The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #522 - 625 GREAT POND ROAD 2/7/2006NONTM Of o .,y0 ° - p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,SSACHuSe1 Permit NO: �' ` Date Received: - Date Issued: IMPORTANT: Applicant must complete all items on this page I L c� LOCATION 6 25 _ �" I OD's _ n Print PROPERTY OWNER Print MAP NO.: 043-0 PARCEL: 0.�, ZONING DISTRICT: TVDW ANr1 114Zr n1V R1 T11 nIN(_ t41gTnRif DlgTRi T VF,S ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ Addition Alteration ,;One family ❑ Two or more family No. of units: G Industrial Repair, replacement ❑ Demolition C Assessory Bldg ❑ Commercial D Moving (relocation) 0 Other t Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED (� �4ce G✓ j� wS vt� s/`�� Identification Please Type or Print Clearly) OWNER: Name: (f " C AL/4111 Phone: Address: C",75 ^ Alqature jn / /61 A)4,u � CONTRACTOR Name: Pho Q \' �5� � � - ne �S-ll-� �� k ve✓"L�� a�y2 Address: � Supervisor's Construction License: zT 797 Exp. Date: Home Improvement License: / Z �Y Exp. Date:/( -2- " D7 ARCHITECT. F.NGINF.F.R Name: Phone: Address: Reg. FEE SCHEDULE: BULDING PERMIT: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $12.5.00 PER S.F. , /-� Total Project Cost :$ / `7 6�� x10.00 --FEE:$ y� Check No. /��'G� Receipt No. 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 ❑ Debris Removal Fon- Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Form ❑ 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 Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑_ FormU__ ❑ 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 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 DF.PARTMENT: BPFOR\105 TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art Swimming Pools Public Sewer Well i_ Tobacco Sales =i Food Packaging/Sales L. Permanent Dumpster on Site Private (septic tank, etc. _ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty .fund Signature of Agent/Owner Plans Submitted ❑ Plans Waived ❑ Signature of Contractor Certified Plot Plan ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS i Zoning Board of Appeals: Variance, Petition Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Water & Sewer connection signature & date Stamped Plans ❑ DATE REJECTED DATE APPROVED ❑❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED DATE REJECTED Comments Comments Temp Dumpster on site yes—no— Fire Department signature,'date Building Pen -nit Approved and Issued by: DATE APPROVED El DATE APPROVED Building Setback Front Yard Side Yard -Required Rear Yard Required Provided Provides Required Provided n1t•�r, t•ic}t��r u11V1EX431V1V Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. CrcaicJJMC Jan._06(, Location��—�'~ No. Date 6 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ J Check # 18064 C /may , ...�--�- C Building Insped�4 A d z 0 i ui a a a 0 a .. w a A o A w zcz v co w w , a�' U -cd u, c,: w a _ COD W LL H W V COD H 'a w a a a .. a A w cG w w , a�' cgi -cd u, c,: t% rA 0 cn 1.-d o cn C C �•m G • C �1 O J O H c � O Aa ci a C e0 W CD C rt.+ O r=. O � Q o o a ES :CS :mac m c E •mm � mCA y .w. m� H — m D H ea _O E� CLU CD 0 7S cp y m ; cc rt... _....� Qf cm p G C Q m pv m � :h 0 o ow C. C y c 'c �.Z o3 N m H m 4: :s Z 'c AD r C 'o.t 1° 5 ++ O c�= a .r Vm .y O CD C -0 C O Z0M� O_ a 060 _.. m � O 0 v O C C s Z o. O y � C I CCM CAO — CD O O .CODg m m CD 0 CD t O.Q �3 O G O Q L _O O CL �Q O � c ev C.) .300 c Z CD 0 CL V CO) O C d y ✓tie taam�nancuec�t/, a� jfuaelia BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 089839 Birthdate: 06/19/1972 Expires: 06/19/2008 Tr. no: 89839 Restricted: UU SCOTT P HOUSE 854 BROADWAY #1 HAVERHILL, MA 01832 Commissioner .�. .lite l�al)t;Jltli-11LllelLGGl2- C�l� l[Q.:J(lff�.r/.Je�1 \ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR 1; Registration: 129774 Expiration: 11/2/2007 Type: DBA PELLA WINDOWS AND DOORS SCOTT HOUSE 45 FONDI RD. HAVERHILL, MA 01832 Administrator '. d.h HUMBER DRIVER'S LICENSE '= 569694966 •�� DATE OF BIRTH CLASS REST HEIGHT SEX 96- 19-11_� D II M 21 -. EXPIRES-' - 06-19-2006 HOUSE SCOTT P - 854 BROADWAY APT #1 0615-1aTP HAVERHILL, MA . 01832 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ^M s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): p'e �` _S Address: ys Fy✓1 d', City/State/Zip: 1J&__4.a at Phone#: g78-�6S-72 SS Are you an employer? Check the appropriate box: 1.;K 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. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. F-1 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ,�Ord IYtsuraACe. Policy # or Self -ins. Lic. #: 03 V C3NLL. S 7q Expiration Date: - D/ 0,6 Job Site Address: ;,-->z.- r r�''�I. City/State/Zip,/��,x�-�/- 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. 1 do hereby certify ut�lthe• and pe alties of perjury that the information provided above is true and correct WIN Phone #: -/ 7610" -2 6S " 7 Z 5S" Oficial use only. Do not write in this area, to be completed by city or townoffccial. 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 #: fNFR%C. Pella Corporation Architect Series® Double—hung Vent a Low —E IG National Fenestration Argon Filled Rating Council U397 ENERGY 7LUJ-FRbacdttoir PERFORMANCE RATINGS (U.SJI-P) Solar Heat Gain Coefficient 0.33 0.30 AODMOUL PERFORMANCE RATINGS Visible Transmittance 0.47 -- Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance. NFRC ratings are detemrinod fora fixed set of emironmentel conditions and a specific product size. For more information, call (641) 621.3114 or visit Peltas web site at www.pella.com or visit NFRCs web site at www.nf=rg Meets or exceeds C.E.C. Air InflAration Standards ILYA 1 / WINDOW AND DDDR , MANUFACTURERS ASSOCUITION H - R15 45x77 CONFORMS TO NMAAMAINWV=101/I.S. 2-97 OP15 I OP30 with Kit OBAZ0001 Complies with HUD UM 111 (Pella, IA)