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Home My WebLink AboutBuilding Permit #40 - 530 TURNPIKE STREET 7/14/2009 L o� OORT BUILDING PERMIT qti T6 0 TOWN OF NORTH ANDOVER o i APPLICATION FOR PLAN EXAMINATION00 Permit NO: Lo Date Received 3 "0R,T.o�•�".�y 9SSACHl15�� Date Issued: IMPORTANT: Applicant must complete all items on this page °�' � " .w'`T"` `s�'- ., �`a i r�w* f y„ "� 4 d •r`a `moi KIWI` 'C z IC �� 1k5 ` sMIN, a a� z.- }rs. a .�`„� r '.:ter"- -arc �7 �+•.,. � zw ;.i. . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 1 New Building ❑ One family [I Addition ❑ Two or more family 13 Industrial ❑ Alteration No. of units: kCommercial ❑ Repair, replacement ❑Assessory Bldg F Others:-e_r7,,o, 7'en ❑ Demolition ❑ Other t.. -�•,. � � .r.�-t �`�� •3�;; - .3•E a:a* _�� .� � :�. a`.t.p„x t:� DESCRIPTION OF WORK TO BE PREFORMED: 7o /-0-P1 -7�7 7 as oP Idep tification fleaseType or Print Clearly) OWNER: Name: So� `r, �v+e. Phone: 51/12 Address: le-z x 04 ilk Ed $ � r �• 1 �. �� xa, � � ,�•s.,�a� "�':.yy �,•�..^ms ,��f�,'�4. 's°", T � � �+ ,� fr „�'� 7l � � �4 p� � •'V�rra 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: $ b�'.57� FEE: $ '� �- Check No.: a` �C U Receipt No.: a NOTE: Persons contract' ith unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor G�� 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 ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED { CONSERVATION ❑ ❑ COMMENTS HEALTH ElDATE REJECTED DATE APPROVED COMMENTS ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ ❑ Food Packaging/Sales Private [Ite(septic tank,etc. Permanent Dumpster on Site ❑ j Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Located at 384 Osgood Street Driveway Permit lKft E iFix, rr� st P� s1 x T"3 f a #' Vie: "W" r x s ..< , 3octed et 24 Ml` 1581 P men# agi � tretae , ' ,X--,� �� ;:r^ +�"� � �?*s� � �•`.�.�� . � ��:: �� Vis,, .x4s7, � � 3� ,� ,ri7 "x.a, r�,� r �,`� �..:aka Dimension i 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 C MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine , NOTES and DATA— For department use ❑ Notified for pickup - Date ---...._.._......._................_..__..-..--- ----- - .. - r i 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 Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit I ❑ 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) f ❑ Engineering Affidavits for Engineered products 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 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 l Location <30 No. Date MORT1y TOWN OF NORTH ANDOVER ?'• -•• G 9 Certificate of Occupancy $ Building/Frame Permit Fee $ 3 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 222 1 1 Building Inspector IMPORTANT DOCUMENT 5 Certif f Fl leate of ess ee S 5 �� ARi � 5 5 REGISTRATION ISSUED BY Date of Shipment S APPLICATION �� 06/08/04 5 5 NUMBER s INDUSTRIE INC.® 5 5 r EVANSVILLE, INDIANA IA NA 47725 Tent Identification 5 5 F121.4 E M' MANUFACTURERS OF THE FINISHED 03850284 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 SThis is to certify that the materials described have been flame-retardant treated 5 5 (or are Inherently noninflammable) and were supplied to:657150 5 5 5 PETERSON PARTY CENTER INC 5 139 SWANSON ST 5 5 WINCHESTER MA 01890 5 5 5 5 S 5 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved S Schemical and that the application of said chemical was done in conformance with California 5 SFire Marshal Code. All fabric has been tested and passes .NFPA 701-99, CPAI 84, ULC 109. S 5 Serial # 8023000(2) 5 SDescription of item certified: 5 5 FIESTA EXPANDABLE TOP 20WX20 5 5 WHITE VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 JOHN BOYLE STATESVILLE NC 5 Signed: 5 5 `SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. rj ""� �S The Commonwealth of Massachusetts Department of Industrial Accident Office of Investigations In P 600 Washington St Boston, Ma 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): t e S , Address: 13 2 'W o h (i►'1 f' City/State/Zip: R /00 Phone#:_ 7o2 y(JDy Are you an employer? Check the appropriate box: 1. ® I 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.] [ c. 152, § 1 (4), and we have no employees. [No workers' comp. insurance required.] *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 ad then hire outside contractors,must submit a new affidavit indicating such. I Contractors that check this box must attach 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 proving workers'compensation insurance for employees. Below is the policy and job site information. / Insurance Company Name: Policy#or Self-ins.Lic.#:W( — �J/— a.�G�� dd Expiration Date: za 9 d f Job Site Address" Sj O 7UKit 4a.1l6_ X 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. Ido hereby certify under thepa' s and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#• Official use only.Do not write in this area,to be completed by the city or town officiaG 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 Inspector 6. Other Contact Person: Phone#: NORTH 0 of No. L404L _ LAKE dover, Mass., COCFIIC ME WICK ADRATED P`P�\ -`� `s E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT...................... .......... ............. BUILDING INSPECTOR ... .. .. "tir"' """" Foundation has permission to erect........................................ buildings on ... .......... Rough .. ... .. ........... to be occupied as....�Q.. ... ........ .................. . . .. Chimney ....... N ............ . e6 Provided that the person accepting this Permit shainekr1res ect conform to the terms of theaPPlication 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 CONSTRU STARTS Rough 3 . .......... .... ................................... 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. ` `. •�achusett. - Depat-tment of* Public Safct Board of Bttiltlin Rrgulatiun: and Standards Construction Supervisor License License: CS 60219 Restricted to: 00 ':='r MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4/27/2011 ('unimi.�iunrr Tr#: 14425