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