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Home My WebLink AboutBuilding Permit #724 - 72 PADDOCK LANE 6/9/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Received Date Issued: (,# -41 — ` IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER Print��✓L Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaae ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIRTION OF WORK W1,19i1r0 le BE PREFORMED: --/C3Ci1-::5- f Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: :5E g �,�E' 6?6- E <f0JJT. 04' i6Phone: 7� ( ` 9yd •G C Address: a S- AOA)6 60002P Supervisor's Construction License:Exp. Date: C1111 121 /J Home Improvement License: ' Exp. Date: � q ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE. BULDING PERMIT. $12.00 PER $10500.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. n Total Project Cost: FEE: $ Check No.: ') 0 - Receipt No.:_;�- � C4 -a -y NOTE: Persons contracting with unregistered contractors do not have access to Vguar my, un signature of Agent/OwnerSignature of coritracto71, - ��z Plans Submitted IPlans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer 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 INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments t Conservation Decision: Comments Waterj& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea %4 FIRE DEPARTMENT - Temp Dumpster on site yes no, Located at 124 Main Street Fire Department signature/date COMMENTS street 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 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 Energy 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) L3 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 2.2008 Location Pei-em(o No. Date D TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Nus <� Building/Frame Permit Fee $ _L r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1)0 2,220 Building Inspector qf The Commonwealth of Massachusetts N, I Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 f I. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address:_a C�0 106wo O rz: 11 City/State/Zip: ��l ��, ol�Phone #: 0. Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no 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 1 LEI Plumbing repairs or additions 12.;J Roof repairs 13.❑ Other *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 the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert' under the pains a pen tie er'ury that the information provided above is true. and correct. Si nature: Date: /CS Phone #: 1?% ; l — 9 `1' Official use only. Do not write in this area, to be completed by city or town official. d City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 0 u cq cur. w ° o o C c U w R. w MD w GG a U w a�' V cn w a O a C7 C w z w w w cA o z cn v Q cn LLI z � 9 M B ay a� O O v Z O d' O CO) o c co cm O_ .CO2 O O g `m m co CD co L_ CL � O O � O M O C CL CMa c CA ccc w J �v 'a- 0O2ts Z CD CL C.3 y O C C c� o C cc CIO o � c O N t. C : cc 0 C.3 C :ac :cvcc m c :s o �1 o 0: CON � � o lbH o c. • O Z C r.+ O C7 O r.. :urn RE c R E E CD L is C H y r c :�3 c C :ZC CO y OCD O �v Em cm .: .2 o cm c=m a :mom m r o O o .._ C=MV O CL C "a H m y m c c N COD L c .. •ADED «. O c ca •O d=LU Z CS CS V CD �- Ci O V CO CO2 a W m0 a` ti 5 O Z =tea O CIO 5- 9 M B ay a� O O v Z O d' O CO) o c co cm O_ .CO2 O O g `m m co CD co L_ CL � O O � O M O C CL CMa c CA ccc w J �v 'a- 0O2ts Z CD CL C.3 y O C C C cc CIO LLF 0 I� LU w C4 W�' W 19 W U) �+,,� 1 � � x,71 X� �, �• ,. -., ,.,.-.. ,,,�, sr 4! d '3 a� _ Sldln� c, s -w':- ' 28 Lonarood Roa( READING, W, 018( Page No. ,i'' of % Pages PROPOSAL SUBMITTED TO / PHONE DATE STREET �> Y� r JOB NAME CITY, STATE and ZIP CODE JOB LOCATION ff ARCHITWT r DATE OF PLANS JOB PHONE f We hereby submit specifications and estimates for: / /e. r .,� ,� � - f,%j V srla-'"� ',�, t��cS �....� !-�/tea ('' ��' J -- /ft✓ _> j �`7 ,�- C_ 1 ,! t . 7 r •' �` l % . ' T 'T . - �' - 7,X1 WP PTopm hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:. % ' f r dollars ($ Payment to be made as follows: f 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 Authorized involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. s` Note: This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. Arreptattre of Proposal— The above prices, specifications , and conditions are satisfactory and are hereby accepted. You are authorized Signature �I to do the work as specified. Payment will be made as outlined above. Date of Acceptance: - Signature \ �f � f = k}$ 0o ° k EoG {ƒ • c \ 2crf w o } k f i44\ v }.k $ LU \ �f 3 % 3 k}$ 0o ° k EoG • c \ 2crf w o } k f 0 $ v }.k $ S.,.0 Z o z 40.4. / �w �$-a , \] � fes± cc f/a � — e ■ � o . 2 = > § $ f 0 z §£24¢ cj 22A3�