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Home My WebLink AboutBuilding Permit #Exception - 995 FOREST STREET 5/1/2018 a NORT11 BUILDING PERMIT TOWN OF NORTH ANDOVER I- APPLICATION FOR PLAN EXAMINATION n � Permit NO: Date Received V �s,4ss^CNUS��,�9 Date Issued: ep IMPORTANT:Applicant must complete all items on this page LOCATION vI q 5 Fore-4 S fre4f-1 h Pri t t PROPERTY OWNER I Y/1 lckcl , l t 'TC'V7Z4r- A`i4 -"4 Print MAP NO: V5 ZONING DISTRICT: Historic District yesrn00 Machine Shop Village yes 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 n( Identification Please Type or Print Clearly) OWNER: Name: kcl c l Ir SC,"'Cer 1-�q S*" Phonel° -609=gglS Address: 1)9 r re.3�- S I red-t CONTRACTOR Name: Phone: Sf#'� �oG�� Jgrr9 Address: PO gog 3s6 njeoloa AN o3fs9 Supervisor's Construction License: 4, � Exp. Date: � I >2 y Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ S7, 0a-O FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to tine guaranty fund Signature of Agent/Owner Signature of contractor �l C ` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page - LOCATION Print PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no 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: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contra tors do not have access to the guaranty fund Signature of Agent/Owner Siaature of contractor Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived .Certified Plot Plan ❑ Stamped Plans El :.�TI'PE:OF.;S> WERAGE.DiSPO�AL" _. Public Sewer ❑ Tanning/Massage/BodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ ToodPackaging/Sales ❑ Private(septic tank,etc. Permanent Dempster 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 . Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nectionlS_ignature & Date Driveway Permit DPW Tow;: Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located'at 124 Mair, Street Fire Departine►it 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 FOL40WING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMENTS CONSERVATION ❑ ', ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate C0MMENTS,An 7j he,,, r ZJI, a 1. ,�!/� /�4m, Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions.^ Total land-area, sq. ft.: -ELECTRICAL: Movement of Meter location, roast 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 112Q'I i4 6 ul� 6du- 0�4 1 U,-/? I c U ® Notified for pickup - Date I Doc.Building Permit Revised 2010 Building Department The foi;�wmg is'`a=list of the required-forms to be filled out for the appropriate.permit to be obtained. Roofii,g, Siding, Interior Rehabilitation Permits ❑ Ruilding 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 Li 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 apo•,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building permit Revised 2012 V-0 --4 tj r-) :e Information Form !n !cipient. If no insurance information is available, please fill print): *Required Fields Date of birth: * Age* Sex: (Circle)* Male Female Month Day Year TZip:� * Phone:* ( ) ber and any letters that are part of that number Number:* Group ID Number: (if available) Primary? Is Subscriber Employed? Yes No Yes No se complete the following: Subscriber's Date of Birth:* Sex: (Circle)* Male Female Month Day Year Zip:* Phone:* i b P H ZY a m BATH CLOSET BATH BEDROOM E DETECTOR O CO2/SMOKE DETECTOR 0 SMOKE DN DETECTOR V/ 4 S SMOKE BEDROOM DETECTOR OV BEDROOM CLOSET EX I ST I NO SECOND FLOOR 1 FF NEAT DETECTOR 0 BASEMENT GARAGE G) NEAT DETECTOR UP ® SMOKE DETECTOR EX157- INo BASE IST 1/4" BATH KITCHEN OS SMOKE DETECTOR DN No. Revisions Date LIVING FAMILY ROOM ROOM DINING ROOM UP OO SMOKE DETECTOR Project Name and Address 93 FOREST ST, NORTH ANDOVER, MA EX I ST I NO FIRST FLOOR Drw.#: Date: DEC 23, 201 Scale: AS NOTED 13'-10J' *�- W.I.F.) 2-3046 CLOSET BATH BATH 1 co C to S e ?� No NO + ., 3•-40 c co ua D TEC TOR Z © COOR © ;� + DETECTQ� CO2/SMOKE �m DETECTOR ' 2668 SMOKE DN p N LE DETECTOR ALIGN W Z O 0 BEDROOMslSMOKE ^ 0 BEDROOM #3 m DETECTOR %0 ol �cNao 1L BEDROOM #2 2'-4- CLOSET 2-3046 EQ. EQ. 13'-10�' cv,LFa i 2X10'S • 16' O.C. W/ R-38 INS. ROOFING COMPOSITE ROOFING NO. 15 BUILDING PAPER 3/4' PLYWOOD RIDGE CEILR49 } 2XIo'S a 16' O.C. VAPOR BARRIER CP4ON CEILING 1/2'wAu. BOARD N J. ?+SOS FASCIA BOARD IT 12 �� e/ WITH VENT a� °G WALL,°�' A R BARRIER 8R . PLYWOOD R-21 INS. E VAPOR BARRIER No. Revisions co "`�� FLOORS 1/z WALLBOARD 3/4'T $G PLYWOOD SECOND FLOOR B. P. EXISTING LIVING FROOM FIRST FLOOR Project Name and Address 93 FOQEST ST. NOPTH ANDOVEP, M/ ioN 5U I LE�) I NO SECT 1 ON Drw.#: Date: DEC 23, 201 Scale: AS NOTED s i I f10, I EXISTING EXISTING HOUSE R 10HT 51 DE ELEVATION - FRONT / REAR ELE\v, 1/4 I/4" - I'—O" kf { k +�g.e The Commonwealth of Massachusetts - Departmint of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Cont°actors/ElectrieianslPiumbers Applieant Information Please Print Legibly Name(Business/Organization/Individual): ) keve - 0 ;C 4,+9 4— Address: Address: P O r3 v X 3 5-e City/State/Zip: 4,e,,,,otvo ov, cj o ;9-5-2 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[M I am a employer with 4. ❑ I am a general contractor and I 6. Q New construction f employees(full and/or part-time).* have Hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. Q Demolition working for mein any capacity. workers' comp.insurance. 9. Q Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 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.Q Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7'Homeowners who submit Phis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees Below is thepolley andjob site information. Insurance Company Name: 1_yV S So/& Policy#or Self*ins.Lie.#: W c C - :Swo- �6 lac/e i 6- a2 O/3 4 Expiration Date: lob Site Address: 995 Fb,,e si City/State/Zip: N, "mss' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL o. 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi u der the ains and penalties of perjury that the information provided above is true and correct. - Signature: Date: /02 Phone#: 29'1- 3 3 3.) - Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: 001 Contract STEVE DICHIARA General Contractor P.O. Box 356 Newton Jct., NH 03859 MA LICENSE#055622 • REGISTRATION#116688 781-231-0768 603-382-6032 PROPOSAL SUBMITTED TO 7r PHONE DATE EETJOB NAME 'y - r ,,L-- CITY,STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for. Wo r e e P Y7)0 r d 6rh Z41 ` 1aIj Oork '1kL dv i� Co(le v -ids e �, d l ' 1-� oz LL ' LU Cv h �G� 012 ' I We 3prapage hereby to furnish material and labor—complete in accordance with above specifications, for them of: dollars($: �0 ). m be tjde as follows: S /�--�,� �J " O U �j Y / S All material is guaranteed to be as speci' .All w rk to be completed in a workmanlike Authorized manner according to standard practices.Any alteration or deviation from above specifications Signature involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or Note:This contract may be delays beyond our control.Owner to carry fire,tornado and other necessary insurance.Our y workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. acceptance of (Contract-The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature work as specified.Payment will be made as outlined above. y �'q� "t Signature Date of Acceptance: