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Home My WebLink AboutMiscellaneous - 60 ASHLAND STREET 4/30/2018 (3) NORTH BUILDING PERMIT 0 I"LED i6 +p 00 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION w Permit NO: Wt Date Received TOO 45 9SSACHUS Date Issued: 3 ;� IMPORTANT: Applicant must complete all items on this page Al LOC , ,ON . � ' t R01? RTY O VNE f j Aa Nli4P ltl4: FARCE ZOG fllSft{ ...��.�= i1STUR[ L}1 SGT ,y s ._ .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 /('(/z;' septic -0 T (❑W ,dplain,! l e"t nds 0 Wd6rshed strict Dater/ ;wer '3 ' zr = fy DESCRIPTION OF WORK TO BE PREFORMFD: OA,'f dV e-V . /,I° Identification Please Type or Print Clearly) OWNER: Name: Zee I s" Arm C'-4z� Phone: Address: Wel 46 � f CON` f;M,01 CSR Nari e Rh N `N � ; 935 . Adj9 its Supervisor s COnn'..stWc ioice sem _ ,Exp �... ; ' Homyr»prnveraenticense. R ARC ENGINEER Phone: HITECT/ Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i GQ' '� FEE: Total Project Cost: $ $ Check No.: 7e?/Z Receipt No.: e2 a/ 7/ NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature o Agerit%Owne'., , w _ Sign Lure.of pontracto 'k wn /�' S f j X;,u/ Location S�,L —A�No. �// Date 7 NORTH TOWN OF NORTH ANDOVER � A Certificate of Occupancy $ ��s'^•° Et'� Building/Frame Permit Fee $ AC MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ - Check # 201 M BuildingtInspector I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ i 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 j DATE REJECTED DATE APPROVED ` PLANNING & DEVELOPMENT ❑ ❑ I COMMENTS I I DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS r., Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer e Connection/signature & Date Driveway Permit Located at 384 Osgood Street `Flh�:iDE�ARTMENT~ 'ehi` �Di�rn sten dt�1�91f� °y�s�� +y[� :.Located at'T24 NI�i�Stre t � � �' Ftr�`t3epartnent s"rgnatureldat : #} ,. . �` . llt Ct7MMtNS S'' 9 li 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� ..............................................................................................................................................................................................................._..........._......_...................................................................................................................................................._............................................................................... Doc.Building Permit Revised 2007 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) ❑ 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:INSPECTIONAL SERVICES DEPARTMENTMITORM07 Revised 2.2007 't Board of Buildin g Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 120181' . Expiration: 10/22/2007; Type: Individual ROBERT R.BELANGER ROBERT BELANGER I 1278 BRIDGE ST DRACUT,MA 01826 Eel _Administrator cy�..A::..: . Z The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # F1'1 I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. Company name: Address �� o✓fir �r �� City O✓ l. f Phone#: 5W Insurance.Co. Policv# l ��l�U� " 21'2 Company name: Address City Phone#: Insurance Co. Policv# Failure to secure coverage as required.under Section 25A or MGL 152 can=to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonment_as welLas_c:ivil.Renaltiesjn.2belarm Ufa-STOP WORK ORDER.and_a fne_of..(.$1 DD_00)_aiday a-gainstme 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date f Print namePhone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing. Building Dept ❑Check if immediate response is required .❑ Licensing Board ❑ Selectman's Office Contact person: Phone#. ❑ Health Department ❑ Other XAORTH own of �r. 4 over -, -�' ' 4 0 No. 7 // _ ,S/Ur0 7 dover, Mass., T 0 LAKE COC MIC ME WICK V ADRATED C7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THISCERTIFIES THAT........................................... ......................................................... ......................... Foundation has permission to erect............:.. buildings on..... .Q..::�5.,��i�/�/. Rough to be occupied as 4rP11 � Chimney rm provided that the person accepting this peit s 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU ;00 O ART4fgG Rouge, ....... Service .. .... . ........NSPE 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. 1[__SEE REVERSE SIDE Smoke Det.