HomeMy WebLinkAboutBuilding Permit #715 - 71 QUAIL RUN LANE 5/8/2006f NORTH
O t�ao 10
+. OL
° p TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
,SS4CHU`�Et s C �
Permit NO: �/tsDate Received:
Date Issued: ,-,�-- G'
IMPORTANT: Applicant must complete all items on this page
rint
PROPERTY OWNERf
Print
iVIAP NO.: PARCEL: ZONING DISTRICT:
rrvvc ANiI ITCF n1P RIT11 11INC Ri�TORW DURTRWT YES F1
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
E New Building
Addition
Alteration
r40ne family
E Two or more family
No. of units:
Industrial
ARepair, replacement
F Demolition
❑ Assessory Bldg
E Commercial
E Moving (relocation)
E Other
❑ Others:
Foundation only
DESCRIPTION U>~ WURK iU BE FFV-1'UKN1 1tV
' c ik �jn� a -kou4c and sldL dvc/ gates �
Identification Please Type or Print Clearly)
ra
OWNER: Name: i C h ad Go 41.
/'7 t -d Phone:
^ Signature
Address: 7 i /�•/jyu.t f n Nd►'k AnLyy WA
CONTRACTOR Name:
hey" d Ni,
2a
Address: 400 SU440Sit- Sui-t ZZ(p 0dVU, AauVe1 —H--A--
Supervisor's
-A
Supervisor's Construction License: Exp. Date:
Home Improvement License: i w4 Exp. Date:
-kRCHITECT;`ENGINEER Name: Phone:
Address:
Reg. No.
7- 14 - a I-
FEE
l-aI-
FEE SCHEDULE: BOLDING PERMIT • $10.00 PER 51000.00 OF THE TOTAL ESTIMATED COST BASED ON 5125.00 PER S.F.
Total Project Cost :$ ay 4, to. 00 x10.00= -FEE:$
Check No.: Receipt No.:
Page Iof4
TYPE OF SEW'ARGE DISPOSAL
_
Tann inglMassage/Body Art _
Swimming Pools
Public Sewer !
Well u
_
Tobacco Sales —
Food Packaging/Sales l
Private (septic tank, etc. Ll
_
Permanent
Permanent Dumpster on Site �
Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the gt tranty f�lund
Signature of Agent/Owner Signature of Contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑
❑ Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
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: Continents
Water & Sewer connection signature & date
Temp Dumpster on site yes___no__ Fire Department signature,'date
Building Permit approved and Issued by:
f'ap!e 2 of
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required
Provided
DIMENSION
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
NO I tS and DA I A — (For department use)
Page 3 of 4
Doc: INSPEC110NAL SLRVICES DERAR f RENT BPFORM05
Created IMC 1.ia-vGr.
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
Addition Or Decks
❑ Building Permit Application
❑ 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 Energy Compliance Report (If Applicable)
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
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
Dor. INSPECTIONAL SLRN ICES 1)1".P.NR'1'NIBN'I':BI'FORN1115
Paige 4 of 4
Location /7.-��
No. Date
NORTH TOWN OF NORTH ANDOVER
O. •t.�o ,� �+
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check # 1/16
I i, I %4
$ 4,e
,e trd
f `5'4,—
ding
Inspe6ttor
I
wr
DAVID CASTRICONE
ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS--,
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
200 SUTTON STREET, SUITE 226, NO. ANDOVER, MA 01845
7 HILLSIDE ROAD, BOXFORD, MA 01921
In North Andover 978-683-3420 In Boxford 978-887-6147
In Haverlrlll 978-374-7314
I/we the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary
materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and
conditions, on premises below des 'bed:
�
l 'J C.A.L1.' .............T ephone#..
Owner's Name......... .... ......... ............
Job Address.... /11.......11 .1..l.... ..4< .................... I......... City...l. a..:..A .o..v e_J................. State...............
Specifications
S..l.�.x.....t�.✓wF.....�l.e..... ....................
......
.. ....... ....
r 6�
...1. �:.t?..d..t. ..�.1...... L4.fi..i.r. ..........�.1`.�..�`�1`:L ......G.,t�at.tP.:..... ...o..i.........................................
.�......�.p.idr.I$.ls:aLS.%�.......�....,�.cS:.�t:�.s:..t.%.............� .,b,.�.�:J.�'....j..
.............................................
l..�.C/.3.......... .
.........................................................................................................................................
........... .
Q
1�.��:.X.a-c.�..�.......G.�.t:.:.�r...o�.S.........1.�S..S...l..n.¢........G.�:a.F.ehrr�.....(..".t�. ... - ..�r. .............
�>r.a.......w.,t.......w..b �.. rr� .r..I:.r . f..... .. rp...�.....................
/►.... ..an..... LS�S....5� �t-x�.nf.S. ....1.�. �s.�zl.l...�..a t-.... ......... A3...
..................a�
.................................... a....l ;g. a. a........ �} ........
C ....... ......c�r ......Y.r...,�.......r..
n...........
rf
/ �.w... .c�t�� ...9`......v..nr......s. c ..:..,...........................c��.�,G.. ................ / ...
One Year Workman hp. ip Warranty (Not Transferable) �� ss� o.� w' c • �a u u'c!g! a�
Manufacturer's Warranty as specified by manufacturer Tel
Materials and Labor to cost $ ....................................... Payable ............................. on .................................
Payable ............................. on .................................. Balance payable on completion of job
Owner or Owners are not responsible for Property Damage or Liability whilejob is in operation.
Contractor is not responsible for any damage to the interior of property, including pre-existing conditions (i.e. water stains, crumbling plaster, exposed nails) or
conditions resulting from application of materials specified above (i.e. objects coming loose from walls, crumbling plaster, exposed nails, dust in attic or other living
spaces, water stains when roofing shingles have not had adequate time to cure).
Upon completion ofabove work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation as requested
by contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid, immediately due and payable. It
is agreed that, if permitted by law, contractor shall be paid by the owner(s) all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid,
that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith.
It is further agreed that this contract may be assigned by contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates.
The undersigned warrant(s) that he is (they are) the owners(s) of the above mentioned premises and that legal title thereto stands of record in his (their) names(s).
There aro no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is the contract
dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all
parties.
All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:
Director, Home Improvement Contractor Registration
One Ashburton Place
Room 1301, Boston, MA 02108 Tel: 617-727-8598
Any and all necessary construction -related permits shall be obtained by the Contractor. Any Owner who secures his own construction -related permit or deals with
unregistered contractors shall be excluded from access to the Guarantee Fund.
Approximatestarting date of work..................................................................... Completion date ..............................................................
Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing
provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be
binding upon the parties and that all of the agreements and understandings of said parties are contained herein.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Owner has three business days to cancel this contract and incur no penalty.
IN WITNESS WHEREOF, the parties have hereunto signed their names this ......9.q......... day of ... Af.P 1 ............... 20...
Accepted:
Signed ..................11...... . ........................
Signed.........................................................................................Owner
Per..., ` ....=z� .................
Representative
0
z
44
O
w
M
tv
a
0
u
o
V°
N
a
cin
x
PU
z
c
wz
o
oG
v
U
G
w
a
U
�
�
o
oG
rS.
a
w
w
W
o
aw
C
-C 0
w
a
p
U
o
PG
a
w"
w
G
m
z
cn
o
8
cn
a
S
N
C �
m C
•
C �1
y
cm
O i
C N
O
C
O
Ci V
•CL
2 N
Q• c
O A
c.C�
h O
Cc
O
Ea
c
�
o
•= v
mo0 0
0 a
h
C
W = O
-0rCw
O
•y
L
CO r
E
0zc,o,
ID
pC C C
c
CO
=
m
1:
CL •-
a
S
N
E
z
NJ
O
N
C
In
m
C
m
b.
O
cm
c
•C
N
m
_
r
O
Z
0
g
O
F.
G
O
p
U
0
V
1�
S
i•7
2
Q
CD
O
E
C L
CD
O h
C C
O
I O „0
O
.MM
EMM W W
CD ow
CL I.-_
= O �
O
cvv o an.
a. CDa
co C .�
00 = C
O
2)
C Z O
V CO)
O C
C
■s
d
CO2
cm
H to
mm
CO
y
cm
�
O
C
y cc
2 N
ECD
�
m I
c.C�
h O
_0y
O
�Z
Ts
oa
mo0 0
N Oa1—
C
W = O
-0rCw
O
•y
O r
'_
M C
E
0zc,o,
ID
pC C C
_
m;
CO
=
G O
r0.. O. -.- CY!
E
z
NJ
O
N
C
In
m
C
m
b.
O
cm
c
•C
N
m
_
r
O
Z
0
g
O
F.
G
O
p
U
0
V
1�
S
i•7
2
Q
CD
O
E
C L
CD
O h
C C
O
I O „0
O
.MM
EMM W W
CD ow
CL I.-_
= O �
O
cvv o an.
a. CDa
co C .�
00 = C
O
2)
C Z O
V CO)
O C
C
■s
d
CO2
cm
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978)688-9545 Fax(978)688-9542
DEBRIS DISPOSAL FORM
tkoRTH
O �tMgo '69
o
In accordance with the provisions of MGL c 40 s 54, and a condition of.
Building permit # the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a.
The debris will be disposed of in /at: , // h
A
Facility location
Signature of Applicant
�•a6
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.