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HomeMy WebLinkAboutBuilding Permit # 7/13/2015 i BUILDING PERMIT 01 t%oRYH TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION (. �.d �d Date Received �,RA ZWn''1` Permit NOS: .9 �Rareo 1 g SSMCHUS Date Issued: 1 IMPORTANT: Applicant must complete all items on this page LOCATION ti 4's Iq Ve Print PROPERTY OWNER M int 100 Year Structure yes o'. MAP 'C� PARCEL:b --) ZONING DISTRICT: Historic District yes Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Fq,6ne family [I Addition Li Two or more family [I Industrial C(Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg- ❑ Others: ❑ Demolition ❑ Other Septic Ci rWell ❑ Floodplain ❑Wetlands ❑ Watershed District r m � l r , urOs✓�+� Y .` an DESCRIPTION OF WORK TO BE PERFORMED: 9 ' x 6 ® Identification- Ylease'Type or Print Clearly OWNER: Name: v e Phone: 7 Address: r� � � -S� VRr Co (41 ntractor Na Phone: O � Email: Address: i`bc� llv°�-� � 3 ` -S "� Supervisor's Construction License: Ex p. Date: Q� Home Improvement License: Exp. Dater L J ARCHITECT/ENGINEER Phone: Address: 42 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: $ L&60,r e 10/ J60 ,06FEE: $ Check No.: Receipt No.: f J NOTE: Persons contracting with unregistered contractors do not have ace ss to the guaranty fund i, Siq AnrV 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENT'S CONSERVATION Reviewed on - ��` Si nature ` - 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 Fater& Seager Connection/signature�1Dato Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street F9RE,DEPARTMENT - Temp,Durn- pster onsite yes na Located at,124 �1 h'Street" FireDeparre signature/date COMMENTS ® of 2 s EAndover S . - __ Z h O LA-NE VVi ' aSS' COCMICNEWICK A04ATED S u BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ....... ... BUILDING INSPECTOR ............� Sw .................... has permission to erect . g r+.. ft-a.,41.�......... Foundation ......................... buildings ....... ..... .. Rough to be occupied as .... ........ .....�a.. .... ! .......DOC-4w A.. ................ Chimney provided that the person ac pting this permits all 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 Aft PERMIT EXPIRES 16 MOAT—WS ELECTRICAL INSPECTOR 111' A UNLESS CONSTRUCT T Rough Service ............... .... ........ ........... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay 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. JOB CONTRACT Company Name Contractor: �-Q p�. � Ol Uf r l Owner: 5��e L�CC�Ct Address e l C0, Address: 5lc� Mcg s s Ave Phone: Phone Phone Email : E-mail: �� i ( ( C&Pq LABOR " r l ;� 0 ix 4 511 Mnsj 4Y �rr>f+k A-n VA 0\,rl I bow tJ y �o© Q o 0 ao 84 4, A9r i S S;v 1i. ,) M Ar" wt5;, 0-f o,' 4a Oncz ro Uc4ecic i �� I if Y11" 01 4 1.46006' b v' c1/1 c Q,•? Wk" 'ro Co S Com l +e, (- r m o-T C�OC.. O c n, [ CN i t (h � 1 a P.T, � ( 1 0iQ G1i✓1CJ CoV t 0 S;. S ov" 2 c, VS iD) S 1 i C w 0,� V 1 r) ,11 .J TOTAL Owner agrees and obligates him/herself to pay Contractor the sum of$ _ Total amount shall be paid to Contractor fiom Owner immediately upon completion of project. A DEPOSIT of$.That leaves a balance of$to be paid when Contract is Completed. Property debris and surplus material creted by the operation will be removed by Contractor. MaterMW'11uppli6�� ed by �'ome OUIJA-V- ,-�� W �Cr4' X X Contractor &ego��r(V KJ�r V, OWNER Company Name 1 North Andover MIMAP June 8, 2015 e1 S'Sa l 4S �►gts ,q h4� ,�aGarr A 1 e'R°ad r rel✓�l",�a,YJi'�1�YY�� 6��sta'� Interstates — I —SR Horizontal Datum:MA Slateplane Coordinate System,Datum NAD83, --Roads Meters Data Sources:The data for this map was produced by Merrimack NORTH Valley Planning Commission(MVPC)using data provided by the Town of t'p Easements Ot�t4to r q� North Andover.Additional data provided by the Executive Office of C„)MVPC Boundary .} b� sb aO Environmental AffenumassGIS.The information depicted on this map is Parcels L for planning purposes only.It may not be adequate for legal boundary O F definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER F. MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING i } THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY '.. 1. t ' {t OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT °off �,.� * ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Ao "p� THIS INFORMATION Also� ACNUs�t�� V=44 ft I t r 1 � tt m 0 Now 13 y� Cox bolus r ti_ 11 IMAN � �i �➢�atia, � E l flu z t 4 a u M Y y r� a, North Andover MIMAP June 8, 2015 045.G-0052 045.G-0051 045.E-0060 145 BEACION HILL BLVD rn 045.6-0059 144 � 155 BEACON HILL BLVD r 045.E-0058 91 .a. 17 ....... .... 045.B-0055 140 BEACON HILL BLU R4 045.B-0057 512 MASSACHUSETTS AVE 045.G-0003 4i 0", ��sach JAAVE h ►V�,hue .0 N 045.B 514 MASSAC 045:G-0035 40'' 505 MASSACHUSETTS AVE 65" 045.G-0006 045.G-0010 gaV stat R"Oad Rali Line Welland. Zoning Interstates :Exem t Lands Busine s 1 District _._1 p 10 Busine s 2 District Horizontal Datum:MA Slaleplane Coordinate System,Datum NAD83, —SR M Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack M Busine s 4 District AORTN Valley Planning Commission(MVPC)using data provided by the Town of Roads M GeneraBusiness District Otao r q� North Andover.Additional data provided by the Executive Office of '.. Easements M Planne Commercial— ommercial Dev �1*y •�a O Environmental Affans/MassGIS.The information depicted on this map is MVPC Boundary " Gordon Development Dist t' _ O(, for planning purposes only.It may not be adequate for legal boundary flLt Corrido Development Dist O M definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER *Municipal Boundary M Corrido Development Dist F A MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING IndZd I 1 District THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Zoning Overlay 'k yF %-Industri 12 District ®Adult Entertainment Yid # 's ^ * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT (3 Downtown Overlay District Indusln 13 District r{. °o �r` ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF [, Historic District M Ind.Mri IS District 4 �q Water Protection Reside ce 1 DiBeside; 2 strict �1 gOh�t1O THIS INFORMATION El Parcels :; Realde ca 3 District �SACHUS@ ki3 Hydrographic Features de ce4 District -- Streams 1"=44 ftde ce5 District + Edece 6 District %'-ge Residential District � or F-T' R a ' 1 3 1! 4 r t" e a 4 r , �r I 0 a r , a T t< ' i rn F... The Commonwealth of Massachusetts Department of lndustrial Accidents r I Congress Street,Suite 100 Boston,MA 02114-2017 ,qp www mass•gov/dia OSM SV. Workers' Compensation insurance Affidavit:Builders/Contxactors/Electricians/Plum ens. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Legibly A licantlnformation f PIV • Name(Business/Organization/Individual): VVN Address: G2 L Phone, ►JH , �? �✓Cpoa � � � f Ci /State/Zip: #: Are you an employer?Cheelk the appropriate box: Type of project(required); em to ees(frill and/or part-time,).* 7. ❑New'coristruCtion 1.Q I am a employer with P y 2.[VI am a sole proprietor or partnership and have no employees Working for me in 8. Q Remodeling any capacity.[No workers'comp.insurance required.] 9• Q Demolition 3.Q I am a homeowner doing all work myself..[No workers'comp.insurance required.]t 10 Q Building addition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.Q Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12_[]Plumbing repairs OT additions proprietors with no employees. 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs ` These sub-contractors have employees and have workers'comp.insurance.t 14.Q Other fr(r'1 T 6.Q 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 o fill out the section below showing their workers'compensation policy information. applicant that checks box#1 must ills' 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 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 employerthat is providingworkers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 0.00 Failure to secure coverage as required under MGL theon punishable by a fine up to formORDER and a fine of up to $200 .00 a and/or one-year imprisonment,as well as civil penalties inhe form of as STOP day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. t. X do hereby certify u er the tins andpenalties ofperjury that the informatioraprovided above is true an ®'�c Date: Si nature: Phone#• CL-7 ® � official use only. Do notwrite in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): [6. .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector OtherPhone#• ontact Person: 1 1t Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Super%isor License: CS-108482 GEOFFREY MURPHY ti 2 FELICIA DRIVE l Newton NH 03858 Expiration Commissioner 06/08/2018 � � ��B�(IOO7L9JL092LLteC6���0����t�CLJJlGe1ZfLJB��J Office of Consumer Affairs&Business Regulation (HOME IMPROVEMENT CONTRACTOR —� ration: 9,__ X82419 T�eistYPe: ,_ Expiration: 6/19/2017 Individual I GEOFFREY R.MURPHY GEOFFREY MURPHY 2 FELICIA DRIVE NEWTON, NH 03858 Undersecretary