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Home My WebLink AboutBuilding Permit #166-12 - 85 OGUNQUIT ROAD 8/29/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit 0: Date Received Date issued: O12TANT:Applicant must com lete all items on this age :LQ:�QAMTON S^ PROPERTY OWNER , Print MAP NO: PARCEL:---I ZONING DISTRICT: Historic District yes 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: 11Commercial [IRepair, replacement ❑Assessory Bldg ❑ thers: i ❑ Demolition _ __ ❑Other �r! .r•-+r: -..-::r_ .s-�-- «y "''A"�''".rte, �^'E � ;'�,:rt =v . �ifC#"`: ..--c-a,.-:•,, rai:_— ._. ?-- s.V=-yc-a=.:.:.-, -_:-.,-:•--:� ®.'Septic__ all; ' �- lood lain t]t,Wetlands ' , 'Watershed F + ,� y't❑ District DES CR-11131 OF,WORK TO EE PER i0_RNIED: (I ntion Please Type or Print Clearly) OWNER: Name: `� / a4c� Phone: Address: �� ►^ CONTRACTOR Name: ��e57U/S � �.�Jslj�� y�L� Phone: FZA cK ap A m -/-, A M ,, Address: Supervisors Construction License: 3-! 3 Exp. Date: J ,�� 3- Home fmprovement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:B ULDING PERMIT-$12.00 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 with unregistered contractors do not have acces h ara ty nd ' `•� =Si' nature'.of�co'-�t Owner.:_ - �u�e:of•A erif1 - - ---- _,_9_...-�ti_._--_- �z 'v�_��. -==->r� = •-� J 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 ❑ El- COMMENTS COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceiptsubmitted yes Planning Board'Decision: Comments i Conservation Decision: Comments Water -& Sewer Connection/Signature&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 i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. i.: _ ELECTRICAL: Movement of Meter location, rust or service drop requires approval or Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$9000 fine i NOTES and DATA-- For department use i Ll Notified for pickup - Date J � � ( I Doc:.Building Permit Revised 2008mi i i J 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 ❑ 'A orkers 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 a Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses' a Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Pian Aid 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 i 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: Doc.Building Permit Revised 2008mi Location Orqv No. °RTh TOWN. OF NORTH ANDOVER 0 F s � s Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ saNusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i Check # �� rx-2 24516 B ector r t AM & AM MASONRY 203 Granville Lane `.. North Andover,MA 01845 + (978)686-2034 STATEMENT J Job Site To -7;�/?" CAVdr-ae1-11A'-. To Address Address City z �^ City g4 D►fit JOB DESCRIPTION AMOUNT /,JS�i''G�. /OCG' �j ✓ �'�� /- d l Payable upon receipt 1 NORTH And over .. Town of _ 4.-. TO dover, Mass., LAKE �J COCHICHEWICK ORATEO qs BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR w �. THIS CERTIFIES THAT............. .S`.:. L:...'............................................................................................. Foundation .............. ......g has permission to erect........................................ buildings on . .........( .u!�,. ..1.1�.. .................................. Rough ✓l. H' 1�...........................`...........:.................................... Chimney l-� ............................................. '� e to be 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 V PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR �bt UNLESS CONS TI N STARTS 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. I �_�„�._—.�;... ... i tr{ntent Of Publie Safety•:': �,., Zta�,�aehucetts-Del Rc;,ulatior+s�u?d St.in.�larils: •.,; )�oartl:t�#8uildin� SuPervisor License. _• GOnstfuctlon =..• _. License: CS 34384 Restricted to: QQ I MANCHINI AN THONY M N j 203 GRAILL MA 01845 NO ANDGVER, �_�; r.: Expiration: J mnii signer. 4. x.• :j r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,.1t1A 02111 www mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual) Ar) &/-� x'2 Address: 3 6/0-0 i l/, >, City/State/Zip: �d Ade,,X Phone#:Dct Z d W A you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with _ 4. ❑ I am a general contractor and 1 ❑ 6. New construction employees(fall and/or part-time).* have hired the sub-contractors 2.El 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 10.0 Electrical repairs or additions required.] officers have exercised their 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.E]Roof repairs n insurance required.]t employees.[No workers' 13.0 Other '1 a4, 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: Policy#or Self-ins.Lic.#: WC, S�� , Expiration Date: 14g l<a3 c?C`.9 Job Site Address: V/. City/State/Zip. A 4 Id,04l'Z Attach a copy of the worker 'coin ensation 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify unde•theai18 and nalties ofpeYjury that the information provided bove 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: