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HomeMy WebLinkAboutBuilding Permit #307 - 671 JOHNSON STREET 10/22/2007 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION « Permit N0: Date Received s A,T E D a�� • � SACHUS t Date Issued: � `' IMPORTANT Applicant must complete all items on this page ems• ,.,pia '° Ash ' s` E "� '�`G,'a, N. 0s."„ x .r sew a fes, " a r S TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: [I Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other UNNEEM0 �,, �r ,�� �� airB BE PREFORMED: S7`i!'1 D, /©"s ske) OA e'J e' Identification Please Type or Print Clearly) J �- OWNER: Name: ✓ Phone: Address: / °L LISA► I/V �_ ��.a �� -F` 5�� 3�� �,� +.�" m,� a� ��u� {�r�� • '�"t ��p� �& '4 � art xs PINION r ' uv ,��rar��� �r i 3 �� � rs.., � �a � r•=�'�,°" t'.. rt x �:.� `x a+ry,� �' r �` ':1S'� M.,t+ -IKa z ,w.��-•Y�',k,.f� ,'� �y�'m,� ;a f�, "" 5 n� '� f b .r ``' r ' •`' a•y a 3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAS`EfD,lON$125.00 PER S.F. Total Project Cost: $ 3 7 f FEE: $ 4"1 Check No.: Receipt No.: NOTE: Persons contracting wi registere retractors do not have access to the guarantyfund uertl s � r �arr �ar� r..fir , m a'.tisvtiv.'a'.?t�wJ ,� :tkw �{ •4.-„K`�.akns3o-��.6.. +f.R3s:. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales 11 Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DA E APPROVED PLANNING &DEYELOPMENT _ ❑ / 7 1� COMMENTS ���'J'�•t , ,,, CJ�. ►.hGrt / C coM.l u�l�1 TE REJECTED DATE APPROVED CONSERVATI ❑ . COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water $ Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street �. `wnv 5 rYa ,aaTs . N+'�a 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 21 A—F.and G min.s100-$1000 fine NOTES and DATA— (For department use) ❑ 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o 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 LocationNo. 36 7' Date —Z z —o NORTH TOWN OF NORTH ANDOVER 3? i • O F 7 Certificate of Occupancy $ • _-1? CH <�' BuildinglFrame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1.2� — 207 { 4 , Building Inspector NORTH 0 0 : 6Andover 10 No. odover, Mass.,�� * • COC MCKEMCK �It ADRATED `s BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....D..... .hl. .............................. ...... ! !. .. .............................................. Foundation has permission to erect.......... i.is..rA.......L.«. .............................. buildings on ..... .. ........... .................. Rough to be occupied as 1.161.11Z..... 13. .. Chimney 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 PERMU EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU C rl§66 T TS Rough B TOR Service 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 FIR_ E DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner J Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): '/Aa✓ i 6 Z 2,1/C,Z rtA� Address: 499 z s 1+ City/State/Zip: fvo(A �'��"'�� Phone #: Are you an employer? Check-the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.0 Electrical repairs or additions required.] 3. I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions yself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I 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. $Contractors 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 t/ie policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: .lob 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains 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 city or town offrciaL 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#: e 3 Industrial Drive CUSTOMER NAME ►/et✓1 < <- I L u Hudson,NH 03051 ADDRESS [,z L.l�S4 1—Q m P Toll Free:(888)85-SHED CITY A-1-Dr44 Ae.a(e STATE�` IP � Trl:(603)883-1362 " Fag:(603)M9566 HOME PHONE(L�) �g� ORDER DATE ? ^d 7 ( www- gym WORK PHONE( ) ; DELIVERY DATE ;UILDING STYLE: ❑GAZEBO ❑AMERICAN CLASSIC ;YSOUNTRY CARRIAGE ❑TRADITIONAL GAMBREL ❑HISTORIC COLONIAL l� q IODEL#: ❑PINE PWINYL ❑CEDAR SIZE:jaX1z $ 7 Ramps 43 Single Door-------------------------------------------------------------------------------QTY. X $ 50.00 ea. $ 4x5 Double Door-----------------------------------------------------------------------------QTY x $ 75.00 ea. $ l O 46 Double Door---------------------------------------------------------------------------QTY. x $ 100.00 ea. $ 47 For Roll-Up Door-----------------------------------------------------------------------QTY. x $ 125.00 ea. $ 0 Pressure Treated%Plywood Flooring Per Sq.Ft.of Floor--------------NO.OF SO.FT, x $ 2.00 ea. $ Pool Filter Hole-------------------------------------------------------------------------------------------------QTY x $ 75.00 ea. $ Plywood Partitions-8-------------------------- ---_---------_----_------------_..______._____QTY x $ 100.00 ea $ P Plywood Partitions-10'--------------------------------------------------------------------------QTY x $ 125.00 ea. $ Plywood Partitions-12'-------------------------------------------------------------------QTY x $ 150.00 ea. $ No Floor—Per Sq.Ft.W___._________�________ ___�_M_____ �____NO.OF SQ.FT.—x,$ -(1.00)ea. $ Additional Wall HT Pine Per Lin.Ft--------------- OF LINEAR FT. x $ 5.00 ea. $ Additional Wall HT Vinyl/Cedar Per Lin.Ft.__________ _:_______NO.OF LINEAR FT. x $ 6.00 ea. $ Additional Std.Window(s)'---------- —__----------------------------QTY x $ 80.00 ea. $ Additional Large Window(s)'-____—---------_---------_____------__-----------m__-- QTY. r x $ 135.00 ea. $ l 3s To Change Standard Window to Largex $ 65.00 ea. $ I Standard Window BoxQTY. x $ 25.00 ea. $ Large Window Box-------------------------------------------—---------- —- ----_ QTY ` x $ 35.00 ea. $ '7a Additional 3'Finishshield Door--------------------------------------------------------------------------QTY._x $ 200.00 ea. $ 0 Additional 5'Finishshield Door---—_-_-------------___ _�_______ ____ _______QTY. l x $ 250.00 ea. $ Additional V Finishshield Door________________________----_-----------------------------_-QTY. x $ 300.00 ea. $ Change 5'Door to 6'Door---------------------------------_-_____________________________QTY. x $ 50.00 ea. $ Additional 5'Steel Roll-Up Door-----------------------------------------------------------_---_-_---QTY x $ 350.00 ea. $ N Additional 7'Steel Roll-Up Door---w._._—_----------------------_----------------------QTY. x $ 400.00 ea. $ To Change 5' Finishshield Door to 5' Roll-Up Door-_--------------------------------------QTY. x $ 200.00 ea. $ To Change 5'Finishshield Door to 7'Roll-Up Door-------------------------------------------QTY.—x $ 250.00 ea. $ S Loft 4 x 10 -------------------------------------- -- ---------------------------------- -----QTY.—x $ 60.00 ea. $ Loft 4'x 8---------------------- --------- ---- --- -------------------------- -------- ' -------------_-:__—QTY. x $ 80.00 ea. $ Loft 4'x 12'---------------------- - —-- -- - - n- -- QTY. x $ 100.00 ea. $ ?Y__—F—o t -- -QTY. / X $ 496890-ea. $ S cJ Architectural Roof Shingles(Not Available on Gambrel Style)--'- --NO._ OF SQ.FT. x $ 1.00 ea. $ 'Shutters included on all Windows SUB TOTAL $ 3 e-1- ROOF 1-ROOF COLOR Standard 0 White 0 U.Brown O Gray SALES TAX $ Z5, Z' 0 Black O Dk.Brown Weathered Wood p 2 --------------------------------------------— -- -- -- --- --—- -- - - ----------------------- TOTAL $_ 3 r• O 'on I 0 Gray Architectural 0 LL Brown Architectural LESS 15%DEPOSIT $ 0 Black Architectural 0 Weathered Wood Architectural SHUTTER COLOR 0 Almond 0 Black 0 Blue 0 Clay 0 White TOTAL,AMOUNT DUE 0 Red 0 Gray XlGreen 0 Brown 0 Burgundy UPON DELIVERY$ VINYL COLOR 0 Frost White O Wicker Beige 0 Victorian Slate`&Sunny Maize O Adobe Clay 0 Warm Sandlewood 0 Vintage Sage O Classic Sand O Harbor Stone 0 Charcoal Gray 0 New Linen l PLACEMENT OF DOOR(S)AND WINDOW(S) DEALER BACK 11A LEFT LEFT Q°�" / IGHT CO-'-O' SIDE �d Sv,��Ie SIDE {° SALESPERSON D AMOUNT RECEIVED$ FRONT ' r er p CREDIT CARD ❑CHECK 0 CASH 0 TYPE SKETCH IN THE APPROPRIATE SYMBOLS r 1 NO. 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