HomeMy WebLinkAboutBuilding Permit #608 - 49 Hepatica Drive 4/16/2008Permit NO:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
//&/a/
_Date Issued:
IMPORTANT: Applicant must complete all items on this nage G^
LOCATION L L 1 - G cis .
Prin
PROPERTY OWNER
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
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
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESC IPTION OF WORK TO BE
OWNER: Name: Kms,/ ko".
Address: %D
Please Type or Print Clearly) .
CONTRACTOR Name ,r lei G-- 6), eaac5 Phone:
Address:
.4
Supervisor's Construction License: ' o Exp- Date:
Home Improvement License:
Exp. Date:
<//
ARCH ITECT/ENGINEERVSv1Z,A +? kefitA--& Phone:
Address:91 �W�2IP'e )'It-ld Reg. No. &�/�
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED
CO/ST BASED ON $125.00 PER S.F.
Total Project Cost: $ .e '0 FEE: $-7
Check No.:' Receipt No.: a 1 of
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fu
If A ent/Owner
gnature o _---
nature of contractor Gti i
me, __ _ Si g._ . __ _ __ . _
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
CONSERVATION Reviewed on Siqnature
COMMENTS
HEALTH. -
COMMENTS
.4
Reviewed on Siqnature
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
DPW Town Engineer: Signature:
Locatea 664 us ooa 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 21A—F and G min.$100-$1000 fine
NOTES and DATA — (For department use
A -A Add6nk, � �
GV✓�^
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
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 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 2.2008
Location
No. Date
Check #
. TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
2 1 0 8 7
Building Inspector
LAWRENCE H. OGDEN, P.E.
198 EAST MAIN STREET
GEORGETOWN, MA 01833
978-352-8318 fax 978 —352-2858
pager 978-502-5921
March 28, 2008
Mr. Benjamin Osgood fax to 978-685-1099
Key Lime Inc.
10 Hepatica Drive
North Andover, MA. 01845
RE: Unit "E Modified", Lot 26 Old Salem Village, North Andover --j/�? Ile -to./¢ C
Dear Mr. Osgood
As you requested I visited the above project to review the Engineered Lumber
used in the framing as shown on plans prepared by O'Sullivan Architects 1-31-08. and
certified by me.
The Engineered lumber is installed as shown on the drawings. I therefore certify
that the use and installation is acceptable and will support the loads as required by the
Massachusetts State Building Code 6 h Edition.
Should you have any questions please call.
Yours truly
Lawrence H. Ogden P.E. / , n 340
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'40RT
0 TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSt;kLLATION
This certifies that I -P !A /t CY4 .....................
has permission for gas installation Z./'�' —
...............
in the buildings of. .........................
at .... '// .............. North Andover, Mass.
Fee. Lic. Noj 71,. 7 ... .... ......
GAS INSPECTOR,"
Check 4 / F ( e�'-
6377
w
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F1'1i,SSACHUS'_-rTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Al�� f j � �� , Mass. Date — 20 OF Permit # ? 2 7
Building Location /fl.�rf}T,`G►4 fjiL Owner's Nam ek,,�
Telephone �1 %� - A3 - 3/G3'f Type of Occupancy JZA,5,I
New Renovation Replacement Plans Submitted: Yes No[:]
Installing Company Name EnergyUSA Propane, Inc.
Address 100 Myles Standish Blvd., Suite 101
Taunton, MA 02780
Business Telephone (800) 822-1300 X8055 Mike Smith Cell (508) 922-7891
Check one: Certificate
X❑ Corporation 132 C
riPartnership
El Firm/Co.
Name of Licensed Plumber or Gasfitter William Kent Corson (800) 822-1300 X8051 Cell (508) 294-6660
INSURANCE COVERAGE: EnergyUSA Propane, Inc.
has a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes X❑ No ❑
If you have checkedeyes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy X❑ Other type of indemnity 1:1 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner Agent
Signature of Owner or Owner's Agent k
I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and
accurate to the best of my knowledge and that all plumbing work and installations performed under the permit
issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Code
and Chapter 142 of the General Laws.
Signature of Licensed Plumber or Gasfitter
By
Title
City/Town
APPROVED (OFFICE USE ONLY)
m
Type of License:
Plumber
MGasfitter
X❑ Master
Journeyman
License Number 3707
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Installing Company Name EnergyUSA Propane, Inc.
Address 100 Myles Standish Blvd., Suite 101
Taunton, MA 02780
Business Telephone (800) 822-1300 X8055 Mike Smith Cell (508) 922-7891
Check one: Certificate
X❑ Corporation 132 C
riPartnership
El Firm/Co.
Name of Licensed Plumber or Gasfitter William Kent Corson (800) 822-1300 X8051 Cell (508) 294-6660
INSURANCE COVERAGE: EnergyUSA Propane, Inc.
has a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes X❑ No ❑
If you have checkedeyes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy X❑ Other type of indemnity 1:1 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner Agent
Signature of Owner or Owner's Agent k
I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and
accurate to the best of my knowledge and that all plumbing work and installations performed under the permit
issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Code
and Chapter 142 of the General Laws.
Signature of Licensed Plumber or Gasfitter
By
Title
City/Town
APPROVED (OFFICE USE ONLY)
m
Type of License:
Plumber
MGasfitter
X❑ Master
Journeyman
License Number 3707
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Date................ ....
T
0* 4,
TOWN OF NORTH DOVER
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas'installation---'�
. .......... �0 ...............
in the buildings of .....
................ North Andover, Mass,
at ...... A ..
Fee�M- Vic.
L
...........
T
Check# - 7111
6370
1� k ori
'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) No KV, — 0-M—N
Mass. Date 3 ?� �c�E 19 Permit
Building Location WC pct e( C S Owner's Name
Type of Occupancy :2�
New 19' Renovation p Replacement Q Plans Submitted: Yesp No p
Installing Company Name GCA -66V,4, ?1 �K Kl�, Check one: Certificate
Address t� 1�1L �,'Zc� ( D Corporation
(Lil(_ . M Y 31 ❑. Partnership
x Business TeI.ephone—_q 43 p Firm/Co.
Name of Licensed Plumber or. Gas Fitter
INSURANCE COVERAGE:
I have a curre�nt�1' ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes Ly No D
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy [B' Other type of indemnity 0 Bond D
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of .the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
OwnerO Agent 0
Signature of Owner or Owner's Agent
1 hereby certify that all of the details and information I have submitted for entered) in aboveapplication true and accurate to the best of my
knowiedge and that all plumbing work and installations performed under the permit issued r th' . pl; tion will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General
$Y TFJo.rneymancense:
ber Signature censed Plum r or Gas Fitter
Title ter 10 3 `I
r License Number
Ciiryffawr�
l i NL
IV
son
Installing Company Name GCA -66V,4, ?1 �K Kl�, Check one: Certificate
Address t� 1�1L �,'Zc� ( D Corporation
(Lil(_ . M Y 31 ❑. Partnership
x Business TeI.ephone—_q 43 p Firm/Co.
Name of Licensed Plumber or. Gas Fitter
INSURANCE COVERAGE:
I have a curre�nt�1' ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes Ly No D
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy [B' Other type of indemnity 0 Bond D
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of .the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
OwnerO Agent 0
Signature of Owner or Owner's Agent
1 hereby certify that all of the details and information I have submitted for entered) in aboveapplication true and accurate to the best of my
knowiedge and that all plumbing work and installations performed under the permit issued r th' . pl; tion will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General
$Y TFJo.rneymancense:
ber Signature censed Plum r or Gas Fitter
Title ter 10 3 `I
r License Number
Ciiryffawr�
l i NL
IV
e?
Date.', �:� ..........
Tol
TOWN OF NORTH ANDOVER
r
0.
.j'�
am PERMIT FOR-ZMBING
This certifies that
..................
has permission to perform ........ ...................
plumbing in the buildings of ..............................
'v �? '74-,e - ; -
at. . North Andover, Mass.
Fee-. . . . Eic. N o./0-3 I/P —IL�' �'
3x ...............
"'�jMBING INSPECTOR
Check
7683
L c�1 Z C
r0m
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
type or print)
,duilding
Date -3 _a -egg
Permit #
Amount
Owner's Name - 010 C Sbq It-, LA
New 1: Renovation ❑ Replacement
FIXTURES
Plans Submitted n
(Print
fie) Check one: Certificate
nnt or
ng Company Name Gia 1 i� Plumbing- u m b i n Q & H g_ t; ng_ D Corp. 1906
e
,,Address P . 0 •Box 1701 pie..
Navarhi11� MA niRi1
Business Telephone 978-374-1743 ❑ Firm/Co.
�a
Name of Licensed Plumber: Stephen C. G a l i n s k y
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy ® Other type of indemnity Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
I
Igna re Owner Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed un r P rmit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Sta P bi d C er 142 of the General Laws.
By: Signature o i e m ur
Title
Type of Plumbing License
I
City/Town LOW um er Master 13 Journeyman 0
APPROVED (OFFICE USE ONLY
I
■:�: � �„ �.,
oano■■�■�■■■mai■■�i■r■r■■■■■■■�■o■�■■■��■■■i
(Print
fie) Check one: Certificate
nnt or
ng Company Name Gia 1 i� Plumbing- u m b i n Q & H g_ t; ng_ D Corp. 1906
e
,,Address P . 0 •Box 1701 pie..
Navarhi11� MA niRi1
Business Telephone 978-374-1743 ❑ Firm/Co.
�a
Name of Licensed Plumber: Stephen C. G a l i n s k y
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy ® Other type of indemnity Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
I
Igna re Owner Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed un r P rmit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Sta P bi d C er 142 of the General Laws.
By: Signature o i e m ur
Title
Type of Plumbing License
I
City/Town LOW um er Master 13 Journeyman 0
APPROVED (OFFICE USE ONLY
I