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Home My WebLink AboutBuilding Permit #001 - 410 BLUE RIDGE ROAD 7/3/2005 Of NORTH N Or 9 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION pOq�n° �`4y 9SS�CMU`�El Permit NO: og?l Date Received: � qW Date Issued: goof IMPORTANT: Applicant must complete all items on this page LOCATION � /f 2Cs' nt PROPERTY OWNER::f d k l� Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building family ❑AdPion ❑Two or more family ❑ Industrial e'Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑Commercial ❑ Demolition ❑Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED /►letl/ It�� r�'" Identification Please Type or Print Clearly) OWNER: Name: �+`' /� /m!4 lI Geo ( Phone: / Si turf Address: /�� f t� /b CONTRACTOR Name: A) __J `�` `�U�--S Phone: 1�./� '��0�`?7 Address: s- � ne-046 f4l'1.7- .S/ Ale X&40ze ' Supervisor's Construction License: 4�0-7 6'�d Exp. Date: �r I zo Home Improvement License: 1,033<gP-- Exp. Date: _& V �- ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING /T•$1010 P000.00 OF THE TOTAL ESTIMATED COST BASED ON$12.5.00 PER S.F. Total Project Cost :$ 3 y x10.00=FEE:$ . 00 Check No.: a Receipt No.: Page 1 of 4 Location ' t No. Ob I Date MORTM TOWN OF NORTH ANDOVER � A Certificate of Occupancy $ �- ri�S',•°•Eta' Building/Frame Permit Fee $ r s�cMus Foundation Permit Fee $ Other Permit Fee $ tit)I TOTAL $ Check # 4,V Building Inspector M�j`--- TYPE OF SEWARGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ ❑ Tobacco Sales Well ' , t, . ❑ Food Packaging/%ies,, r Permanent Dumpster on Site F1 ' Private(septic tank,etc. ❑ t, "i 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection signature&date t/ Temp Dumpster on site yes—no— Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 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:BPFORM05 Created IMC Jan.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 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) 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 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:BPFORM05 Page 4 of 4 x.10 R TH Town of 19Andover 0 .- 0 No. AA = dover, Mass., 7 . 3elmO COCMICMEWICK RATED P"p Ky S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...1A... ..� R * 0,a..•.�•. ............. ........... ........................... Foundation has permission to e�eel....r'+�� Ir11� buildings an .. ..�. ...... ��i• !fi..:. �M Rough to be occupied as-14.t. �.`.... .... 1 1�„ ......•ay�/C . ... Chimney .......................................................................... .. provided that the person cepting his perm all in every speQAnform to the terms of the application on file in Final this office, and to the provisions of the Codes and gy-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. `I PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids fhis Permit. Rough PERMEXPIRES IN 6 MONTHS Final IT ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough ...................4....... .... .... �. Service . .. . . ............ ........ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE S 1 D E Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordanceit the provision of MGL c 40 S 54, a condition of Building Permit at: 6110 ,9 is that the debris resulting from this work shall be disposed of in a prope licensed solid waste disposal facility as defined by MGL I11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: —41e" (Location of Facility Signature of Permit pplicant Fire Department Sign off: Z Dumpster Permit .3- 0 ate Pae# of pages rl CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh A Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted To: /J Job Name Job# Address � / Job Locat' n Date / Date of Plans �9—d 4� "I:' 4' Phone# Fax# Architect We hereby submit specifications and estimates for: / h/ 0 J 44 v ---------------- ell— ier! 7p�roposehereby to furnish material and labor—complete in accordance with the above spec'(cations for the sum of: $ Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order,and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdra n by us if not accept d within days. R Zcceptance of Vropogar The above prices,specifications and conditions are satisfactory and are Signature hereby accepted.You are authorized to do the work as specifi Payments will be made as outlined above. Date of Acceptance Signature tontrttoilwealth o /llassachrtsetts C .l Ur7lartmcrtt oJ"Industrinl1cc•idcrrts Office of"III vesfi, (ftions 600 Washillgiolr Street Roston, AIA 01111 Workers' Cotnpellsation Insurance Affidavit: tltlilders/('(talc;icf(,rs/Electricians/i'lrrlit el)ers A > >,licant Information ,cam --._-- Please Print Legibly Na1r1C (t3usincss/Organization/individual : /�'+t� ��_� � `� �QNS } Address: vl� 5 -- City/State/zip: PlOr /J/VD p4yel?_ 1'4Z Theme IL f 7,f� - 623 Are you an empioyer? Check the appropriate boj� hype of project (rcgltlra�e➢): 1.❑ i am a employet with 4. i am a general contractor and 1 6. �� New comim('iiorr employees(full and/or part-Bate).* have hired the still-connaciurs 2.❑ 1 ant a sole proprietor or partner- listed on tLc altltchcd ;lice:!. 1 7. [_.] {Zcnxxiciing strip and have no employees ''Hese sul.i contractors have 1)cn101111on workingfor nic in any ca acil workers' comp. insulancc_ (t. {3uifding addition Y p� Y� [._:J [No workers' comp. insurance 5. ❑ We arc a corporation Incl its ltl.f-.] 'IcOtical repails m- additions requited.] officers have exercised their right ofexemrtion pct i�i(3{, I1.( ) Plumbing1q);1its err additions 3.❑ I ant a honicownct doing all work g 1 { myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No wolkcls' 131Other millp. insurance. icquncd - -- -_. Any npplicnnt that checks Ix)x ill must also(fill(lilt the Section ix ow Showing tile it w(nr:Ct'. mili11civ-ji l)11 1)(11 icy ill linmilt iun— -- -- t llonlcownets who Submit this nrfidnvil indicating they nit doing nil Wolk rind 111en hilt mltside coutw lurs must sulnnit n new nnidnvil indicnl inp such. icunhnetots thnt cheek thisbox must attached nn nddilionni sheet showing the nmne or the sill cnnllnctlns and 111cir workers'cutup.policy inVot tt)ntiun. I nrn all empinper that is proOding workers'compensation insurance for min emplo Yes. Below is the polic.l,attd job site irtfvrmntion. ` n ,> Insurance Company Nante: Policy if or Self-ills. Lit,. n: Fxpimtiott��G�G ��0 -1 �-----._ - bate: ll—tlY-0 6 -- - -- Job Site Address: q1 �� /1 jl��-� �� 4 p�/.(XJI, Attach a copy of the worker's' compensation policy declaration page (Showing file policy number :rad expirltion date). failmc to secure coverage as required under Scction 25A of MGL c. 152 can lead to the. imposiIlon ofcrinmud penalties of I fine tip to$1,500.00 and/or one-year imprisonment, as well as civil pcniltics in the foini of a SLOP WORK OR DFIR and I finc of up to$250.00 a day against the violator. Be advised that a copy of chis statement limy he forwarded to the Of fico of Investigations of the DIA for insurance coverage verification. I do hcrehy cc► ifp under lite pains and pcnaltics o pc►jtrr j'that flit, inlin rnation pi-ovided ahore is true and ccrrr-cct. ---.- Uatc: Signature: � �1/�Ew�'_-- --------- ---....__._._. _ -�� o � . --- - -Phone It ��f, G73 -------------------------- -- ------— Official use onlj,. Do not write in this area, to he completed lrp vill,ur(onvr alfcial. City ot-Town: 1'crnrit/➢,iccnsc tl lssning Authority (circle one): t. 13oard of Health 2.guilding'Department 3.e:ityruown Clerk 1. F.lec l-kal 111"pector 5. plumhinh lns3tector G. Other Contact Terson: _ Phone -------.-_--- 00-35,000 cf enclosed space / (MGL C.112 S.60L) I �pommtootureac� ✓�la00 t A Masonry only ' _ SOAR q OF I.IILDING REGULATIONS 1G-1&2 Family Homes Failure to possess a current edition of the IUioe,nso CONSTRUCTION'SUPERVdSOR tate Building Code 022680 Massachusetts S d Numbe. is cause for revocation of this license. 9 _ 39 Tr.not 28249 'F ARTHUR J WALS x' DIG SAFE CRL1-CENTER' (888)344'7233 I 55 PLEASAIJT ST °o / ,,4,, N ANl7pC/ER, MA 01 6 Cbmmisslone'r fie�omr�xaovu o$s and Standar ;B1. ds oard of B�diug Reg .,; CTOR HOME(MOVEMENT CONTRA Registt7ly i 103358 �rAepse ttn712006 Qr,r"tration valid for individul.use only ` to Corporates before the gyration date: lyp ' Board of$o�tdm If found return to 6�4 Asy� ERegulaho.S and$standards. 1-! $o ton�J; 0#ton Place Am 1381 A.J.W:ALSH& Ma:02108. Arthur Waish Jr. .55 Pleasant Stv Adn�t,ator dove Not valrr� W. s` nature