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Home My WebLink AboutBuilding Permit #506 - 88 PEACH TREE LANE 3/6/2008_ BUILDINGPERMIT o` �t, •o ,° Ati � TOWN OF NORTH ANDOVER c APPLICATION FOF 'PLAN EXAMINATION f n Permit NO: Date Received �°gATeo ►� � r �SSACHU`-+�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION QZ�2 r4f Print PROPERTY OWNER , c` ' (2 ° yq gig j �Q, a, Print MAP NO: PARCEL: ZONING DISTRICT: Historic District Machine Shop yes no ves no TYPE OF IMPROVEMENT PROPOSED USE l esidential ._ Non- Residential New Building One famil Additionvvo or more family' Industrial Alteration No. of units: Commercial Repair, replacement ' Assessory Bldg Others: Demolition Other. . Septic Well Floodplain Wetlands Watershed District Water/Sewer V OF,W0,RK TO BE PREFORMED: an Lq Identificati n Please a or Pri t Clearly) OWNER: Name: ' Phonel 191?0 Address: e�� & . CONTRACTOR Name: d 4,izS4� Phone: Q-YA Address: �' �? +� ! , �•c9 �/ fes_ Supervisor's Construction License: f Exp. Date:' �-- Home Improvement License: Z-�%7 Q$� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. E - FEE SCHEDULE: B ING PERM/I/T: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Lp Check No.: Receipt No:: d / --i� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund f � ignature of Agent/Owner Signature of contractor Building Department The following is a iistof 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 Addition Or Decks Bldg Permit ❑ Building Permit Application ❑ Certified ,Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of HJ.C. And C.S.L. Licenses ❑ . Copy Of Contract ❑ Floor/Cro,ssection/Elevation Plan; Of'Propbsed- WorkWith 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 95.�.❑ Two Sets iof 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 2.2007 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 COMMEN DATE REJECTED DATE APPROVED HEALTH- COMMENTS EALTH- 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 Located at 384 Osgood Street �1 FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date 1 COMMENTS reel Dimension Number of, Stories: i 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 ,. ,,,.��°� Foundation Permit Fee $ . i � C)thar Pornnit Foca 4 TOTAL $ r' Check # 3�--- 20975 Building Inspector f / Location r�� A22017 TGA- C Date' . d Na 'oRTM TOWN OF NORTH ANDOVER 3l 9 Certificate Occupancy $ • o� _ _ J .S .of . Building/Frame Permit Fee $ D C14U f ,,,.��°� Foundation Permit Fee $ . i � C)thar Pornnit Foca 4 TOTAL $ r' Check # 3�--- 20975 Building Inspector CA m m C m m C2 F C � CO2CD C..' Ca Z y CD = ? C2. = y 70 O CD o p CD O .-% CLQ d CD CCD owwS C��D C CD M. CL y co CD n z C_ O c?�O m W. am -m w y S" ® CL 0 m C7 y m .+ C ?-S N '� _ -► m a -4 O . M. m ti O rw y �--1 O 'mc O Cm! O H CO! ED -COO CL. mCD m y : 1 O m Cl - m • CA � C Iy � CL. p� C W cr CL E;C,to rE m. H CA �i C SCDU2 cl: CO +FIs 0 0 O � : • '� � mC O z 0 o' 6111. a-, : s : CR z O o s l „� m :3 O 0" ^D Il O CO .- R O �" £m mo: O �' `G s CD: O Zr,Q:3 O a 03 O. C► y O CL W ate, dp CL Ca, � n GO b yn C O� O � • O CD • I�j G rA (n C7 CR z O b7 O,, ►�y :3 O 0" R O �" O O �' `G `� O Zr,Q:3 O a 03 O. C► y O CL W brA � n GO b yn O G o • 4 ir y . L , I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ., Applicant Information Please Print Legibly Name (Business/Organization/lndividual):O, &42U Address: /®/ City/State/Zip: (fi &9,0r,��Q��/,� Phone #: 9 70 7gq-D-_;9 V z Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2.1W I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. remodeling 8. ❑ Demolition 9. ❑'Building addition 10.❑ Electrical repairs or additions 1 l .❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. I Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the perjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Lic. # CS 064384 PROPOSAL - CONTRACT SATISFIED Hic. # 137695 CUSTOMERS Reliable K.M. BROUILLARD are Our best *V9 Service FINISH CARPENTRY & REMODELING ADS Kitchens_ • Decks • Additions & More SHEET NO: COMPLETE DRYWALL SERVICE DATE: Re. yfo'iAob 978-794-0247 Proposal Submitted To Work To Be Performed At Name ' Street Street City State City .6 Date of Plans State J� i Architect Telephone Number aAs�►�e� We hereby propose to furnish all the materials and perform all the labor necessary for .the completion of: ''• Teti ov A>' on ta D V-0 Ai 0 f , f it e WA AL0, ell, D IVS n V6 o f ts ' -� J ♦ {. 4 f � All material is guaranteed to be as specified, and the above work is to, be performed in accordance with the drawings and specifications submitted for above work and completed in '9 substantial workmanlike manner for the sum of I'LL4000 Fwu9t7 IN o0F'0AFT'04e_ m Dollarr($ j Uo0' y "$ with payments to be made as follows: C- LECTftI 64 L p j 1llj�• j S Ol, 11 1 MID is L&Acle Parties agree that any change order/amendments to this agreement made at the request of the Customer/Homeowner, shall be made in writing, sent by certified mail to Contractor's address: 101 Everett Street, Lawrence, MA 01843. Parties agree that Contractor shall charge/bill Customer $ hr. to incorporate said changes. Thereafter, all changes/amendments shall be incorporated into this agreement and shall be treated as part of the original agreement, dating back to its original signing. Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above estimate. Owner to carry fire,.tornado and other nece y insurance upo ab a work. Respectfully submitter) b Note - This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Accepted c 2' log Date q Signature 41 LOA, LAWRENCE, MA 01'843 )F (BUILDING 1REGUL'ATIONS JSTRUCTION SUPERVISOR i 064384 /24/1957 /24/2008 Tr. no: 25498 ce4 z ,.�.. Commissioner ✓/d g��t� Board of Building Regulations and Standards lug HOME IMPROVEMENT CONTRACTOR Registration:' ,137695 Ezpjrafaffi-1 J19/2008 Tr# 124418 Type;; :I divi�ual KEVIN M BROUIL'L-"AR KEVIN BROUILLARDR: 101 EVERETT ST,e„eQao...� LAWRENCE, MA 01843 Administrator