Loading...
HomeMy WebLinkAboutBuilding Permit #365-2017 - 95 FOXWOOD DRIVE 10/5/2016 VCpw►vG D NORTI1 BUILDING PERMIT O��TLEo ,bqq•� TOWN OF NORTH ANDOVER 0 A APPLICATION FOR PLAN EXAMINATION l b•S - 7-c I � � a„ .wK Permit No#: 36 �Q 0 Date Received �gssgc►+us���y Date Issued: L'0 s G IMPORTANT: Applicant must complete all items on this page LOCATION, I`� 7 C>� 7 Print ' PROPS TY OWNER -� �'4 Jsn p�°t100 Year Structure MAP PARCELC °2.. ZONING DISTRICT: Historic District Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VErOne family El Addition El Two or more family ❑ Industrial eration No. of units: ❑ Commercial epair, replacement ElAssessory Bldg [I Others: ❑ ❑ Demolition ❑ Other _ ❑ Septic. 0 Well ❑ Floodplain ❑Wetlands 0 Watershed'District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- lease Type or Print Cie ly OWNER: Name: Phone: Address: - f_ Contractor Name: _. -�,,. I r Phone: o1 _22 �` ? Email: Address: _- Supervisor's Construction License: T ,3<,-z Exp. Date: Home improvement License:_ _ _ 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: $ —C Q _FEE: $ Ge— Check Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 8ignatureof Agent/Owner ignature of contractor Location qS f-oyvico - e No. 3hS• 9 617 Date �d - $^. a 01 co • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ (P©'� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ,i Check# S190 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming ❑ Tanning/MassageBody Art ❑ g Pools Well ❑ Tobacco Sales El Food Packaging/Sales ElPrivate(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On 1C� rj �l Signature_ j COMMENTS CONSERVATION Reviewed on [0 j Si nature i COMMENTS 'HEALTH Reviewed on Signature e E M COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ,r€ JPlanning Board Decision: Comments Conservation Decision: Comments Water & Sewer Conn ection/si nature& Date Driveway Permit _ DPW Town Engineer: Signature: FIRE DEPARTMENT Temp.Dumpster on site;R es, Located _" w 4 Osgood Street Located•at 124±M; y no a a 2.. ain,Street: s_ Fire Department signature/date COMMENTS. 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on C> J � Si nature , - COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: � Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: ERE' EPAT 'T - Located 384 Osgood Street _j�R tMENT �Ternp�a®umpster on s t �` --� iLocated atIQ4�'Main StMR? � -0, Iry a�De attrnent s g - ;�_ � nature7date _ � 4 ' MENTS, Dimension i 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 ofElectrical 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 Call Email _Date Time Contact Name Doc.Building Permit Revised 2014 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract Li Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application o Certified Surveyed Plot Plan Li Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract a Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products I NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract u Mass check Energy Compliance Report a 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:Building Permit Revised 2014 14ORTOI '9 Town o _ n over �o h ver, Mass, 10 • S • of d. 4i A�gATIE ►.P���� s V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • THIS CERTIFIES THAT ....................IX9. .......Tf V.-;40....................................................... BUILDING INSPECTOR . .. has permission to erect buildings on ..........ism.......F.D?A.W PR Foundation Rough tobe occupied as ................................................................................................................................... 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUN STA S Rough ..................................... Service ... .. .. ....�. . ....... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. PROPOSAL NO. SHEET N0. DATE/ PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: 2Ce NAME ADDRESS ADDRESS DATE OF PLANS &414 40 PHONE NO. /L s ARCHITECT 7 We hereby propose to furnish the materials and perform the labor necessary for the completion of I/10C 09 We4 14 j�� gA /I 4Z V ."� Ar) All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifi tions submitte or above wo nd completed in a substantial workmanlike manner for the sum of Dollars ($ )with payments to be made as follows. Any alteration or deviation from above specifications involving extra costs will be executed only upon written order,and will become an extra charge Respectfully over and above the estimate. All agreements contingent upon strikes, submitted accidents,or delays beyond our control. Per 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. Payments will be made as outlined above. � (/ Signature V OF Date L:�t 15Signature �j:adamsr D8118 3-12 a d MEE ME SON IN 0 ME i'i'Ei ■ e� ■ iiiiiiii� MEE SEEMS NINE! molONES MEMOS No I MENMISIMENoIMS MEN IMEN 1 0 Elm NEON MEN M NJ MIN I EN oil IN ME ME ENE FA• N MIN IN ME 00 0 MINES rp 1� ��fg;'dk► � � 1 f-.. � t'� ,f,ST ,+'!�.' ' �:_ ���ti r 1 f n i. c T Tkt 1" r it Ts' 1 rt, . a s„ �t}^r�+' •� , r VII lz At .thy bT 61 ta'.r The Commonwealth of Massachusetts _ Department of IndustrialAccidents v.. 1 Congress Street,Suite 100 Boston,MA 0214--2017 . �c www mass.gov/dia ' eAffidavit:Builders/Contractors/Electricians/Plwmb Workers,Compensation Insnrancers. TO BE FILED WITH THE PEIMTTING AUTHORTTY- please Print Le 'bl A �licant Information Name(Business/0iga'&""on/Ind1vidual): Address: —t!7t �4- City/State/Zip: Phone#: priate box: Are you an employer?Check the appro Type of�project(xequired); 1.F1 am a employer with employees(full annd/or part time)..' 7. El N&W'constraction 2.❑l am le proprietor or partnership and have no employees working for mein 8. ❑ Remodeluig capacity.[Noworkers'comp.insurance required.] 9, ❑Demolition 3. I am a homeowner doing all work myself[No workers'comp.insurance required-1 t 10❑Building addition <1 T am a homeowner and will be hiring contractors to conduct all work on my property. I will 11 ❑Electrical reP,.airs or additions ensure that all contractors either have workers'compensation insurance or are sole12'EaPlog repairs or additions proprietors with no eupl6ye6s. S.❑I am a general contractor and I have hued the sub-contractors listed on the attached sheet. 13•.❑Rb6f repairs These sub-contractors have employees and have workers'comp.insurance.t 14.❑Other 6.❑We are a corporation and its,office.rs,have exercised their right of exemption per MGL c- 152,§1(4),and We Have no empldyees.[No worker3'comp.insurance required-] *Any applicant that checks bbx#1 must also fill out the section below showing their workers'compensation policy information: I Homeowners who submit•this affidavit in d to additional doing wing the name of the sub contractors and state wheth r c r,reew pot thos een hiren ties,have tContractors that check this Box must employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. rre foyer that is providingworkers,compensation insurance for my employees. Below is the policy and job site lam an employer information. Insurance Company Name: ExpirationDate_ Policy#or Self-ins.Lie.#:. City/State/Zip: Job Site Address: the onumber and expiration date). Attach a copy of the workers' compensation policy declaration page(showing p lio y Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by a foie up to$1,500.00 in the and/or one-year imprisonment,as well as civil pe.ala be forwarded to the ffi o o Inve form of a STOP WORK tigatr°ns of the DIA for insurrancand a fine Oful)to $250.0 e a day against the violator.A copy of this state en may coverage verification. is and coct. X do herehy cer' under tliepains andp Iti fperjury that tlae information provided above true rre c Date: Signature: Phone#: Official use on Do not write in this area,to he completed by city or town offzeial. Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2-Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Massachusetts -DePArtnaent:of Public Safety Board of Building Regulations and Standards _. supei:.sRor- License: CS-090863 �I JOAN E•TRULLI,:` 149 COTUIT ST ° ''..:. . NO ANDOVER 11IA 0 Expixation•` ; Gomniissioner 0111,1312017 e �1PO%J 7J.2JLC4'FirrJ/ �.�� 11-"G,O + OnSumC _rlffav�= 9,1CCCfCTCJh OMEdMPRO�f.EMEhT Maine's Rul..iyor "ONTRACTOR r `r e9�stration 175983 y e � >%Ex. « C-.- ,.: G anon 45/311�(}.� TgR Individua; S JOHN TRULLI = I JOHN TRULLI ' 1 � f 149 COTUtr ST. `� 4 ! NANpOVER, MA 01,845 i`-a a., •.. 4 Undersec'r eta r '! t%