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Home My WebLink AboutBuilding Permit #41 - Bldg-7A-Groupe Schneider 7/14/2008 BUILDING PERMIT NaRTM a`�SLLG TOWN OF NORTH ANDOVER t APPLICATION FOR PLAN EXAMINATION r Permit NO: Date Received 4SS CH Date Date Issued: I IMPORTANT: Applicant must complete all items on this page -ry _ ffr' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential bKNew Building ❑ One family ❑ Addition ❑ Two or more family .S-�'lndustrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ,Z1�ers: ��f ❑ Demolitiope n ❑ Other .� r,.. ,..:,. !+'.. a'. h-°- 1", tt -0, 11 DESCRIPTION OF WORK TO BE PREFORMED: � U Identification lease Type or Print Clearly) OWNER: Name: Phone: P27- 2S- e—ri I q Address:— OR ._. 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: $ �� FEE: $ � Check No.: Receipt No.: NOTE: Persons con tr ctin with unregister ontractors do not have access to the guaranty fund VSignature of Agent/O ne of contractor !- _ - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DA x, TE APPROVED 1 PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage.Body Art ❑ Swimming Pools,, ❑ Well ❑ ❑ 1 j Tobacco Sales Food Packaging/Sales' ❑ PrivatS(septic tank,etc. ❑ Permanent Dumpster on Site • ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Drivewav Permit Located at 384 Osgood Street pp F s �, � ��i' h'r yds " sx " �-,, � �� r � ?t s ,•. � 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 I ❑ Notified for pickup - Date _ i 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 o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products Addition Or Decks � I ❑ 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 New Construction (Single and Two Family) ❑ Building Permit Application o 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 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 Location A-A No. J Date 7l /o NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ S3 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t 22212 Building Inspector N )RT#1 Town of : s 4 over IVT o. It dover, Mass., T 0 Z- LAKE COCMICMEWICK 7,95 FATED P'f BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... N .040 4 . ....,. .t�...... .. .. ..................................................... Foundation has permission to erect.............. buildings on.........I........... ... l.S.h......... .. .........�.......................... Rough ............ . .......... S to be occupied as 3O �s.. �� ,�, ... ................. Chimney .............. .................. .............................................. ' provided that the person accepting this permit shall in every respect conform to the terms of the apo ication on file in Final 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 3� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU Rough ................. . ..................................................... .......................... Service BUILDIN 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. r .,. S 4 of 1 ........... l\f .� __ I M P O R T A N T D O C U M E N T ONED nROMEMEORUn��n��n�u��n�u��n o 5 5 55 5 'QCertiffrate of if tae REGISTERED ISSUED BY S5 5 APPLICATION CHOR Date of Manufacture 5 5 NUMBER y > INDUSTRIES INC EVANSVILLE INDIANA4 7711 Order Number 5 5 5 F121.4 M � 5 5 E MANUFACTURERS OF THE FINISHED 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 5 5 657150 5 5 PETERSON PARTY CENTER INC 5 5 139 SWANSON ST S 5 55 5 WINCHESTER MA 01890 P 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California Fire 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: c S Serial #: 5 8109000(l) 5 5 Description of item certified: 5 CENT MATE 30W X 45 VL W W 5 5 _ 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 5 5 JOHN BOYLE STATESVILLE NC — Signed: ✓' -�`� 5 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. 5 r�u�cPrJ2PrJ��PrJ�rJ�rJ��l�rJ�rTrJ��r-rJ��PrJ�cP�rl�PrJ�cPrJ��PrJ��P�PrJ�r�rJ�r�rJ�r�rJ��nrJ�rJ�i l�rJ��rrJ�rJ��r�rJ�r�rPr��nr�cnu��P�nr��rrJ�r��P�Pr��nrJ�rPrJ��Pr�r0J0PrJ00J�gP�PL3n�P[j-P[pr a7 The Commonwealth of Massachusetts Department of Industrial Accident Office of Investigations 600 Washington St Boston, Ma 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): e S fZ Address: 13 2 'w A h 4m S(- City/State/Zip: R /PfO Phone#: ylJO D Are you an employer? Check the appropriate box: 1. ® I am a employer with U-n 4. ❑ I am a general contractor and I Employees (full and/or part-time) have hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. Ship and have no employees These sub-contractors have Working for me in any capacity. Employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their Myself. [No workers' comp. right of exemption per MGL Insurance required.] ] c. 152, § 1 (4), and we have no employees. [No workers' comp. insurance required.] *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 ad then hire outside contractors,must submit a new affidavit indicating such. Contractors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is proving workers'compensation insurance for employees. Below is the policy and job site information. / Insurance Company Name: 191a Uo-� Policy#or Self-ins.Lic.#: Expiration Date: U d 1 Job Site Address" l 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 pai s and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#• Official use only.Do not write in this area,to be completed by the city or town officiat. 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#: `:i�.arhu.cttx - Department of* Public Saner-' Boat-d of* Building Re�-ulatio n, an(I Standards Construction Supervisor License License: CS 60219 Restricted to: 00 -. Win. MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4/27/2011 ( ummi.�inrr Tr#: 14425