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Home My WebLink AboutBuilding Permit #269 - 800 MASSACHUSETTS AVENUE 10/11/2007 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ^o e 1. Permit NO: Date Received �9ss w••p,��y AGHU Date Issued: 'a IMPORTANT:Applicant must complete all items on this page ,., vpy r `:... .�� '��,,�.� f "�'a �h"v.,:. 5..- �SY.:'„�,,,.._w.•.�dW,... �..,>, ,*,�.��[s.�a+.,s gii .�, x. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Building ❑ One family ddition [I Two or more family . El Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ham SIXH^ w f DESCRIPTION OF W%RRK TO BE PREFORMED: ��trl+G l�w d 1��.t.i5� ��'Se�.tw�t, Qec.P.,�,�,�.•av DwL T 7' Identification Please Type or Print Clearly) OWNER: Name: V e. - Phone: Address D g e.f 4k:C,14 P D e4� 41LOCie, INS ". h', e3�'k +e 4 eT Y�.., Y dam' FY'Mv •"sem., 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: $ Oaf FEE: $ 490 Check No.: o� Receipt No.: c>/Ul& NOTE: t ons contracting with unregistered contractors do not have access to e guaranty fund gnaiure of A eri/�wn � Slgnature�o �onlracN ` f � 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, ❑ El, COMMENTS t 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 wa FSR flEP kJA ENT Tei p r s eer on site x fir, r ocatea�14lairstreetZ f x +✓ },^s k;"n.,ro, Jda 'Yx.. i gY 'r vTs X A F l p """jj "a" tr epar rr�en srgraature date f � :, 3 C33M ENT _ '��ae�s. -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)- ❑ 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 Reportort ❑ 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 Location 11-�7(/ No. Date NORTH OTOWN OF NORTH ANDOVER f? : �..e , tiO 9 0 Certificate of Occupancy $ CM Building/Frame Permit Fee $ ,SSAUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20676 Building Inspector c1ORT�M ToNvn of No. Z G - C% 0 dover, Mass.00 0 LAK 2 COCHICHEWICK ADJ�ATED `r BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT.... � ..... ..... ..................................................................................... Foundation has permission to erec ....... ..............................A;lIdIngson .. .... .... . .... ...... . ......... ... .......�..................... Rough to be occupied as.:.... !!! .......................... .�........ .. Chimney ................................................................. 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 �4 PERMr r EXPIRES IN 6 MONTHS -, ELECTRICAL INSPECTOR UNLESS CONSTRU S ARTS Rough , ...... ... Service ...... .. BUILDING 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. t ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY RENEWAL QUOTATION WORKERS' COMPENSATION TEL.# (800) 876-2.765 PLEASE MAKE REMITTANCE T A.I.M.Mutual Insurance Co Date 07/13/2007 P.O.Box 4070 Burlington,MA 01803-0970 Keylime Inc IMPORTANT: COVERAGE WILL NOT BECOME 1538 Turnpike Street EFFECTIVE UNTIL YOUR POLICY EFFECTIVE North Andover.MA 01845 DATE. PLEASE PAY THE TOTAL AMOUNT F SHOWN BELOW NO LATER INSURED � �d I / t / L,. I /,. 08/2612007; M P Roberts Insurance AgencLCORD Inc 1060 Osgood Street 7North Andover, MA 01845 PRODUCER OAGCY Policy Effective Date 09/15/2007 Policy Number AWC 7013446012007 Estimated Total Rates Per CODE $100 of Estimated Annual Premiums NO. Annual Remun- Subject to Remuneration � All Other eration Modification SEE EXTENSION OF INFORMATION PAGE TOTAL ESTIMATED ANNUAL PREMIUM 2,939 TOTAL MA ASSESSMENT 2,034 x 5.5000% 112 DEPOSIT PREMIUM 2,439 DEPOSIT ASSESSMENT 112 sbindman TOTAL AMOUNT DUE 2, 551 FOR COMPANY USE ONLY Net Amount of Check Initial&Date placing office: 705 AP 4921 (9-89) Board of Building Regulations and Standards ' Construction Supervisor License J.iceriset CS 75302 Birthdate-{2/4/1941 Expiration 112A/2008' Tr# 6950 j Restriction 00 .r'j 3 BENJAMIN'C.OSGOOD ,r If\ 69 OLD VILLAGE LANE - �J NO ANDOVER,MA 01845 Commissioner