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HomeMy WebLinkAboutBuilding Permit #634-13 - 49 BRIDLE PATH 4/1/2013BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received °4�, Issued: RTANT: Applicant must complete all items on this LOCATION `7 % /. l�llf Print PROPERTY OWNER & lhfft � Ali IT * s' �1 I�GG Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaqe yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Pone family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial iPRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer I �yw &,&,V/ 1;�J 1/,&3 ,S7,01A f— P— Identification Please Type or Print Clearly) OWNER: Name: affc-9 �'Fi9Ti Uz VWf. Phone: ��,, 99/- 7$s6 Address: i 157, 5 &•'9%/ CONTRACTOR Name: Phone: 603 � 3g�.. 2nd , Address: Supervisor's Construction License* ---Jgy�3$1 Exp. Date: Home Improvement License: /1, A 7 Exp. Date: d o ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED ST BIASED ON $125.00 PER S.F. ` Total Project Cost: $ FEE: $ Check No.: Receipt No.. NOTE: Persons contracang ith unregistered contractors do not have accesklo--twfl, ra gnature of Agent/Owne f� Signature of contractor - c� Location �q z X No.61�/—/ ZY Date I . wle Check # 26241 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL 6-1 -� Building Inspector Dimension Total square feet of floor area, based on Exterior Number of Stories: ft" Total land area, sq. mast or service drop requires approval of Meter location, m No MO Yes------' of ►VI yes ELECTRICAL'actor No Electrical insp LITER�TJRE: yes n�►NGE R®1�� tion 21A—F and G min X100-1000 fine dimensions.�- i yes ------- I od Stfeefi Doc.Building FeMlt Revised 2U 1" 10 U note v o S� Ce/l; f, tore. Cg/ e 2c�eP� oaA;o ` a �trao t St f�he amped A; ans � 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 El Notified for pickup - Date Doe.Building Permit Revised 2010 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 ❑ 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) ❑ 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 ❑ 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 ❑ 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 app. al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Cakulaflon Construction Cost A500.00 m $ - $ 462.00 Plumbing Fee $ 57.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 57.75 Total fees collected $ 677.50 49 Bridle Path 634-13 on 4/1/2013 Kitchen Remodel, Den/LR to Stud /Bdrm The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ,Y www.mass.gov/Zia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): 84V-!!C',ka Address: Z, a ,, x(- 1)39-7y City/State/Zip: Phone #: 603 -, l -7M kre you an employer? Check the appropriate box: ❑ I am a employer with 4. [ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors [�} I am a sole proprietor or partner- listed on the attached sheet. t l ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. P Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F01 Electrical repairs or additions 11.E Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other iy applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. w an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site brmation. urance Company N icy # or Self -ins. Lid. #:_ Expiration Date; Site Address: City/State/Zip: :ach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 tp to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification. i hereby 4rt* un(,ffryf the„pai1Y-qndie ¢lties ofperjury that the information prodded gboye is true and correct. )fficial use only. Do not write in this area, to be completed by city or town official. �ity or Town: Permit/License ssuing Authority (circle one): . Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector �. Other m m m m y m N m v .a C CO) 0 10 0 CD 0 Z N 0 SD m 0 CL co. c=n 0v CD CD CL Cr =r _ CD CD 0 WIma v CD CC CD I � v 0 0_ O 0 CD a CD Z m cn 0 0 cn v z" I O 1— m z a� O Cl) < 00 � o 0 o a N = �`�•mo n Qo m o v y a:. ,y o� O o. m N S. o N o = O Q C n CQ U) C O Erp S. CD .a 0 CO to 3 N: � N O N _ '0 Z CD n M U U) > 0 C Q. p _ to CL— N� N o 0 ., as v � ' CD yJ\: o' -h 3 <aCD 0 aao=/ v � CL H 0 N OT. O O rT W C 7 O =+ m v m V m T O N Z7 O OOA S n N (n n Q _T O (n O �o O OOU S m m n '.' N m 0 T 7 d WT O UCq S C 3 Z Gl H m 0 j d n S O w O QCq S T C = fl_ C v_ Z V O N 'O rt f1 3 T O O- \ ' W y v O m x 0 c --I Dimension Number of Stories: i - Total square feet of floor area, based on Exterior dimensions. a?�' Mao 4d40j Total land area, sq. ft.:y34 i'o -t ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No -� DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) No Doc.Building Permit Revised 2012 �,p G OL SM Pi- V A/0 D J ❑ Notified for pickup - Date Doc.Building Permit Revised 2012 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor `— License: CS -049386 MARK D RAPE BOX 156 ' Seabrook NH 038'14 F lil 1 Expiration Commissioner 09/30/2014 North Andover MIMAP April 1, 2013 1t13.a-x115 35 BRIDtE'PA-T1J 63.0-0004 49'BRIDLE-PATH _��Uater1E�rotechon :.•'...••;� �i'� x� IM017/ 6'3,BRIDLE,PA r J 0 � 3 r '' iQ,4:11C 2 063.0-0016 — Rail Line 'W Wetlands Zoning Interstates — Interstate - Exempt Lands - _ Bust! Busine s 1 DisMct s 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, — Major Roads - Busine Y Busine s 3 Di„ict s 4 District AORT#1 Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of Roads r Easements 0 Gene' O Planne Business District Commercial De v Of «te '�1, < r0e O O North Andover. Additional data provided by the Executive Office of Environmental Affairs/MassGIS. The information depicted on this ma is P� p C) MVPC Boundary rY ” Corrido C Comido Development Dist p Development Dist �'� 3 L OA' 1" —' 9 for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER [3Municipal Boundary O Corrido Industri Development Dist I 1 District MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Zoning Overlay B Adult Entertainment f. Industri 12 District t t • THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT 0 Downtown Overlay District C Industri p Indusld 13 District I S District K o t ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ©Historic District ®Water Protection Reside :. Reside ce 1 Dislricl ce 2 Di'tnj 'ff °+♦�io •'h 7S Et THIS INFORMATION ❑ Parcels 1—ide ce 3 Dis ict 'SACNU`+ 0 Hydrographic Features}, de 1" = 62 ft �� rrde ce 4 District ce 5 District Streams YY de ce 6 District ���.ge esidential District