HomeMy WebLinkAboutBuilding Permit #796 - 76 GREENE STREET 6/30/2007BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Issued:
V, AP NO✓ PARCE _ Z+
Date Received S ^ 3 1 - 7
icant must complete all items on this
Print
TYPE OF IMPROVEMENT
IMPORTANT:A
LOC; -A IUNe
°
F-1 New Building
❑ One family
V, AP NO✓ PARCE _ Z+
Date Received S ^ 3 1 - 7
icant must complete all items on this
Print
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
F-1 New Building
❑ One family
Li Addition
❑ Two or more family
Industrial
U Alteration
No. of units:
❑ Commercial
X Repair, replacement
U Assessory Bldg
U Others:
U Demolition
❑ Other
Septics lilell❑
Fioodplan d Wetlands
�1YVa#ershed;- ?istn�t.
1Nater/S�we� -
6 x
�.
DESCRIPTION OF WORK TO
N
PREFORM D:
W;0JLj90 as
Identification Please Type or Print Clearly)
OWNER: Name: b13yQ-+Ckri5 6Qi,1±, Phone: F7i�"6��
Address:
CONTRACTOR
4d ss '
Z' ffi - n
Supe i -be Constrpction ` Jcense
_
1'
ARCHITECT/ENGINEER
Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 16, Z% . FEE: $ i3
Check No.: 4o, Receipt No.: 2D Zz Z --
NOTE: Persons contracting with unr gistere contractors do not have access to the guaran fund
Signaturedf AgentJ+vnir s Signature of contactor,';
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
o Building Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
u Copy of Contract
o Floor Plan Or Proposed Interior Work
Li Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
L3 Certified Surveyed Plot Plan
Li Workers Comp Affidavit
u Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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)
Li Building Permit Application
o Certified Proposed Plot Plan
Li Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o 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 2.2007
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans D.
TYPE OF SEWERAGE DISPOSAL
Public Sewer El
Tanning/Massage/Body Art
Swimming Pools `: ` _1
`
Well
Tobacco Sales
Food Packaging/Sales < .'-,f]
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑i
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
DATE REJECTED DATE APPROVED
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
r
4
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
Located at 384 Osgood -Street
L
EDEI ART TENT m
1'�ep Dumpster on "site eyes na
F10
Lor t d at;1;>4Nair} Street
p,
,Fire Department signature/date 71'
-, �� P�� �:.., • • � ''°ire ':. � � � �^�'�.� °-a�" �?
{,
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
NOTE5 and DATA - (For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
Dimension
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine
NU I t, ana UA I A — ( hor department use
No
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art E
Swimming Pools
Well
Tobacco Sales��
Food Packaging/Sales
Private (septic tank, etc. ❑
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
A
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
Located at 384 Osgood -Street
L% (I
AFIRE DEPARTMENT -Temp Dempster on site eyes., no
5 M.
:Locafed at;1'24=MaiiaF$I�eet�� `"-P
:Fire,Department signatur_d-j ate .
z'
�GOMMENTS
e
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
o Building Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Li Copy of Contract
o Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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)
Li Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
a Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li Copy of Contract
a Mass check Energy Compliance Report
o 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 DEPARTMENTMFORM07
Revised 2.2007
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received -E-3/-07
/v-�i�to / sr•NO\
vJJ 6` 1,,' y C OLpop
R
Date Issued: ,;
- I - ACHi
0 — —
IMPORTANT: Applicant must complete all items on this page
Residential
Non- Residential
LOCATIO�-'
❑ One family
Szf'A-t e
D Addition
m
fir; m�Pnnt .
PROPERT1f OVVNEWI{F
MAPZONING
Pnnt s
DISTRICT: d�istnyes�no
X Repair, replacement
-Histo
❑ Others:
.<, y actiirae�Sfo Nillagejrss .:: no.
TYPE OF IMPROVEMENT
PROPOSED USE
OWNER:
Residential
Non- Residential
❑ New Building
❑ One family
Szf'A-t e
D Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
17 Commercial
X Repair, replacement
❑ Assessory Bldg
❑ Others:
9 Demolition
❑ Other
R ;aas' �
u0'ervlsor's Cons bd i n License =
;Septic" ❑ V11
fl Vltater/Serie
FIdodplain n W40ands
o 1lVatersi a ,District "
,
UtSGKIF I ION YF WORK TO BE PREFORMED:
9001C A(v-m�f &J;AJVd -S
ARCHITECT/ENGINEER
Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 16, FEE: $ 3O
Check No.: 40, Receipt No.: 20 Zz Z—
NOTE: Persons contracting with unr ,gistere,4 contractors do not have access to the guaran fund
Signature"of AgentlOwne Signature of°contractor '
Identification Please Type or Print Clearly)
OWNER:
Name: ciQ+Ckri
Phone: 5'79"6
8- 67,1,157
Address:
Szf'A-t e
dress
ARCHITECT/ENGINEER
Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 16, FEE: $ 3O
Check No.: 40, Receipt No.: 20 Zz Z—
NOTE: Persons contracting with unr ,gistere,4 contractors do not have access to the guaran fund
Signature"of AgentlOwne Signature of°contractor '
-�,4 YY __'� �� Trr. °4�„ w`,�
°'�
.� %ea^�^ Y�v:. >P �,� nod
w.;•�� "';�
dress
R ;aas' �
u0'ervlsor's Cons bd i n License =
a
`Exp Cate
„
x�f
oFne Improvemeritq Llcrse.:=
Exn[]atP
�x=
ARCHITECT/ENGINEER
Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 16, FEE: $ 3O
Check No.: 40, Receipt No.: 20 Zz Z—
NOTE: Persons contracting with unr ,gistere,4 contractors do not have access to the guaran fund
Signature"of AgentlOwne Signature of°contractor '
Location –)6l-'
No. Date
NOR,
TOWN OF NORTH ANDOVER
f �
i:� •roc
� 9
Certificate of Occupancy
$
�'� s'•^°';<�'
•�CMUS
Building/Frame Permit Fee
$ 1 3 U
c
Foundation Permit Fee
$ `
Other Permit Fee
$,.—
TOTAL
$
Check N
it
20262
��---
•' Building Inspector
The Commonwealth of Massachusetts
Department of Industrial Accidents
Ogee of Investigations
600 Washington Street
Boston, MA 02111
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Dors/Electricians/Plumbers
Dlicant Information
Name (Business/organization/Individual):
Address:
City/State/Zip:
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 me .• have hired the sub -contractors
2. I am a sole proprietor or partner- listed on the attached sheet. t
eh;.,d These sub -contractors have
workers' comp. insurance.
5 ❑ We are a corporation and its
officers have exercised their
right of exemptibd per MGL
c. 152, Q 1(4), and we have no
employees. [No workers'
coin
an ve 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
Type of project (required):
6. ❑ New construction
7• ❑ Remodeling
8. ❑ Demolition
9• ❑ Building addition
10.0 Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
p. insurance requrred.] I
III
*Any !✓,./�
`Any applicant that checks box # I must also fill out the section blow showing their workers' compensation —licy mformatron.
t Homeowners who submit this affidavit indicating they are doing all work and thrn hire outside contractors must submit a new atiidavit indicati
'Contractors that check this box must attached an additional sheet showing the name of the outside
contractors
o s must submit___.
ng such.
i am an - - lump. poncy mlomlation.
information.
employer t at is providing workers' compensation insurance for my employees. Below is the policy and job site
Insurance Company Name: I It
S Oho 0Gt
Policy # or Self -ins. Lic. #:
Expiration Date:
_q,�,,_
Job Site Address:_
Attach a copy of the workers' compensation policy declaration page (showingthe Policy n�Dd�( �4
Failure to secure coverage as required under Section 25A of MGL . 52 can lead to the imposition bof criminaler and expiration datea
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WOR{ ORDER and a f
of up to $250.00 a day against the violator. Be advised that a copy of this statement may forwarded penalties of a
Investigations of the DIA for insurance coverage verification the
Y rwarded to the Office of
-- .1 ccrIS9 anaer the
perjury that the information provided above is true and correct.
Offlcial use only. Do not write in this area, to be completed by city or town g1liciat:
City or Town:
Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4
6. Other . Electrical Inspector 5. Plumbing Inspector
Contact Person:
Phone #:
OP I% D SATE IMMrOD�)YY1rY) j
AC-O,RD- CERTIFICATE OF LIABILITY INSURANCE COHDA 1 d laios�a6 ':
PRODUCrER THIS CERTIFICATE IS 19SUED AS A MATTER OF INFORMATION
Davis, Davis 6 Moody
40 Renoza Avenue
Haverhill MA 01830
Bkone:978-373-1347 rax:978-556-0285
--- --
INSUNED
90nMunx, Stbeit
Have.
hi l IDI 1830
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AF°ORDED 9Y THE POLICIES BELOW
INSURERS AFFORDING COVERAGE - - — _ LNAIC 0
111,Uit hA. Patrons Mutual ;4923
INSURFR 8.
T-
INSOPCR E:
,-�c PUL CE: 0^ I'ISI:RPIJCE I_•STF'? P.FLOV' HAVE SEEN SSU5:: ).�'�^F. ;hil,'� :� NAI'cC:.3
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04/04!2007 08:52 FAX 16038938196 HARVEY IND SALEM
Line Item #: 0005 Line Item Qty: 1 Initial:
Location: -
Existing Opening Size: 2'8 112" W x 4'4 3/4" H Unit Size: 32 118"W x 52112" H
400 Series, WDHI Single Insert Units
Unit Codelltem Size: WDHI 32 1/8" x 52 112' - 8 Deg
Existing Opening Dimension: 2'8 1/2" x 4'4 314"
Operation/Handing: AA
Unit SIII Angle: 8 Degrees - Moderate ( for 5 to 10 Degrees SRI)
Exterior Color White
_ Interior Color: Clear Pine
Glass Type (Top): High Performance Low -E4 Glass, Finellght
Grilles -Between -the -Glass, Specified Equal Lite, White/Whlte, 314'
Glass Type (Bottom): High Performance Low -E4 Glass, Finelight
Grilles-Between•the-Gless, Specified Equal Lite, WhitelWhite, 3/4"
Grille Construction (Top/Bot): Flnelight Grilles-Between-the-Glass/Finelight
Grilles-Between-lhe-Glass
Custom Lite Pattern (Top): 3W2H
Custom Lite Pattern (Bot): 3W2H
Insect Screens: Insect Screen, White
Z003
Comments.
Qty Part Num Item Size
Description
Total Price
Extended Price
1 0000000 WDHI 32 1/8"x 52
Unit, Equal Sash, 8 Degrees - Moderate SIII (for 5
$ 478.80 S
478.80
112" - 8 Deg
to 10 Degrees Sill), White/Clear Pine, High
Performance Low -E4 Glass, Finelight
Grilles -Between -the -Glass, Specified Equal Lite,
3W2H, WhlteM/hite, 3/4" (Each Sash), 2 Sash
Locks , White Exterior Stop Covers
1 0000000 WDHI 32 1/8"x 62
Insect Screen, White
$ 27.94 $
27.94
1*'- 8 Deg
$ 506.74 $
506.74
. .........
QUOTE: 000970 Print Date: 04104/2007 Page 3 Of 8 C Version: ig7.0
• High Performance Lcwr-E4 glace will be available as a running change on Andersen Architectural Specialty Windows. See order
acknowledgement to verily glass type. '
BOARD OF BUILDING REGULATIONS,
License: CONSTRUCTION SUPERVISOR
Number: CS 063220
Birthdate: 0113111966
Expires: 01/31/2008 Tr. no: 13112
Restricted: 00
DANIEL L GOBEIL
80 MONROE ST
HAVERHILL, MA 01830
�— — — ✓/ze Pan�zmuueall! o��G�aaaac�u6ei�
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 132182
Expiration: 11/30/2008
Type:
DAN GOBEIL CONTRACTING
DANIEL GOBEIL
80 MONROE ST.
HAVERHILL, MA 01830 Administrator
commissioner
License or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
Not valid without signature
Dan Gobeil Home Improvement
80 Munroe Street
Haverhill, MA 01830
(508) 451-0493
C.S. 063220 CONTRACT
REG. 132182
CUSTOMER: Chris Logan DATE: March, 04 2007
76 Green SL
North Andover
978-688-1908
PLAN: Replace existing windows
THE JOB WILL INCLUDE THE FOLLOWING:
PRICE
• Replace thirteen Double -hung Windows with Anderson 400 SeriesWoodwri
ht
Doubte-Hung Replacement Windows.
• Insulate all pockets surrounding windows.
• Seal inside and outside of windows
• Grid patterns to match existing patterns in between glass.
• Payment Schedule:
• 1/3 at contract signing. L :110'
$3865.53 �;Zd
• 1/3 half way through.
$3865.53
• 1/3 at completion.
3�v.S
• Permit Fee
$150.00
• Any paintingto be done by others.
• Clean and remove all debris
• Anything above and beyond said work will be done on a time and material basis
at a rate of $45.00 an hour.
TOTAL MATERIAL AND LABOR:
M4—,59"4—
59",TOTAL
ACCEPTED & AGREED TO BY: br�C
Chris Logan Dan Gobeil
DATE: �/ t �� DATE: Z� D
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