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Home My WebLink AboutBuilding Permit #204-4 - 745 FOSTER STREET 9/9/2011 R: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: ORTAllTT:Applicant must com lete all items on this page LOCATION e4—A- c Print PROPERTY OWNER To h int MAP NO:%)ARCEL: ZONING DISTRICT: Historic District yes no It Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑Addition ❑Two or more family ❑Industrial Alteration No. of units: ❑Commercial ❑ epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other I® Wall, `'r a® loodplan: ��Wetlands (® Wate shedDistnct= �` ®�Narer/S rarer' DESC.t TION OF WORD TO BE PEU,ORMED: get 114 C Fitt i t-4 �t (Identification Please Type or Print Clearly) OWNER: Name: %�_�_. Phone. Address: G CONTRACTOR Name: vp2. 01 /(D Phone Address: 0�- Supervisor's Construction License: u***'0 6' Exp. Date: oZ/a3�l Z Home Improvement License: Iso V�3 Exp. Date: ;o t 3 ARCHITECT/ENGINEER Phone: t Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PVTF11 00 OFT E TOTAL ESTIMATED COST BA ED ON$125.00 PER S.F. Total Project Cosi: $ �f I[ g � - FEE: $ Check No... Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access th guar f d Signature o_'Agerit/Owner:_.. __ _Signatu:ceof contacto "' Location No. U I"1- Date r NORTIy TOWN OF NORTH ANDOVER OL 9 Certificate of Occupancy $ sACMUS Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ - Check # 24566 Building Inspector 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS e Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board'Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Sic#nature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. i.: _ i ELECTRICAL: Movement of deter 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 . l i ® Notified for pickup - Date Doc:.Building Permit Revised 2008mi 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 ❑ !AJorkers 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 MOTE: All dumpster permits require sign of from Fire Department prior to issuance of Bldg Perr, Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Con. ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler flan And Hydraulic Calculations (If Applicable) o 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 Perm, 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 ❑ Engineering Affidavits for Engineered products INOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Fermi In all cases if a variance orspecial permit was required the Town CIerks 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: Doc.Building Permit Revised 2008mi TME The Commons 25 Indian Rock Road SALES ORDER Windham NH 03087 Q P Tel: SO-15487 8/18/2011 Fax:603-537-0556 IIIIII VIII VIII VIII VIII IIII IIII Customer Contact. Ship To Jack Meaney Jack Meaney 745 Foster St N ANDOVER MA 01845 UNITED STATES Tel: (978)420-9821, (978)994-8222 Account Terms Due Date Account Rep Schedule Date 9784209821 Cash 8/18/2011 Steve Bretton 8/3/2011 Quotation PO # Reference Ship VIA Page Printed SQ-17156 Customer Pickup 1 9/7/2011 1:03:51PM L Item Description Order Ship Price UM Discount Amount 1HST8021-4110 HERITAGE, Pol Stone - Matte Black 1 $2,999.00 EA $299.90 $2,699.10 2LAB25Note Install Wood Insert w/Full Liner 1 $0.00 EA $0.00 3ZFXZFLKIT625NT Liner Kit, SS No T - 6x25 (20ILKTX_I) 1 $724.73 EA $724.73 4BKPB690 Pipe, 6x90 Adj Elbow - Blk 24GA BM0014 1 $11.50 EA $11.50 5ROC6DP Damper Plate 6" 1 $44.95 EA $44.95 6LAB02 Labor - Install 1 $650.00 EA $650.00 7 These parts represent a typical installition, however other parts may be required or substituted at the time of installation ****IT IS THE CUSTOMER'S RESPONSIBILITY TO CHECK WITH THEIR TOWN ON THE REQUIREMENTS FOR A PERMIT. ANY FEES FOR PERMITS AND PROCESSING WILL BE ADDED TO THE BALANCE DUE.**** 81abnote ********NOTE********** 1 $0.00 EA $0.00 9 These parts represent a typical installation; however other parts may be required or substituted at the time of installation. Our Store Policies are located on the back of this document Tax Details Taxable $0.00 In order for us to improve as a company, your feedback is EXEMPT $0.000 critical. Please take a few moments to fill out our survey on line @ www.stoveshoppe.com Thank You for your business! ! Payment Details Total Tax $0.00 8/18/2011 V XXXXXXXXXXX6019 $1,300.00 Exempt $4,130.28 Total $4,130.28 Paid $1,300.00 X Balance $2,830.28 Dep. Avail $1,300.00 S-Rore Policy e Please remember to keep your receipt. It is required for any returns. NO RECEIPT- NO RETURN o A 20% handling charge may apply to your return. o After 30 days,, any returns or refunds on deposits will result in a store credit only. oSpecial Orders require a 50% deposit-All Sales Final. No Returns or Refunds, ® All sales on electronic components are final. a Returned checks -A $20 charge will apply. 0 Please rernember to pick up any items You order, We will not be responsible for items that are left over 30 days. 0 Most prices reflect customer pickup; however, delivery and setup are available for an additional fee, 0 If you elect to pick tip a stove or fireplace, you must plan to come with a truck or var). THIS EXCLUDES GARS. We use a forklift to load stoves and fireplaces. They CANNOT be placed in the trunk or bacilk, seat of a car. If you do not have access to a truck or van, we offer delivery service. * Per our InsUrance regulati(:)ns, -*e are- not allowed to supply customers with T\N"1NE, ROPE or TIE-DOWNS of any kind. We cannot tie down anything that customers pickup. Gift Certificates are available, Visit Lis on th, web at: www.stoveshoppexoni v~;N1,f encesunli ni ited-com Talc you foir your patronage! THE The Commons mmm( 25 Indian Rock Road SALES ORDER Ldl � Windham, NH 03087 ! aPPIR _ Tel:603-537-0555 SO-15487 8/18/2011 Fax:603-537-0556 1111111111111111111111111111 Customer Contact Ship To Jack Meaney Jack Meaney 745 Foster St N ANDOVER MA 01845 UNITED STATES Tel: (978)420-9821, (978)994-8222 Account Terms Due Date Account Rep Schedule Date 9784209821 Cash 8/18/2011 Steve Bretton 8/3/2011 Quotation PO # Reference Ship VIA Page Printed SQ-17156 Customer Pickup 1 97/2011 1:18:50PM L Item Description Order Ship Price UM Discount Amount 1HST8021-4110 HERITAGE, Pol Stone - Matte Black 1 $2,999.00 EA $299.90 $2,699.10 2 LAB25Note Install Wood Insert w/Full Liner 1 $0.00 EA $0.00 3ZFXZFLKIT625NT Liner Kit, SS No T - 6x25 (20ILKTX_I) 1 $724.73 EA $724.73 4BKPB690 Pipe, 6x90 Adj Elbow - Blk 24GA BM0014 1 $11.50 EA $11.50 5ROC6DP Damper Plate 6" 1 $44.95 EA $44.95 6LAB02 Labor - Install 1 $650.00 EA $650.00 7 These parts represent a typical installition, however other parts may be required or substituted at the time of installation ****IT IS THE CUSTOMER'S RESPONSIBILITY TO CHECK WITH THEIR TOWN ON THE REQUIREMENTS FOR A PERMIT. ANY FEES FOR PERMITS AND PROCESSING WILL BE ADDED TO THE BALANCE DUE.**** 81abnote ********NOTE********** 1 $0.00 EA $0.00 9 These parts represent a typical installation; however other parts may be required or substituted at the time of installation. 10MET6TIT Tee w/Ins Cap 1 $280.61 EA $280.61 11MET6T48 6 x 48"Length 1 $250.24 EA $250.24 12 MET6T36 6 X 36" Length 1 $198.54 EA $198.54 13MET6TJS Joist Shield 1 $33.94 EA $33.94 14MET6TDSA Smoke Pipe Adap Smoke 1 $66.14 EA $66.14 15 EXC6UBAF Pipe, 6" Dbl Wall Smoke - Adj 40-68 1 $195.00 EA $195.00 16EXC6UB90 Pipe, 6" Dbl Wall Smoke - 90* Elbow 1 $84.00 EA $84.00 17LAB02 Labor - Install iNSTALL OF METALBESTOS 1 $450.00 EA $450.00 CHIMNEY Our Store Policies are located on the back of this document Tax Details Taxable $0.00 In order for us to improve as a company, your feedback is EXEMPT $0.000 critical. Please take a few moments to fill out our survey on line @ www.stoveshoppe.com Thank You for your business! ! Payment Details Total Tax $0.00 8/18/2011 V XXXXXXXXXXX6019 $1,300.00 Exempt $5,688.75 Total $5,688.75 Paid $1,300.00 X Balance $4,388.75 Dep. Avail $1,300.00 Store Policy ID Please remember to keep Your receipt. It is required for any returns. NO RECEIPT- NO RETURN * A 20% handling charge may apply to your return. o After 30 days, any returns or refunds on deposits will result it) a store credit only. o Special Orders require a 50% deposit-All Sales Final. No Returns or Refunds. o All sales on electronic components are final. 0 Returned checks -A S20 charge will apply. o Please remember to pick up any itenis you order. We will not be responsible for ite:-ns that are left over 30 days. 0 Most prices reflect customer pickup; however, delivery and setup are available for an additionat' fee. 0 If you elect, to pick up a stove or fireplace, you must plan to come with a truck or van. THIS EXCLUDES CARS. We use a forklift to load stoves and fireplaces. Trey CANNOT be placed in the trunk or back seat of a car. If you do not have access to a truck or van, we offer delivery service. 0 Per our insurance regulations, we are not alliowed to supply customers with 'I WINE, POPE or TIE-DOWNS of any kind. We cannot tie down anything that customers pick Up, 0 Gift Certificates are available. a Visit us on thie web at: www.stoveshoppe.corn v vvww.f,--,ncesunIimited.com Thvnk you for your patronage! NORTH TON- M Of 9A o , dover, 1VMass., COCHICHE W ICK �ADRATED PPS\ �cb �qS BOARD OF HEALTH Food/Kitchen Septic System .PERMIT T D BUILDING INSPECTOR K THISCERTIFIES THAT..................... V!1! ........................ ... ............. .... ............................... ........ .................. Foundation has permission to erect........................................ buildings on .......... ...........................1. ..... z.� .._.... ' Rough • Chimney tobe occupied as.... . ..................................................................................... 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 PERMIT EXPIRES IN 6 MLATHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT(6. ..... ............T 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. Burner Street No. SEE REVERSE SIDE Smoke Det. S The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02I11 qV www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/]Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): T-',J 1?c /Y I1W491vC Address: c?9 7�,&;a J�acg , City/State/Zip: Ald Ql �7- Phone#: (",.r�3 7—d SSS Allto er with or an you an employer?Check the appropriate box: Type of project(required): 1. I am a employer m 4. ❑ I am a general contractor I P Y 6. New construction employees(fall and/or part-time).' have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. Y9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 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' 1 , ther comp.insurance required.] *Any applicant that checks box#1 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Azx4A,��L Policy#or Self-ins.Lic.#: W C 0-',l 11s,I O' /O Expiration Date: DDr� Job Site Address: qqT Fa51zk City/State/Zip:&Ail� 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 vio e advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins ce cov age verification. I do hereby c 2y der t� s a penalties ofperjury that the information provided abov is true and correct. Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: