HomeMy WebLinkAboutBuilding Permit #690 - 396 ANDOVER STREET 6/11/2009Permit NO: 6(?b
Date Issued: ('I/ f
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
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I IMPORTANT: Applicant must complete all items on this pate I
LOCATION 3J:4AAfhoUi2vi— /Vo Apyjl ot/f/2-- M o/ J
Print
PROPERTY OWNERc%M4,S L�Nv__
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Villaae ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One mil
Addition
wo or ore family
Industrial
Alteration
i s:
Commercial
epair, replacemen
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
,,pp DESCRIPTION OF WORK TO BE PREFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: �/AotAg'S lio,:*m) Phone: 1P7e- 4FL-V4
Address: A to 14cover e
CONTRACTOR Name: AaN:9n "` Phone/"y'--)s;,) so - t
Address:�S}S-t >✓r --c :5y-. /fla.
Supervisor's Construction License: Exp. Date:
Home Improvement License: /S- k -,;L- 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: $ so
. --
Check
7 DOS � FEE: $
Check No.: /66 r% Receipt No.: 72 11'9
NOTE: Persons contracting with unregistered contractors do not have access to the gugxanty fund
mature of conte,
Location -3 q
No. C, `/6 Date
„oR.N TOWN OF NORTH ANDOVER
D
Certificate of Occupancy $
�� s'•^° Eta Building/Frame Permit Fee $
ncMus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
22'1 10 41
Ifuilding Inspector
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
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:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Locatea J64 US ood Street
FIRE DEPARTMENT Temp Dumpster on site 'yes no
Located at 924 ;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 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
❑ 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
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BONENFANT CONSTRUCTION CO.
This form satisfies all basic requirements of the state's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard
language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of "a
Massachusetts consumer guide to home improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the
Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757.
Homeowner Information Contractor Information
Name
ompany Name
AKoNj)
IF64bJfAIrm 66,-1reac Trcpv
Street Address (do not use a Post Office Box address)Contractor/
Salesperson/ Owner Name
City own State Zip Code
lusiness Address (must include a street address)
t2 0/
OG 5 -At r- A, Sr -
Daytime Phones Evening Phone
i y/TownState Zip Code
n — G � G ` .2
3
IV* A o fz 1,64 d /f tli--
Mailing Address (It different from above)
Business Phone Flederal Employer IO or S.S. Number
taw requvea that nwec home un-
Home vement conmaor Reg. Number
Expiration date
pmvemmt matractm have a
The Contractor agrees to do the following work for the Homeo
d re&bntio" number
ner:
C
(Describe in oetail the worK to completeu, specirvink me Me. orana. ana Mae
or malenals IQ DC Use
. use a I tuna 5 ee S I necessary
kr-if�rvvE ecvEiv po2C14 P6sTs �' l�Fc/c i7�iM
Q f_Pc,a-c F_ Al /T# A&r
Required Permits - The following building permits are required
and will be secured by the contractor as the homeowner's agent,
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of
MGL chapter 142A.)
rp trart Prim and P•vmnnt C,hnrtnln
Proposed Start and Completion Schedule - The following schedule will
be adhered to unless circumstances beyond the contractor's control arise
Wj/.o"fWhen
contractor will begin contracted work.
when contracted work will be substantially completed.
The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of: 000 M
Payments will be made according to the following schedule:
$ CPO upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater)
$ �— by _/_/_ or upon completion of
$ by _/_/_ or upon completion of
$ 00 upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following material/equipment must be special $ _f'00 to be paid for Pow K C L UM PJS
ordered before the contracted work begins in order $ to be paid for
to meet the completion schedule.(•-)
NOTES: (•) Including all finance charges (••) Law requires that any deposit or down -payment required by the contractor before work begins may
not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule.
Express Warranty - Is an express warranty being Provided by the contractor? No Yes fall terms of the warranty must be attached to the contract) / yi,49- 4,40.00 -
Subcontractors
a®oKSubcontractors - The contractor agrees to be solely responsible for completion a work described regardless of the actions of any third
party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor under this anreement
Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the
contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices
carefully before signing this contract.
• Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear.
• Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor
registration by writing to the Director at One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or
1-800-223-0933.
• Does the contractor have insurance? Check to see that your contractor is properly insured.
• Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the
third business day following the signing of this agreement Seethe attached notice of cancellation form for an explanation of this right.
VV INV I bIWN I11I6 U01V7KAU'f IY'FHEKE ARE ANY BLANK SPACES!!!
ATwo identical copies of the ContraM t be completed and signed. One copy should go to the homeowner. The other copy should be kept by the contractor.
0e s i ature Contractor's Signature
Date Date