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Home My WebLink AboutBuilding Permit #208 - Exception 9/19/2006 i TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION 0 IUIO #6q�o o i Permit NO: o Date Received a 9q At"'K V �R1T[D Date Issued: — v� 9SSq US�t IMPORTANT: Applicant must complete all items on this page LOCATION Y C 9— WO-1 JQ V C4- Print PROPERTY OWNER e> Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑ Addition ❑Two 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 X 60 <701V L ro�_r U YR f C Q( Gp 6 Identification Please Type or PrintClearly) OWNER: Name: e !� Phone:=E�_�__ Address: CONTRACTOR Name: /401 1P__d46tr11r Phone: �/w Avo& 261-' 1 kI G) -0�«P' �� ' Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ h��a FEE:$ Check No.: Receipt No.:l Page lof4 Location r—,2� No. —2^ e � Date MORTq TOWN OF NORTH ANDOVER O: • • OR F 9 ' Certificate of Occupancy $ s o� �'�J'•� "us E Building/Frame Permit Fee $ tC Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 19592 �� Building Inspect f` 1 i TYPE OF SEWERAGE DISPOSAL Swimming Pools 11❑ Tanning/Massage/Body Art ❑ g Public Sewer Well F] Tobacco Sales ❑ Food Packaging/Sales ❑ El❑ Permanent Dumpster on Site Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner�� Signature of contractoz> Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ i COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS A FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS 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 Building Setback ft.) Front Yard Side Yard Rear Yard Required Provided Require Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use i Page 3 of 4 � Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 r 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Page 4 of 4 NORTH o Of over No'cgofr over, Mass., COC MIC..WICK 0"I'ATEDPPa\ C:) BOARD OF HEALTH Food/Kitchen PERMIT T Septic System # BUILDING INSPECTOR THIS CERTIFIES THAT........................ ... ....... .......... .... . ...................................................... Foundation ....... .... .................7a s has permission to erect...................... ................................... buil gs on .... .. .. ... ..to..................... Rough to be occupied as .............................................................................. Chimney ............................................... provided that the person acceptin Is permit shall in every respect conform to the terms of the application on file in Final this office, and to, the provisions 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 CONS"1_ CTION S Rough ....... ........... Service ......INSPECTOR Final Occupancy Permit Required to Occupy Bu ing 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. 11 SEE REVERSE SIDE—JI Smoke Det. The Commonwealth of,Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street �11 ��'1Z Boston, A14 02111 ! :7' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ��-- Please Print Legibly Name 1l3tlsiness/()rganiiaUon/II11I14IJUiIII: �D�J S ��_/l-u G/ ' Address 7 � - &4__ r City�'StaterZip:AhsG�o ?(�- Phone #: 7<C-1 — -3—Y (' — LV(I FAreu an employer?Check the appropriate box: Type of project(required): am a employer with4. ❑ 1 am a general contractor and 1 6. ❑ New construction mployees(full and/or part-time).* have hired the sub-contractors . am a sole proprietor or partner- listed on the attached sheet.' 7. Remodeling ship and have no employees These sub-contractors have 3. ❑ Demolition working for me in any capacity. workers' comp. insurance. y. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] ";\ny applicant that checks box P1 mist also till out the section below showing their workers'compensation policy information. +tIomeowners who submit this affidavit indicating they are doing all work-and then hire outside contractors must submit anew 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 tin employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy 't or Self-ins. Lic. 4: r61 y� G Expiration Date:_______ _— Job Site Address: _ � � – CityrState/Zip:14�1-4UV 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%IGL 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 form of a STOP N ORK 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 and penalties(#'perjury that the information provided above is true and correct. date: Official use only. Do not write in this arca,to he completed hr vi(y or sown gfflc•ial. City or Tow n: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 3. Plumbing Inspector 6.Other Contact Person: Phone#: _. _. - die "COOrynmt��, 4�✓��tde�l`6' Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 100683 Expiration: 6/22/2008 Type: DBA PAUL L.ROBBINS CARPENTER&BUILDER I Paul Robbins ` 520 North Avenue Administrator Wakefield,MA 01880 Deputy 5 ,/�f,�eaarluoe�ta '� } BOARD OF BUILDI G REGULATIONS License: CONSTRUCTION SUPERVISOR 018158 Number: CS Birthdater 02116/1929 17593 Tr.no: Expires: 02/16/2008 } Restricted: 00 PAUL L ROBBINS i 520 NORTH AVE WAKEFIELD, MA 01880 Commissioner ROF�F�I NS CONTRACT(NG 520 North Avewue wa lee f�eLd, MA 01220 (721) 246-3634 or (972) 535-3622 FIAL l wsured �C� 0 z,yS -27 7'- , J P,-00F PROPOSAL Str%p sKKgles doww to bare boards. ?�� IKstall Kew drop edge. IKstall i,ce ,� water shgeld, 0 Tar paper over revKaLKL" bare boards. Rtpaw up to a area of bad boards, �f Kecessarl�.C� ��-' so- r arch"�tectura� t e sh�K fie. yaiKstaLL a JP 9 Protect house with tarps, to the best of our ab'Mtlu. pouble flash chlmtAeU, Lf vwessarU. R.evwove all trash. ALL labor awd vu.aterlals supplied bU me., � ***it is up to the homeowner to cover avWu personal belo►n.gings %n crawl,space or attic. ***The above price, specifications and conditions are satisfactorU and are herebU accepted. You are authorized to do the worle cis �4a&z�� speo�fvd. iaUments wM be made as follows: i/3 deposit, i/3 on start ofducovu.pletion. Date: 0;1'06 signature: ' 0 HARVEY'S AUTHORIZED INSTALLER s Roofing Vinyl Siding Vinyl Window Replacement