Loading...
HomeMy WebLinkAboutBuilding Permit #103 - 49 PATRIOT STREET 5/1/2018 Of gORTM 9 a pL TOWN OF NORTH ANDOVER � . .•�•' APPLICATION FOR PLAN EXAMINATION +err° 9SS1CHU5E Permit NO: IQJ .3 Date Receit— Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Prin PROPERTY OWNER / Print MAP NO.:_J_,_3 PARCEL: / ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential 0 New Building ?15ne family ❑Addition ❑Two or more family ❑Industrial lteration No. of units: ❑ Repair, replacement ❑Assessory Bldg 0 Commercial ❑Demolition ❑Moving(relocation) ❑ Other 0 Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: /V) �� o 4 ht /� �� odPhone: nature Address: V9 a -!:—: � CONTRACTOR Name:/ l !.� L� 1 0:V Phone: 94 `6'kf_0173/ Address: 55 Supervisor's Construction License: Exp. Date: �op" Home Improvement License:—/ Exp. Date: �D ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE:BULDING P IT:$10.00 PE1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost x10.00=FEE:$ Check No.: Receipt No.: Page Ioi'4 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 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) 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 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 Page 4 of 4 I ■ I TYPE OF SEWARGE DISPOSAL Public Sewer Swimming Pools ❑ ❑ Tanning/Massage/Body Art Elg Well F1Tobacco Sales ❑ Food Packaging/Sales 11 F1 Permanent Dumpster on Site ❑ Private(septic tank, etc. NOTE: Persons contracting with unregistered contractors do not have access to the guar ty fu d Signature of Agent/Owner Signature of Contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other 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 Temp Dumpster on site yes no_ Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 �I Building Setback ( Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft..- NOTES .:NOTES and DATA—(For department use) I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created IMC.Jan.2006 i f Location t "r► r'! L7 � �'!a`� No. /9 3 Date 7d ,.ORTM TOWN OF NORTH ANDOVER F A 4 Certificate of Occupancy $ �'�s"•n° '<� Building/Frame/Frame Permit Fee $ s�C usE 9 Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ Check # 19343 - ` m Building Inspector Kt(,— NORTH 0 of _: t 4Andover 0 No. 3 Co dover Mass. O '- l A K 1 ' �- COCMICMEWICK V �d DRAT-ED P'V S BOARD OF HEALTH Food/Kitchen Septic System , PERM T T DBUILDING INSPECTOR THIS CERTIFIES THAT...... ..0. . h.,,,., ,.. ., ..... 0 .................. ....... ..... ...... ........ Foundation has permission towe�t: .!�.". M .. buildi gs on ... .. ... �.. .. 'e.�l. , �. . ugh Ro to be occupied aS...�..A. �...... .M.A.. C�..1It. Chimney provided that the person ac ing this permit shall In. ery respect con orm tterms 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough ...... ...... ------------ Service UILDING INS R Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous -Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Bumex DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P.0.Box 1025 State Road,Stow,MA 01775 PERMIT Date: North Andover permit No (City of Town) (If Applicable) Uig Safe Numf�er In accordance with the provisions of M;�'it 8 Chaptte�as provi in section S 2 CMR M R 3 4 Start Date � /7 This Permit is granted to: �� G��O�` Full name of person,Firm or Corporation Perrnissionto locate dumpster for construction/renovation/demolition of building Comments: dumpster must be 25 ' from structure if unable to place with required Restrictions:cleara ce dumpster must be covered with plywood or tarp end of work day at . (Give location y street and no.,or describe in such manner as to provieedd adeq t t ntification of location) FeePaids 50.00 "'1'41, Y// Fire Chief This Permit will expire, ,�-J]704 (Signature of offical granting permit) Offical granting permit (Title) �� TI-IIR PFRMIT MI ICT RF r'r1NRPlr i inn IRl V Pr1RTFn I IPr)M THF' PPPUMPR �� t ? \ At, Commonwealth of /11ns.tn< 1lll.S('ll.S r' 1)('1J P-011('llt Of 1111/115117111 ACCidt'llt.S 1 Alli(-('Alli( (Il 1111'(',511 atloll.5 600 lhashim toll ,Streit Boston, I LI 02111 n'lprt'.nrnss.gori(lin Woi-kers' Compensation Insurance Affidavit: Mlilclere!( ontrncftlrs/I,lectriciansll'Itttttl�ers Applicant Information Please I'rint L,e;?ibly Name (nosiness/Organization/individual): eIl' - Address: City/State/Zip: O rtt/ f,(�1'flctnc ff: 7� �Y7_.._ ..--------- Are you an employer? Check the appropriate bo}: •i ypc of project (required): 1.❑ 1 and a employer with 4. 1 ata general conilarfor ;uui f f, (� Ncw<:rnlsUuclion employees (full and/or part-time).* lhavc hired the suh-contr,hclors 2.El am a sole proprietor or partncr- listed on tl,c atU;clhcd slice: i 7 `� Rcnuxlelin� ship and have no ciiiployecs 1•hese sub call(.Actors 1mvC R. i)entolilion working for me in any capacity. workers' comp. insut;ulcc 9. Building;id(lilioll [No workers' comp. insurance 5. ❑ We arc a corporation and its required.] officers have exercised their 101-1 f;lecllicai repairs car additions. 3.❑ I am a homeowner doing all work right of exenlpfioil per \}(.1. 1 1 ❑ Plumbing repairs car additions myself. [No workers' comp. c. 152, §1(4), and wc.have no 120 Roof repairs insurance required.] t employees. [No workers' 13J- Oihcr C'm1p. insurance equaled I _.-.__--- 'Any nlq)licnnl that cliccks lm fit must also till out the action below showing Ihcir wockcrs'cent{+cnmli,m policy infi+nnnhion. --- t Ilumcowners who sulmhil this aMdavit indicating they mre doing nil wohk noel then hire oulside contcmdms aunt^ulmhil n new nrlitInvit indicnt ing mach. lCunhaciots ilial cheek this box must attached run ndditionnl sheet showing the umn,c or the sul*cnnicnclots nod their wuhke+s'comp.policy inr<,ihrhalion. I arrt an enlplayer that is pl'oviding workers'collriacnsalion insurnnce for my emplorccs. Below is Clic palic.l' and job .cite irtjvrrnntiv►r. // /�/ Insurance Company Name: Policy 11 or Scif-'ins. Lic. #: I 2-o'D _� - - — i:xpir:ttion Job Site Address: 7 c `mit A-11_ City/Sl;llelzip:_ A/ Llpeep, Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Faiitrte to secure coverage as required under Section 25A of MGL c. 152 can Icad to 111c imposition ofcrinlinal pcuaitics of fine tip to $1,500.00 and/or one-year itnprisonnlenl, os well a.q civil perlaliics in the form of;i STOP WORK ORDER m(l a fine of tip to 5250.00 a day against idle violator. Be advised that n copy of this s1;1(crllcnl 111;1y be forwarded to (he Office of Investigations of the DIA for insurance covcrage verification. 1 do lua-ehp reiYi under the pains acid I')I'll of Ileljln)• that the ir+lnrrrrntion Iu-orirlyd ahove is line all correct. + �ioattirc: _—.. --- _-.--- _ . - D;1tC Phone tl: - �/ ---- - — Official use only. Do not write in this mica, to be completed by ritl• ur Icrhh'lr of ficial. Cil)' or Town: -----___-- Issuing Authority (circle one): . 1. Board of iicaltlt 2.Building ncprtnctit 3. Cit fown Cl -k -1. hle06cal ins ecor S. Plmnhilig lnsheetol. 0. Other Contact Person: _ Mimic tl: Page# of ages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted T • Job Nae Job# '(�,k Address L Job Luca' n L2��q� 4 Date G � Date of Plans fee Q Phone# Fax# Architect rwehereb submit specifications and estimates for:-.-.—. P We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: $ ' DU ✓ �.�G� Dollars with paym nts to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order,and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted/within days. rr�� !acceptance of Pr ga The above prices,specifications and conditions are satisfactory and are 4'Signature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature