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HomeMy WebLinkAboutBuilding Permit #323-11 - 777 JOHNSON STREET 10/19/2010 BUILDING PERMIT of NORTH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION y Permit NO: 2 — � Date Received Date Issued: IMPORTANT Applicant must complete all items on this page t's,c�.. ...��• aC`J �t')i'."t�yt 7. t �R`� �1 u$.r-x � { � � 1jyt # ��.. r y 4�i � ,5 t r - f �s��i' TI01� '< to�` �"tI ( r f ��, �IL.- Y.4 l...0•• f Yrs P .' ; 4 h`` Yf Tt t C 7i z f i s t r 91 ` +-��'. .}' r x :,•.c.. .r r i ac... F. aa } �. r ;.i'� t _ ' 1 -..trF �t i c`."�• 7 eS•{�a v.t�'C�: n ` �. f•3 -v'. �� s.z �,4 r "r- xef '�'.n ,,,_ x c +s P.C�T 011�1ER t � x s r- - r'��'r'-'' .,yiq f q'SY *-1�r a s, r ft 1 t F''� rz y,A- w f• 1 t''r5 ��w.u= �,r rr 9iaf �^^�. r �iS'a .zA ti.rSLtt .r'� 14S-s4,ast.k- t�.ti'F7'LiyCr. 7F—c tom: ` a ''��n1`�..,a�'.`"tr.}c'+.eccY,.•a�fs�. i �,.t+- �''•'m �IX iltl �, rri- r'Sa 3 �n r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other „Yr�Ft'a�e�Y:i�t.�LreiWs+w erp�'�'�'.-'-�r-t��t•^�sa't's.t.xT^is�,e,�.">7`'�7a�.7-'�".'�t1°af•„( i�."sr'y-�`4^,em!'&.'�-kti5:-.N.ru'x•-2-�wca-�''L.`:s�`-.fit��..:,�Y1'/-etfa5 Ta.r.i.�ds t�'-�*S r7,a°r ee�`L -�YY'�..fs S-ix..3.�`'.-�r•,��i,�� q`p+ te1 �c s r. DESCRIPTION OF WORK TO BE PREFORMED. QA / 1 �' G 121 / KAI re ka Identification Please T e or Print Clearly) OWNER: Name:—TA AA t (� h ric t1r) 1 .P . V1 . , Phone: ���( �F17 70 Address -7- JA'1S1(Jh Shea 4%'IdQwl M/T 04yj- ail 75 :r"" yi..-.m 1 !rJ��itt '�n� 'S�I ice: '9. ,.t i Y i% * 'St sv4Ab F..+7•.1'� I F v� lasL•+.t ':+^vi'S'U�o.f'§;'74'.�+� sae a.�''7 'cT-:`�+, �a^tr app s '� }-'r.4..a nn qty r t 3•R-.rrip,:�^I , Esu.-w 7x'f amu.. 4-r.f,y„5�''t'yyy r+nl '"`2' Yy {�, .►y�y_„ -�. sr .3i' x r'I t. fir. � +v"r�-' ,,��}� ��}a�a q3.r � Y r.1�Fr 7 +'�,�q�r -'�,r.�`� ^+�• ,y^ v.- t 'r` Z ..ti• 1 r+-,.:5.1,.� a'S+w' } r}�'3 ! z '� ,xa�r's'a �-�,.f' c���.� '�"i• 4 v .- - ,y > r i` -' i->,;3•. fi a q i ',lJlsf+a�w7 c .;..v; Y c ai sem• -t.r'�'a - s� VM,-, } 4 1 " - t" ..x s. .. '>r'.'N •• ,.,tW'� 5 .t _.`-a �,rj*�,3�3r�'�ty.. T�';n,'x. 4, v..x' MR, � Yac "xx 3rd r-i�t•.y a f'6 yrF� " .:J'� - -�� A � � •r„zi'� M �'� '�s<..t r E�'t 5. nr sv, r � C' 'y„ v t.r`�'�� ,.,3 �" `'"i�. -u . X •.t3..$�FSY�'a�. 'L1.���.K��y Y"' l IC 1.T 5 � �� � Z����f � (�-�+� rl•�r, �G.J�se;,: ``�ti'rs•3.t7` l s,y ri $a s r �.v. �£ 4,. R 1 �T.fYefi �7l 'I ! �AiYdu�ii�l� 1 U { - ..ir-.,-� r r• ..::,, ,r... ..,:.. �v.::•:e „�...._.�t__ x .. .. �,+t !�,,L �ru s..n �7f,a th-'S '� 3 "SFY �"'` �1R tl t i r". ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 P, Total Project Cost: $ 0 3rJ '1� FEE: $ 2Z.— J o" Check No.: �`�� Receipt No.: Qs74. 1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fund ignatur�]of Agent/Owner gnatu er nflcOn ractor Y ; t 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 Signature COMMENTS i 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 DPW Town Engineer: Signature: Located 384 Osgood Street 1RE DEQ i2TMEl T lernp`Durnpst .r mn srte des no vacated at'I� /lam S#reef {1 F kA s�gnaure/da#e`- 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 2010 Building Department The following is a 1.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) ❑ Building Permit Application ❑ Certified Proposed Piot 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:Building Permit Revised 2008 Location r� Yoh(1 S�n S No•.3 — Date v NpRTM TOWN OF NORTH ANDOVER 0 R A Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ J�cwust 9 Foundation Permit Fee $ Other Permit Fee $ i TOTAL $ Check # 235 `% 1 Building Inspector NORTly olm 0 6 over No. �3 ..3 - ao �� K * _ - - - o over, Mass. b ' i COC MIC HE WICK 'Ll,9S°RATE° P 'CCl U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR I THIS CERTIFIES THAT...........�....d..0 .j...........� ...Q..h.!1.t•.5........................................................................................ Foundation has permission to erect.................:...................... buildings on .. ......s ................... Rough to be occupied as .......... ............t' 12Q..4. Chimney ................. .......................... . ............................................................... provided that the person accepting th per shall in eve respect co m to the terms of the lication on file in P P P 9 P every P PP 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 MONTHS UNLESS CONSTRUCTI T TS ELECTRICAL INSPECTOR Rough ........... ......... . .................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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. DAVID CASTRICONE CASTRICONE ROOFING&SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and ld conditions,on premises scribed bSe.tdY .n.. xIS...................Te hone#.....Owner's Name........ F: t1S .............City.... '....�.......�e.l...t..St:.a.t.e...1...".1�11./ .�J............Job Address...�fL .... .� . Specificalions: ) ............................................................................................. / strip existing shingles.) -Xpply new drip edge to all edges. , ...................................................................................................................................................................................................................... -vApply _feet ice and water shield membrane to bottom edgesspof house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. 3 1 f. drt,. /,.P_,�r .................................................................................................................................................................../.........I............................. Apply felt p r nderlayment stall ridge vent to r,, s� .,,� ........................................... ........................ ✓Reroof using MA� shingles with aQ year warranty. ........................................................I........�..................... po ...................................................P.........�.�............� ............. -Counterflash chimney. '`F'1Qew vent i tlashi Ll al disposal of all debris. K, ................... an .......................`''`'.........` .. ................e`............. Area(s)to be worked on: 1..�..... ...� ..... .... �. . .... R.fs. o-'sRA.4n.Y�.t/[Esu S... Gi df:dR..r ..AG (/r.,� ..�.Lc�.r''t.t7:t:�..�rr.-t...G�.f..j?.(.��..1.'1.�tsl....i✓..1.rt..l�¢.l.'ir..cS.A....,(4........................ ....tr..�............. Roof board replacement if necessrry @ /sheet oF'Vp°/foot. Ct.Go F ................................................................................................ ....................................................... �.... ............ ...... ..... ..... Two Year Workmanship Warranty(Not Transferable) M`anufacturer's Warranty as specifi by ma ufacturer The contractor agrees I�tp9 perform the work d m ish the als specified above for the SUM o .........40..�.:.0.......... Payable.....21A.,...............on.� b.�J Payable.............................on.................................. Balance payable on completion of job Owner or Owners arenot responsible for Property Damage or Liability while job is in operation. Contractor is not responsible for any damage to the interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials specified above(i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces).Items in attic may need to be covered by homeowner.All materials are property of contractor. Any dumpster placed by contractor is for his use only.Upon completion of above work,all undersigned hgree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation as requested by contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid,immediately due and payable. It is agreed that,if permitted by law,contractor shall be paid by the owners)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid,that shall be incurred in enforcing the terns and conditions of the contract and/or any lien in connection herewith.it is further agreed that this contract may be assigned by contractor,and also that the obligations hervif shall bind and apply to their heirs,successors or estates of the parties.The undersigned warrant(s)that be is(they arc) the owners(s)of the above mentioned premises and that legal tide thereto stands of record in his,(their)names(s).There are no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in.zferencc hereto shall be binding only if in writing and signed by all patties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:Director,Home Improvement Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-727-8598 Any and all necessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction- related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date of work...............................................: Completion date............................... Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been rend and the contents thereof understood and that no representation or agreement not herein contained shall.be binding upon the parties and that al of the agreements and understandings of said parries are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Owner has three business days to cancel this contract and incur no penalty (see noti a of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their es this... .. ...da of..(1.�d:�7.(�..,20......4.1. Accepted: /`CSig ......................................... ........... 'aOwner Signed............................................................................. Owner David Castricone;President Imo' \ The Commonwealth of Massachusetts f Department of Industrial Accidents Office of Investigations 600 Washington Street Boston'MA 02111' ,2. www.mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): AV i 'b A ST I:I c o N E= o U F t N 6-- a S 1,3 G c. Address: 20 to So—i.-ro rz �C_ 2 z.%.J City/State/Zip:Jy o A ii -o ov A 6 1 8- Phone#: 9 7 b V33-3�a 1, 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. ❑Newconstruction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ 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 11.0 Plumbing repairs or additions thyself. [No workers' comp. c. 152,§1(4),and we have no 12.m Roof repairs insurance required.]t employees. [No workers' 13.❑ Other 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. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors acid 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: C f-f A-g T is Policy#or Self-ins. Lie. a 0 r-;q ,3 °7oA 3 Expiration Date: 9 /f/ L Job Site Address: 'I I� V Q h nS� A i1 f f City/State/Zip: N 0 YI t11/�r kq al r 11 �% 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 tnay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyundder t(h�epains andpenalties ofpeijury that the information provided above is true and correct.' Signature: J / �J Date: Phone#: q 8 U 3 3q Z o Official use only. Do not write in this area,to be completed by s Ity or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Buildirg Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Town of North Andover �o�v O Building Department a �• 27 Charles Street (� North Andover, Massachusetts 01845 (978) 688-954S Fax (978) 688-9542 ocwl[,IwaN 1 04ATED SHCNuS�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Es'c' Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector,