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HomeMy WebLinkAboutBuilding Permit #228 - 40 CANDLESTICK ROAD 9/16/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: ORTANT:Applicant must complete all items on this page LOCATION O l2d Ce s�(' _k 9d, . PROPERTY OWNER Pr' t Unit MAP NO/ �j ? Print # PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village y n 100 year-old structure y s no TYPE OF IMPROVEMENT PROPOSED USE Res' ntial Non- Residential ❑ New Building One family ❑Add'ion ❑Two or more family ❑ eration y ❑ Industrial No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Demolition ❑ Other ❑ Others: (]SSeptie (jWell }O�VUatei/Sewer Floodplain ,Wetlands }p kWdtersled' istnct" iDESCRIPTION OFWORK«T BE PERFORMED: 0a Ident iication Please Type or Print Clearly) OWNER: Name: C ad p fK-0, - Phone: Address: C) CONTRACTOR Name: e �5 Phone: Address: yS r4 Supervisor's Construction License: %0)_ (�6 Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT;$1200 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $-7!4 6 QQ Do > FEE: $ Check No.: 99 � NOTE: Persons c Receipt No.: C'f contracting with unregistered contractors do not have access to the arae { _ g ty fund Signature of Agerif/Owner Swnature-bf.contractor . . . . ._ . .. . . .. . : . ::,. : ;, - Location 1 t-Cl/10! � , - i Z Z " Date No. ,.o*TM TOWN OF NORTH ANDOVER . o . . a . _ c . % ; , Certificate of Occupancy $ 1/� . + 4 • ,b++ -'tBuilding/Frame Permit Fee $ , - 1 SJACNUSE ,0 - Foundation Permit Fee $ Other Permit Fee $ e ' , TOTAL $ . I .: I Check # roo . .. . .. _. {.. F r� [ �y r� Building Inspector - 245 2 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 ❑ 'El- COMMENTS COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTSCOMMENTS Zoning,Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Plar'iing Board Decision: Comments -- 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 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 2011 June/mi 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 Perr 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 ❑ Flo or/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 Permii 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 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: Doc.Building Permit Revised 2008mi NORTH T0 0Andover ., No. o , dover, Mass., COCMICME WICK A0,%ATE D P.? Cl S ` BOARD OF HEALTH PEn T T D Food/Kitchen Septic System . BUILDING INSPECTOR THIS CERTIFIES THAT.................. . . `v ..................................... .................................. ..... ............................... Foundation has permission to erect..................................:..... buildings on ...40 ... ........ WW Rough to be occupied as.............?CC:11PE;�tI-s`permft . ...'f ...... ........................... . .................... 3 Chimney provided that the person shall in everyresp conform to the ter s 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 I I� to PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR J UNLESS CONSTR.UC . .. N TARTS Rough . ..... ........... ........ ....... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy 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 SIDE smoke Det. NORTH TO" of .......... A K E o , dover, Mass., COCHICHEWIGK RATED P'pa � BOARD OF HEALTH PER T Food/Kitchen Septic System 4BUILDING INSPECTOR THIS CERTIFIES THAT.................. w .............................. ..................4............................... Foundation ......... ..................� � has permission to erect........................................ buildings on .....K .......�K ...(j!..��v.�.................. Rough �f 06 3 L Chimney to be occupied as.............2:01pii5k. ...... ........................... ...............provided that the person is permit shall in every resp conform to the ter s 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 II� • PERMIT EXPIRES IN 6 MONS ELECTRICAL INSPECTOR UNLESS CONST RUC N TARTS 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 SIDE Smoke Det. l f• . t The Commonwealth ofMassachusetts Department of Industrial,Accidents Office of Investigations 600 Washington Street Boston,MA 02111 U www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/./Electricians/Plumbers Applicant Information } Please Print Legibly Name(Businesslorganization/Individual): JkJr('q f Address: 3 Berrrw City/State/Zip: I An Q V A 6/M_ Phone,#: 97Y- 6 87—a- Lf 7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a emplo e with`3 4. ❑ I am a general contractor and I 6. ❑New construction employeesd/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# �• Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Pl -repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12. oof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.n Other *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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: ( 6 Policy#or Self-ins.Lia#: Expiration Date: (71301,"12- Job 3© , "12- Job Site Address: 11 �l Q J I�( (� /C '� k 4"E#' City/State/Zip: r/-B{ M4 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify er the ai a dpenalaes ofpe ' t at the information provid;70�,l true andcorrect. Si ature: Date: Phone#: LO only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: FREE ESTIMATES PROPOSAL Construction Supervisor Lic. # 002663 FULLY INSURED _ti,.I_C. Reg,# 139569 WRIGHT GUTTERS AND CONST'RUCT'ION Specializing in Seamless • All Colors Available 350 BERRY STREET . NORTH ANDOVER, MA 01845 TELEPHONE: 978-687-2247 PROPOSUWITTED TO ry PHONE( ( — _ P GATE -l/4* SLY' 6 - 116111 STREET JOB NAME I LOCATION YolC1 R CITY,STATE AND aP ODE / JOB START DATE -30 5�- Ilk f- c Ue — , We PCOPOSe hereby to fumish material and labor-complete in accordance with above specifications,for the sum of:$ 00.0 0 t, T Payment to be made as follows q All material is guaranteed to be as specified.All work to be completed in a substantial workmanlike Authorized according to specifications submitted.per standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate All agreements contingent upon strikes.accidents or delays beyond our control Owner to carry fire,tornado and other necessary n2wance Our workers are fully NOTE This pl'Cposal maybe c�vei^d by Workme;i s Compen:yation Insurance Non payment by agreed party may result m tdigat+on withdrawn by us if not accepted within days. with penalties including court cost and compensation both real and punitive Acceptancc Of Proposal - The above prices, specifications and Y conditions are satisfactory and are hereby accepted,making his a valid contract. Signature F� You are authorized to do the work as specified Payment will a outlined. Date of Acceptance:--------------- — Signature Office r& uerrs tB mess egu a►°on a HOME IMPROVEMENT CONTRACTOR Registration: x138569 Type: Expiration: :4/14/2013 DBA W T GUTTERS Y SCOTT WRIGHT 350 BERRY ST. _ X NO.ANDOVER, MA 0],8,45 ._-. Undersecretary i Massachusetts- Department of Public S7r� Board of Building Regulations and Stan Construction Supervisor License License: CS 102663 " ? r SCOTT WRIGHT 350 BERRY ST NORTH ANDOVER, MA 01845 Expiration: 8/12/2013 Commissioner Tr#: 3384