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Home My WebLink AboutBuilding Permit # 6/9/2015 BUILDING E -v D IT O��.c LESI(gtiO T RT !! ,6 ® APPLICATION FOR PLAN EXAMINATION q socw Permit No#: Date Received '� A�Rnreo rPa R`9 ,. �Ssgcwus�c Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 2 -3q 4 if •' bAr Print PROPERTY OWNER ^ - Print 1 100 Year Structure yes no, r MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building Xwo e family El Addition or more family ❑ Industrial Iteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other „w arwr I �r r��"�'�VYI'rvr i'+ rr� ryn,'�dM46�j� f�yllflf6;i61fi(� iennirf Air/l�"1nr�IC1l^xGdM14�Y4'~n+y�},�,� , r� , J r✓ir� r�,�^K4p',�"rr1110IN16�'�iJur,��U9d'C�d/` (°fk�i�f�(YP+�Y��"Y" �r(r��, DESCRIPTION OF WORK TO BE PERFORMED: t Identiti ion- Please Type or Print Clearly OWNER: Name: ry Phone: Address: �. 1, 1 ° Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Dater ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ I FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with n 'stered contractors do not have access to the guaranty fund rr ✓r r rr ,./ r �o r c orr:-�.l,/L.. ,G. ///9 r r r,�7 /ir ,�arna�t�rrrr��irrrG��c�/�%%:✓ ,/r� ,��r��, 7D/�lin�///0 �� r/,1 0 /' I / /�� ///0,/ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F F SEWERAGE DISPOSAL ewer ❑ Tanuiug/Massage/Body Art ❑ Swil- � g Pools ❑❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster oil Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORINT PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS Signature .�. x d.p '� �.........� CONSERVATION Reviewed on , 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 Driveway Connection/Si nature& Date Permit -� v DPW Town Engineer: Signature: Located 384 Osgood Street FIREIDEPARTM y EN1T�� Tern JDum" s : % ,. ter on site. /�"' J1�lA1lai i,r / ,.� `] p ,,: �J✓/„ ,J.rJ r; ' .,r:, � y aG dHJ �(��r��1✓�i� ,✓/`�r,��/'�/�l�iii� /1 �/�f,.,,�� ,. y � 10"A vu LocatedatJ124/ i J % fi%%/ MainyStreet J rJ ,.,� . /.,. t/ l .lr,�i r!� ✓�� /,,;:� � �,,,, ,,,,, ,; J„J�,�JJ% ...... %,1 it, i,,.,;�,/ /ice/r li i w >; Fire;De artment� �I Ca�$Ure� � tl�te ,� ,,,,.✓ J / i., ✓.. ,.al//1 i. /i �// �/ l � r�..rbc/ /r„(l'.,iil b.. iJ. J J OJJ .ij i y l ✓/ i ✓ Jiro / %. /li�i/i/r'i�f/l/ri ��ri�/„rdl/Ir 'Yi%f rr, �i�iYil %%'Sr JjiFJ/ J�i�i cr.�o is ii J 1 ,aii J��J°%%/ JlAii��rJ i J l / COMMENTS”' �oR4fj own of E .�, \Andover p { No. h ver, Mass, ,a( by A- COCNICAWICK y1• 7�ADR^TED ►p�,`'�5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT JD...A./!A..... . ........c,ael; .......................................... BUILDING INSPECTOR has permission to erect .......................... buildings on ...3.2-7:34 .......... ..... Pude— .. Foundation...... Rough to be occupied as ..{.�... ........�d.. .®` ...... �.1�.......... ...................................... .........�!'). � t,v n�!? ............. Chimney provided that the p on accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final . PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST T Rough Service ........................ .... ....... ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Requited to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 4�axr TOWN Off` •ORM AND OVER Q£Kiwco�,�a d OF-BICE op t 600 D`�"gOQC��` 00tBuff di'jT,,lg2,u[+�.+J0,-rS/`�ilit(,2,-3b �p�A37xn F .t�J .LV�1xA.1. �Q �t. y 'C�v�'.�s`tj.�illui YI1L]'`f A �S_`AC3-1t15k'' Gerald A.Brown `�eZep�one�978�6$S 9��5 YnspoutorOfD,;ff ngs r Fay X978}689-9542 pleas�rinE �OB LOCATION., luznbex S�xeetA ddress Map) o ' `Ht AlVMDW E �1•azne �ion7.el'hone WoxTc�'bone . An"J ., vi v, Al .. The to Delude owuex occtip'xed d�ve�lin�s to i�vo units ax less and b allow� � ?omPo,refs io engage an tiVidual.forl7ire-who does notpossess a licouse,provided that the ovirmx acts as supezv?sox). Sia-teBu+IdingCode Sect?on.:1.�8.3<5.�� , DEF. ITION O]FROMEO• M g po'son(f)WhD Pas aparcel ofland on whichltelshe resides ox attends to reside,on which there is,ox is infended to ,a one or two family structures. A person.vtI.o constructs more tziat one,home in aiwo yearpmi d shall not be considered ahomeow r: The mdexs%gned llhozo(swnee,assumesresponsibi ity'f'oroomplianeesWIM the StafeBuildiug Codeanti otTter .A.pplicable cones,by laws,razes and-xogulations. ectndexsiguetl"homeowner"celfiesthaE�er'shevnders�ds�eTavtn o�1`7orEh AndovexBuzlel%ng�eliaxfinez�t mzuirnumins •peetiouprocodumsand xeaucl'th With;saldpxocaduresand requirmiouts, . • , HOAMO'6VN`MS WONATT •A-")', OVAL OF 13TT.TLDMG t7p�ICTAL Revised 7.2Q09 )Form nozmmmars Exemption , - • X.YS 30AM)OFA.ITEAM"68$-9541 CONTSER•ttA.UON 699-95.30 xrTt?Ar.rFr��Q_o�an 'DT A'ATATMT—rnn rt The Commonwealth of Massachusetts F Department of lndustrialAccidents M 1 Congress Street,Suite 100 Boston,MA 021142017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Le 'bl A licant Information YJ Name(Business/Organization/Individual): w VA t �(V Address: ( C. Phone#: 7d2- 5" 7 City/State/Zip: / — Are you an employer?Checicthe appropriate box: Type of project(required); eees fill and/or part-time).* 7. ❑New'construction mto 1.[]I am a employer with P Y 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required] 9, ❑Demolition 3.�1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[]Building addition 4.❑I am a homeowner and will be,hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12,F]Plumbing repairs or additions proprietors with no employees. 5.F1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13,❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14 ❑Other----. 6.[]We are a corporation and its,officers have exercised their right of exemption per MGL 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. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached 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. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lie.#: Job Site Address; 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD.ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby eei• W un a the p.. dpenalties of peijuly that the information provided above is true and correct. � ._. . Date: Si nature: - Phone t 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 Z.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone##: - - - I I I i I f I -- - I Ir 1 �`�`��„! I I I I I i i ( � rl � I `il� � I I ,r•��'I '1 I ji II I q kRI I I r 1 I , ll - 1 I I It Lj i I _ I 1 II I 1 I i I I I I 1 II 1 � 1 I 1 I I 1 I I I �• ._ � 1 - - _- it - ��__ I I -- �1-- ...SNI .r �,W- ;i �',_ _ .'I_... I .. I._ I _'i � I -�-' � I �. I �rl --'-"= � � - I 1 I I � 1 � __�,'_11-1 1 I 1 I I I - 1 I I I I II I 1 1 ;