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Home My WebLink AboutBuilding Permit #613 - 87 BARKER STREET 5/13/2009Permit NO: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: f2.1 -1S ev - IMPOR NT: Applicant must complete all items on this pace LOCA = MAP NO: PARCEL:Z�dT ZONING DISTRICT: Historic District yes Machine Shop Vllacie ves v StLc.. •6•-ryO\ no 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: /S7 Identification Please Type or OWNER: Name: Address: 9,7 1,5A -r.LER -.,�7" CONTRACTOR Name: � E,< 5 6/V -7aM D > phone: ` F-~91 Address: „ /5AI u6vs " - -i —;7-23s' Supervisor's Construction License: e: s i qks Exp. Date: Home Improvement License: %'1'Exp. Date: '7' %� 6 16 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: SULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST ASED ON $1250,00 PER S.F. Total Project Cost: $ 3 6 FEE:. ; o Check No.: ` Cha %� Receipt No.: &-- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ownetr':=:7L--� 4. Signature of contractor Location S 4'a -g—, —.5 No. 6el � &I Date of TOWN OF NORTH ANDOVER 4,90" 41 Certificate of Occupancy $ B uilding/Frame Permit Fee $ 04 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22 U/- 8 0,`;1 - Building Inspector 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 Siqnature COMMENTS n HEALTH Reviewed on Siqnature COMMENTS 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 DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS --I- Located 384 Osqood Street yes no 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 Doc.Building Permit Revised 2008 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 O z s: x A ;® o F U c v a o ` w Dara � O w (A6o v cn G m p w O a4 E x U r. w a p C U W �' W co C7 m 0 G W ate' w v � d z v Q ui am w a O O co L O Z °D Q O CO) Q C I cm CODO •— y Q -0 CD ._ E m m CD O O O � � Q03O L cc O d a cm< y C* Cc Cc d OCO2 Z y0.. C co CL V CO) c C— . C c CO)CL Q v/ LU C4 19 W LLI ce LLIw CO) ;® o c v o ` C H _O C CL C O ea O :t O co co Ea D c Cf) :14 4. 42 .) 1 � L) CL zy • O �o= C.2 +c :mom E �O m a •� m V` o Z' = U) CA Of 3 y • ' C W fA +� CL o �• y O ; 3 m :5 .00 cm rte: CM" y R O V h Z p • � CL. Ql C Q i y m C _ C -O O N �O. y O ~ CD CO2 �O" CD Z UVJ O W W r•+ O V� E .m d_.+ C C3 Z LU Q.0 F - y a m . = W c acm 0. H O N s awm F. w a O O co L O Z °D Q O CO) Q C I cm CODO •— y Q -0 CD ._ E m m CD O O O � � Q03O L cc O d a cm< y C* Cc Cc d OCO2 Z y0.. C co CL V CO) c C— . C c CO)CL Q v/ LU C4 19 W LLI ce LLIw CO) The Commonwealth of Massachusetts k� Department of Industrial Accidents Office of Investigations 600 9 ashington Street Wit ,` Boston, MA 02111 www »wss gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AlDpiicant Information Please Print Leg bl Nttrne (Business/Organiration/Individusl); S�Gi�i{/1/ v e .�7 Address: City/State/Zip: ��. Phone #:. Are you an employer? Check -the appropriate box: i.❑ I am a employer with 4. ❑ 1 am a general contractor and I Type of project (required): employees {full and/or part-time).* 2. have hired the sub -contractors 6. ❑ New construction 7 I am.a.sole proprietor or partner- listed on the attached sheet t 7. ❑Remodeling ship and have no employees These sub -contractors have 8.Demolit Q ton working for mein any capacity. [No workers' comp. . insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9 Building addition required.] 3. ❑ I am a homeowner doing officers have exercised their 10. F7 Electrical repairs or additions all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No•workers' comp. insurance c. 1.52, § 1(4), and we have no 12. Roof ❑ repairs required.] t q ]..employees.[No workers' 13.❑.0ther comp. insurance required_] it nu out Rte section below showing their workers' compensation policy information t homeowner¢ who submit this affidavit indicating they are daring all work and then ham outside contractors must submit a new affidavit indicating such. #Contractors that check this box must anaabed an additional shut showing the name of the sub•cotrtractors and their workers' comp. policy information. I am an employer that is.providing:workers' compensation insurance for RV eMployees: Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: 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 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 may be forwarded to the Office of Investigations of the DIAr insurance coverage verification. I do hereby certify paras and pen Ps o�rjury that the information provided above is true and correct ria! 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): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: r u .CYC V IX uj F- oO .. j m J aUj LLco O ami I � CO UJ N V JJ y ` a :._V 4 N 0 F- �.0 y m CL Q. w ` c 4zz q r u .CYC V IX uj F- oO w j m J aUj LLco ami I � CO UJ N V JJ y C O N � V L y Q f- � c . o` F- �e 0 Q :, m H" �n o �0 w N N Q> [Yp 1, r a� ui }f .ESU Q m lul z ca � c w w.� O 2 o W w m W w co N U EMERSON REMODELING 225 BddAeo'St Chelmsford, MA (978) 256-4177 PP,000SAL 40 �,A Joe NAME JOBLOCA7,10-N STATE 4-,d ZIP CODE ANCt�Ii L DATE 0; joul-VIUNt: I WG nO((A)y and QV;mM0- fOr: "u.0 -44 K0, ..................... . herby to ju,n;sh material ard labor --:OMPIGIO ill loccrbanc.; abs -n. srecificatiors, -o,, the Sura o:.- Paynino to -Vace as sull— .............. All work. to De C,rnr,041,�j lea12 id al"re ,_ only U,t 04 UVV ThIS proposal mav I -,o tic relor jADVOU"' iomac* End whef.,conw), wz-,Mr.-C• pr W::IyZ; Lo/and 0k'f,!Q— 'c' "t -V ""4' vvi;l-drawn tl,l�ub ii f�ct cic--4PIR�.'d i,su%lco. -t7' . . ......... .. �rp vi --Tfic lbolc .rL :on'." CrIS are Q1.11 v tli r'lade, Z�, ow:11myj doo,!!7 CIO