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Home My WebLink AboutMiscellaneous - 16 BIXBY AVENUE 4/30/2018 (2) TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION permit N0; .7 Date Received Date Issued: L �/ I EWORTANT:Ap heant must complete all items on this page LOCATrON / 9/X 6 y Ave.,?U e- *6"-14 ,�i c'(d vc"' 1g14 j — Print PROPERTY OWNER `� Print �p NO: PARCEL: ZONING DISTRICT: Historic District rao 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 A Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ®Wetlands ; h'tar 100.w--terslie'd District' ; , L} A s(]t�T�ter/SeTNer. �`f�4 DES CR i t TION OF' 1`TORIC TO 3E`EIRFO` AMD: lD 4vJ o �o k ZA r��' d (Identification Please Type or Print Clearly) OWNER: Name: �5. 6. /°l i/Y7h�// `i-�d lr/a l f(��.f e- e444'Lt Phone: '7 , �s g K-. Y 7 Address: ?/� 7i'rn6c,� �Ca/�c �ivc% �. CONTRACTOR Name: e09Ji)e1cd1J& pW riPhone: 2 Jy z U Address: 02 0() �u-hk,? Lf� c�iii ZZ+a /V a. ,4Ny o vt HA D/F YT Supervisor's Construction License: `�9�5�� Exp. Date: /d -/6 -d d/3 Home Improvement License: /d. V50 0 Exp. Date: 7/�{,�a/Z. ARCHITECUENGINEER Phone: Address: Reg. No. FEE SCHEDULE:B ULDING PERMIT.-$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $___A 1cf FEE: $ �j 5 Or Check No.: / Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fund - ---_s°_-�. r�y�--- ,.rr:a:-- •i'- _ - - =s::,�_—:fie'�r3:g_—za--Rc�_i;f i_ ?' :r,^— -_ --= ;S� nature:ofAgenfilOwner: _ __-- -------�=g=—>===-.--•--_-_--_=r��'-=_,:�,>:-_c'. _.�__ __ r Location/,,,/ No. Date e - TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ ,� Building/Frame Permit Fee $�'� � Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ Check# ) ` 25227 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanninga4assage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR 01',QCE USE ONLY INTERDEPARTMENTAL SIGN OFF-` ORM =ry DATE REJECTED DATE APPROVED PLANNING & DkVELOPMENT ❑ ❑ COMMENTS 'i CONSERVATION Reviewed on Signature F COMMENTS xyEALTH Reviewed on Signature �MMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/recelptsubmitted yes Planning Board'Decision: Comments Conservation Decision: Comments i Water& Sewer Connect!on/Sig nature& 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 I 4-N The Commonwealth of Massachusetts c I Department of Industrial Accidents Office of Investigations 600 Washington Street .,. 1 1W / a_ Boston, MA 02111 w ;� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Ind ividual): T R l CO N(: I 1 ��F1 � Address: a U 0 -5u r ro I`l STr Su I l e- 2- � City/State/Zip: N o- kid o Jt✓lc HA p !iPhone #: q 7 C) � � � j` A o Are you an employer?Check the appropriate box: Type of project(required): 1.© 1 am a employer with u 4. ❑ 1 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 required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions thyself [No workers' comp. c. 152, §1(4),and we have no 12,fRoof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13T] 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 acid their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ayt/S Policy#or Self-ins. Lie.#: W C()y3 V 8 / /61%) Expiration Date: y"I Job Site Address: 0/k ye12 c.,P— City/State/Zip: W )6OVe-. Attach a copy of the workers' compensa ion 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 pains and_pp_enalties of peijury that the information provided above is true and correct Sip-nature: Date: Phone#: 9 7 F • 6 �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 Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone M NORTIy , own of 6 ower No. IML or, over, Mass., Y O - LAKE IfsCOCMICMEWICK ti S RATED U BOARD OF HEALTH Food/Kitchen Septic System .PERMIT T D -BUILDING INSPECTOR THIS CERTIFIES THAT.......... ..,.... ....�.....�.... .. �. r.. ...................................................................... Foundation has permission to erect........................................ buildings on....1.6.........F.+....!Ada j........Pre .................... Rough Chimney to be occupied as "' �w• y ........ ......... .................................................. ............................................................................. provided that the person accep g this permit shall in every re pect 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 "r PE EXPOS 6 MONTHS ELECTRICAL INSPECTOR 3 CONSTRUCTI Ta-S - � � SS Rough AWWWWO 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 I 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. Town of North Andover NnkrM O Building Department o 27 Charles Street ~ North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 �°� °pwTeo rFw°y,��J �SSHCHUS�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL C.l 1, sl 50a. The debris will be disposed of in/at.- Z' ` � , { e Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, �I:u.achusct[x - Ucliat•tmcnt ul Public ."uf(•tN � Buartl of Builtlin', Ilc,ulatiun� anti 5tandari..l - --- Construction Supervisor Specialty License License: CS SL 99358 Restricted to: RF,WS DAVID CASTRICONE x 31 COURT STREET ar*, NORTH ANDOVER, MA 01845 � Expiration: 12/16/2013 ( uuuuiai a•r Trl;: 7924 %�✓ '�r.,uaiituiztu:ni�l� ,../�ira,;uciatrlld Office of Cuusumei Affairs i 19usincss Itcbulaution ,HOME IMPROVEMENT CONTRACTOR lJ i Jl•I Registration: '104569 Type: �. Expiration: 7/14/2012 Private Corporatio DAW6 CASTRICONE ROOFING, SIDING& David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 •� Unilcrsecrcenr} i , i..a � CERTIFICATE OF LIABILITY INSURANCE1912312011 DIDDIYYYY) i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS -..--- - CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF, INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sy, AUTHORIZED IMP6RTANT:7the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). NTCT PRODUCER NAME: Eastern Insurance Group LLC - Main 233 West Central Street PHONE _ _ 7 Fac N.,508- - 8 OR9 "AIL Natick MA 01760 ADDRES INSURERS AFFORDING COVERAGE NAIC p b HNSURERA:commerce Insurance Company 34754 INSURED 31969 INSURER B: David Castricone Roofing & Siding Inc INSURER C: 200 Sutton Street #226 INSURER D: North Andover MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2141633407 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ��kI�V F�FF 192V API un �.ri�vmocn f tf mi r r� GENERAL LIABILITY EACHOCCURRENCE M'$ COMMERCIAL GENERAL LIABILITY PREMISES a occurrence) $ CLAIMS-MADE 7 OCCUR MED EXP(Any one erson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ POLICY 7 PRP LOC $ A AUTOMOBILE LIABILITY BCNGCV /1/2011 /1/2012 Eeacck ni U _ 1000000 ANY AUTO BODILY INJURY(Per person) $20000 ALL OWNED SCHEDULED BODILY INJURY AUTOS X AUTOS (Peraccdent) $40000 X HIREDAUTOS X AUTOS-OWNED Per PROaPERTYCCDAMAGE $ ldenl $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ g WORKERS COMPENSATION C003989723 9/23/2011 9/23/2012 X WCS A U• OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $100000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in E.L.DISEASE•EA EMPLOYE $100000 un M yes,describe under DESCRIPTION OF OPERATIONS below E.L,DISEASE-POLICY LIMIT $500000 i DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION Castricone Roofln Sidin SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9 g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Suite 226 ACCORDANCE WITH THE POLICY PROVISIONS. 200 Sutton Street MA 01845 AUTHORIZED REPRESENTATIVE North Andover, ®1988-2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ACVRHCERTIFICATE OF LIABILITY INSURANCE °"'�`"""°°"""' 9/9/2011 THIS CERTIFICATE 16 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOER NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: It tM certlflcate holder Is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,cartaln policies may require an endorsement. A statement on this certlflcate doss not Confer rights to the certificate holder in lieu of such endorseman s. PRODUCER CONTACT NAME' _ _ _ Willows Insurance Agcy PHONE 976 475 3414 51 Coohichewik E-M Dr MLE+ali- —--' AODR E¢a;---....._._.— PR UCER _ North Andover MA 01845 INSURER(S)AFFORDING COVERAGE MAIC Y _ INSURED ...INsuRER A b'taiden Specialty Ins Co - 1 RERe_ DAVID CASTRICONIV ROOFING & SIDING INC INsuReRc: -- - ---- _ — -- ._..._._.—._ 200 Sutton St suite 226 1NeURlR a: INSURER E: NORTH ANDOVER MA 01845 .. _ ..._......_ . . INSURER F: COVERAGES CERTIFICATE NUMBER:CL11990ti255 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVEBEEN REDUCED BY PAID CLAIMS. iIt9RA TYPE OF INSURANCE bL SUER _._._—.. POLICI EFF PoucY EJIP --- ---—— POLICY NUMER W M OO LIMITS OEHERAL LIABILITY EACH OCCURRENCE _ S_ _ 1000()00 X COMMERCIAL GENER�AL LIABILITY PR_EM�1S TO RENTED etleunenra_� I a 50000 A _ CLAe,L4•MADE I x l OCCUR 00031600 9/06/2011 /6/2012 MED EXP An ensBreen +619 1000 -PER.SONAI b ADV_INJURY 1000000 GENERAL AGGREGATE S 200000_0 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG b 1000000 PRO __._.. ... _ .. .. ._. POLICYLOC a Ad TOMO6ILE WBILfTY COMBINED SINGLE LIMIT ANY AUTO (Ee Kcidelnl) a ALL OWNED AUTOS BODILY INJURY(rw penon) a -....._......--'-- SCHEDULED AUTOS BODILY INJURY(Per ac6dWl) g HIRED AUTOS PROPERTY DAMAGE (Per accider) a. I_ NON-0OWNED a UMBRELLA LIAB OCCVR UMBRECESL Aa EACII OCCURRENCE a CUIM$M�oE AGGREGATE DEDUCTIBLE a_. . RETENTION a -- a WOR9M COMPENSATION 4 AND EMPLOYERS'LIABILITY WC STATU- OTT+ ANY PROPILETOR/P1IRTNERlEXECUTIVE Y!N _ .. TS7.RY LIMIT,$ OFFICERMENBER EXCLUDED? a NIA E.L.EACH ACCIDENT a (Mandeleq IA NH) _....._ K .describe under DE RI E L.DISEASE•EA EMPLOYE j $C PT10N OF OPERATIONS — ' ...... ONS twlan E.L.nI$EASE• LI Po cY UMIT a DEaCRIPTON OF OPERATIONS I LOCAM—W I VEHICLES (Attach ACORO I(M Addlilone)Remake Schedule,N man epeCe IS rogUINld) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN David Cas triCOnO Roofing & Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS. Cast-riOOne Roofing 200 Sutton Street Suite 226 AUTHOMMUPUBMINrATIVE N Andover, MA 01845 / ", ACORD 25(2009109) INS025(20MM) The ACORD name and logo are 1`99 Stared marks of 0 ORD CORPORATION. All rights reserved, Fix 978 -(-83 ,- 3-9 7 DAVID CASTRICONE CASTRICONE ROOFING&SIDING'NC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 478-887-6147 In HaverhMI 978-374-7314 G,::-t..�.- 918 -cUS2- 5875 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described: 7 Owner's Name....Jr�k;D 'L/}5.; f_ �� /�/r//3.'�L:L Telephone#....�/ f (��"� `�S `�'� '............�.....T ..........::........................ � ..........*., ........... 1 Job Address........ t3x � ...... eNyf.................... city...Nnd... ..................State......H..../... ...........�....... Specifications: ...................................................................................................................................................................................................................... StrQexisti__ ng shingles. Apply new drip edge to all edges. .................................................................................................................................................................................................................... Apply j feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. ...................................................................................................................................................................................................................... Apply telt Paper underlayment. Install ridge vent to T (� f'!` ''i-: S ..::................................................................................................................................................................................................................. Reroof using t i,--I rr 4 I-V -L 4f D .`=!rf.d %EL Z r shingles with a_3e_year warranty. ...................................................................................................................................................................................................................... Counterflash chimney. New vent pipe flashing. Legal disposal of all debris. ................. .�.. __.......---------- ...... ...................................................................................................................................................................................................... Area(s)to be worked on: ,- , t •- .................................r........ ......fzz........ ... .... ................................ ::.............................. Lt... .:...r� :v.......... ,.C.. :..4...ft.....1. �<. ............::............................................•............................................................... ...................................................................................................................................................................................................................... ..............................................................................................................................................................................................................I....... Roof board replacement if necessary aQ=�C.' /sheet or,5. /foot. .................................................................................................................................................................................................. . Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specified by manufacturer The contractor agrees to perform the work and furnish the materials specified above for the SUM of S...a .i�J.t�!�;::.1.:L Payable............ /<...1-:::.....on...;.4...11,&.a.......... Payable.............................on.................................. Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job is in operation. Contractor is not responsible for any damage to the interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials specified above(i.e-objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces).Items in attic may need to be covered by homeowner.All materials an;property of contractor.Any dumpster placed by contractor is for his use only.Upon completion of above wort`,ail undersigned agree to execute and ddivet to contractor,their joint tale in accordance with his(their)above obligation as tequcstcd by contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid,imm,diately due and payable. It is agreed that,if permitted by law,contractor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid,that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith.It is further agreed that this contract may be assigned by contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or,states of the parties.The undersigned warrant(s)that he is(they aro) the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names(s).Thera are no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral herein,nor is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. All Home improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:Director,Home Improvement Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-727-8598 Any and all necessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction- related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date .......... Completion date......................................................... Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. "4 b7 � IZ xaep/Ied- Z.J. �..�.�.:�, 19.. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. i.: ELECTRICAL: Movement of Neter 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 2008mi 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 Como 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.j I l Addition Or Decks ❑ Building Application Permit A lication ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ® Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contraet ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) E3 Building Permit Application 3 ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses .13 Workers Comp Affidavit o 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 oft 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