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HomeMy WebLinkAboutBuilding Permit #24 - 922 DALE STREET 7/14/2008 BUILDING PERMITof N°DT 6�ti TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION pq q. Permit NO: Date Received °R,..o t 9SSACHU`��t Date Issued: ` 1 ` IMPORTANT: Applicant must complete all items on this page LOCATION Pri t PROPERTY OWNER Y t'C.�.T�' Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shap Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building mil 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: AU, Identification Please Type or Print Clearly) OWNER: Name: fie- �`G*1`11 Phone: ���' -79y- Address: 2 �Ar4- rF CONTRACTOR Name: FA e-II Phone: Address: = `fin( r( A Supervisor's Construction License: 01Z© 5 Exp: Date: 0-7 OY ;?L)10 , Home Improvement License: t Exp, Date: ` 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: $ ,, Z50 FEE: $ J� Check No.: � —)© ` Receipt No.: S- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund §ignatur_e of Agent/Owner Signature of contractoru,%r Location i 2- DG 6— 5;;:T— No. ;;:TNo. `� Date NORTH TOWN OF NORTH ANDOVER Of""s. '',�O t!? OL F41 p 4k Certificate of Occupancy $ sACNUs<� Building/Frame Permit Fee $ S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ : Check # D 2 3 i 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 Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street 'IRE DEPARTMENT - Temp Dempster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 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 o 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 NORTH Town - of _ Andover -No. SS. - • ,� 1 o dower, Nia I� COCHICMEWICK A0RATED BOARD OF HEALTH PERMIT T D - Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..�.��� 4. wo.�...... ............. 4a..... ...................... Foundation has permission to erect........................................ bui mgs on ......... .Z ............... . .....Aw.......*.....41..... Rough t0 be occupied 8S........ 7..........: *............................................. ......_.................. Chimney e provided that the person accept g this permit shall in every resp onform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relatin o 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR I` UNLESS CONSTRU ST Tis Rough Service BUILDING INSPEC - 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. MA Construction Supervisor#082056 Home Improvement Contractor#135385 ROB FARRELL r ROOFING, SIDING& REPLACEMENT WINDOWS FREE — r FULLY ESTIMATES 978-682-9449 No.Andover 603-378-0515 Hampstead 603-2474668 Cell INSURED 29 Cortland Rd, E.Hampstead,NH 03826 llwe,the owner(s)of the below mentioned premises,hereby contract with and authorize you as a contractor to supply all materials, labor,and perform all workmanshipin accordance with the following specifications,terms,and conditions on premises below. Owner's Name T_ C) CA�7�y Phone �'7 ' 7qy- 1770 Job Address I z z- Dme- ST. City �D�fh �- -- State _ SPECIFICATIONS tLA COQ%kt-a ' GoT;gq- AL,2' X t , T CQ- t id14T#-�- A:e:l W All I-t ee Al 6'0 kx Of �yoT a Alom"30M (Z69�L Wu-rant CLA;19- QW �N t It1t��t_ C ,rTeF �gS , A 3 ��yhNgy�'�: + .. SQr►L..,�` (.en Cwo-1 Xy L;jI T + Se L OS 09_ Si' I,Ca tje, E bMiNATQ- 00 scoq tkr?) Do LDkkL d� � ;rl�le. US�,)3 30 re.ilk j LL'Te,--r tiYT-yk. ��'��� -x K, CAMb2��. c����\ at.) 4" �(1 . MA.9&1r TD (10J . All �a► �5 `je qt 1 L1{r►Ar'.S�,,Q 6v ALA A-K- 4 c..oho l k NU 5 &kK Site. .OBJ SrAkr Materials and labor to cost Payments to be made as follows is 00 F�.,;.Sh Options: Additional cost$ Additional cost$ The above costs,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Owner.has 3 days from date signed to withdraw without any consequences. Respectfully Submitted: Signature, 1& 441 �.A 3-29- QT V 0wner This proposal may be withdrawn by.us if Signature Date not accepted within_q days. Owner .54 EGl�LA'n BOARD OF'B� G 12ONS ISOR TRU TION SO. ` CONS License* 082056 Number CS Borst d�ite�O IOS11966 27645 E,ares 43.10812008 Tr.no: Restr�ca AO X ROBERT J FARFtEL`L I 29 CORTLAND "= NH 0384'1' Commissioner HAMPSTEAD,_. ds Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Regist►a� , 135385 264060 i orrs X129120102.4 Tr# ter` -' DBA OFi +'SIDING ROBERT FARR�n �, ,: �{!� ROBERT FARRELL 29 CORTLAND RD —' Administrator HAMPSTEAD,NH 03826 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UF4 ' 600 Washington Street ,lits ; Boston, MA 02111 moi•i- www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �`� ��}A-kG t &hii Address: Q1 AT Lit,) /6 City/State/Zip:6, 4Awlgg�Ad N Phone #: 6o3 Y(6ba Are you an employer?Check the appropriate box: Type of project(required): 1.�1-I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ 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.E] Electrical repairs or additions required.) officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I].❑.Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.5eoof repairs insurance required.] t employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. non5eowneis who subiinl i-dhis of idavii iirdicatiiig they are doing iii!work turd 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. Insurance Company Name: T nut-QA Policy#or Self-ins. Lic:#: -0;-JG 6D( SZ!p0 Expiration Date: Job Site Address: geDft 1e- ST- City/State/Zip: GA xbutC 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 certtiQify��under the pains andpenalties of perjury that the information provided above its true andp correct Siartature: �hrJI,P.�'�. A.J Date l I- ZERO Phone#: 603 A7 - 4/66 X 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#: PTS INSURANCE AGENCY , INC . February 27,, 2008 Robert Farrell Roofing & Siding P. O. Box 3182 East Hampstead NH 03841 Re: Policy# 1W-VWC601152100 (WORKERS COMP 2008) Effective February 15, 2008 to February 15, 2009 I AM PLEASED TO ENCLOSE YOUR WORKERS COMPENSATION INSURANCE POLICY ISSUED BY AIM MUTUAL INS CO. THE POLICY HAS BEEN ISSUED WITH THE FOLLOWING COVERAGES/LIMITS SCHEDULED: $ 500, 000 - BODILY INJURY BY ACCIDENT, EACH ACCIDENT $ 500, 000 - BODILY INJURY BY DISEASE, POLICY LIMIT $ 500, 000 - BODILY INJURY BY DISEASE, EACH EMPLOYEE CLASSIFICATION PAYROLL ROOFING NOC & YARD EMPLOYEES $ IF ANY PLEASE' REVIEW THE POLICY. IF REVISIONS ARE REQUIRED, PLEASE CONTACT OUR OFFICE TO ENSURE THE POLICY IS CORRECTED. I WOULD LIKE TO TAKE THIS OPPORTUNITY TO THANK YOU FOR LETTING OUR AGENCY BE OF SERVICE. THANK YOU. Since ely yours, I Pa a e o ovich P/pe INSURANCE AND FINANCIAL SERVICES 1060 OSGOOD STREET■NORTH ANDOVER,MA 01845 TEL: (978)683-8073 ■FAX: (978)683-3147 0