The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #136-12 - Exception 8/16/2011 ill TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �2 Date Received Date Issued: -kl/ok IMPORTANT:Applicant must complete all items on this page LOCATION 14S r54AAWoOD AVC - UN1 T *la -- 0AlSA6-E GAiW Print SND O S PROPERTY OWNER L_A R/ZY Le G-D 12 Unit# /D _ Print MAP NO: y6f PARCEL:AS' ZONING DISTRICT: Historic District yes cn6' Machine Shop Village yes =no' 100 year-old structure yes �n� 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 0 Well ❑Floodplain 11 Wetlands ❑ Watershed District_ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) CEL L OWNER: NamA ,� y r-e: A L E o fZ Phone: '78;?5 ?tf SL 7 Address:_ ?.5 646111 H000 A.0.4-0 - S?'o��fi�/�-�-( , /�f� o'zl?a CONTRACTOR Name: kJ& W Phone: ?&-r 8�-Ol G7� Address: - I Supervisor's Construction License: 6/� 3 6/ Exp. Date: Eo 12 Home Improvement License: Exp. Date: 2012- ARCHITECT/ENGINEER 2ARCHITECT/ENGINEER Phone:_ Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 2-$ FEE: $ Check No.: -33 2 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �S[gnature.oflO,wner:. Signature of contractor "I� Location Xv No./ l /2 Date S76 KORth TOWN OF NORTH ANDOVER �j0•,t`•o •�hOw O a ' Certificate of Occupancy $ SS<�'• Building/Frame Permit Fee $ d'r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 r �rt.. J "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 Siqnature 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/Siqnature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster 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 2011 June/mi 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 ❑ 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) a 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: Doc.Building Permit Revised 2008mi NORTH Town of And 19 LAKE o dover, Mass., COCHICMEWICK ��• ADRA7ED P'P�\ �� S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �1 BUILDING INSPECTOR THIS CERTIFIES THAT. z' �f��r cs.^✓c o..........afc.s ...................................... Foundation has permission to erect........................................ buildings on ./S_ .........� .... Rough to be occupied as.............,3.....�-�r o/.A ��r�-�<�...it/�!�'��Il�.f/5,.................. ................. Chimney ................... provided that the person accepting this permit shall in every respect conform to the terms of the application 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIRISTARTS Rough .................. ....../ .......... ................................................. Service BUILDING INSPECTOR 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. 1° o� Board of Building Regulations and Standards Construction Supervisor License License: CS 96836 Birthdate: 2/9/1975 Expiration: 2/9/2 Tr# 96836 010 Restriction: 00 ROBERT DARNELL. 11 SPAULDING STREET WAKEFIELD,MA 01880 Commissioner f The Commonwealth of Massachusetts Department of Industrial.Accidents Office oflnvestigations 600 Washington Street Boston,MA 02111 U www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers Applicant Information nn Please Print Legibly Name(Business/Organization/individual):_ ►C %�L- 6C11/ �T�7r �- ! U/J� Address: City/State/Zip: C,o�ztc7-- � _rti,s� Phone#: Civ i 6175 q Are you an employer?Check the appropriate box: Type of project(required): '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 m the attached sheet. ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition working forme in any capacity. workers'comp.insurance. g• E]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.El Plumbing repairs or additions myself. [No workers'comp. c. 152,§ (4 1 ,and we have no ) 12.F1 Roofxepairs insurance required.]t employees.No workers' comp.insurance required.] 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. f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site information. Insurance Company Name: /u(,p4q �YvS h Gf Policy#or Self-ins.Lic.#: C/ki 8 36 2/= Expiration Date: 2v 12- Job 2Job Site Address: )d5 FPMRcz-OV Adt City/State/Zip: y+lokw 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. X do hereby certify under the pains andpenalties ofperj at the information provided above is true and correct. Signature: Date: a W_/.d/ Phone#: i 6"tS-I;c Official use only. Do not write in this area,to he completed by city or town official City or Town: Permit[License# Issuing Authority(circle one): I.Board of health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector [.Other Contact Person: Phone#: Royal Contracting&Remodeling Invoice 11 Spaulding St Wakefield, MA 01880 Date Invoice# 8/10/2011 152 Bill To Ship To Item Description Qty Rate Amount Description supply and install new windows 2,500.00 2,500.00 Thank you for your business. Total $2,500.00 Payments/Credits $_1,600.00 Balance Due $900.00 i" ref f � � �f - �r E K N l 1\I j + 4 bey 1 r u:s aax•4 r r r � 1 4 �a• : , tis' (�.� •<< �� t ► � ,t � �-:� ,� ,�.fir ,�