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HomeMy WebLinkAboutBuilding Permit #15 - 60 INGALLS STREET 7/8/2008 BUILDING PERMITo�No oTH qti ,�- TOWN OF NORTH ANDOVER o2 4` `` ` *° °�, /s APPLICATION FOR PLAN EXAMINATION * ; ei Permit NO: Date Received - S10, '4 Argo �/ ��SSACHUS Date Issued: a d IMPORTANT:Applicant must complete all items on this page LOCATI�ON��� '� �, �/"�`` . Pdnt PROPERTY OWNS Priv MAP NO PARCEL Z;O'NING DISTRICT: 'Historic�-Distrnct. �yes� no Mac' ine Shop Ville e es no 9 Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition - Two or more family Industrial Alteration VNo. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well �Floodpiain : Y : : Wetlands Watershed District Water/Seaver: DESCRIPTION OF WORK TO BE PREFORMED: *44 ��,�o �. i�J��, t.,�e/ - s a 7 Identification Ple se Type or Print Clearly) OWNER: Name: 14110 L. /.�0�g Phone: `Z6dad, d�L",9 Address: ti CONTRACT7R Name: y :; ./ I / d '' Pnone: = � f� Address: Supervisor's C©nstruction=License:� :� r�` Exp. mDate._- -r,l�W . Home Inprovement:License: ✓ ' ` Exp j Date2 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: $ !�/� � FEE: $ � Check No.: � Receipt No.: 3�� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty#and igneture o Agent/Owner ignature ofi contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer *J 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 USE ONLY i INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT r., COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH r COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Sinature&Date Driveway Permit Located at 384 Osgood Street FlimsEPARTMENI'� aTerrip Dumpstef tin site yes no Located,6 X24 Main Sti eget` P d Fire department s�gna#ure/da#e.s- a ` y - ,A NTS " rc R J Dimension Number of Stories: Totals 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) .wr f ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 En . ergy 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 ❑ 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 - Revised 2.2007 i LocationQ No. Date ©� NORT11 TOWN OF NORTH ANDOVER 0 Certificate of Occupancy �' b''•°•'<�' Building/Frame Permit Fee $ CH . Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 21 305 Building Inspector 'tJ North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that.the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: 13 FI ti-IPEA- See.ytC C. (�JdTarnesY id #, (Location of Facility) ti Signature of Pe i Applicant Date I ' NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector r NORTH '9 Town of Andover No. D /,Sdoo =_ Y dover, Mass., !2" O LAKE �. I� COCHICHEWICK V 7�pSDRATED 7 BOARD OF HEALTH PER.. M -,IT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......���.c � .......... a ' ............. ................................... ....................... ....... Foundation hasP 9 .........,�i�... ..+�.�0 g permission to ere ....... ............................. buildings on .......� J............�. Rough 1 • to be occupied as...... '........&op +.A �. t Chimney provided that the person accepting this permit still in eve respect clnform to the terms o e application on file in P P P g P nl P PP 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 PENT EXPIRES IN 6 MONS jqj0VELECTRICAL INSPECTOR. STARTS UNLESS C®NSTRU N S ARS Rough .... .. ........ Service BUILD TOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No LathingD Wall To Be -Done or � - FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents 1j'V Office of Investigations 600 Washington Street .Boston, MA 02111 www.mass.govldia Workers' Compensation Insnranee Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): ftyL �f C�d Address:162� Ci /State/Zi tY p: L. , A Phone.#: 7 - '/d d Are ayou an employer? Check the appropriate box: 1.0 I am a employer with 4. 0 I am a general contractor and I Type of project(required)i� j employees(fiill and/or p�.* have hired the sub-contractors 6 ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet.* 7. �Remodeling ship and have no employees These sub-contractors have g, Demolition working forme in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.$ 9• ❑Buildingaddition required.] 5. We are a corporation and its 10.0•Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurancerequired.]t c. 152, §1(4), and we have no 12.0 Roof repairs employees. [No workers' 13.ZOther �` n comp. insurance required:] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeov.ners who sub—nut this affidavit indicating they are doing all work and them hire outside contractors must submit a new affidavit indicating such. !Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities employees. If the sub-contractors have employees,they must provide their workers'comp.policy ofi number, have I am an employer that is providing workerscompensation insurance for my employees. Below is the po information. licy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 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 Investieations of the DIA for insurance covers a verification. I do hereby certi under t eRan' d penalties of perjury that the information provided above is true and correct afore: W Date: Phone -_ " GQ [6. ial.use only. Do not write ut this area, to be completed by city or town official or Town: Permit/License# ng Authority(circle one): ard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspectorheract Person: Phone#: ,,pp�� ✓sie �omvinvnurea�i o�✓�aaaacliuGella ��� Board otBuilding Regulations and Standards _4j QrV. a/fl1ids-& '"&W HOME IMPROVEMENT CONTRACTOR ar o w c mg egu ate s an an ar y Construction Supervisor License 1,%„ Registration 159019 r. License: CS 39928 Expiration --3/26/2010 Tr# 265660 Expiration 3/16/2010 Tr# 194: Type Individual PAUL A.PIEROG 3�, VI?J t5 - PAUL PIEROG � _ r 1000 TURNPIKE ST+ PAULA PIEROG�� 1000 TURNPIKE ST � NO.ANDOVER,MA 01845 Administrator - N ANDOVER,MA 01845- Commissioner �Tb anp jouiiber ,— Sr�c. ii 13 SEWALL STREET 'r PEABODY, MA 01960 ' ` fG�y.GPP Jv OFFICE: 978-922-6120 SPECIFICATION SHEET _ Home Phone . . .. . .. .. . �. Owners Name �• . .A. . .`: . . . Work Phone: . . . . . .E. . . . . . . . . . . . . . . Home Address . . . . Ci ry State Zip . . . . . . . . . Job Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . City . . State . . . . . . . . . Zip . . . . SIDING 1.Siding Type . . . . . . . .: . . . . ."..p. : ! Width . . . . . . . . . . Color 2.Area to be done. Main House'(� -". `�.. . . . Breezeway -f4 . . . Garage . . . . . Additions • • . Dormers ''f. . ` . . . . . . . . Other . . I 3.Insulattoti ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Trinr.cover CJS}'s ❑Na Collor' . .4-11',1-"4 r:11YC . - - . . . f ' . Trim to be done: Soffits "�'" - . . . Fascia � '� 'f'r"` Rakes . Ceilings . . . . . . . . . . . . . . . . . . . 5.Casings. r- .t. . . r � .«� . . . . . . . . . . . . . . . . . . . . . . . . . �.Shuttersand spouts [a'l'es No Use heavy gauge.seamless .t� �� rr"%�!s� - Color 8. Windows and Doors t{.' ., Vit- - f ;•��" -s�.,�'``"`' �? _ �? I!"4 '. . �- - .f r. � . d`. f�� ROOFING f t - X% �s 19 4 Material Type . . . . . . . . . . ... . . . .. . `. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Color . . . . . . . . . . . . . . . . . . .. Areas to be done . . . . . .,?. . . . .. . . . . . . . 4 . .. . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . • Remove existing shingle 'l Yes :`..1 No 15 lb.felt . . . . . . . . . . . . . . . . . . . . . . Metal Edging . . . .. . . . . , •, iChimney and vents,rftc.,, . . . . . . . . . . . . . . . . :. . . . . . . . . Other. . . . . . . . . . . . . . . . . . . . . r . . . . . . . . . . . . r NOTES:'��. .,:': .�.` > t� ..,:�-.�' : .< �.�:.:�. . .,�.`� °". -,�,�`-;7!"• "':�`�'�". .�:--;�''. .t:�:, -�'-^'� fl; . . ., p.� r. . . . . " � ,(„".�1.��t','.d,'� .Fr,��,.�.` �r•``°"'�. '^� -:-''-> f.. '��e��. � ..r•�"n�,..-�; `�' ".;. 4? � i ..''fi4,.•M"d°rC- 1V�K ' ''. . .e -. .t !fs.+ "4.. . . ' ...�. . . . . . . . . . . Y . . . { . . . . . . . . . . . . . . . . . . ” t '.Deposit... . . . . . . . . . . . . . . . . . . . . . : Material and labor to cost$. ,r/ t € a t.*`. , •", . , , , , payable as follows: $. . . . '. . .1st installment $. - . . . . . . 2nd Installment $. 41, �� .Balance on completion i Contractor will do all said work in a good workmanship manner. You may cancel this agreement if it has bn consummated by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you noth•the seller in writing at his main office or branch iby ordinary mail posted,by telegram sent or by delivery not later than midnight of the third business day following the signing of this agreement. IN WITNESS'THEREOF,the parties have hereunto signed their names this. . . . . . . , r-' - .€ . . , ,day of- 20 t r € �l oleo Acce ted. *' -'- r . P C_ Signed.d -,- rtr 4. . 1 . *'`� Owner Yb Ulonp jDaftberg, Inc. Signed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f Owner } Per(� 4 C-�'' � Represen.tiltive Authorized Rep. . Strikes,labor disputes,inclement weather,or material supplier delays resulting in work stoppage are beyond the control of the company. The company guarantees all workmanship for a period of I year from the date,of installation. Guarantee of workmanship assumes performance of product f installation under normal wear and tear conditions and does not guarantee against storm damage.,acts of God or nature,neglect of proper maintenance or l malicious damageor vandalism. Material guarantees are the sole responsibility of the manufacturer. i �