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Home My WebLink AboutBuilding Permit #1053-2016 - 50 MAYFLOWER DRIVE 4/7/2016 1� I low NoRTM . (� � BUILDING PERMIT OF1t1-Mo ;b�tio TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION V 0tl Permit No#: 16-J�'�� Date Received �s Rareo 9��5 Sgcmus Date Issued::U1 ORTANT:Applicant must complete all items on this page LOCATION /r Print / PROPERTY OWNER Sugee i'�N• �oW tlG-611U "1+0 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: 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 Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑`Septi6 ®WellF ❑ Flootlplain ®�Wetlandss p ❑ wW�tershedpiDistrcictR I I DESCRIPTION OF WORK TO B PERFORMED: r � + o;54 ttEwwi 4 ..eoeL41 Z. Identification- Please Type or Print Clearly OWNER: Name: �CogeeA4 &,qtivG-vn f 14 Phone: Address: So (M "( Wr- -bP-%Ue If k4o ��ovQ� V14 e ( Contractor Name-e--";*n.`.1 C' t 6-� O Phone: 6 0 8 -3a ,r- 4i6-4a Email: K�y�:�rt Co.".� -s�. Na(- Address: Itel-�a�i4�-Ga- bf GUa �ove� . Supervisor's Construction License: C s 07S'305- Exp. Date: /�lY/ /& Hom nse: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST'BASED ON$125.00 PER S.F. 'r Total Project Cost: $ 11'0V FEE: $ Check No.: Receipt No.: NOTE- Persons contra ng registered contractor do not have ac to the Panty fund naF Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ - TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swhmng Pools, �4 l'❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales` ` Private(septic tank,etc. ❑ ElPermanent Dulnpster on Site THE FOLLOWING SECTIONS FOROFFICE USE ONLY' INTERDEPARTMENTAL SIGN OFF' - H FORM PLANNING DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS I i HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes c Manning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/s�,nature� Date Driveway Permit DPW Town Engineer: Signature: FIRE DEP f LoceJed 384.9sgood Street �;ARtTLIIl1ENN��Temp Du .Al, m ste t o F ¢r- f �' ' ;P n site, ,yes ., b�° �.�x ��;:t r''�no . -,� LocTed at 124, Mam1Streetsx�'�3'�" *GC ►`} +`'s,F � ,a�}. 4r,�,�r,sy ,{��jt t. i ; f•~ �...I� . . , +partmen Mature e, : z �t,A31� ar��da��aiL..+` f.`rart��s3:,iuhr r ' �gL '+ . N r`i r tJ +A 1 i �3 t Yy c ;< �, '` t �.,•t ,~, �� 6:43 " �{ r 4i _ �f;,r MNIENTSf CO a �, .� t #'�'j..if'�ll.fi:+±=J•�' y;.•�rtrt#i '• r ;�• K ' �' � Ft.+ •+� J �'."v ',♦ 1 t i4-. c 1 { r �•t, ,i ';� '`4�+,�,��. r i 7xk' ,�t' � y] ��_{}?'fry 1 -- I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Dieter 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) ........ ----- - -- ....................._ _ ..._.... _....._ EI Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 r 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 a Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application 4. Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit 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:Building Permit Revised 2014 i Location CA No. '�� Date '41 -711tea • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ /� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y_ Check It-7 e�7 �, ;� Building Inspector I NORT1{ Town of 0 to No. ver, Mass, 2Ai ( coc«icKewrcw x.95 R^TED 1 V BOARD OF HEALTH Food/Kitchen PER I T T L D i J Septic System `� BUILDING INSPECTOR THIS CERTIFIES THAT .......... .. .......... :..... .. ...... ....J. .... ...................... .......�.... Foundation has permission to erect ........ ................ bui dings on ....i%........ .. ........ � ... .... .... Rough to be occupied as ............ ... ..��........... . .. .. .... . ......... .. ....................... Chimney -00 provided that the persona ting this permit shall in every respect conform to the terms of the application Final on file in 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 ARTS Rough Service Z :`............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Burner Until Inspected and Approved by the Building Inspector. Street No. Smoke Det. 1 NOTICE NOTICE TO10 o TO EMPLOYEES EMPLOYEES T w i ip�M v The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017 617-727-4900 http://www.state.ma.us/dia As required by Massachusetts General Law,Chapter 152,Sections 21,22&30,this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring vAth: ACE GROUP NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORQ MA 02344-1450 ADDRESS OF INSURANCE COMPANY (GS62UB-OG23626-9-15) 08-15-15 TO 08-15-16 POLICY NUMBER EFFECTIVE DATES �= M P ROBERTS INS AGENCY 1060 OSGOOD STREET - NORTH ANDOVER MA 01845 .� NAME OF INSURANCE AGENT ADDRESS PHONE# OLD SALEM VILLAGE OF NORTH HEPATICA DRIVE & o� ANDOVER CONDOMINIUM TRUST; MAYFLOWER DRIVE NORTH ANDOVER ..:�,. MA 01845 =—• EMPLOYER ADDRESS E'MPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the °-_ injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS W20PIG15 TO BE POSTED BY EMPLOYER Massachusetts Department of Public Safety Board of Building Regulations and Standards Conctraction Supervisor License: CS-075302 BENJAMIN C OSOOOD 69 Old Village La>6e North Andover WR 01(,8-45, � t �A` Expiration I Commissioner 12/04/2016 i; Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supercisar License: CS-0753.02 BENJAMIN C OS 69 Old village Lade North Andover NFA 0 ' r Expiration +4Commissi r 1210412018