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Home My WebLink AboutBuilding Permit #665 - 74 HEWITT AVENUE 5/1/2018 NORTH BUILDING PERMIT 0.4-f..o 06. TOWN OF NORTH ANDOVER 3? �' ' °L APPLICATION FOR PLAN EXAMINATION Permit NO:Ca Date Received ��SsgcHus��y Date Issued: d IMPORTANT: Applicant must complete all items on this page LC?CAfON �' + f, . 1?nn PROPERTY OWNER L zn'e: e ��' Print, MAP NO: PARCEL . ."Z{� tINC,.DISTRIG M HISTORIC DISTRICT yes nod' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building P<Dne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ A ration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other QSeptic. amI A� FI)6dplein� D Wetlands a � DC7>�Watershed�?tstric O Water/Sever' p DESCRIPTION OF WOR TO BE PREFORMED: n � !� S 1''r-M4d Ue— I Y 01,06 Ir �) t ?.0 r. D�,v IdentificationTease T e or Print Clearly) OWNER: Name: _�Iv��., �"` � � Phone: Address: _ r 4. - CCJNTRACTC}R� Name: ►\ ;��,� r `� tY . ,s : Pho e. ' 'V to 8` +t Address: D g Supervisors Cf7C1,&uctiQT1 License: E r dz� ! " Cp. Date' /IoQs'A 7. w : w Home Improvement License. -d 6 ? Exp` Date: " ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ DOO O� FEE: $ � �— Check No.: �V dReceipt No.: 0 0 i a NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 'o 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 FIRE��?EPAF'tTMENT ,,��Teinp Oumpsteron �it�, yes � n�"" �� . t �, Located.at 124 Main Sfiree , . Fire l rop'artmentsignature/date .3�:-; - - _ - _ d ay...o S .. `A hex• ,COMMENTS: 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 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 ❑ 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) I ❑ Building Permit Application I ❑ , 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 I Hydraulic y c 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 I I Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 4 • � I Revised 2.2007 1 -- Location? No. Date 4///s f ' NORTh TOWN OF NORTH ANDOVER A Certificate of Occupancy $ 9 Buildin /Frame Permit Fee $ �— s�cwust Foundation Permit Fee $ J' Other Permit Fee $ TOTAL $ `r Check # C) 01 Y� 20 '41 _ Building Inspector 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 Lezibly Name(Business/Organization/Individual): �t CAV rd L. Address:_ . �f0 fin,-6W r City/State/Zip: O Mhone#:_(I 7�) 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 I 6. ❑New construction [el (full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. wilding 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 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12,❑Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.0 Other *Any applicant that checks box#I must also till 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. #: Expiration Date: 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 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 erthe pains and 50FUes perjury that the information provided above is true and correct. Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town offciaL City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• �� RSP toce•� v�i��u,,1 ►1'1 t6 b f / IA7 U S i a i i f z vApRTH Town of Andover No. to a ~ �-41 dover, Mass., COCMICMEWICK V 7,9 A°RATED `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... 4...................... Foundation has permission to erect.......... ............................. buildings on.... ......... .. ��!...� . ..... ...................... Rough Ch' e to be occupied as.16...... .....& 0. �.... :.:...: L.� ............ tmn y provided that the person accept g this permit shall in every respect conform 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 & 00W PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI T ELECTRICAL INSPECTOR Rough ..... .. .......................... Service . ... ..:.. ........... ............ BUILDING INSPECTOR 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumex Street No. SEE REVERSE SIDE smoke Det. _ Carbonless Cites IVC 3898-50 3 PART PROPOSAL _ IlI6AR Nbm ANDGM. MA 01 DATE PROPOSAL SUBMITTED TO: /z s7 • WORK TO BE PERFORMED AT; 1; i DATE 0F PLANS- PHONE NO. ARCIiITECT rc it 7: I .. .:: `;41�t•'' i1• At 4 ® . All material is guaranteed to be as specified, and the above work to be performed in accordanceIh the drawings and specifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of I a fo- -- �- — ---Dollars ($__ V. 0 with payments to be made as follows. 11 ®t�3 h &A J� /.2 �u c-&-nip� . � Respectfully submitted sd Ary alteration or deOation from above specifications involving extra cats will be executed only upon written order, and will become an extra charge Per over and above the estimate. AN agreements contingent upon strikes, ac- [ cidents,or delays beyond our control. Note--This proposal may be withdrawn – by us if not accepted within—days. '� �'�"ANCf�:'•:bl�f�'�tCAf�4�AL' , . The above prices, sped#ications and condiifON are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. L_� /Signature d6L Dote_ _-- Signature CNC 3816-50 PROPOSAL MADE INIh USA