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Home My WebLink AboutBuilding Permit #569 - 95-97 Second Street 3/3/2006 NORTH� + o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,SSACHUSE� Permit NO: Date Receiveda� Date Issued: —d� IMPORTANT: Applicant must complete all items on this page LOCATION_ _ _ PROPERTY O\VNER /�, lit- I � , /c) C� � / Print MAP N0.1/ PARCEL ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building O�e family Addition � wo or more family Industrial Alteration No. of units: :/Repair, replacement Assessory Bldg Commercial Demolition Moving(relocation) Other Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED -e o o -/1,,v I `t Identification Please Type or Print Clearly) OWNER: Name: //, IA/q S K ow Phone'Cr0393 Signature Address:,L �fn c p o k Rd 9,4 I evk, 7Ll CONTRACTOR Name:'�a��`t ,S� �� Phone• (, D 3-ff, Address:3 9f/14,v 1 '�r �y P >Py►.` ��' Q 3D Supervisor's Construction License: Exp. Date:�� Home Improvement License: ) q Exp. Date:&- ARCH1"I'ECT:F.NGINFF'.R dame: Phone: ,address: Reg. No. FEE SCHEDULE:BULDLVG PERMIT.510.00 PER 51000.00 OF THE TOTAL EST1:114 TED COST BASED ON 5125.00 PER S.F. (-e- Total GTotal Project Cost :S �Xp&el x10.00-FEE:` Check No.: / /. �O 2 -- � Receipt No.: TPE OF SEW ARGE DISPOSAL ! I Sti inuilin" Pools i Tanning/Nlassage.Body :art Public Sewer - __ Tobacco Sales - I Food Packaging,Sales Well i ' i Permanent Dumpster on Site Private(septic tank,etc. NOTE: Persons contracting with tinregistered contractors&)not h(Ne(ac'c'ess to the I,uartin(j,fim(I Signature of:-XgentyOwner Signature of Contractor Plans Submitted J Plans Waived V Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ U ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE, REJECTED DATE APPROVED CONSERVATION ❑ U COMMENTS DATE REJECTED DATE APPROVED HEALTH n COMMENTS Lonin_ Board of Appeals: variance, Petition No: Zoning Decision receipt submitted yes __ Plannuru, Board Dcclslon: Comments- Conservation Decision: ---- Comments.— ----------_---__—_-- — Water& Smer ccmncction signature Temp Dumpster on site ycs__no_ Fire Department signature.'date Building Permit ,Approved and lssucd by: _ i Building Setback (ft.) _ � I Front Yard Side Yard I Rear Yard Required Provided Required Provides Required j Prop ided I DIMENSION Number of Stories: Total square feet of floor area.based on F,xterior dimensions. Total land area, sq. ft.: NOTES and DA I n—(I-or department use) I I I 1 I 1, 1 is 7� 'J .d i `.'1( 1., ,; AlF(;I:..,... Building Department A 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 ` • Debris Removal Form c, Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Forfn 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) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Form U 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 In all cases if a %ariance or special permit was required the Town Clerks office must Stamp file 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 cope and proof of recording must be submitted with the building application Doc:I\S111-If-HONAL SERV 1(ES DEPARTME\T:13FFORN105 Location No. / Date NORT1y TOWN OF NORTH ANDOVER 3?0�,•`•O •,h0 f � P s ; : Certificate of Occupancy $ CNUs<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ e7/� . s� Check # � . ( �` Building Inspector r D D r1 ti 1 Page No. of Pages ST. JEAN HOME IMPROVEMENTS 34 Granite Ave. SALEM, NEW HAMPSHIRE 03079 (603) 898-7831 Toll Free (877) 898-7831 PR OSAL SUBMDATE A DRESS PHONE DATE OF PLANS OB NAME AND LOCATION ARCHITECT JOB PHONE We hereby submit specifications and estimates,subject to all terms and conditions as set forth on both sides,as follows: - .... .L.__ .1-1.._............. ....................._..... ........................... ...................................................................._....._......_.. ._.._......._......_.__...._..................................................._................................ i (Read Reverse Side) We pro}IIISP In reby to furnish terial and labor complete' accords a wit above specifications, od for the sumo dollars($) NOTE:This proposal may be withdrawn by us if Authorized not accepted within days. signature Amptdi: The above prices, specifications and conditions are satisfactory and are hereby accepted.You Signature are authorized to do the work as specified.Payment will be made as outlined above. Date Signature jj, ✓lzeanrrrcoiuue« h' o�✓�aaaac�ucdea BOARD,OFBUII,DING REG SULATIONS - License: oCONSTRUCTION UPERVISOR - Number CS 063011 'I t}irttadate 09/24/1948 i s - � rEacp�re§ 09/24�2b07 Tr.no: 5436.0 ROBERT A 34GRANITEAVE' ;£,� SALEM, NH 030:79 i ' GArnMIS'ioner HOME IMPROVEMENT CONTRACTOR ``; RegistratioD 10127.9 ' -_ Ea[piratiac�:_-X12512006 k Type- paOersMip ST.JEAN HOMOIMPROV�IiAEFI "j Robert St:Jean 34 GRANITE AVE SALEM,NH 03079 AdmioistTa,.0r s The Commonwealth of Massachusetts I , Department of Industrial Accidents I..; "`-,�` I;: Office of Investigations 600 Washington Street ( Boston, MA 02111 Mh www.mass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/t)rganizaIion/Indivi(Iual): &7 Address: 4 e .6u e- C ity/State/Zip: c) t9 i P V1, / y 0 30 Phone #: Gp O F2. you an employer?Check the appropriate box: Type of project(required): I ain a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-tithe).* have hired the sub-contractors I ata a sole proprietor or partner- listed on the attached sheet. _ 7. 0Remodeling These sub-contractors have 8. E] Demolition ship and have no employees working for the in any capacity. workers' comp. insurance. q, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their right of exemption per MGL 11.0 Plumbing repairs or additions 3.F1 ata a homeowner doing all work g p p myself. [No workers' comp. c. 152,§1(4),and we have no 12. Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *:any applicant That checks box#I must, till out the section below showing their workers compensation policy information. t f lomeowners 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 most attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer thtit is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company 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 tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forth of a STOP WORK ORDER and a tine 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 u d penalties of perjury that the information provided above is true and correct. Signature: Date: 1'Iu,ne 14: 0 �5 , � Q..ficial use only. Do not write in this area,to be completed by cite or town olfrciul. City or Town: Permit/License# LLBoard ority(circle one): ealth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector on: Phone#: NORTH Town of 4Andover s60 0 o z�-- dover, Mass., LA CO C MICKEWICK DRATE D PPS �C:) S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System .f. BUILDING INSPECTOR THIS CERTIFIES THAT ............................................... Foundation • has permission to erect........................................ buildings on .......3........ ....... ......... Rough to be occupied a Chimney ...... ......................................................................................................................... provided that the person acce g this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisio s 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ...................... : Service BUILDYNG INSPECTOR 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. SEE REVERSE SIDE Smoke Det.