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HomeMy WebLinkAboutBuilding Permit #670 - 50 FARRWOOD AVENUE 4/5/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: / IMPORTANT: Applicant must complete all items on this page PROPERTY OWNER r 41# Print MAP NO: &k �-PARCEL:� ZONING DISTRICT: If i Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑ Well 0 Floodplain ❑ Wetlands 0 Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: / �� ��' Phone: 5W - S'7Y-3f� Address: ��� �i Z� fir= Supervisor's Construction License: 7Z 4 Z 4�' Exp. Date: Home Improvement License: / 2 7 <e 3 Exp. Date //--/ 4,-/ z- ARCHITECT/ENGINEER ��'ci Phone: A0 ly Address Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMA Total Project Cost: $ �"J, � ' _FEE: TED COST BASED ON $925.00 PER S.F. Check No.: a'y Receipt No.:� y0.3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 1Signature of Agent/Owner Signature of contra e--, --- ,x - Location �) U �vviqa No. r Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ CH Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# Building Inspector 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 -PPE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes _ • 4 Play ming Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes, Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no 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 No vin �-- �w� ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008mi 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 ❑ 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 MOTE: 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 90TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit i all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals 'at the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi * Massachusetts - Department of puhlic Saeet) Board of Building Re�oulations and Standards Construction Supervisor License License: Cs 72629 V Restricted to: 00 BERT G INGS .ROBERT # 85 RIVEREDGE RD N BILLERICA, MA 01862 I Expiration: 5/3/2012 ('ununissiuncr Tr#: 25994 E Of£ceqto umer j' si ea�h�ss f HOME IMPROVEMENT CONTRACTOR z Registration: 127563 Expiration: 11/16/2012 Type: Private Corporation' � I 'CONTRACTORSING I ROBERT INGS ` 85 RIVEREDGE RD., BILLERICA,MA 01862 4 Undersecretary I s MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t (Print or Type) l NORTH ANDOVER Mass. Date 93� Y iauilding Location 2lyD?Jp A1J� Permit # �� Zd Owners Name �� /? 7�Vt77`-�I New .7 Renovation D Replacement JU Plans Submitted FIXTURES (Print or Type) Check one: Certificate Installing Company Name Corp. Address aZp Partner. 54-.y-•- Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter �,j�-yf �I - ©'o•✓�/G `v Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy M Other type of indemnity Q Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent I hueby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowtedse and that all plumbing work and installations pafonncd under- Permit issced for this application will -be in compliance with all pertinent provisions of the Massachusetts State Cas Cade and Chapter 143 of Use General LAws. - By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber Gasfitter iiigna.4re of Licensed Master Plumber or Gasfitter Journeyman r 45-- n7 tS% License Number moons mom MMIMEMM�MNIMEEM (Print or Type) Check one: Certificate Installing Company Name Corp. Address aZp Partner. 54-.y-•- Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter �,j�-yf �I - ©'o•✓�/G `v Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy M Other type of indemnity Q Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent I hueby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowtedse and that all plumbing work and installations pafonncd under- Permit issced for this application will -be in compliance with all pertinent provisions of the Massachusetts State Cas Cade and Chapter 143 of Use General LAws. - By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber Gasfitter iiigna.4re of Licensed Master Plumber or Gasfitter Journeyman r 45-- n7 tS% License Number Date... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Vto This certifies that .......... ...................... has permission for gas inst flation in the building, f .... I .14.e ..................... at lZr North Andover, Mass. A1.4K-3/.)L10 00. . M4� S . INSPECTOR ........... - �t-t WHITE: Appi'-,--A—t C2AR�YB.iZ111g Dept. PINK: Treasurer GOLD: File • z s.; O GQ w° cin 0 w a Z O =o m m 0 w ~ � a �. a U Wcz co Cf)w a O C7 C w GG O Off. o 11 cn Q cn ui am 0 z O U C/) s e O yO O =o m m C ~ � co :oftm o� C V O Off. M: �� • � wv CO2 C � c Cc Cc v •: a:=c O r Cc Ca Z C Q �..± o c O C C C c 0 CLCO3 0 m� s� �ca co "D C o 5cm c E -Me d o C' 3La m ... N N A Cl C.i O H o x cm coQ ' N O O m :C.3�Z Cl w c O` O CL y m C cm c O Q m mw 3 x ~ r0. N m N D COD •O' '"1 � t .._ ,r c .. .co o c CD H W . y az E v 'p COD •t z C V m ca O F— Q VC = d O� O' M e = O CNv .'O.. = a CL 0 z O U C/) s C o' O yO O .9 m m C ~ � co :oftm C cc O Off. M: cma CO2 C � c Cc Cc v J .o O co C Z C Q �..± CL y O C C C c CLCO3 0 Date... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .....' ...................................... . has permission for gas installation ................ in the buildings of ............ ...r:......................... at ....'... s ...:...::..:..... ....... , North Andover, Mass. Fee..... Lic. No........... .......... GAS INSPECTOR Check # _ v� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:�i ► Av1� OV Q`�' , MA. Date: \O o O� Permit# 6 9 Location: Owners Name:)XQrAorQ Building Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ® Replacement: Plans Submitted: Yes ❑ No v� INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ! No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 9 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Title City/Town eoaaOVF❑ (OFFICE USE ONL Type of License: ������� ® Plumber.c�C1�,� ❑ Gas Fitter Signature of Lildbnsecl Plumber/Gas Fitter Master '�\% ` ❑Journeyman License Number: ❑ LP Installer WW Y Ui = X 1— W fn 0 W N U W U ON0= w W m 2 zO Z F- C7 z J O H fn W 0 � 0 W � Q 1=- rn w W > W 9 W� m Oo O� Q = U) n. 0 Q W w= LL 0 U > 0 W z W C7 Wz J F- N 0 z J W C9 F- LL W IN„ = Z W W F W W W z W� rn —' Q Q m W 0 z 0 v, > z Q H SUB BSMT. BASEMENT 1 FLOOR 2 N u FLOOR 3 FLOOR 4 FLOOR -5'FLOOR -6 "FLOOR 7 FLOOR 8 FLOOR .. � Check One Only Certificate # Installing Company Name .?'.L' ► � a nit ��501�1 j c� City/Town z+s � �^ State: � Corporation Address: � \� r"' !!` SS - 4 �"i ❑ Partnership Business Tel: L'tiCj1 CsaV11% ��t'"�� Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: t^Q �.'� ►C� a�`�� INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ! No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 9 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Title City/Town eoaaOVF❑ (OFFICE USE ONL Type of License: ������� ® Plumber.c�C1�,� ❑ Gas Fitter Signature of Lildbnsecl Plumber/Gas Fitter Master '�\% ` ❑Journeyman License Number: ❑ LP Installer 7_ O U w A. v z a z c� C7 w F LW w .j O W q V) o O z m U H_ w W. o W � a Ow w w p0 7^ z O F � w a ,o a Q w W m U a a vj Q ui W w 7_ O U w A. v z a z c� D z w z w U w LW .j 0 o z m W. m w w p0 7^ z F � w a a Q .d W m r D z w z w U