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HomeMy WebLinkAboutMiscellaneous - 21 ASH STREET 4/30/2018 (2)N r O �/ ,;11,4 _r 4 S � No. ? 7 — / 3 Check # S-3-1 3 26234 Date.34 7// TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $,IM Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �77 Building Inspector Permit NO: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page i�nrrnTin'nit �. � f wT - MAPxNO f7, PARCEL;; ,j Printf ,Z®NING©LSaTRIC9T; 100iYeara J -0d Svuclure, Histonc�Disfncti Machine)Sl opiVilla -e, yes" yes yesJt no) nod •riot ❑ New Building TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial P'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ®Septic) D�Welll '`s - IF plain' ❑11Netlands, ; i CYC ` Waters s D Watershedipistnct ❑,111/ater/,8 ewers DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Address: 1 t# cz:T CONTRACT0Rt Name:.TiK-Aml fSPhone3t $mac. _1� �oov�c I Address _ Supervisors)Construd-t on�Lidensea +-'RIS 4 ___ .__ Exp?, '®:ate:: w i.. .. , _ ent':Li ARCHITECT/ENGINEER Phone: Addres Reg. No. FEE SCHEDULE: BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ FEE: $ 30,00 Check No.: �`.3&I -f- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund :Signature of Agent/OWner . _ Signature'of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 4. 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 COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Yater & Sewer Connection/Signature & Date Driveway Permit 4W Towu ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT _ Temp Dumpster onsite yes Located at'124.Main`Street.-_ Fire Department-signature/date COMMENTS Fix Z t9 LU LL oz Ov m vm t y O . LL +�+ Ln N :O- N p a z z C 1 7 LL to 7 4' v CC C V C LL O � z J a to K LL F- y Z u W J W OA 7 d' u i N C LL W. O a z Ln a c� 00 w LL z Q W c LU °C LL ` N m Z 41 v N +' Y O (n O : LL 0 v p : U W :a co z da CD c z c o U E C. i U) : m C0 • d.+ ow Cl) w c m z 0 0 L 0 " 3 •" NJ E �O m a Z > � cj) `° a; r�o ti W OC o . N o� > n. �N�a G XZ 0 W N c c cl) 3 c W J cep aZ CL .-. m co o r c .O L m 'a C N m t 'a O C �+ H C C L C -a_ CD -0 0 C .o+ Q. o U > �. i LLI U) N W W W U) The ConimoisweaX, ofMassacltusetts -DeparhmRit of 2't:dastrW Accidents O. f ice nflnvesdgadons 600 WasizhTwn Sft e Boston, MA 02111 . y -- Workers' Coni ensation 3[n wwwanassgov/dia : P surance Affidavit Builders/Contractors/Electrici=s/Plnnbers Lpiicant Informafinn Name (Bps;Hess/organ;zatoa/Inaiviaual): -- Address: City/State/Zip::b-�11L Phone.#:____! Are Y an employer? Check the VWOP>j�kte bog: 1. Orl am a employer with _2 -- '4. 01 am a general contactor and I 2 ❑employees (full and/or part fame) * I art a •sole Pr6PdEtor 'have hired ihe v&,,ontractors or pa-tutrr- ship and have no employees listed on the'atfached sheet These sub. -contractors have working forme in any capacityy_ [No workers'comp. employees and have work=— insurance I ❑regzm�3 I am a homeowner doing tromp_ insurance - Weuea'MWO atioaand% all work myself [No workers, comp. officers Dave exercised, their —=`? right df exemption prance r-� t per MGL c. 152, §1(4), and we have na employees. [No workers' Type of project (required}: 5- ❑ New ccrr t cdoa ?. ❑ Remodeling $- ❑ Demolition 9- Q BUWZ addition 14.0 E1�cd repairs or additions 11.0 P . "mgrep� or additions 12-epai s 13.V(ther (1CL k't ncY t 'Any applicant that checIts b'ox #I ``.-F- �urzmce requited j _ r Homeowner; who submit this must also at ng the section belowshowing their �y�. COmpensation oli tnf tConbactors that atMdavit kbit ting they, are doing an WO'k and �� bine outside contractor; mustW - °tion. check this box m¢stattached an additional sheetshowin sabmitanew aiiidavitindicatingsu& employees. If the sub-contractan � l g ihename ofthesvb contractors and state Why ornot those entities hat e P oY, theymustprovideffieir-DoficYmtmber. Iam:anemnlmm..sL�= -- - . - ---- FS vysni infornuttionng wor"rs' compensation insurance for my em plopees. Below is o the F UcY and job site Insurance. Company Name, 1 , Policy #• or Self -ins. Lic. #: L ExpaationDate: — 6 Job Site Address:� cn- Attach a copy of the workers''compensatioapolicyLLOOg declaration page (sho y/�t Zip. Failure to se � Policy number and cure coverage asrequired espirafion date): egaired wader Section 25A ofMCrL c. 152 �� � the - fine zip to $1,500.00 and/or one-year imprisoffizent; as well as civil imposition ofcr'm3hW ofup to $250.00 a da Penalties or'a Y agate S violator- Be advisedihat a co Penalties in the form of a STOP WOMORDER and a fine Investi of the I?lA for insurance t:o PY of thisY be forwardedto the Office of Ido hereby_—3ficateon. ' ' er the dpenaTtries ofper*7 a& me a formation provided above is true and correct Si �atare: Date: �aA W- +N-- f A 4 use area, or town offIC&L City or Town: _ ' PermidUcense # issuing Authority (circle one): '1_ Board of Health 2. BztOdmg Department 3. CItyJTown Clerk 4. Elecfiicai 6. Other Inspector 5. PIumbing Inspector Contact Person; Phone #: . HRH WrIlliam HC) 80CAMPB NORTHL- Massachusetts - Department o� p of Board Of Buildiuo:, ng Regulations I.,z ,. Safe; Szanclarcj Safe:.: (',,n%rructi,jn.Sul)cn i%,,,. License: CS -0S7754 (' WXUAKDR101ii go CAM MRIL RD NANIDOVE#MA 10194.5 Commissioner 0310412014 - - - - - - - - - - -- - 0fr1ce Of C011sumerAffairs & BUSWess RegulationPDME IMPROVEMENT CONTRACTOR gegistration- Type. Expir4tion: 4. Private Corpomficl, 5TRUCT, .1NC_ e ELL RD —CM MA 01845 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: office Of Consumer Affairs and Business Regulation 10 Park PIM - Suite 5170 Boston, KA 02116 Plot valid without ej ature ��"" VCR 1 11"IVH I C yr LIHa1LI I T IIYOUMMIMLor- 1 1 I lwwlLv I G 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPOR''TANT: tf the certrf• rcate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 1f 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). PRODUCER Emond &Associates 857 Turnpike Street Suite 133 CONTACT NAME: Emond PHONE FAX A1C No 978-90"71 A E-MAIL ADDRESS: mikA—Prnnndafarnifamily cam POUCY EFF MM/DDNYYYI North Andover MA 01845 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Fane Family Casualty Insurance Com an INSURED NRH Construction INSURER 8: INSURER C: 80 Campbell Road INSURER D INSURER E North Andover MA 01845 INSURER F:: � GUVhHAGtS CERTIFY ATI` MI1UU=D• r,r.n................... 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. INR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POUCY EFF MM/DDNYYYI POLICY EXP (MMMONYYYI LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITYr CLAIMS -MADE � OCCUR � I 2001X0726 11/2012011 11/20/201 11/20/2012 11/20/201 EACH OCCURRENCE $ 1,000.000 PREMISES Ea occurrence $50,000 MED EXP (Any one person) $5,000 PERSONA L& ADV INJURY $ Included GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2 0 0 0 $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT Ea accident) _L11,000,000 000.000 A ANY AUTO AUTOS X AUTOS Spe-VAI X NON-OWNED HIRED AUTOS X AUTOS 2001 2001 C4287 -4A 03/16/2012 03/16/2013 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA UAB EXCESS UAB [XOLCCUR CAIMS-MADE r 2001EI169 12/14/2011 12/1412012 12/14/2012 12/14/2013 EACH OCCURRENCE$1 000 000 AGGREGATE $1,000,000 DED I X I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS• LIABILITY v 1 N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICEIMEMBEREXCLUDED? N/A 2005W6827 12/07/2011 12/07/2012 WC STATU OTH- TRY LIMIT E E. 0 L EACH ACCIDENT $ r E.L.DISEASE - EA EMPLOYE $500,000 (Mandatory In If yes, describe under und 12/07/2012 12/07/2013 E.L. DISEASE - POLICY LIMIT $ 500,000 111CRIPTION OF OPERATIONS bAIMM ------- ---------- -------- Ff r- is by nameainsuie-"-"••`"""" �...... . t......•.....,nl, �u 1, ..uu1-41 NemancS acnes ie, R mom Space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS_ AUTHORIZED REPRESERTATW,, / W 1WGV-AU1U AGUKU GUKPUKATION. All rights reserved. G * Conser atlon Services Group CONTRACTFOR nationalgrid- CONTRACT, SERVICE !CORK HEREWITH YOU. HERE FOR YOU. This service is brought to you through support from your local utility 1. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these `Premises" in a professional manner and in accordance with the terms of this Contract, including the a0ached recommendations/work order describing the work in detail (the `Work)which are incorporated herein by reference: Description Whole House Fan Box: Thermal Barrier Polyiso 2' (Attic) Perform Air Sealing at Estimated 62.5 CFM50 Per Hour Quantity Location 1 Living Space $154.32 8 Living Space $616.00 Sub Total: $770.32 Energy Efficiency Incentive $770.32 Not Sales Tax After Incentive $0.00 Total $0.00 Printed: 2/19/2013 Page 1 of 2 Il. PAYMENT Customer agrees to pay Contractor for the Work, the Customer Share of the Contract Price as follow : Payment kl: S as a Deposit payable to CSG upon signing the Contract (not to exceed IM of the total retail costs or actual costs of s orders, whichever is greater). Mail check & contract to CSG, Attn: RCS, 50 Washington St., Ste. 3000, Westborough, MA 01581. Final Payment S ///// as the final payment for the Work shall be due and payable to the Independent Installation Contractor ("ITC") uponsai or. c pletion of the Work Customer understands that thelshe will not be required to pay the Utility Incentive Share of the Contract price in the amount of Sihe Utility incentive Share is dependent upon the package purchased and/or prior incentive utilization_ Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. 111. DISPUTE RESOLUTION The IIC and Cast ereby mutually agree in advance that in the event that the IIC has a dispute concerning this the HC may submit such dispute to a private arbitration se�vicerfiiclr has app,'�ved by the of CormunerA�ausanct Business Regrdationand (ktsto er 1 he to ibmitto such arbitration as provided in TLG.L c 14?A Customer. L" " t 5 Contractor. You may cancel this agreement if it has been signed by a party the— is at a pla a other than an address of the seller, which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch by ordi ry mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signig f this agreem41%1/ent: DO NOT SIGN THK O { RACT IF THERE ARE ANY BLANK SPACES. f� Customer Signator Dae ?�. Indic -ate your selec d IIC here, if applicable (OR) Initial here if you want (j( �j () �) 5S t C�rt�'1C r0 �r the Program to assign a ,—— Participating Contractor CSG Signatures `• D e I Name of CSG Representative (Printed) t _ TERNS AND CONDITIONS APPEAR ON THE REVERSE. 1/13 reference: Quantity Location 690 Living Space $966.00 (Attic) 1 Living Space $38.09 24 N/A $44.40 Sub Total: $1,048.49 Energy Efficiency Incentive $786.37 Net Sales Tax After Incentive $0.00 Total $262.12 Printed: 2/19/2013 Page 2 of 2 II. PAYMENT Customer agrees to pay Contractor for the Work, the Customer Share of the Contract Price as follows- Payment fl: $ UK `7c � as a Deposit payable to CSG upon signing the Contract (not to exceed IM of the total retail costs or actual cr rs Cf s ci , whichever is greater). Mail check & contract to CSG, Attic RCS, 50 Washington St, Ste. 3000, Westborough, MA 01581. final Payment $ l . as the final payment for the Work shall be due and payable to the Independent Installation Contractor ("IIC") upon s sfa for orrrpletion of the ork Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of S . . The Utility Incentive Share is dependent upon the package purchased and/or prior incentive utilization. Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. 111. DISPUTE RESOLUTION The IIC and Customere utually dvance that in the event drat the IIC has a dispute concerning this may submit such dispute to a private arbitration service v%Nch has i appy ed by the p iConsumer Affairs and Business RegrrLation and Qntome re Co4 1 t to nrhn to such arbitration as provided in M.G.I. c 192A Gust rr iA ��it Contractor. You may cancel this agreements been slgned by a party the elo—at a place ther than an address of the seller, which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch by o dt a mail p st d, y telegram sent or by delivery, not later than midnight of the third business day following the sio his a e DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES �ta�'t3IniL..--- er a e 110 Y� Date lndicp your selected 1 here if applicable '{QR) tial here if you want oZ 1 C 3 C '�� S 1� j wK (t A the Program to assign a Participating Contractor C 4r S;m,a nre Date Name of CSG Representative (Printed) TERlfIs AND CONDITIONS APPEAR ON WIRE REVERSE. 1/13 f Location No. 7 Date`� TOWN OF NORTH ANDOVER EE Certificate of Occupancy $ Building/Frame Permit Fee $ S Foundation Permit Fee $ 4v Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ cc 5a TOTAL j $ lam Build g Inspector i Div. Public Works U • 2 OA n Zf O 2 O z m > n m r m r a u+ p N m + N m - m 0 0 G, r 0 t r + 0 + C 1' p a 0 a Q w O � s m c m m x 8 11 r z O fl 0 a z W -1 M C n 1 0 z N m r > > m a u+ p N m + N m - m 0 0 0 f r 0 t r + 0 + C r 0 C a 0 a a N m c m m rAi n n p 2 m _i 0 _i O m + z z 0 ,+ + a a r 0 r 0 Z O m r z n m z 0 m z 0 m A a x 8 11 r z O fl 0 a z W -1 M C n 1 0 z N r� Al 0 Nei C, D z , v O m D $A {A m r y N> a u+ p N o m m> 0 0 f r 0 N 0> 3 > o r m c m c m c>>>> rAi p 2 m � m 0 ,+ m r r 0 r 0 r 0 Z O m r z n m z 0 m z 0 m A a m n a a 0 0 > 2 O 2 O O 0m A O z - 4 a o> z m > 0 nm r O p m F 3 3 z m i m z > o; m m �^ N 0A 0 A m a V (1 0 ; -1 Z z j) r m i m �. , U1 r 0 0 G a C A H O 2 IN m t 2 i a �+S \ 'S @ z 0 1 \ 1. 0 . y m Z - m m C l W, H a m N m N m a m� a 2 m o N 9 a m > 2 I C p I z z 0 O i O z O z p>i z r o 0 0 •+ i °a m n n c o o 4 ,, 0 m 0 o 0 A 0 A w m 0 A 0 z Z 0 0 z z 0; pl z a C O ,1 1> a (fr C_ r O 0 -mi ren 0i m -4 o< o m N a n 0 0 0 o p z a N Z 0 0 0 > 0 0 r z > 2 m 2 f> 0 r >A F --4 m o � a a _ r'� N O r z m x = z O \ > m 2 m o OT R o A I> �fn r� Al 0 Nei C, D z , v O m D $A {A FORM U - LOT RELEASE FORM .INSTRUCTIONS: This form is used to verify that all necessary a ro Boards and ^"partments having jurisdiction have been obtained. T vals/perm is from the applicant and/or landowner from compliance with an applicable This does not relieve Y pp icable or requirements. ****"*******"*"***********APPLICANT FILLS OUT THIS SECTIO AP LICANT �,ar%� /� 7 / C 0 PHONE'/� LOCATION: Assessor's Map Numbereel,, PARCEL SUBDIVISION ( STREET S / Si LOT ; . S) ST. NUMBER USE ONLY TIONS OFTOWN AGENTS: n rr r / /� c UUNSERVATION ADMINIST TOR DATE APPROVED b DATE REJECTED COMMENTS) �� �/ �� TOWN PLANNER EALTH TH DATE APPROVED----------------,' DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED L irw PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE h O h h Td lld90:S0 866T 9T '-ALW VT08 S89 80S : 'ON 9NOHd ;r► **.S31Aw**SS31N I UiS : W08J W CD CN Ln Lo r^yI v V (^ 00 r�vXj V M( v V 1 00 h O h h Td lld90:S0 866T 9T '-ALW VT08 S89 80S : 'ON 9NOHd ;r► **.S31Aw**SS31N I UiS : W08J w 10 C cq�o m 2 p _.y O Q N QO�m .0 N, v o timd0 Z ? c N m O fA � poop O IE S m > > IF CA CD O CM)'O O 'LA.mCD C2 Z CA A �-+ C� o; a o ij CL /CT] _ O �• J O VO ? C m N� 1 cn m =rc b ^r) am O O1 N : O d S 1 ' ^1 J m :� C VJ O C v CD � H CD . ���pp • v J y N 0 CT d H O\ 2 O' CD O CD Q O o b 0o coZ m par 11 �. Coy �} (n O 3 CL CD CO) CD co CD o Cn ? m +� CD N �• to CD 0 Sr: CD a'o O � o CD O � O En o � � b w OQ r w dp i� M 1`^.e� 00 p�j b M O w � G p m 0 d n A ON vz M M v 0=3 0 0 c l It MI 9 m k X� o c�; c w � � 9 m Commonwealth of Massachusetts City/Town of RC V D System Pumping Record 411 Form 4 OCT 2 6, 2012 M DEP has provided this form for use by local Boards of Health. Other D lfh information must be substantially the same as that provided here. B OnE with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System LocatioRight front of housef hous Left /right side of house, LeftRight side of building, Left / Right front of building, Left �Q-%?Er� t rear of building, Under deck Address A- �Sk- Cityrrown /State 2. System Owner. �"D � 3) Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Zip Code 5tate� 0 � ��od-k Telephone Number to- Cg- \@- Date 2. Quantity Pumped. Cesspool(s) Septic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Conditione) sCttem IVQ� � "'�- C-^— Z. 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatihere contents were disposed: /-G""L�SJV Lowell Waste Water '11—N 10ie276a-�e� t5form4.doc• 06/03 F5821 Vehicle License Number Date System Pumping Record • Page 1 of 1 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 B Notified for pickup - Date 3 F Doc.Building Permit Revised 2010 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 40TE: 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 40TE: 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 appal 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 2012