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HomeMy WebLinkAboutBuilding Permit #564 - 810-812 Salem Street 4/2/2008I i NORTH BUILDING PERMIT o� TOWN OF NORTH ANDOVER 3� '�`'` `-' °� APPLICATION FOR PLAN EXAMINATION Permit NO: APFR0 to Received f .0 rep►�,` Date Issued.: 2 IMPORTANT: Applicant must complete all items on this page r'�. s ra tr .,-= a ia a '# :s" sMe ., v'� -,to ti�- .'yl •"' s,+ - ^� �, +Z11..,x' P - >c+- rz�=� -a '.�' � M�4„�.. -: MPO n �� 011EF )Of iHas#or �stfiot� eB'' ox +t'�+�`` �!O(la� � �'B fl a � TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial lacement Assessory Bldg Others: Demolition Other S Ed �r teTstD s,f-I t> z .,. DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) % 47,-s�q, a?-ar OWNER: Name: S•r&Ae, iL� T2�. T Phone:�12.7XZ -;.I e)© Address: 477Y L'"1- 35�s'�s�i�J 5T ,/44✓s��i'eG ,g � og -'�iT',x r`"'3:� s.R` '�- s,a'�.+'.',Yy na.� '. ^ai.z� ,°'a;+s�r `�Y�""t t. Sr �"! -�'x.^a: ' xat:2 - r... tw' y£, Y �'. r..,.F`�xa,'� rr� .,t - sa r^gm f RA u 1 61 -12 �a 4a 'r 'Y� +5� � '"= .. ra �` . '.^Y�. ,„,n-c -'-�•rs.- rz.,�, .. . -`�' x ' '"�- ', w �,'"z�. �'m, 'moi-x'a�Ra''�` # iG- 'v - ''? $ ,:t .�,F•���r""�"'--x a Yvim° �-� xes's^ 'n75 ''*";. .az'�',.-.s?�"r`.r w. n'`''� i ',FS ,.5 'r' ,2€• '^n, £ -e`r' ,..e n,j� "...: .''nri .a. E a*lp ray^,. .x-"5=x. ,3t•�,.F-`' v�. r.5 ,.^�^r.,�s `�," '� ��,.✓zrz rtey�v,� � a x �.� ti� ,a: �5�.r..�m.fa �,t �'���-;^,. � "4�`rx�..n,.a.'s;.;+�X�.u'�-':, 4��t }, � r�5i r yr ` •s,�"'%r+��'�}}�p ��„`�rs .:a tt e�'�- 3 7p q'�y,� a 3 y� p }t� ��,�?�Y$ T�;;'�������t:Xi+.�'�����. 2�i}��}�,,� ^:�aak��� ��,�.w�+Gd.'�r 1n� tt,�'�,•F4 s"'�.4) ,,z'7w+ '^� asap , 'k ARCHITECT/ENGINEER Phone: Address: Reg. No. f FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /D l0-PO FEE: $ Check No.: 73 D Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund S� - atue of Aeraner = �. c� = C3 - � tc�naturea contractor _ � . 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 DEPARTMENT:BPFORM07 Revised 2.2007 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 DATE REJECTED DATE APPROVED CONSERVATION '����` COMMENTS ,✓ti�/�� Gni °� rl �~ � DATE REJECTED DATE APPROVED HEALTH COMMENTS �3 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit Located of 384 Osgood Street x � 7P �,,�, rr � �G % c> � ..��' i r`P�"d. � d��"S�'�- `r�i.WON=fr � x"E• - IRt., EPAF�T�YtE NT�� T ��Du t�#aster �s�te� fess ���� � � �na��� � .�,'��nG.xr:Y �r i++x,y t err ${. .5'� � Y+tis,T$�,: Loca ed at IT-2 �Ma Sttee - s�, x 4i r ,�.° '.^: a x.z";�" ;,, -'r ,� zF�reDePartrrentstgnatrir �ate r� i � � "�a �' �� x.r ;�+� an '4T;M 3rF,� �':r' dt . . 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 / 4- � v v ' -Z i77 4 y 2 Z& _Zoo ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Location / ` ��2 No. �' Date TOWN OF NORTH ANDOVER ~ 9 "/f Il t y tee Cervi icaoOccupancy $ y Building/Frame Permit Fee $ / 'ta s�CNus Foundation Permit Fee $ ter' Other Permit Fee $ TOTAL $ Check d Z0 1 " 4 1 BdiIding Inspector NORTH T0VM of Andover N o. 0 A 0 dover, Mass., Z� 0 L COCHICHEWICK 14 OJ'I'ATEDOPS` C S BOARD OF HEALTH Food/Kitchen PER M I T,!!:::..- T D Septic System THIS CERTIFIES THAT..S-/—.c xA BUILDING INSPECTOR ............ .............................. ...........7...... ................... ................................................................... Foundation has permission to erect........................................ buildings on ......rz ....... ........ .... Rough to be occupied as.........................P.. ....... ........ Chimney provided that the person accepting this permit shall in every respec�znform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relatind 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 CONSTRUCTION STARTS Rough ...... ....... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE--]I Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688=9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 0i0 IOU s,*(or a- is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws'Chapter 148 Section I 0A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Fire Department Si off: P � Dumpster Permit ate I 1ne commonweattn of Ivlassacnusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): %�2fO ,C JZJC Address: .1rol /,r e�51 g77 City/State/Zip: Phone 171eFS1 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 7. Remodeling 2. I am a sole proprietor or partner- listed on the attached sheet. # ❑ g ship and have no employees These sub-contractors have 8. g 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.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: 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 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 andpenalties of perjury that the information provided above is true and correct. Signature: Date: f Phone#: 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#: ORS ANDS O 0 TICAL COMA February 13, 2008 TO: Mr. Gerry Brown, Building Inspector, North Andover, MA FROM: North Andover Historical Commission RE: Chapter 82 - Demolition Delay Application for Demolition filed by Mr. John Carroll, 1501 Main Street, Suite 15, Tewksbury, Massachusetts In accordance with the provisions of Chapter 82 -Demolition Delay this written notification is being sent to Mr. Gerry Brown, Building Inspector and Mr. John Carroll, applicant. On February 11, 2008, after an on-site visit of the property located at 810-812 Salem Street, the North Andover Historical Commission determined that the property buildings, consisting of barn, sheds, and farmhouse, are not significant. Although the structures on the property date back to more than one hundred years almost no architectural elements from the earlier periods remain in the existing structures. The most historical aspect of the property is the rural landscape including the stone walls. The Commission recommends that future development plans will make an effort to retain the stone walls. AQ� �,ipda Tremblay Vice-Chairman .prt ,09ver Historical Commission =r'-tb-dMf i4:bb rrom:HVUUVtK UUbiKUUIlUN 7fb t:)d 71(3 Io:yfb ti b txl,D r.1 1 nUP. uO uJ VTiLur vulm %.avvuiI 010-ona-uCLJ p. J JUL-24-2684 01:58 Feem:ANMR Crh; TRXtl0H 970 259 9173 To:978 850 9,13 P.3'3 FOWn of Worth Andover ,�►oAth SuNding Oop ftMflt 27 Chnrks Sheet F A North AnaOvar MA 016UUL � Tot:998-41MI 1M Rax:IiS4MM2 n � ^�♦ atlr,�s t � QF"XfTIgN Oe:I"NGNG ANOW T 2 Jp �77 OWNEWS NAME A AWR@5S 714.3 C.A CAWLL � I-V l�Ir1'�l• S/�IYP/�_� LOCATION OF PRi)PE M D — I !;,re a a�d}t mss_ �� XA 0 SCRIPT d,M ' �Yl�.NL. �: A��AP.'nC..M ��►Cr.~ CONTRACTOWS MME a e;ff7 Ok�!A11T�f�ft pEPT. PUBLIC WORKS WATER xG --�- GU�f ► 7 -- (`,AS 0,L ap EL TR A TFi F"ff CABLE TAXES v F_XTERMeN�YtZp__ /'I�A �!7 Gr` bIG`stLT►} Say 9 a�3 !_-_--. ._� _kmps,rER; -NOFF,STREET Slew)- a y INSPECTOR _._... --- 7 Board of Building Regulations and Standards Construction Supervisor License Lice .,,,CS 52289 Birthdate -6(4 5/1958 E Prat iQn 6 513009 Tr# 14314 M �Restrkpop � k, JOHN H CARROLL 1501 MAIN ST#15 TEWKSBURY,MA 01876 Commissioner