bays to maintain air flow. $108.00 STAIRWELL: Provide labor and materials to install Class 1 Cellulose iusulatica to the sheetrodc or plaster oerlmg and/or walk of a stairwell which are common to heated space, through a surface drill and plug methal. The holes are plugged with slyrotbam plugs, and spadded to a rough finish. Any m Ming and panning required are the customer's responsibility. $175.00 BASEMENT CEQa1Cr Provide labor and materials to install (86) linear feet of R-19 undhoed, norglass insulslioa to the perimeter ofthe basement ceiling at the house sill. $150.50 BASEMENT DOOR: Provide labor sad materials to insulate the back of the basemead door Wdmgto the hul1&Wd with r rigid board that meets the sections R-316.5.4 and 316.6 mpircmants of ba'ld'ing code. Seal all edges and seams with FSK tap& $72.22 RISE En&ecriag will apply all applicable, eligible inoaniv&c to this cordract You will only be billed the Net amount Cuaemly, for eligble measmes, Columbia Gas off m 75% incentive, not to exoaed S2,Qo0 per odor year, and an incentive of 100% for the Aa Sealing measures up to the fast $680 and an additional $340 if savings are justified by the auditor. For the safety and heath of your homds indoor air quality, we will be conducting a blenver dear diagnostic of the available air flow in your home both before the wok is begun, and alter the weathmization work is c omphne. We will also cioudnct a full assessment ofthe combustion safely of yo rhesting system and water heater This has a value of $90 and is at no cost to you. Trial allowable weadwrization incentive is $3,110. $90.00 Federal U) # 06040566 RISE RISE Engineering RI Ca aetw Reg�gon Noel$$ A SyMon orlbidah Engineering r NO 1� Registrason No 020120 EWGNE(RlNG 60 S6aw=4 Canton, MA 02921 339 -SM -5197 VAX 339.502.6345 CONTRACT Page 2 PROGRAM TM CONTRWrW :I3�oBi%CMAEU ENOMMMMANOCUSC OFSCItWEdTFJM aIt Pima DATE CTm * T'WWtCWM Sebastian Patine (978)729-8533 12/04/2015 424819 00002 SBMM STRM Tri sa STREET 39 HewittAvenue 39 Hewitt Avenue 88MCE COY. eTAMMP UUM MY. STAMBP North Andover, MA 01845 North Andover, MA 01 JOB DESCRIPTION Total: $3,682.03 Program Incentive: $2,940.00 Customer Total: $742.03 WE AGM ritROWTOFUMM5M=W-CMWLEIEwACOOROMCEWMABOMWEC iCAWN3FMDMSUMOF **'Seven Hundred Forty Two 80 031100 Dollars $742.03 UPONFU LLAT PMUONNOAPPMALIffFM Te.CUBTCNFAAORMTOMWANWTW MMIURUJ.4V MWCFf%T"IMCRA MMNRe.YONANT UNPA[D AFlFitiGCAIIS.SEERBIIHtBEFORnIPOaTANrINP0l0lAiICNCN GUARARrWL W MC RMMMN $MMVAIN%=C=MACMRFMP®i MTM Im NOT SIGN 7HIS CONTRACT IF THERE ANY BUW�K SSPPACES AIM TURB.RIE�n p CUSTWMACCEPTMNCE r /J �,T� D `,/ NOTE`TT cwwACTummvmmwA movuswwrwmcwwwmCN OATSCFAOCEPTANCE be c �- rhf �/V��P /0 , W 30 ACCEPTANCE CP CONTRACT -THE AGME P(tlCGB, SPEMCAYMM ANO CCUMRQ($ A W c '�— DAM A�sePepq� PaneEaso aunWR®TOTwno want The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Print Form www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #: 603-324-1974 Are you an employer? Check the appropriate box: . 0 I am a employer with 100 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.+ 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑✓ Other Weatherization *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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 state whether or not those entities have employees. if the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ACE American Insurance Company Policy # or Self -ins. Lic.##: WLRC 48151553 Job Site Address: -3 I Aue Expiration Date: 6/30/2016 City/State/Zip: 0, knlue� X# Q(O`(S 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 certify under the pains andpengties ofperjyry that the information provided above is true and correct. 603-324-1974 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 #: ACRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/06124/22015015 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services Central, Inc. Southfield MI office 3000 Town Center Suite 3000 CONTACT NAME. (AIC.NNo. Ext): (866) 283-7122 F'ACX. No.): (800) 363-0105 E-MAIL ADDRESS: Southfield MI 48075 USA INSURER(S) AFFORDING COVERAGE NAIC N INSURED INSURER A. Old Republic Insurance Company 24147 TOpBUild Corp. 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER 8: ACE American Insurance Company 22667 INSURER C: ACE Fire Underwriters Insurance Co. 20702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570058348882 REVISInN Nl1MRER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MMIDD/Y1'YY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LJABIUTY MWZY3 4 4 � � EACH OCCURRENCE $2,000,000 CLAIMS -MADE ❑X OCCUR DAMAGE O RENTED$2,000,000 PREMISES Ea occurrence MED EXP (Any one person) S25,000 PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRCJECT LOC GENERAL AGGREGATE S4,000,000 PRODUCTS - COMPIOP AGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT Ea accident $5,000,000 BODILY INJURY ( Per person) AUTO ALL OWNED SCHEDULED IxANY AUTOS AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident HIRED AUTOS XNON -OWNED AUTOS UMBRELLA LAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE DED I RETENTION B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY,PROPRIETOR I PARTNER I EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA WLRC48151553 All Other States SCFC4815190 06/30/2015 06/30/2015 06/30/2016X 06/30/2016 PER OTH- STATUTE R E.L. EACH ACCIDENT $1, 000,000 (Mandatory in NH) If yes, describe under WI Only E.L. DISEASE -EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD `m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Builder Services Group, Inc. A TopBuild Company AUTHORIZED REPRESENTATIVE 260 Jimmy Ann Drive Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD `m 01. Qffiee of Consumer Affairs nib Business e ulatlors .� ;. 10 Park Plaza - Suite 51170 Boston, .Massachusetts 02 116 Home Improvement Contractor Registration BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASH UA, NH 03063 Office ofC:onsumer .Affairsb Business Regu In tion IMPROVEMENT CONTRACTOR 'r egisttation: 179141 Type Expiration_ 6«5/1616 Suppler, �ard 11LDER SERVICES GROUP; INC. �FHARD SCi iJ ARTZ 0 JIMMY f --.NN DR!VE ,YTONA cEr.CH. =L '2? 14 i ndersccrztar}' Registration:: 179141 Type: Supplement Card Expiration. 6'2512016 i'ttdate Address and return card. Mark reason for change. 3ddre � Renev<aI Fniploymrnt I..ust Card License or registration valid for individul use unl� before the expiration dale. If found return to: Ch%cc of Consumer Affairs and Business Regulation IO '4rI I'!a - SLyte 5170 Boston. MA 02116 Not vai<A-ithout sign2ture r M to Permit NO: Date Issued:` 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this page I LOCATION 3 Q Eyi (TT A U UUL- Print PROPERTY OWNER SP bi n t d- io,, cc- Pa4anf- MAP NO.: Print IJ ►BONING DISTRICT: 3 ()&a qy TVPF. AND USF, OF BUILDING HISTORIC DISTRICT VF,s n TYPE OF IMPROVEMENT I� •Y '� ' 1`] PROPOSED USE Residential Non- Residential 0 New Building ® Addition 0 Alteration IN One family ❑ Two or more'family No. of units: ❑ Industrial ❑ Repair, replacement ❑ Demolition 0 Assessory Bldg ❑ Commercial ❑ Moving relocation ❑ Other 0 Others: ❑ Foundation only to] &I'Me]N:48C0 a3WN:4To] A81:111] o2 5 -Ar o az4ai �m A nv, is Twg 4n % %VAa . OWNER: Name:y Address: 32 41 CONTRACTOR N Address: Identification Please Type or P u 4icts., -,�- -J v(JC e 'k-' Supervisor's Construction License: Clearly) Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. ine: 97&- FEE SCHEDULE. BOLDING PERMIT. 512.00 PER 51000.00 OF THE TOTAL ESTIMATED COST BASED ON 5125.00 PER &F. Total Project Cost :$ d r O o FEE:$ 1$2-6 IIff Check No.: �I �� Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ �. Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales El❑ ❑ Permanent Dumpster on Site ❑ Private (septic tank, etc. Electric Meter location to project NOTE: Persons contracting with registered contractors do not have access to the guarantyfund Signature of Agent/Owner 4Signature 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 D JECTED DATE APPROVED CONSERVATION COMMENTS_ fizl" DATE REJECTED DATE APPROVED HEALTH COMMENTS ❑ ❑ FIRE DEPARTMENT - Temp Dumpster on Fire Department signature/date COMMENTS no Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided- Dimension rovided 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:13HORM05 Crated IMC. Ln.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-Cv ff-tdavit ❑ Photo-Copy-of-R.I.C. And C.S.L. Licenses— It— ❑ Copy Of Contract d ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) V❑ 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-varianceor 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 DEPARTMENTMFORM03 Page 4 of 4 Location / No.—? Date d' V TOWN OF NORTH ANDOVER Certificate of Occupancy $ cMus Building/Frame Permit Fee $ , s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # IJ?� OG0L.170j V Building Inspector