Loading...
HomeMy WebLinkAboutBuilding Permit #352 - 447 MASSACHUSETTS AVENUE 11/5/2007 BUILDING PERMIT of N°oT" TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received /fes" Date Issued: 110,ol HU IL I ��+++ IMPORTANT:Applicant must complete all items on this page I-©CA? C 3�-4 Y Fhb ( l k f J k Y� y .3P& 49" PR7�ER7YOIERly ' x J�7ss;+r=t c° F � -} h r�^z `.. � tr � f � �''.�.Y'� .P ��� sr s� , q rL✓r r t'���'S�-. M 7 P- ��. ,4 PA CEt_ Y 017 G ;IST )OT n s >Histo c y�s r ct yes=" x dot r k Machine Shop 1�Illage �,.yes no r 4. .. N TYPE OF IMPROVEMENT PROPOSED USE '-_ Residential Non- Residential New Building One family Addition Two or more family industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other R WeII s ia. } n'� T r k 9" ,zz - r - '+ 5 1s S' 5 w Flood�l91h , We#larads 111a#ers ed Dlstr�ct M117ater.7Sewer n . ry DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print,Clearly) OWNER: Name: 'y�1�GY/� ���?l> Phone: g? fZ Ste—Z-7/Z Address: L[c(' S 0 ':7t �, "i .� � ;..r r-�t J MR �C��7TR��TOR Nar�ne rt i ! �'dress f� "5 .a.-f .& .r-r xhn -A �, x e5' Su.pjervisor"sConstru �©r �cerase �'-,�' d *�P- EAR S d aa, n C;a r F',y `P, d orae�rovernentL»✓ense :, .z _ ,... ;:. 4 r ,�E�x�p date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTTBASED ON$125.00 PER S.F. Total Project Cost: $ �, / FEE: $ 0? `f Check No.: I Receipt No.: w] a NOTE: Persons contractin g with unregistered contractors do not have access.to the uar f Slgrature of Agent/Owner Signature of contract - - -. 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 L3 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 o 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) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 thea appeal period is over. Th a Registry The applicant must then e t pp p pp b t this recorded at the Rebistry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL44 Public Sewer Tanning/Massage/Body Art Swimming Pools I 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS O MENTS 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 Driveway Permit Located at 384 Osgood Street FIRE DEPART�IIIENT Temp Dumps ter on site yes no _' Located at 124 blain Street = x Fire Department$11gna#ure%late r 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) I ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Location) No. 35 Date �oRTM TOWN OF NORTH ANDOVER M y s ; ; Certificate of Occupancy $ ". E<�' Building/Frame Permit Fee $ � AG MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # l 20765 ' Building Inspector G lel 5 T 2 L.��=-T t-t:7r�+ Sz:���v iS t�6Z- __��it �:l.-i�•t j�f Z:J��i Civ.�' Chi�u�1Ls�j�'iiC. C n%�C' #-" q3 fL c� �s;� T�:, W. l` i 13 ?&3 2 DUNDAS AVENUE vv• Michael Scott / ANDOVER, MA 01810 Andover Renovations Page c of 470.2640 Additions • Carpentry • Remodeling PROPOSAL SUBMITTED TO PHONE DATE u j1fI #,4 YW"o 9 ? a 5- 2- 7T"RE I T STREFT JOB NAPE RIJ-5'S . \A///00 945 CITY. STATE ND ZIP CODE JOB LOCATION Oovr6e 5 ARCHITECT DATE OF PLANS JOB PHONE We nemoy propose to turrtgn materials and tabor necasaery for the compieuon of. 1?6P4446 /a G MM99u 5 _ //� /�Aow mill4w)&W&Y/ %/�7" (e,14-sw l�ay44-t'r nlL; ec>Nt6/JQru S />c >bslG />1-5A! P64efr e*etrshkJ /"723r�/Z- W 4ijh�r4 6U�ee�S wl int 7N G�YTd r��L `i GJI�IIG /W?SGT / W-AlsS7& . e5 ��re- 7;?-,W 'Ta a'V� G0,qy0s,'77!9_ 1119P 4?C-�nr5 Z-V l S77/1!� SI d./WK' ©i(-7 rrgO7t[T J30-6:� t.J LGC- A3 e l"' 45207� GD ST, l&7Z'�fW- �iN f:U!c t �E Wht7z:#00 $ �o r67 /�trSS/�3� ChTIA14 -'L1 03(5 IIK5'rl*wwl r/��2! S irlfv� �e1�rGae SaLi E 44ye_C. tom. ^TSS<� /2t3yrlor�.p-� T"- Gv If CS //I---7z-' WJV ®a/ woo-&b_ S �E�GlKE B4e �Uv P'� f v2�� c<r� �lf �ovfL fL • TD /5's- WE PROPOSE 5'FWEPROPOSE hereby to furnish material and � labor —complete /iin a=ordance with above tpacificationt,for the sum of: dollars / ^� /`�/�� ./csG f Uf�t► (inlE r� /tt j r /r1r9/ tS /.5v ayment to be mace as follows: 411^t00t✓ Cos75 "70 499;�*/it6 All material Is guaranteed to De as specified. All work to Oe Completed in a sub- stantial workmanlike manner according to specifications submitted, per standard Authorized Practices. Any alteration or deviation from aoove specifications involving extra StNnalars r1r Al_l� costs will be execute* only upon written orders,and will become an extra charge over and above the.estimate.All agreements contingent upon strikes,accidents or Note: This proposal may tit delays beyond our control. Owner to carry fire, tornado and other necessary in. withdraw" by Ys 11 nal act opted within darn surance.Our workers are fully covered by Workmen's Compensation Insurance. ACCEPTANCE OF PROPOSAL The .bore prices, specifications and condi• tions are satisfactory and are hereby accepted. You are authorized t0 d0 the work as specified.Payment will be made as outone above. Signatute 14-I,-el tr_+.-- NORTH Town of 6 Andover L �( a T �0 - l A K � , �` dower, Mass., dore C 3W OCHICHEWICK y1. ADRATED F'*? �C3 S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT...1"INV%6BUILDING INSPECTOR......... ..�......... ..........�:�.�.�.�..�.............................. Foundation has permission to erect........................................ buildings on... ........... ... ...,. ....... .. .�..... Rough to be occupied asW.!YSA#.0j.A } Chimne................ •,..................................�T. ..................... . y provided that the person accepting this permit shall in every respect conform to the terms 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 ;P(o"MOWN& PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR CONSTRUC Rough ..... .................................................. ................. Service BUILDINR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RouFinagh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE smoke Det. ■ E•^v M-M-Mmz s�v WUHKhHZS I:UMF'tNSA 1 1UN AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (7PJUB-0047B39-A-07) RENEWAL OF (7PJUB-0047B39-A-06) INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA NCCI CO CODE: 13579 INSURED: PRODUCER: SCOTT, W MICHAEL BYETTE INS AGCY 2 DUNDAS AVENUE 853 MAIN ST ANDOVER MA 01810 TEWKSBURY MA 01876 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 10-01 -07 to 10-01 -08 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA o. M B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee a— C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any,listed here: `O COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A 0 D. This policy includes these endorsements and schedules: o SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 09-18-07 MB ST ASSIGN: MA OFFICE: DIRECT ASSIGNMENT 701 PRODUCER: BYETTE INS AGCY 25GSF 001430 The Commonwealth of Massachusetts ^, 1 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): M t K G S-GO 11 Address: ,•.t,C>A Av City/State/Zip: b tjvtr- 7 qC r� # Are you an employer?Check the appropriate box: Type of project(required): 1.(� I am a employer with 3 4. ❑ 1 am a general contractor and 1 6. ❑New 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.t TA Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for mein any capacity workers' comp. insurance. 9. Building addition [No workers' camp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work. right of exemption per MGL 11.0 Plumbing repairs or additions myself [No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t :employees. [No workers' 13.❑Other comp. insurance required_) *Any applicant that checks boz#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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the pollcyandjob site information. Insurance Company Name: Policy#or Self-ins. Lic. #:--7 PTU-6 -&-D 14113 -35.-,4- Expiration Date: A, Job Site Address: qL/7 M SS mc. City/State/Zip:N•J17iy0vrXL�PA Ol P-kz/ 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 pad a pen . s of perjury that the information provided above is true and correct Signature: Date: I I 5 c 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#: -# �. I ✓ltP. C/3lY1J7/IJ7.aI7.l!/P.2Lld1 O�•v�� �LICJP.�6 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 044723 Birthdate: 01/11/1950 r Expires: 01/11/2008 Tr.no: 13347 Congtr�cgan.C-S.testricted: 00 W MICHAEL SCOTT 2 DUNDAS AVE ANDOVER, MA 01810 Commissioner Boaril'rof B�i41(i3?r� '� dns/and Sf�nc arc s HOME IMPROVEMENT CONTRACTOR Registration: 113863 Expiration: 7/19/2009 Tr# 130331 Uul Type: Individual W MICHAEL SCOTT W MICHAEL SCOTT 2 DUNDAS AVE ANDOVER, MA 01810 Administrator 1