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HomeMy WebLinkAboutBuilding Permit #283 - 48 CHURCH STREET 10/15/2007 BUILDING PERMIT OfNORTHs1�ao ,6qq TOWN OF NORTH ANDOVER �� 4`.., ' =6 oL h APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received A7to'•"`h __ �SSACHU`��� Date Issued: v S IMPORTANT:Applicant must complete all items on this page :LOCATION t -, c PROPERTY OWNER Ix e e. Print MAP NO: F>Ll PARCEL: ZONING DISTRI( Historic District yes no Machine Shop Village iM no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building a fami Addition Two or more family industrial e io No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: fi o a1 S C'<L'� F.Vlo ,Identification Ple e IN7e, or Print-Clearly) OWNER: Name: O "..Q C 1� `1 Z , Phone: Address: -ct— I`C`^e Cz ©ISS 3 CONTRACTOR Name:. 0, 23Z Phone: Address:_ Supervisor's Construction License: 0!�T:? C(9-1Exp. Date: 7 Home Improvement License. 2 c Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PMMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $�/3�, �' FEE: $ ��bb Check No.: f-� (4 Receipt No.: C-0 NOTE: Persons contracting ith unregis red tractors do not have access to 72',7- Signature.of Agent/Owner Signature of contractorY Location /� CS No. �12 Date /y ~ U MORTN TOWN OF NORTH ANDOVER 3?0 �`D MOO Certificate of Occupancy $ 'S S Building /Frame/Frame Permit Fee $ �cH� st Foundation Permit Fee $ Other Permit Fee $ TOTAL $ _ Check # Building 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 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 Driveway Permit Located at 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 2 1 A—F and G min.$100-$1000 fine NOTES and DATA— For department use) 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses Li 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 o 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) o 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 2.2007 NORTH 0 0Andover No. �. `AK o dover, Mass., d� COCHICHEWICK 7�AORATED O'P� � BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System - BUILDING INSPECTOR THIS CERTIFIES THAT......... LC.V. iI........................................................................................ Foundation z .............. buildings on 7 C 40 �............................. Rough has permission to erect......................... g .... .!�..... ...... .. .... .. . .....S - .. � g to be occupied as........ J. 4.6.6. • .. Chimney provided that the perso 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 Final I S PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU TART Rough INSPECTOR Rough ................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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. fte Board of Building RFgulat'ons and Stndards`i One Ashburton ,, - Room 1301 Boston. MasS!achusetts 02108 Home Improvement_�.ontractor#egistraI;ion t / Registration::. 1 E 740 y Type Individual } Expiration 9/(1)6/2008 KEVIN DANIELS KEVIN DANIELS 84 BENNINGTON ST 4 . HAVERHILL, MA 01832 Update Addreas and returr'card. Mark reasgn for change. Address Renewal t E1111,'oyment Lost Card DPS-CA1 Co 50M-05/06-PC8490 _ `� The Commonwealth of Massachusetts 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): Address: �et C4_ City/State/Zip:_ ��/�� VV k?,2 Phone #: 971 - tl 7` —l2-3 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.9_1 am a sole proprietor or partner- listed on the attached sheet. 7• [-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 10.❑ Electrical repairs or additions 3.❑ I 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' 13.0 Other comp. insurance required.] *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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 herebytcyuer the ains n penalties of perjury that the information provided above is true and correct. Signa . Date: Oc r. /i z� Phone#: 7 4 - r , i 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#•