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Home My WebLink AboutBuilding Permit #214 - 74 ELMCREST ROAD 9/21/2006 Op NORTH 1N a OL ~ p TOWN OF NORTH ANDOVER #•� . .•°.' APPLICATION FOR PLAN EXAMINATION 9SSACHUSEt Permit NO: 0 Date Received: Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION c I? 5 �' Print PROPERTY OWNER tv4nb U Print MAP NO.: �� PARCEL: / ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential . 0 New Building One family 0 Addition ❑ Two or more family ❑Industrial ❑ Alteration No. of units: Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other 0 Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Al Identification Please Type or Print Clearly) OWNER: Name: P1V,4e0 )?14 Y/VFR Phone: Q? Signature Address: % ` e /? 5� r 5`7: A, �N Jf CONTRACTOR Name: .11/° 00P,44A/-' L`• Phone: Address: '� � Supervisor's Construction License: Exp. Date:_ Home Improvement License: / 3 / 95'0 Exp. Date:_%T,3 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. Il FEE SCHEDULE:BULD/NG PER IT: 10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST, ED ON$125.00 PER S.F. Total Project Cost :$ ��;`— xI0.00=FEE:$ Check No.: Receipt o V �� t No.:P Page I of 4 N Location � � Date No. _ , `^ NORTM TOWN OF NORTH ANDOVER .11° , ,h0 f � 9 y i Certificate of Occupancy $ ��s',^°•E<�' Building/Frame Permit Fee $ ACMUS Foundation Permit ee $ Other Permit Fee $ y TOTAL $ Check # 1 q 19-00 Building Inspector it TYPE OF SEWARGE DISPOSAL i wmmn SiPools 11Tanning/Massage/Body Art ❑ g Public Sewer ❑ Well 11Tobacco Sales Food Packaging/Sales❑ { 11 :Permanent Dumpster on Site ❑ Private(septic tank,etc. F1 Permanent Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of Contractori � Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS 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: Comments Water& Sewer connection signs re&date G Temp Dumpster on site yes_no_ Fire Department signature/date G�/i/� � �j/_O,6 Building Permit Approved and Issued by: Page 2 of 4 Building Setback ( Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 t_ r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Th 4 9 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 NORTH Town of : t 4Andover 1L 29 _ q.A�® o �D ^�+ LAKE o dover, Mass., COCMICMEWICK V 7�S RATED BOARD OF HEALTH PERMIT ' T D Food/Kitchen Septic System � BUILDING INSPECTOR 40 THIS CERTIFIES THAT.......... 1N.4...... .#A ft.r................................................................................... Foundation has permission to erect....... buildings on .7-y..... ....r.�.rye....uv.4...�....................... Rough tobe occupied as....�. .. ............S. ... ....(.4t. ................................................................... Chimney provided that the person accepting this permit hall in every respect co orm'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 PERMrF EXPIRES IN 6 MONTTIIS ELECTRICAL INSPECTOR UNLESS CONSTRU AR Rough ........... ...... ................ ......... ... ...... Service . .... . ..... . ....... ........ BUILDING Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of,Vassachuselts Department of Industrial:lccidents Office of Investigations 600 Washington Street Boston, VA 02111 www.mass.gov/ilia Workers' Compensation Insurance affidavit: Builders/Contractors/Electricians/Plumbers applicant Information Please Print Legibly Name V Address: Z/- d rEwIll V/-C- w /o -- City;State.Zip;/ `i� 4 � 'hone 7 — 7 — u/2 �z Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with d. ❑ 1 am a general contractor and l 6. ❑ New construction " p tloyees(full and'or part-time).* have hired the sub-contractors 2. l am a sole proprietor or partner- listed on the attached sheet. > 7• ❑ Remodeling ship and have no employees These sub-contractors have 3. E] Demolition working for me in any capacity. workers' comp. insurance. y. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per%MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.�oof repairs insurance required.] employees. [No workers' comp. insurance required.] 13.❑ Other _ `Any applicant that checks box 111 must also fill out the section below showing their workers'compensation policy intimnation. Ilomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. l'ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am tin employer that is providing workers'compensation insurance for my emplgyees. Below is the policy and job site information. Insurance Company Name:___— - -------__--- --- __-- Policy I or Self-ins. Lic. 4:—----- -- _ Expiration __— 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 11GL c. 152 can lead to the imposition of criminal penalties of a tine up to 51,500.00 andlor one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a tine 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 a the pains and pet allies al'pe iry t ut the information provided above is true and correct. tii n;tture: ✓��'Li ' [late: I'llonc_._ _� � (9 �� -- --------- ---- _ 1)lfrciul ase only. I)o riot trrite in this tirea,to be cwinpleted by cit-ew to wit,,/ficial. (City or Tow n: Permit/License# issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. E?eetrical aaspector S. Plumbing inspector 6.(:Other C0nt:act Ptrsaaaa: Phone#: ___ NORFOLK AND DEDHAM MUTUAL FIRE INSURANCE COMPANY SMALL CONTRACTORS POLICY RENEWAL CERTIFICATE Poiicy # R0412920 Named BLAD, NORMAN Agent INTERNET INSURANCE AGENCY, INC Insured 40 FER?IVIEW AVE #10 Phone (978) 685-7690 N ANDOVER MA 01845 Agent # 20155 FORM OF BUSINESS: sdi.v...i.dua.l.......:......:::::::::..................:.:.:.:....:..::...................:..................... ..................:.:::::::::::::......................:::::.:.:.:::::::...........................::.:....::::..:........................::..::. Policy Period: ONE YEAR from 02/04/06 to 02/04/07 This declarations page together with the policy jacket, the policy form and any endorsements, completes this policy. Coverage begins at 12:01 A.M.. Standard Time at the covered premises. : .::xx ::..:::.:::::::::.:::::::::::::::::. Basic Annual Endorsements State Taxes Total Annual Add'I/Return $957 tj Bid . /Locati on gg 1 Addres s if Different Mortgagee Information Business Description CARPENTRY POLICY DEDUCTIBLE $250 BUSINESS PERSONAL PROPERTY Limit $10,000 Included TOTAL PREMIUM PER B U I L D I N G $857.00 X. x. EXCEPT FOR FIRE LEGAL LIABILITY, EACH PAID CLAIM FOR THE THE FOLLOWING COVERAGES REDUCES THE AMOUNT OF INSURANC4 WE PROVIDE DURING THE APPLICABLE ANNUAL PERIOD. PLEASE REFER TO PARAGRAPH D.4 OF THE BUSINESS LIABILITY COVERAGE FORM. LIAR & MED EXP (OCCURRENCE/GEN AGG/PROD COMP OPS AGG) $300/ $800/ $600 Included MEDICAL EXPENSES Included DAMAGE TO PREMISES RENTED TO YOU $$5$5 Included :.... ............................................... SEE ATTACHED PAGE i ..:. l:r... . . X X > ;.;......:..:.:.......:...:>..:..:.::.:....:... 3.811" :n ...f 301! .., .... I:�, ,...!.1, .. ..� .,II111111 .. .1:011:. .. . ,•,•I.::1,.. I.I, ,I.,t :..n :1 I ,•1 ':.is I M hl •,. I: ••,r.II I •I �,I I„ 1 1.�II•I NIII1111111,.�,. rl1 HOP-- 1.1111!116'111111111111111,111!!lll'll!Ily�il hlAlyllil II{i IIII'Ili;l!I; (REV.04/05) Type of Payment: DIRECT BILL 10PAY :.. � ✓le �oonononuea�i o�✓�aaaac�ivarlld f I BOARD OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR `. Number: CS 016141 Birthdate: 03/15/1947 Expires: 03/15/2008 Tr.no: 20180 Restricted: 00 NORMAN L BLAD 40 FERNVIEW AVE#10 G— a N ANDOVER, MA 01845 { Commissioner Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 131950 lia .Expiration: 10/13/2006 Type: -Individual NORMAN L.GLAD NORMAN BLAD 40 FERNV I EW AVE 0 N.ANDOVER MA 01845 Administrator y a fi a, it z 'e Page# of pages Norman L Blad Construction 40 Fernview Ave. #10, N. Andover Tel: (978)687-6263 Lic# 016141 - MA Reg# 131950 Proposal Submitted To: Job Name Job# ice"•%b��:1"!r �� /��/"�'�. �..�.._ Address t- Job Location y Date ;Z Date of Plans Phone# fry h ✓ ax# _._ _ ,_, Architect _ We hereby submit specifications and estimates for: ....................... ......... .............................._ .... . -_ d.. i .... . _ .-.-..__ /-.-, _ ._- .. _ ..--.__._..._._ ,- .. f__._ _................. - _..-._--- _ -----..._....... _- - _----------- f - - - - _. I-...... ........ __. I61U d� _ - ......._ _ . .... _ ...... .......... iIL rWe propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: I ,� �, .2 d . ' ' with payments to be made as follows: Dollars An alteration or deviation Any e anon from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents,or delays submitted f beyond our control. Note—this proposal may be withdrawn by us if not accepted within days Y C � 21CCe tdnCC � of Prop al i above Theprices, i specifications and conditions are.satisfactory and are Signature - hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined/above. i Date of Acceptance �Z f 'J Signature C >' NC3819