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Home My WebLink AboutBuilding Permit #044-16 - 83 MILLPOND 5/1/2018 4 q BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION b Permit NO: Date Received � �=-- �sS C Date Issued: IMPORTANT:Applicant must complete all items on this page `S 2 im N&NLIL- '3 ' 1 i L OW �� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family CI Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other w� 3 �" c\i tl � y IR a 6G,,' Identification Please Type or Print Clearly) OWNER: Name: Rob 1..eV�/ _Phone: gaA-'k9 o -a"75$ Address: e3v z a' Rl 1�1 All v v X , \ � x � R v4v�0 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: $ ` Cl 3 8g FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with nregistered contractors do not have acce to the guaranty&nd "17 Pry C7 CV r NOR T11 PERMIT 46 BUILDING P °��zLEo 'b 6 �. hP...J. .'u, TOWN OF NORTH ANDOVER 0 - APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �'°RATEC SSAGFiUs�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no 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 ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other h Septic (]1Nell ❑�Flootlplarn Wetlands D Watershed�4Distnct; _, , ate` DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting jvrkh unregistered contractors do not have access to the guaranty fund .. _• . _, ,, _,- v � d � r Q �r — — Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, InterioRe abilitation Permits Qom, .4. Building Permit pplication 9_ � orkers Comp Affidavit 4, hoto Copy Of H.I.C. And/Or C.S.L. Licenses opy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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/Cross Section/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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Pp Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses 4 Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 2014 _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE RA, E DISPOSAL Public Sewer ❑ Taming/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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS e Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments r Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit ]DPW Town Engineer: Signature: . _ �� Located 384 Osgood Street tFIRE DEP'A S e t RfTMENILI7 Tem ®um seer onsite es _ p �=. *gyp ' � y rno i , L�"ocated at.1�24 IVlain Street,r °�, -r-- +Z-m+> l f- f$Fiee Department�signature/dates , � r x v >� - ;° xa .if;�.",,:....+Lc..3 r S =s Yn-t x•+y4 o SLty +u� ��- 4 a*y* c y...(^ �,?e x�; i r�tr !q} �� L't'.'�{,-'Gy.r�'j'r �,�!� fs �`;�,i;r � 's r;,{ n c"F�� 5G� �. Za '�..:.� CfV1MENTSti Ys t� T} 1 t y r' 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-$1000 fine NOTES and DATA— (For department use) U Notified for pickup Call Email Date Time Contact Name Doc.BuRding Permit Revised 2014 Location lS. a, 11 lid Y2J - No. Date • TOWN OF NORTH ANDOVER 4.' - • MY �• Certificate of Occupancy I$ Building/Frame Permit Fee $1 Foundation Permit Fee $ Other Permit Fee $ TED TOTAL $ ¢ Check# i Building Inspector 2-.903.7 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 1%388.00 m $ - $ 232.66 Plumbing Fee $ 29.08 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 29.08 Total fees collected $ 390.82 83 Mill Pond Road 044-2016 on 7/9/2015 kitchen remodel i i t►ORTH own o Andover h ver, Mass, �A C0C"1C"1W1Ck 1' °R�TEo ,.Qa'�,�5 9S U � BOARD OF HEALTH PERM T T Food/Kitchen Septic System THIS CERTIFIES THAT ................... ......Q... ......ttV.. . ...................P................... .... BUILDING INSPECTOR 83....M.1 11.M.4 �A..". .. Foundationhas permission to erect.... ... ................ buildings on ................ ,.,.. • Rough to be occupied as ...... ... ..l). go..................... ......................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 a3� , PERMIT EXPIRES IN 6 MO HS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO R Rough Service ....................... ................................................... Final BUILDING INSPECTOR GAS INSPECTOR i Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final I No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Northeast Custom Kitchens Estimate 474 Main St. Wilmington, MA 01887 Date Estimate# 1/24/2015 0424 Name/Address Rob Levy 83 Mill Pond Rd. N.Andover,MA 01845 Project Description Qty Rate Total Kith Kitchen Cabinets per design. 11,588.00 11,588.00T Removal of existing cabinets,and countertops. 775.00 775.00 Install new cabinetry and all moldings. 2,625.00 2,625.00 Debris disposal. 300.00 300.00 In home delivery of new cabinets. 350.00 350.00 Removal of existing wall between living room and kitchen. As long 1,500.00 1,500.00 as wall is not structural and no beam is needed. Update kitchen electrical. Basic work. 1,300.00 1,300.00 Basic plumbing and reconnection of appliances. 950.00 950.00 Subtotal $19,388.00 Sales Tax (0.0%) $0.00 Total $19,388.00 118" 2312 36" 27" 27" 4117" 7612 2 21 3 1 , 21 36,E OF W2730-Butt W2730-BI ) ;J N RW3612 - - N N Nr, 212484-RO B21 L BE 6L 0) �I r U1 ml �I �a� N CD Ww � Y i El.", ------ ------ W • - NI, BIW _ M /.a \ C40 C FT_ V1 00 000 - M W W i FH _ 0 N, � I W930R to = U OD Cn 00 cn ;U O ' 0 n `J, FH-B123412R 0 A N I� i I All dimensions size designations20 This is an original design and must Designed: 1/17/20151 1 given are subject to verification on TECHNOLOGIES not be released or copied unless Printed:6/20/2015 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Levey,Rob All Drawing#: ] I No scale.) The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAMTING AUTHORITY. Applicant Information Please Print 'bl Name(Business/orgasm ion/Individual): - ]✓ Address: V City/State;/Zip: �J t Phone#: Are you an employer?Check the appropriate box: ry Type of project(required): 1.aI am a employer with Y employees(fiill and/or part time).= 7. New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in $. Remodeling arty capacity.[No workers'comp.insurance required] 30 1 am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. Demolition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole I IQ Electrical repairs or additions proprietors with no employees. 12.F]Plumbing repairs or additions 5 0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.Q Roof repairs These sub-contractors have employees and have workers'comp.msurance.i 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14_[]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infomtation. 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 state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employee& Below is thepolicy and job site information. Insurance Company Name: V&\)tl, ex Policy#or Self-ins.Lic.#:_ 1-) 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerci the pai&and penal' that the information provided above is true and correct Signature LpkDate: Phone M 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): 1.Board of Health 2.Building Department 3.'City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor 1 &2 Fami1v License: CSFA-067737 GARY S MOAML-AN 111 ARKANSAS ROAD: k, s TEWKSBURY Ofi r t € Expiration Commissioner 08/17/2015 c �fe`(po-m�r�znaxtuea.�a��Gaa�a�r�6etl,�- --- _� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: :126257 Type: Office of Consumer Affairs and Business Regulation piration ..-5f7/2016 Private Corporatio 10 Park Plaza-Suite 5170 Boston,MA 02116 COUNTRYSIDE CUSTOM BUILDERS;INC. GARY MCMILLAN 111 ARKANSAS RD TEWKSBURY,MA 01876 ` Undersecretary N alid without signature I