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HomeMy WebLinkAboutBuilding Permit #209-13 - 391 STEVENS STREET 9/17/2012 BUILDING PERMIT tIORT11 °�tT��o Ia'�ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: a��" ` Date Received �SsacHus�� Date Issued: IMPORTANT:Applicant must complete all items on this page ;i. �f E'S+�``� "fib Y ',=�1`." I .�-ryc5"'.,�..:�, t��'+',,9;�twntt.w' rr��x3;`• ,�.,,ia r _ ,��� � '�i} t*'J I �^� � _,,. 't£•5 r 5 I �s°ie �P" .- � •}ti h.u-x r ��, .,�[^K• ' .:ag � 3 � � �qf,r g�`�-.� t-1.;,3 � 'a" r ,r T �-`'_ate wF'#"t•��t'„C xr-fir-ts ! i T< .F` ;� ..� .. ' iia^ u;FS' '�- s- -r"';'+=•F.�i•=�5cax ..nn.:f.^ �.. ,. .,r �i yrr, - ..T-T �' � YT r}: ♦ ��'ad� ����ec`` � nl� --��w'rb•_•1�.+r -r,' '�Tx���.,�, sl�t',�t�z=a1� ,a c,epic s �o4.-�5�'" ''�anj�k�F'' � �e•�,`� i� � 'c.F� .... � ������=P�-�� t ���`d� I Ty� � y"-7 ta'� �� .•�,. �� ,���S� r dy�1�r'��' T nom. �bya •'° _ y � .:�� � k J._ �"' �' 1 { nl � �`. .h-t�'JJ�; �i.7T {iL7L.', 'IFJ�'�A(�A-J � y�� �r= �• r+a �ihiC,`t�d�.. '# s�s,�ayn:.- .4�: �cyr 9_ +��•�^y„v'?g "',a ^.+-_ e' �. S,. � y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Buiidin One family ddi ion wo or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other • � naL911` a7 # ETwS c" fc�7,l��t Fs°Y F$ a nom � � r DESCRIPTION OF WORK TO BE PREFORMED: } Iden ' cation Please T Pe or Print Clearly) OWNER: Name: 6m ��.Y�AI � ir�„>,�'S �- Phone Address: � .13a � v _ I J`r � 1"r� >w � .L'•'p' '� _`�. Cj i' ..., t t � , a w � �IA Iii � m 'F' ..• .. rr A���_. dtl- .r' �� "'1 __ ;;r. ��"i'`t.rw+ Y� � „('+y. �r N�• "�,',�'. �1' r_Yyp'pUN�YyiwyfY_��!�•-Wr� r. Tyr+..�6w�a�l�r,u u. �jFs��r,vzi32x'?til t-.....-.r - �� +�''�s�"�i�f� et. �.. S} "• � �'i� P -r s��as+3�rt. `"tai'ue. ARCHITECT/ENGINEER ©v1 ✓P,41ey 'Sa.zr Phone: Address: /,? // Re9. 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: $__ FEE: $ Check No.: /��� Receipt No.: j 7/�/ NOTE: Persons contracting w'h unregistered contractors do not have access to the guaranty.fund baa _rEra /.Oarune - �� -`5�gnat �eco -' _.. Plans Submitted Plans Waived Certified Plot.Plan Stamped Plans 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 D Vlo� 1Ov1 !�1 C'e12 moo' CONSERVATION Reviewed on Si nature COMMEN TS 1r HEALTH Reviewed on Signature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water $ Sewer Connect ion/si natur D eDrivewa Permit DPW Town Engineer: Signature: - 4e �G Located384 Os ood Street tF�ID #P� 3 '171 -T3eJai 'Iun � e� es:' jw :•ur`� -a �'eo- e,'-v acta x_a-ar :Lzocatedsatfairaf� ef .� '� e QRS 4"M't,AY{.�y ",t`'",+�.Y C.`'Y u•r'' -c- ,,` " d..'i.+ { z y l a `'3K g - ,rya {FIfT�?�e�3AV�tL9� L?SIX �3��i7�ae`� � e L T h r 1 J Ccd ¢ tJ Y 1 1 t tea^ Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 1�d6j+ - 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) l �I ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract e Floor/Crossection/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 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 o 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 o 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:Building Permit Revised 2008 r -i NORTH ve" 'o No. h ver, Mass, 91/71x'.COCNil""WICK �,e A�RRtEO PPP��� s V BOARD OF HEALTH Food/Kitchen PERM T LD Septic System THIS CERTIFIES THAT � BUILDING INSPECTOR Q�.. ��.�� Foundation has permission to erect.......................... buildings on .. ../. ... ........................... ..�..........:................ Rough ... �....:.7 ...... .../. ............ Chimney to be occupied as ................... .`.: ...: : ® .. .. ./ .......... ... y provided that the person accepting this permit shall in every respect c6nform to the terms of the application Final on file in 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 CONSTRUCTION STARTS Rough Service .................................. ............... ..... .�„�." Final BIDILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE Date TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . . . . . . . � .�� . . . .1�. has permission to perform . . . . . . . . . . . . . . . . . . . wiring in the building of . . . . . . .���!'liil'ft.�f�.Z�'. . .l�• �'��. at`. .3 .. . . . . . . . orth Andover, Mass. od Fee Vis.--'.'. . Lic. No. z6��. . . . . . z ELECTRICALINSPECTOR Check# q 1098 -C11\ Commonwealth of Massachusetts Official Only Permit No. �V C Department of Fire Services Occupancy and Fee Checke BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC,52 CMR112.00 (PLEASE PREMOR TYPE ALL INFORMATION) Date: INT 3I City or Town of- NORTH ANDOVER To the Inspector bf Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) .79 Ci/ S Owner or Tenant Telephone No. Owner's Address 4 JE Al, /"%)71/1 ,illfit aOl�E Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building T-2i ee Vl( c— Utility Authorization No. /3::3'7W � Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Z,110 Amps A) I dW Volts Overhead E4—' Undgrd ❑ No.of Meters / Number of Feeders and Ampacity -.,f ✓, !a V,_1 /40 'A'A4 Location and Nature of Proposed Electrical Work: �:U fL &/?Wy Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans TransTotal J Trsformers KVA No.of Luminaire Outlets No. of Hot Tubs Generators KVA AboveIn- o.o mergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of Switches No.of Gas Burners No.of Detection and TotInitiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Dis osers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection No.of Dryers Heating Appliances KW Security Systems:* y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: y g No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) I certify,under thepains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: P� 1n -k,- yam Signature LIC.NO.: 3� (If applicable,enter "ex pt"int a license number line.) Bus.Tel.No.. Address: P 1A Alt.Tel.No.:J *Per M.G.L c.-147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement, I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: Signature Telephone No. 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 Legibly Name (Business/Organization/Individual): iei,,/� 1j Address: QT, 6 /�yfw- � City/State/Zip: L, AA14_1� �Z Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[94-am a employer with 4. ❑ I am a general contractor and I 6.LF iNzw 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.$ E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. 9 y p ty ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.,❑ 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.] employees. [No workers' 13.❑ 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: v Policy.#or Self-ins.Lic. Expiration Date: i�:2 3 j_3 Job Site Address: �3r'I/ J�Z f/f� S - City/State/Zip: h_ __ tnl 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. [do hereby certify under the p 'ns d penalties of perjury that the information provided above is true and correct. Signature: A Date: r Phone#: 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#: