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HomeMy WebLinkAboutBuilding Permit #185 - 45 HIGH WOOD WAY 9/7/2007 BUILDING PERMIT TOWN OF NORTH ANDOVERA ' p APPLICATION FOR PLAN EXAMINATION t � � Permit N0: ` �5 Date Received / p°RATeD�Ppy�y �SSACH�1$�� Date Issued: IMPORTANT:Applicant must complete all items on this page a IM K"I � y IBM a i G TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: 0 Com mercial ❑ Repair, replacement ❑ Assessory Bldg D .Others: ❑ Demolition ❑ OtherRPM, IWEI .' mN -: So i^I Em ..DESCRIPTION C�F WORK � � . . I TO BE PREFORMED: Identificatton Please Type or Print Clearly)) Name: Phone: — l2 ,,. OWNER ��f/`.c ���C?�cl ,�i7� /��.—LL9 Address y u>a ¢ ft �� x:, c'€x-c '°.� 5 ' .�• tis�.;�, "�. ,� �'" ' vim.,. . . .. ..., , ARCHITECT/ENGINEER Phone: Address: Reg. 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: $ 64 FEE: $ Check No.: '�_ Receipt No.: o2D S / NOTE: Persons contracting 'th u re gis red contractors do not have access to the guaran and $? tmu�Rre..�cr 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ . ❑ COMMENTS i DATE REJECTED', .DATE APPROVED HEALTH El— COMMENTS 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 Located at 384 Osgood Street77 Driveway Permit PRNT� eaptrtii sl `es 777 al_CC�teL QiJ1F1 , k� 1 r y�tp ,s r b ` tl a«Oxy«r 2 �WWepar���n ltatur+ece= I ® ,� re � »"� �'� ,� �..+.��' r �r �`a��'.ev-�r� 'z r x -�- -. J' 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 'r MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) f R ❑ Notified for pickup - Date ..............._... . Doc.Building Permit Revised 2007 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 o 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) j ❑ 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 Li Certifi ed Proposed Plot Plan E3 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 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 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 i Revised 2.2007 Location � / doe�' [ No. Date NORTH TOWN OF NORTH ANDOVER . o r f D Certificate of Occupancy $ s < Building/Frame Permit Fee $ J 6 '. Foundation Permit Fee $ .Other Permit Fee $ "_ Y TOTAL $ �3 j Check # Building Inspector ' A CERTIFICATE OF LIABILM INSURANCE 03/2° 07 FrAllucm UM GWUWAlE M UMM AS-A'WWM CW dGVffM7M Matthews Insurance Ag!p c COZY AND CONFEM WO RJGl M UPON 7HE CER71FfCATE 162 Parker street . 71t1S t •'[fA'!E a� � � OR AUER DE�.A BY YHE I � BRow Lawrence, KA 01849 976-601-1112 HIND RER8 AFS cOVRr"E 16AWO Mum li 0563 Construction, x3c mm k r tea ua Itta P.O.sas 1769 a 8alemo MR 03079 R 1-603-2351-7024 COVIEPMES THE POLICIES OF v4sumiNCE LISTED BELOW NAVE BEEN BSUED TO THE INSURED NAMED ABOVE FOR De POKY PERIOD M CATED.NOTWITHSTANDING ANY REGNANT.TI M OR CONDMON OF ANY CONTRACT OR OTMER DOCtE mNr YWTH t Tp WittCll THIS t�2T�iCATE:t�1AY BE RSStJIEO OR MAY POTAIM TME WSURANCE AFFORDED BY THE POLIO OBOM B� B SUBJWT TO Au,.M TERMS. AIS COIrDRI0tl6 OF SUCH POLICIES. SHOWN YAYHAVEBEEN REDUCEDBYRAIDCLAU S. ti01lf.TlAtt{t L OalIORIi UACLM 6JtGN GGG�C�tGE S NMMEPoCl�R GE71EltlN.lfMllltl' vvi�� i n $ CtA1MB/AA05 �OOCIIA t4�prp aitsptaHtlnZ S 7F6R9X4llL&A9VNUUW S conAvoralm UWANIMPER: GRAMM A6101i S aaoouc�s.ca�ron� s Ammaimmtiwertlrr At�aWI�AVI03 ' � sstrtaEtnaT t BCt�UL�A1l1a$i matzo" 6 �NONR�AAUIOS I $ aA1�lOQLIAEILIfY i AWAM AU1aat0f-EAA 6NT 3 afr�EAlwiuO ERA= a uAsitmr Y` Am CZ�tIR CiAMMAN Val Cupi g AeAtB s a p SI S s uAsas�'sw� ' 23253338IQ015 02/23/07 02/23/00 E1 r�SalAr µ•� a EL.DREASE-MEWUM $500,00D'—" °° Ft. -POICYLYyIr s . 0 a�n'�s,tAasi+oWterva�a.ea,moea+ruto+�to,t�a�r�ot � 'J�9 Afeli OV7ME A®pya p 4MCANi snow 7M VWMV a t Tam Tele araC SDR To mus wraneN s ple mar,nac �yao�+ �T+eLesr.mrrmnal000sommL no+om as a:Am Wm ret= tre Aii as �+DRDgp�' �O�RATiON1$+8@ � I I (603)898-4468 CONTRACT No. (800)458-4468 Cell (603)235-7624 A.J. WOOD CONSTRUCTION, INC. 5-7 Delaware Drive,Unit 3 Salem,New Hampshire 03079 E-mail: info@ajwoodconstruction.net ®t•�' Website:www.ajwoodconstruction.net ROOFING•SIDING•VINYL REPLACEMENT WINDOWS a DECKS 7L4 eAt_,� Workmen's Compensation and Public Liability Carried on All Work Date AJej 42 2004'-E I (we), the undersigned, hereby accept your proposal to furnish Labor and Materials to perform the following work on premises located at the following address: No. d; � fir'' f (Street) �" +%"i r,'� (City) (State) ( ipcode) Owner's Name —Tel. r Address "� "' ✓ .! �' In accordance with specifications given below: SPECIFICATIONS OF CONTRACT RECOVER THE FOLLOWING AREA ONLY: Strip of all existing roofing material. Install iqe and water shield on all roof edges,valleys and roofing protrusions. Install GAF Shinglemate roofing underlayment with 8"aluminum drip edge. Install 30 year roofing shingles with a Cobra ridge vent on peak. All permits and debris removal included. AFvr-the-suiw,of$ r Additional-work at _ n, c v fi -Deposit the undersignetr propUfty-ovdner-agrees-upon /: A_dA ^.a .cornpletion-of said,work,-4 pay°c'ash-(if--any-) $ � and-e ecu .aYpron.iss®ryenot fvr the balaree-of$ ',� 00 PL�S-TfIE DtFf-BRENTtAt7'OP- a ,� Payable in equal monthly installments of�. .- fzz", - Owner agrees that the title or equity in this property is his and is security for this contract. IN WITNESS WHEREOF the undersigned has(have)hereunto set his(their)hand(s)the day and year first above written. Buyer(s)Acknowledge Receiving a Completed Legible Copy of This Contract. r/ This contract may be voided by the Owners giving written notice to the Contractor by ordinary mail within thif e full business days.following the date hereof. L.S. r (Legal owner of property to be improved) By �� e �_,,- �� u s L.S. (Authorized`Agent) (Husband or wife of legal owner) flF {:=tr/71 J1NG17l,{✓rf!} 2,. jf'1�Jti :card of Bnitding Regaiations and Standards ;onstruetion Supervisor License License: CS 70882 Birthdate: 7/2811956 Expiration: 7/28/2009 Tr# 16025 Restriction: 00 RICHARD J SMITH p0 BOX 1769, SALEM,PIH 03079 Commissioner � tJ Board of Building Regulat ons and Standards One Ashburton Place - Room 1301 � L Boston, Massachusetts 02108 Construction Supervisor License License CS: 70882 Restriction: 00 Birthdate: 7/28/1956 Expiration: 7/28/2009 Tr# 16025 RICHARD J SMITH PO BOX 1769 SALEM, NH 03079 Update Address and return card.Mark reason for change Address Renewal [-] Lost Card OPS-CA9 C, 501J•05/06-PC84.90 NORTH To" of . 2 over No. 4w. 1;., In o z' A1tE ©` dover, Mass., I� C.CH.CHEMCK 7�S RATED E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System •S BUILDING INSPECTOR THIS CERTIFIES THAT........... ......... ... ................................................ ................................................................... Foundation has permission to erect........................................ ildings on ...... .. . . ........................... Rough to be occupied as....... . . . ....! . ......•................................................................................. Chimney provided that the person accepiing this permit shall i every r pest 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR S T 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address:IX City/State/Zip: CA tC I N 3Q 7? PhoneYk,0_3 ,��'' Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am ageneral contractor and I 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. $ E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. Y9. F1 Building addition [No workers' comp. insurance 5. We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 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.] t 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. f 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: e� - Policy#or Self-ins. Lic. Expiration Date:_ 9 Job Site Address: e, A City/State/Zip ,j/ S,S' 61gsy Attach a copy of the workers' compensation policy d claration 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 pains andpenalties of perjury that the information provided above is true and correct. Signature: Date: � Phone#: // 3- 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#: