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HomeMy WebLinkAboutBuilding Permit #640-12 - 505 FOREST STREET 3/6/2012TYPE OF IMPROVEMENT PROPOSED USE Res' ential Non- Residential ❑ New Building ne family 3 ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Others: ❑ Repair, replacement ❑ Assessory Bldg *-Demolition ❑ Other -S - Septic .,,❑.Well._ 0 Floodplain ❑„Wetlands ❑Watershed District ater/Sewer II .Date OWNER: Name: Address: 00 { ION OF WORK TO BE PREFORMED: n Please Type or Print Clearly) 4 4 CONTRAC ' AOR Name t �h Phone 3 w ;Address - '� L __ it t0 v �� .tNI�sS. -S - I Supervisor°s� -,,o ruction tLscense: Exp .Date `Home ImprovementLicense _ _,Exp.: bate:_-__ _ it ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ a '506 FEE: $ 30' Check No.: L b Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the 'quaranty fund Location No. & Date3 Check # lo 0 1 -?— TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL $ 25074 Building Inspector 4 15 6 0 Date ...... / ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................................. / ....................................... .............. 64as permission to perform ........ o, v wiring in the building of ..... ................................................. I r05-- I-Wr5t at...... c ........................................ S./ ....................... /. North Ando S. Fee .... .. Lic. Nw.-tj�10 .......... 7" ELEcrRicAL INSPECTOR Check # Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL , Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Poo is Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 - Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed o COMMENTS HEALTH i Reviewed COMMENTS, 1 1 �- DATE REJECTED DATE APPROVED ❑ ❑ L—/r e' - Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: 'FIREeDEP Y - Located 384 Osgood Street A_RTM NT rTemp Dum:pstbt on site eyes Locatedrat°124 Main Street firerDepa_ r_ men 's signature/date r CQMMENTS t , . t __. - 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 d ent use Ll Notified for pickup - Date Doe.Building Permit Revised 2009 Building Department The following is a list of the required formsAo be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application D Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract ❑ r ropos d Interior Work ❑ or Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application Li Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 o 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 I Hydraulic Calculations (If Applicable) ❑ Copy of Contract Li Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: 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 2008 CA 0 Cd i■i 0 5'0 �CD c o ` : O y CcO V �L w ev ev w W a a O W 7t. 0 0 C. y.. C4 E c IImo: ® ° a a U G w y R w°' cn w Qf C C,o w w cn cn' 5'0 �CD c o ` : O y CcO V �L ev ev oc s o 7t. 0 0 C. y.. C4 E c IImo: m c y R C Qf C m 4 A D O O CL y m W O C Q y i.7 Z cc 0 CL Q m `-.m C = m p Q— y m �� COOyr W C .0w'fl = LLm +' C +r 44 CL. .y W •E v,= v ci a �.,®.._ o C* mCOD H .0 a' Q.._..m The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington .Street oWt Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r Please Print Legibly Name.(Business/Organization/Individual):. r�QI� PoV,h� [gumbal . Address: l*5 W'ui Pr Sf *l 00 W 3 S 3 City/State/Zip: AN Mj (A4, W 016&5 Phone W: UT V 3� q 07 Are.you an employer? Check the appropriate box: 1. YI am a employer with ' 4. ❑ I am a general contractor and I employees (full and/or part-time):* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' coma. insurance reauired.l Type of project (requir 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.11 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.E50ther F,111 11A POO' *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Nakewf Grrhe Policy # or Self -ins. Lic. #:' Expiration Date: Job Site Address: SOS F��5� SE, 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 to the 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 Office of Investigations of the DIA for insurance coverage verification. I do hereby(certify under the pains gn'�i�enalties of perjury that the information provided above is true and correct. Signature: Date: r Phone #: not write in this area, to City or Town: or town official, Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact. Person: Phone #• Alassaehi usetts Home -Improvement Sample Contract ii This form satisfies all basic requirements of the state's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard language to protect homeowners Seek legal advice if necessary. Any person planning home improvements should first obtain l copy a da Massachusetts Consumer Guide tC! (Home Improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Bi iness Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. . ���n�ome9weer Iai<formati0n ntractor Information KG�F6tR� I I (/„fl. � �R • Street Address (do not use a Post Office Box address) Countractor/ Salesperson/ Owner Name , Ci /Town �y 13 �Iq rtes 5 {. J5 fV U State j Zip Code Business Address (must include a street address) Daytime Phone Evening Phone own State State Zip Code - 3Mailing Address (It different from aboSe) q9l-Y0- Business Phone federal Employer ID or S.S. Home Improvement Contractor Re;. Number Law requires flint most bomo improvement contractors have a valid registration number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the workto completed, specifying the type, brand, and grade of materials to be used, use additional sheets if necessary.) Required Permits -The followinglbuilding permits are required Proposed Start and Completion Schedule -The following schedule will and will be secured by the contractor; as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their oivn permits will be excluded from the Guaranty fund provisions of S Z ! Date when contractor will begin contracted work MGL chapter 142A.) y :j I a 2 Date when contracted work will be substantially completed. Total Contract Price and 'Paymemt!Schedule The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of. C?� I Payments will be made according tothe following schedule: $ upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater) $-----_ by /_; or upon completion of $ byL or upon completion of $ 506 upon completion i the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted ,�oilc begins in order to meet the completion schedule (**) $ to be paid for NOTES: (*) Including all finance charges (**) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of i (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Ex ress Warranty -Is an ex ress warran beinrovided b the contractor. Subcontractors -The contractor agrees to be solely responsible for completion of work described regardless of the actions of any thud materials and labortmder this ontract Party/subcontractor utilized is a the contractor. The contractorcement further agrees to be solely responsible for all payments to all subcontractors for Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lieu lir other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contracts li • Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. • Malce sure the contractor has alvalid Home Im rovement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registerediwith the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by rect writing to the Dior at 10 Park Plaza, Room 5170 Boston MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. • I{now your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her mainigffice or branch office 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. See the attached notice of cancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BL itr T o Iden wa copies ofthe contract must be completed and signed. One copy should go to the homeowner. The other copy shouldSljopt by the SPACES!!! 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This certifies has permission to perform plumbing in the buildings of ?,M -5'K/—( ............ at ..... North Andover, Mass. Fee$.6,j�?�Oc' Lic. No. .. ..... Check # /0 PLUMBING INI�R 5426 r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location 6-66- rO R'eS�- Sf Owners Name �pu1 ?/I JAS 9 ke Permit # 1E9 -95L- - r"-7, /' Amount &&0 �— Tvpe of Occupancy � /'G�-��% New Renovation Replacement FIXTURES Plans Submitted Yes No (Print or :type) Check one: Certificate Installing Company Name_ J p 4 rl j rf?41V,0iPj4A1%:— -P Corp. Address CQ le- 9-1/ 51411 W 'AA 026ZF r Partner. Business Telephone g _ �s g^ 7 AR S- Firm/Co. Name of Licensed Plumber: 3A N, 'rQ 14 W 61 P14 W �- Insurance Coverage: Indicate the type f insurance coverage by checking the appropriate box: Liability insurance policyEl Other type of indemnity ❑ 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 Signature Owner ❑ Agent F1 I hereby certify that all of the details and information I have submitted o entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations,pOrmedunder 't Issued for this application will be in compliance with all pertinent provisions of the Mass huse, s State�',lrnnbir Cock anChaj-)rM142 of the General Law&.' By: `Type of Plumbing License (4,2012 21 icense m er Master ❑ Journeyman :;N Department of Fire Services BOARD..OF FIRE- PREVENTION REGULATIONS Pen -nit Na. Occupancy and Fee Checked: (Rev. 111991 (leave blank) APPLICATION: FOR. PERMIT PERFORK ELECTRICAL MIM All work tobe performed in accordance with the Massachusetts Electrical Code,(MEC), 527 CMR 12.00 - (PLEASE PRINT IN INK OR TYPE ALL INFORMA TIOA9 Date: /0 %n_02_ City or To of: Ab AA�X VZTZ - Ta the- Jnq7e&crof Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work-descn-bed-below. Location (Street & Number) Owner orTenant - &W, ) Owner's Address X: Telephone No. Is-this-permit-in-conjunction-with.-a-buikUng•Permit? Yes - [,].No ], (Check Appropriate Box) Purpose of Building_�' �&C- Utility Autherizafion No,. Existing. Service Amps I Volts Overhead Undgrd New Service Amps- I Volts Overhead F�, - Undgrdfl Number.of Feeders and Anipacity Locadon-andNature-of -Proposed -Elfttr-Kal-W,wk:. No. of Meters No: ofMleters- - mv nr t,?Np oym he waived by the hLmctor.of IRML No. of Recessed Fixtures No. of CeiL-Susp. (Paddle) Fans.. INO. of. Total ftransfermers- . KVA No. of Lighting, Outlets No: of Ele-Tubs - Generators KVA No. of Lig Fixtures.. Swinuning.Pool Above [I- In- grnd. grPAL of Emergeney Lighting - R.Units_ — No. of Receptacle- Outlets No. of OU Burners FMK ALAICHS , —of I No. of Zones No. of cites No. of Gas Burners Nob Detection -and 1nit2ating–Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste -Disposers- Heat Pump - Totals. I Number I Tons I KW N&_of SeMontained tioulAierii Devices - No. of.DisbvvasiteM Space/Area Heating� KW L.caL.n um'UP21ts Other No-of.Dryers. Heating Appliances KW Security Systems: Noof Mvites or E "valent- _ of -Water Heaters_ KW No -of No. of Signs Ballasts- ' Data.wiring: No: of Devices -or Equivalent N4_H-ydiomassag,e Bathtubs No. of Motors Total HP- eleconununications wiring: No. of Devices or E4uivalent OTHER: Allach aaamonat aefalf y aesirea, OF as reqzurea-uy uw.­*� uj 1M.I.- JNStjRANCE. C0VERAGF, Unless waived by the- owner, n& permit for theperformame of electrical work may issue unless... . the_ licensee provides proof of liability irmarance,including. "completed operation" coverage. or its subst-aitial.equivalent_ The- mutersipacerrifies-fttsa(zh-cov=geisirrfome-;and-hasexh%Aedpioaofsanwtothe-perrfaitissuiugafE= CHECK -ONE: -IR'. BOND[:f' OTHER [I (Specify:) 1 —0 C) ? (Expiration Dzte�) Estimated Value of Eliectrical..Wark:- , t (When rc-quired-by municipal policy-) Work-to.Start Inspections to be requested in accordance with IVIEC Rule 10, and upon completion. I certyjf, under dw pains andpenalties qfperjary, that the information on this applicadaq is true and complete FEM,NATV1E:G'kjUTz_tW b;-Lwrj�� - d/ UC. NO-- A- 15301 Licensee. (If applicabi Address: a Lam aware LIC. NO.: HJUL TeL..IWo TRIP. No.: does not have the liability insurancecoverage-normally required by law- ELy my sWat=_be1ow1 I hereby waive this requirement I am- the (check one),[] owner Q Gwna Owner/Agent SiLmatum Telephone No.. PERMIT, FEE. $ r,,dJ