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Home My WebLink AboutBuilding Permit #552 - 49 MEADOW LANE 3/28/2008 RTH BUILDING PERMIT 0* NO"O c 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * ,� Permit N0: Date Received Arno �SSACHl1`��( Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION , , PROPERTY OW,NNEI ° #rr - nin 3. MAP NO., PAROL: ZONING DtSTR3CT Historic Distnc# yes Machine. Shci 1illa - p .ge.: 'yam `np, . TYPE OF IMPROVEMENT PROPOSED USE Re ' Non- Residential New Building One famil A —Two or more family Industrial Alteration No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Septic lrtle°II, FloodlilairaWearads #eael District Water/Sewer _ = DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) _ OWNER: Name: i %Qt 3 Phone: Address: Vim. L- 10 . CONTRACTOR 7 Name: L.,4i A--Z- : 114.4 Phone: , Address: ` S-upervisoesConstruction:License: Exp, Date_ Horne lmprovernerl, ice-,nseI p.. Date: –T Y ARCHITECT/ENGINEER Phone: Address: z 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: $ �i 4TH2�ua FEE: $ X90 Check No.: Receipt No.: "dA 2 ��— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund i nature of Men = na#ure of contractor;. 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 COMMENTS HEALTH • COMMENTS { 1 1' 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.MEN Temp Durn;pater on site yes ago -Located-at 124 Main Street Fire Departrne_nif sil gnatur /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 ❑ 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 o 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 2.2007 Location � 1c�A�ls� � • No. 6S- Date NpRTh TOWN OF NORTH ANDOVER Fj •. pw * Certificate of Occupancy $ �'�s''•'"'tt�' Building/Frame Permit Fee $ S AC MUS Foundation Permit Fee $ 41 Other Permit Fee $ (TOTAL $ Check # 2 1 0 2 '1 ' —� Building Inspector 144" �E W 04 X I` P: N W 1 r m — Cx r 0) -nC 00 v cn I I 0 N im I.Q OD C� N I I3 a ( _ •gyp. � �' x � mm I N' C g.: ..... ....3. 15 2F r h W W3� Abby �. 53 MW-HOOD 1230E w rj Zh\ - °-- , �..�2. .y at"arin 3., All dimensions_size designations given are Helen Miller This is an original design and must not be Designed: 11/15/2007 subject to verification on job site and Carole Industries released or copied unless applicable fee has Printed: 11/15/2007 adjustment to fit job conditions. 781.933.3339 Ph been paid or job order placed. 781.938.7624 Fx Finn2 All Drawing#: 1 NORTH Town of Andover No.l%fSL -- _ Y 00 yy dover, Mass., O T O - LAKE ^ T COCMICMEWICK V 7� 0RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ��' �� BUILDING INSPECTOR THIS CERTIFIES THAT........ ... �.... ..... Foundation has permission to erect...............................e buildings on ..... ................ Rough to be occU led as........ Chimney p' I . ... ........ .. ......... .. ... ........ ,. .................................................................... .... 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 Final ago PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRU TS 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 Industriar,4ccidents Office of Investigations 600 Washington Street .Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: ]Builders/Contractors/Electricia Applicant Information ns/Plumbers Name(Business/Or _ PIease Print Legibly panization/IndMdual): Address: pity/State/Zip: Phone*: rAre you an employer? Check the appropriate box: I am a employer with 4. 0 I am a general contractor•and I Type of project(required)` employees (frill and/or part-�).* have hired the sub-contractors 6 ❑New construction . I am a:sole proprietor or partner- listed on the attached sheet 7. Q Remodeling . ship and have no employees These sub-contractors have working forme in any capacity. employees and have workers' 8' Demolition [No workers' comp.insurance comp. insurance.# .9. (]Building.addition 3.❑ required.] 5. [� We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exercised their myself. mp right 1 l.❑Plumbing repairs or additions ys [No workers' co ri t of exemption per MGL Insurance required.]t C. 152, §1(4), and we have no 12[]Roof repairs employees. [No workers' 13.[] Other comp. insurance required;] *Any applicant that checks box#1 must also fill out the section below showing their work=,compensation poficy information. t Homeowners who sub—nit this affidavit indicating they are doing all work and thea hire outside contractors must submit a new affidavit indicating such. +Contr<-tors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors.have employees,they must provide their wor kers'comp;policy number. amemployer that is providing workers'compensation information. insurance for my employees. Below is the policy_and job site 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 of up to$250.00 a day against the violator. Be advised that a co penalties in the form of a STOP WOE{ORDER and a fine Investigations of the DIA for insurance cover- a verification. PY of maybe forwarded,to the Ofnce of Ido hereby certify u der the pains•and penalties of perjury that the information provided above is true and correct Si atur`e: Date: 2� 0 Phone#.: Official use only. Do not•write in this area, to be completed by city or town official City or Town: Permit/License# Issuinb 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#: Information and Instructions Massachusetts General Laws chapter 152 requires HE employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." r An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartiaents and who resides therein,or the.occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on.such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or to cal licensing a;ency shall withhold the issuance or renewal of_a license or permit to,bpera"te=a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co xopliance with the insurance coverage required." Additionally,MGL chapter 1,52, §25CO)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurame requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s), address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. lf.an LLC or LLP does have employees., a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law.or if you.are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to.contact you regarding the applicant. Please be sureto fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if accessary)and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that.has been.officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is I-JOT required to complete this affidavit The Office of Investigations would like to thank you in advance far your cooperation and should you have any questions, Please do not hesitate to give us a call The Department's address,telephone-and fax number- The umberThe Gozmnonvvealth of Massachusetts Department of Industrial Accidents Ogee of Inveestipfiens 600 Wasl i gton Street Boston,MA 02111 Tel.#617-727-4904 ext.406 or 1-877 I IASSAFF, Fax # 617-727-7749 Revised 11-22-06 _ wwwMass-goyleiia r t 8T 0 0 0 Page No. r' of ; Pages SLS CONTRACTING - Building & Remodeling 6 Bentley.Lame L._..�i CHELMSFORD, MA 01824 (978) 256-4567 FAX (978) 256-8287 OSAL SUBMITTED TO PHONE DATE JOB NAME S A and ZIP CODE JOB LOCATION rr,tcV v DATE OF PLANS JOB PHONE ereby submit specifications and estimates for: �' tG eto ' We Propose hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: dollars($ ). layment to be made as fo ows: G e- Sl mater' is guaranteed to be as pecified. All work to be completed in a workmanlike r miner according to standard practices. Any alteration or deviation from above specifications Authorized .:,%Aig extra costs will be executed only upon written orders, and will become an extra Signature am e over and above the estimate. All agreements contingent upon strikes, accidents or a ays beyond our control. Owner to carry fire, tomado and other necessary insurance. Our Note:This proposal may be e"t�ers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. - . -3e -C Board of Building Regula ons and Standards = One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 105440 Type: DBA Expiration: 7/17/2008 BLS CONTRACTING Steven Lindquist -- ---- - -- 6 Bentley Ln -- ---- Chelmsford, MA 01824 Update Address and return card.Mark reason for change. F] Address ❑ Renewal ] Employment :_ Lost Card DPS-CAI 0 50M-05/06-PC8490 o r o] ui gd&egulVioh's an tan' r s One Ashburton Place - Room 1301 .• Boston, Massachusetts 02108 Construction Supervisor License - License CS: 15810 - Restriction: 00 Expiration: 1/4/2010 Tr# 14344 STEVEN N LINDQUIST 6 BENTLEY LANE CHELMSFORD, MA 01824 Update Address and return card.Mark reason for change Address Renewal Lost Card DPS-CA1 ej, 5OM-07/07-PC8490