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HomeMy WebLinkAboutBuilding Permit #354 - 5 CROSSBOW LANE 3/31/2008 BUILDING PERMIT Of "o DTH qti TOWN OF NORTH ANDOVER 3� 6`s'- `-M6'° �0 ` .,� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �° "`"' /1 �Ky� qArsot �✓�P x� SSACHUSfc Date Issued: (/ IMPORTANT: Applicant must complete all items on this page LOCATION �5 UrT)E b6 lie. /t+'o, 17j' i 1]t4 P nt PROPERTY OWNER f j�/ l�'P..LV LA t)PJb" ,�7'' `iI,,AJ Print MAP NO: PARCEL:o 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 v/Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESC IPTION F 1N ,TO BE PREFORM E -�- i G1,§T S CCS 111 tl e-r � U Y. 1 r)rn C- te- C EX I ft' S 61&rs entificatio Pleas Type or Pri Clearly) OWNER: Name:22 Y4L-1� .moo yri r d A t"k '!�l'� i/� Phone:9'P'�4 a��� 7L J, Address: dQ(/E'.Y' L z�k.P CONTRACTOR Name: P) Y`' Phone: �� Address: l? r>y , Il . o oe-r Z) Supervisor's Construction License: .3 t ! o Exp. Date: 3-14 -o-010 Home Improvement License: Q 1 ! Exp. Date: ARCHITECT/ENGINEER Phone: Address: 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 �©C) FEE: $ 1 0 o Check No.: '� Receipt No.: l a NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund S nature of Agent/OwnerJ '' ' Signature of contractor - c Location No. 537 Date ✓ � �aRT� TOWN OF NORTH ANDOVER 3?0�,�,•e I•,h� O f e �` A � s �a Certificate of Occupancy $ CH�s Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2iQ2 ; Building Inspector i 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 i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS i DATE REJECTED DATE APPROVED HEALTH COM)JIENTS 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 DEPARTMENT - Temp Dumpster on site yes no Located at 124"Main Street Fire Department signature/date COMMENTS 1' 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 21 A—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 followinga list of the required forms to be filled out for the'is q 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 I 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 KI.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 i I 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 NORTH omm 0 T f Andover 0 No. C. LAKE o_V�• dover, Mass., • 3 ( • a Q COCKICMEWICK ADRATED PPS` �C S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System �, BUILDING INSPECTOR THIS CERTIFIES THAT........P�N4 '.r �1.............................................................................................. �•!�--......•••• •• •• Foundation has permission to erect........................................ buildings on .....�...... ...... ....................... Rough � to be occupied as.... ............................................................! ea(/,� Chimney .......... ..��... .. ................................... provided that the person accepting this permit shall in eves respect conform to a 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 /'T Z PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONS . TS Rough c ..... .................................................................. 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 Industrial Accidents Office of Investigations 600 Washington Street Boston, RIA 02111 www.m.ass.gov/dia ' Workers' Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/,P AapIicant Information Please Print Lesnbly Name(Business/Organizationdndividual): p(J� 1' 1 Gl& Address: . Mo City/State/Zip: Phone.#: Areyou an employer?Check the appropriate box: 1.❑ I am a employer with ' 4. Q I am a eneraI contra Type of project(required)i. g ctor and I Employees (full and/or part-time).* have hired the sub-contractors 6, ❑New construction 2.[ I am'a sole proprietor or partner- listed on the attached sheet 7. []Remodeling . ship and have no employees These sub-contractors have working forme in any capacity, employees and have workers' 8' F-1 Demolition [No workers' comp.insurance comp. insurance.$ 9• ❑Building-addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their ` 11.❑Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL insurance required.]t c. 152, §1(4), and we have no 12.0 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 workers'compensation policy information. t Homeow-ners who submit this affidavit indicating they are doing all work and them hire outside contractors must submit a new af'f'idavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-conv=ters and state whether or not those entities have employees. If the'sub-contrdctors.have employees,they must provide their workers'comp,Policy ori number, 1 am.an employer that is providing workers'compensation insurance for my employees. Below is the policy.and job site information, Insurance Company Name.- Policy ame: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 tothe imposition of criminal penalties-of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the O Investiations of the DIA for ins Office of insurance coverage verification. I do hereby certify under the vainVndpenalties ofperjury that the information provided above is true and correct Si ature: Date: " d 9 Phone#: Official.use only. Do not write in this area, to be completed by city or town o iciaL ff City or Town: Permit/License# Issuing Authority(circle one): '1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing In 6.Other g spector Contact Person• Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensationffor 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." i 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 apartments 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"ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to,bpera'tera business or to construct buildings in the commonwealth for any'., applicant who has not produced acceptable evidence of compliance with the insurance coverage required." 3 Additionally,MGL chapter 162,§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 insurance 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-contractor(s)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. If.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 sure to 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 necessary)and under"Job Site Address" the applicant should write"all locations in ( ty ci 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 1-40T required to complete this affidavit The Office of Investigations would like to thank you in advance for 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 Commonwealth of Massachusetts Department Of Industrial Accidents Office of Investgations 600 Washington Street Boston,IMA 02111 Tel.#617-727-4340 ext.406 or 1-877-MASSAFE ` Revised 11-.22-06 Fax 4 617-727-7749 t www.mass-govldia I 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: �ass d 0�12. IV,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: -SY- (Location of Facility) Y i Signature of P 't pplicant Fire Department Sign off Dumpster Permit i Date I Board of Building Regulations and Standards - -_ License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration;, 159019 Board of Building Regulations and Standards Expiration_3/26/2010 Tr# 265660 One Ashburton Place Rm 1301 1Type: Individual Boston,Ma.02108 : { PAUL A.PIEROG, PAUL PIEROG r r a 1000 TURNPIKE ST`-, NO.ANDOVER,MA 01845 Administrator Not valid.without signature I aril o7t7io n an 'ard Construicense LiExpi010 Tr# 19439 Restriction: 00 x0. PAULA PIEROG_. 1000 TURNPIKE ST N ANDOVER,MA 01845 Commissioner II I I I HIC # 126-356 ®Yb �oior�p �uirber�, �r�r. 13 SEWALL STREET PEABODY, MA 01960 OFFICE: 978-922-6120 SPECIFICATION SHEET Home Phone: < . .' . r' Owners Name . . . .': r'. � :,.'.'.'.>.? . . . . . . . . . . . . . . . . . Work Phone: .,. ... . . . . . . . . . %l J Nome Address .,,. . . . !':- :'. r.� :�'-. . r. . . . . . . . . city .!' . !. :: •—.•� . . . . . . State . �c' ., Zt p . . . Job Address . . . . . . y _'. :'.;: :• City . . . . . . . . . . . . . . . . . . . . State . . . . . . . . . Zip . . . . . . . . . SIDING 1.Siding Type(�; ,. ., :'.� -':1:�. . . "` . . . . .'�.�. " Width �. . . . . . . . . . . Color . . . . . . 2.Area to be done. Main House .'. . ,.'. . . . . . . Breezeway . Garage .` . . . . . . . . . . . Additions .. . . ..... . . . . . . . Dormers .'. . .` . . . . . . . . . :. . . . . . . Other . . . . . ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r 3.Insulation . . .. . . . . . . ... . �. . . .. . x r`. 4. Trim cover U Yes U No Color . . . :. . : .E . . . . . . Trim to be done: Soffits . . .'.". . . . . . . . Fascia .' ; . . . . . . . . Rakes . . . . . . . . . . . . . . . . . . . . . . . Ceilings t`.'.-._. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 5.Casings . {. ... : _ -t. . . . . . . . . . . . . . . :. . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . 6.Gutters and spouts L] Yes J No Use heavy gauge seamless . . .e. ! . ..: . . :. . ' . . . . Color.... . . . . . . . ..Z. . . 7.Shutters 0 Yes ,E No . .'.i r-,. :: :�%'!.> :_.� :. . %, . . . . . . `. .. a. . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . 8. Windows and Doors . . `. . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ROOFING MaterialType . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Color . . . . . . . . . . . . . . . . . . . . . . . . Areasto be done . . . . . . . . . . . . . . . . . . . . . ..'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Remove existing shingles Ll Yes J No 45 lb.felt . . . . . . I . . . . . . . . . . . . . . . . Metal Edging . . . . . . . . . . . . . . . . . . . . . . . . . . Chimney and vents, elc. . . . . . . . . . . . . .r. . . . . . . . . . . . . :. . . . . . . . . . Other.`. . . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . . NOTES, '. . , ..1 . .�` :..- .a: . . . . . . . . . ... ... . . . .. . .C".`. . . . . . . :. . . �✓`. . . .: . . . . . . .'�. . . . . . ._. . . . . . . .�.. . . .,. . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1•;i . . . . . ... .i: . . . . .r` x'j -�. . . . . i �. r; . . . . .'f . . . . . .}. . . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .J. . . . . . . : ... . :. . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .�. . ... .�. !. . . . . . . . . . . . .. .-. :�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . .•. .': . . . . . . .Deposit Material and labor to cost$. . . . . .`. . . . . . . . . . . .payable as follows: $. . . . . . . . . . . . .I st Installment $. . . . :. . . . . . . .2nd Installment $. . : . . . . . . . . . .Balance on completion Contractor will do all said work in a good workmanship manner. You may cancel this agreement if it has been consummated by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you nottfv the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. IN WITNESS THEREOF,the parties have hereunto signed their names this. . . . . . . . ... .. . r,..,/. . . _.day of. . .. . . . .f. . . . . 20.L. . . . Accepted: " Signed. (. . . . .�. . . .� ',t.'.' . . . . . . . .!'. . (91b Coroup 'Muilbrrq, 3btc. Owner e' Signed. . . . . . . . . . . . . . . . . . . . . Owner Per. . . . . . . . . . . . . . . . . � . . . . . . . . . . . . . . . . . . : Representative Authorized Rep. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Strikes,labor disputes,inclement weather,or material supplier delays resulting in work stoppage are beyond the control of the company. No2 '174 _ ......../....��......��...d� NORTH Q • °!,"'°;•1" TOWN OF NORTH ANDOVER a ` F? �•,r ... -••OLP PERMIT FOR WIRING g �,SSACMus� This certifies that ...... ..L.O.:... :.......5. .c��?��.�.f ... ys. ..... has permission to perform .............J .x.41...... �.R ........................ wiring in the building of J2ti..r.Y../ ;it.... y—....C.. d.5.5.......f.os!�:........!7:k�......... ,North Andover,Mass. Fee.-, Oe-.OJ. Lic.No.. �................................................................. tl ELECTRICAL MpECTOR C� cP-7�r� WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Use Poly a The Commonwealth of Afassachusetts r..,ats •.. *- Deportmertf of Public Safcty Occupancy S ter Checked BOARD of FIRE PREVENT10N REGULATIONS S27 CIdR 1200 3/90 tle,ve blank i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK NI work to be performed In accordance With the Massachusctu f'sieetrieal Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) � Date City or Torn of__hL. RNDQVe � To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Lou tion (Street & Number) Owner or Tenant- tv i—eLe omig '7 Owner's Address SAME t9 .79) r —56 1 4 Is this permit in conjunction with a building permit: Yes ❑ No 91 (Check Appropriate Box) Purpose of Building Utility Authorization 110. Existing Service Amps / Volts Overhead ❑ Undgrdl No, of Meters e New Service Amps / Volts (Overhead ❑ Undgrd❑ No. of Haters t Number of Feeders and Ampacity Location acid Nature of Proposed Electrical Work Installation of Alarm System No. of Lighting Outlets No. of Hot Tubs ' No. of Transformers Total KVA No. of Lighting Fixtures SwimmingPool Above In- grnd, ❑grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting t Battery Units No. of Switch Outlets No. of Cas Burners FIRE ALARMS No.-of Zones No. of Ranges No. of Air Cond. Total one No. of Detection and Initiating Devices No. of Disposals No. of pumps Total Total Tons KW No. of Sounding Devices` No. of Dishwashers S ace/Area Heating KW No. of Self Contained Space/Area Detection/Sounding Devices No, of Dryers Heating Devices KW LocalEl Municipal ❑Other Connection f I No, of o. o of e No. of Nater Heaters Si ns Ballasts cin g No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO 0 I have submitted valid proof of same to this office. YES❑ NO ❑ If you have. checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify) ©p Expiration ate Estimated Value of Electrical Work S d Work to Start. Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME A.D.T. SE_CURITV. SYSTEMS NORTHEAST INC. LIC. No. 1231( Licensee DONALD A BROOKS ignat a N0. 123.IC Address 11.1 Morse Street, .Norwood, MA 02062 s. el. No-4413) 737-4400 Alt. Tel. No.(7R1). 9 1 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or is sub- stantial equivalent as required.by Massachusetts Ceneral Laws, and that my_signature _on .this•-pernit�-4-:_ ' application waives this requirement... Owner- Agen (Please check one) !!�� Telephone No. PERMIT FEE S �7 Signature of Owner or Agent C� .