Loading...
HomeMy WebLinkAboutBuilding Permit #4 - 586 OSGOOD STREET 7/2/2007 pORT1p BUILDING PERMIT ?Oe ., ,.:06 bio TOWN OF NORTH ANDOVER a APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received -Q 3y q�RATop SSaCHuse Date Issued: 2'2— IMPORTANT: 'ZIMPORTANT:Applicant must complete all items on this page Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition 0 Two or more family 0 Industrial ❑ Alteration No. of units: ❑ Commercial 0 Repair, replacement ❑ Assessory Bldg ❑ Others: e k,'r ° ❑ Demolition ❑ Other 2 ,11 es M-.1mo f � Y.A, 11' M"'Igilnli' Y* DESCRIPTION OF WORK TO BE PREFORM D: Gam/ ' Identificati n Please T e or Print Clearly) p OWNER: Name: 2/4 ,w Phone: AS 4-— Address: a sic c i ma n F ARCHITECT/ENGINEER Phone: Address:/3-,/1�v/i>>7ZI x , ��Ivjrs&go /77 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: $ /2 . 7�� FEE: $ Check No.: �/o 2, Receipt No.: 2b 3 �-- NOTE: Persons contracting with unregistered contractors do not have acce s to the guaranty fun Signature of Agent/Owner Signature of contractor- i ��' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY f INTERDEPARTMENTAL SIGN OFF- U FORM , DATE REJECTED DATE'APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED `. CONSERVATI COMMENTS_ /IrIT (,0� N DATE REJECTED DATE APPROVED HEALTH ❑ ❑ OMMENTS TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well-' ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Priytte(septic tank,etc. ❑ Permanent DumP ster on Site ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driyeway Permit Located at 384 Osgood Street al mg 0-7 RW � r i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i 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 �I ❑ Notified for pickup - Date ........._.._.........-.....__... .._----...._.._....._. 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 o Building Permit Application ❑ Workers Comp Affidavit C'j Photo Copy Of H.I.C. And/Or S.L. Licenses �o. tract amOr Proposed Interior Work -a---Er�gering Affidavits for Engineered products Addition Or Decks L3 Building Permit Application j ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit - o Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (if Applicable) o Engineering Affidavits for Engineered products New Construction (Single and Two Family) ❑ Building Permit Application o 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) o 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 r, Location No. Date -7 -2 �- } �aRTh TOWN OF NORTH ANDOVER F *Aiimi - 9 s i + ; ; Certificate of Occupancy $ bis',"'Eta Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # J Z ry 2035 :'- Building Inspector NORTty Town of No. o dover, Mass.,- LAKE COC MIC ..0 V 7�ADRATED P'P��"`� S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System IP ��'I��i►. �i �/�� BUILDING INSPECTOR THISCERTIFIES THAT.... ..... ...... ���..................................... .......................................................... ............................ Foundation has permission to erect........................................ buildings on-r-It.4.........494 ....+... .!!!0...�...�.......... Rough to be occupied as..... .. .. .....Adi ................................................................................................ himn y C e provided that the person accepting this per all in every respect conform to the 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR LJNLESS CONSTRLJC ST TS Rough ....... ...... :. ................ .......... Service BUILDIN CTOR 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. ' I 1 A I S T1 -L s o 0 propoot I�LLI�I3LE CICSSTruclics Remodeling All Professional Carpentry Decks Sun Rooms Kitchens • Finish Work Richard J. Morrison 603-898-0984 PROPOSAL SUBMITTED TO PHONE DATE /177 R A!�< �— Z-/�4(/Z /91- �� A j 9 ff-- STREET JOB NAME LSr v S 6-6-0 J s JOB LOCATION CITY,STATE and ZIP • D H nl 0 i/�r ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: --------------------------------'-'---------/------------,------------------------------------------------------"Q--------------y...../.-------------------------- ....--.... —`,' ...... ..------............_.................................................................................................................................................................................................................................. ...... T- �q A<�:r `...................... .--------------............------------------------------------------------------'----------------- .. --- .... r B�./�.. �� ......E Cly/.. ....�....1, .ff.�... �.......r�i vl�.. .........._..._. Cd . ./�.........�'R... `m- ......... r..:r.—. f. 1 ./..n. .----v�A-11-- . .... ---. ....... ....... ............ .............. ........... ------ ---------------- ' 12)e V ropo.5e hereby to furnish material and labor- complet in accordance with above specification , for the sum o S / dollarsr$ sZ �d Payment to be made as lollows: 9-'2- l '1 ! T;, G /o I 0 L� 7� _�—OBC'�I�1 �[ E —)'d N C� Authorized �/Y� All material is guaranteed to be as specified.All work to be completed in a workmanlike ��/ manner according to standard practices.Any alteration or deviation from above specifications Signature involving extra costs will be executed only upon written orders,and will become an extra Note:This proposal may be r and above the estimate.All agreements contingent upon strikes,accidents or ix.p Y charge ova a da S g withdrawn by us if not accepted within _ Y be nd our control.Owner to carry fire,tornado and other necessaryInsurance. delaysyo Lntheei.work e of Propw5al - The above prices,specifications and satisfactory and are hereby accepted.You are authorized to signature specified. Payment will be made as outlined above. nce: Signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ir www-mass. 600 Washington Street Boston, MA 02111 Workers, Compensation Insurance Affidavit: Bu de`s/Contracto A ticant Information rs/Electricians/Plumbers Please Print Le ibl Name(Business/Organization/individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: 1.❑ I am a employer with4. ❑ I am a general contractor and I Type of project(required): 2.❑ employees(full and/or p .* have hired the sub-contractors 6 ❑New construction I am a sole proprietor or partner- listed on the attached sheet,t 7. ship and have no employees These sub-contractors have Remodeling working for me in any capacity. workers' comp.insurance g• ❑Demolition o workers'+ P ance comp, insurance 5. ❑ We 9• Builth are a corporation ❑ ng addition � nandi required.] � qu officers have exercised their 10•❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemptibti per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp, c. 152 14 insurance required.]t + ' ( )+and or 12 have no , o q j employee es. [No workers' ❑Roof repairs comp.insurance required.] 13•❑Other *Any applicant that checks box#I must also fill out the section below Homeowners who submit this affidavit indicating they are doing all orkwand their workers, o��com pensation policy information. !Conhactors that check this bo outside x m co must attached nhactors submit a an additional sheet showing the name of the sub-contractors and their workerscom davit indicating such. i fo an employer that is providing workers'compensation insurance for my employees Below is the po%'�information. information, Policy and job site Insurance Company Name.. Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: Attach a copy of the workers'compensation policy declaration page showin City/State/Zip: Policy number and expiration Failure to secure coverage as required under Section 25A of MGL . 52 can lead to the imposition of criminal p ration date). fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties of a of up to$250.00 a day against the violator. Be advised that a copy of this state entf may be forwarded WORK ORDER and a fine Investigations of the DIA for insurance coverage verification y arded to the Office of do hereby certify� br under the pains and penalties of perjury that the information provided above is true and correct Si na Da e: Phone#: FFPersou: only. Do not write in this area,to be completed by city or town gJ�lciai n: Permit/License# ority(circle one): Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. 6.Other Plumbing Inspector son• Phone#: NORTH Town of And No. - o dover, Mass.,T7.0%;k Q LAKE �• COCHICMEWICK V ORATED 7 v ` BOARD OF HEALTH Food/Kitchen Septic System PERMIT T Df BUILDING INSPECTOR THIS CERTIFIES THAT....�� �r ..................... .. ........................................ ........... '� """"""""' Foundation has permission to erect........................................ buildings on ..��....t. .......... ....... .. ................... �...�/ ..... .......... Rough ..... to be occupied as..... .. .. ........ ................................................................................................ Chimney ' e provided that the person accepting this permit shall in every respect conform to the 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 ®� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRU ST TS Rough Service ....... ...... :. ................ BUILDIN TOR 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.