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HomeMy WebLinkAboutBuilding Permit #111 - 49 OLD VILLAGE LANE 8/14/2006 TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION o� t,bo gtio �O I * _ Permit NO: Date Received Date Issued: I �SSACHU`����� IMPORTANT: Applicant must complete all items on this page LOCATION i D V, Al A3< .rte, { Print PROPERTY OWNER C "x� ��5 ICY IP�f 1 i Print MAP NO.: 5 9 PARCEL: �"1 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building V107 ne family ❑ Addition ❑Two or more family ❑ Industrial 2,Mteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑Commercial ❑ Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: C h A-t-1 0- R� 11 '� Phone: � o 4 t 5 Address: y °l O CONTRACTOR Name: ���°''`e s 1'� %`�' 'p Phone: ? 6$� �`0 Address: A Supervisor's Construction License: "'�L S "'� '��5 Exp. Date: G 1 k 00 T Home Improvement License: TiCS.l A 13 1d Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PE MIT: 12.00 PER$1000.00 OF THE TOTAL ESTIMAT D COST BASED ON$125.00 PER S.F. Total Project Cost 1 ��'� FEE:$ Check No.: �� Receipt No.: _) 3r) Page I of 4 TYPE OF SEWERAGE DISPOSAL Public Sewer Swimming Pools ❑ Tanning/Massage/Body Art ❑ g Well Tobacco Sales ❑ Food Packaging/Sales El❑ ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund -` Signature of Agent/Owner a0.��� Signature of contractor C,,,,,..a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM I' DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ I 2 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 f Temp Dumpster on site yes_nop Fire Department signature/date Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides RequiredProvided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use � P ) Page 3 oP4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1MC.Jan.2006 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 Addition Or Decks ❑ Building pp Permit Application ❑ 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) i New Construction (Single and Two Family) I ❑ 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 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:BPFORM05 I'm-4of4 �0 H ® of 4Andover No. 0 pyhyL A E dover, Mass.,#Py or COCMIC ME WICK �� ADRATED PP"L\ BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • • BUILDING INSPECTOR THIS CERTIFIES THAT........C... .......N.....�,�,Z „1.,,,,,,,. .................................................. Foundation has permission to erect........................................ buildings on4. ....... OW.....V.tt .....L*....a Rough to be occupied as....�h,�.r'�4.I.I. 4-k i o.InM. . ....*.W.%..... t. 1, Chimney 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 c, ® PENT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI ST TSELECTRICAL INSPECTOR _ Rough ...... ................. Service B ECTOR Final Occupancy Permit Required to Occupy Building x 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. 7E37A Building and Remodeling 5 APPLETON STREET NORTH ANDOVER , MA 01845 (978)682 2023 PHONE/ FAX Proposal August 10, 2006 Proposal Submitted To: Charlie and Sally Nigreli HOME PHONE: (978)688-0845 1-i`1 Old Village Ln. North Andover MA, 01845 Job: New Bathroom Obtain permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. Construction: Totally gut the part of the room down to the studs. Install a new wall to divide the bathroom from the living room. Remove the double window in the back of the house , board it up and patch in the siding. There will be a shower ,toilet and vanity . There will be a closet with a laundry hook up. Wire bathroom to code and install a new bathroom ceiling fan/light combo in the exsisting bathroom. Rough in and finish the plumbing to code. Hang %blue board and skim coat plaster the ceiling and walls. Tile the floor and the new shower stall. Note : There is no allowance for plumbing fixtures There is no allowance for tile There is no allowance for painting A finance charge of 1!/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of: $ 19,975.00 Nineteen thousand Nine hundred Seventy Five Dollars ONE HALF TO START SECOND HALF UPON COMPLETION Authorized signature I reserve the right to cancel this contract if not accepted in-30—days Signature Signature The Commonwealth of Massaelutsetts Department of Industrial:accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name ttlusit,css;t)rzanizalion/lndivialual): ��a'^^ 5 1 e S �' Address: PE � •�+ a - -JNA Vol 0(a 14 is City/State/Zip:t0o jA'i0,,J,(/L Phone 4: al F u an employer?Check the appropriate box: Type of project(required): m a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction 1ployees(full and/or part-time).* have hired the sub-contractorsam a sole proprietor or partner- listed on the attached sheet.' [�'Kemodeling ship and have no employees These sub-contractors have. 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their right of exemption er MGL 11.[] Plumbing repairs or additions 3.❑ I am a homeowner doing all work g P P 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.] *.\ny applicant that checks box 31 must also till out the section below showing their workers'compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating,uch. `Contractors that check this box most;attached an additional sheet showing the mune of the sub-contractors and their workers'comp.policy information. l um an employer that is prowling workers'compensation insurnnee for my employees. Below is the policy and job site information. Insurance Company Name:— _-- ----- —_.---- --- -- Policy 'f or Self-ins. Lic. ?1: --_ _ Expiration Date:__—_—_ —_ Job Site Address: CityiState;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 NIGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP'1VORK ORDER and a tine 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. tdo hereby ce ' • under the pains and penalties of perjury that the information provided/above is true and correct. Sit n,tttire: � Date: FI tv © (O — Dlfcial use only. Do not write in this area,to be completed by city or town ulfrciol. City or Town: Permit/License 4 Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 4: NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: `-(c( 1,A-is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits`are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facili Signature of Permit Applicant Fire. Department Sign off: Dumpster Permit Date s 4�4 REGULp71ONS BOARD OP BUILDING SUPERdISOR CONSTRUCT License ION NumbeVolr: CS, 054718 0610811965 1450 ,wcw Birthdate: 7r.no: a Expire S.0610812008 Restricted: JAMESComrnissiorer ..— 5 APPLEVER,ST p1$45 N ANpO ,• I ��g4p dW Ol��ddd 9 iS'3l S�Wdf 962p2\ O�dWi KWON ted' 1N�W3n o 1io1�da1No ��� 141-OII o 1-5%11 x 3'-4� , 41 II exatetIng bath / \ AV Proposed _ AV Exelsting New Bathroom Q v closet t m x 2/21-411Laundry -V m 31-011 N __ SHELVES s'-1o11 Exeteting bath and closet to remain the same proposed bathroom Sally Ntgrellt 1�10ld village Lane North Andover , MA exeieting living room Location i V, )''9"f'G.- Lew--c. No. Date ATo NORTH TOWN OF NORTH ANDOVER N n i Certificate of Occupancy $ Building/Frame Permit Fee $ 4C MUS ,f Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # a�� � 935 `i 62 Building Inspector