HomeMy WebLinkAboutBuilding Permit # 9/22/2016 tt%ORT11
BUILDING PERMIT aF��tiEo ,bq�o
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TOWN
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION _
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Permit IVo#: Date Received '�S p'4ATEo
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Date Issued: -- -
I PORTANT: Applicant must cam fete all it on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residentia
❑ New Building ❑ One family
❑Addition ❑ Two or more family 1-1 Commercial
Industrial
[i Alteration No. of units: ❑
El Repair, replacement 1:1Assessory Bldg ❑ Others:
Demolition ❑ Other /
_ r„,U "U�latershed Dastr�ct,�rr// ,'
Wetlands
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DE C PTIOPJ OF C7RK TO BE PERFORMED:
dentif cation- Please Type or Print Clearly
OWNER: Name: 4 �, „ 0 V
Address:
one UW of North r1�9ar� r
CntrCtOfrNrrle r r r
y,September 1 ,20'16
/
aymenDate
as w&�N��amka Fri1709 61
Adresr //
ratorourltep I
/r /,"Z i//%ri�'
r
perr)s r/ ; stMotion license E?� ? c uM1� 1n� INSPECTION) $60.00
r / r/iii
r r tal Paid $60,00
Hare Irnp�o�;���n�pfi�..Icense
,ash $60.00
ARCHITECT/ENGINEER PhoCha 6e $0.00
kooeipt Plumber gotm00006024
Address: Reg.1/23/2016 6:46:16 AM
Jame 66 UNION STREET-;316-2017
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED:a hier Id, treasco11w17
Total Project Dost: $_ FEE: $
Check No.: Receipt No.:
NOTE: Persons corrlraeting with unregistered contractors (Jo not have access to the guaranty f and
- G `� �� a � i ,
ignature of Ag Owner/, 'q fm., w" _ Srgnature of contractor
� .
I
9
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
V
o
TYPE OF,SEWERAGE DIS7L?ITobacco
Public Sewer nin assa eBod Art ❑ Swimming Pools ❑ ,
g Y
well Sales ❑
Food PacIcaging/Sales ❑
Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF U`FORM
� LANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on 3 (v Signature:A
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
C.Planning Board Decision: Comments
Conservation Decision:, Comments
Water & Sewer Connectionlsi nature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARRTLocated 384 O od Street
s� PMENT TrnpDump�ser on s�te1 yesg�� ;nn s ° J N
Located ate'
124' WK, .� .
�� Let 2 9 zx
ar a t rx
Fire:D c
� e artment�signatuf•el ,{, � �� ��� ��: �:y ,
�d�.��'.,7^,r� �` � .�^� a "�� 'r r ��.L� .�' �.� a " ,�r- wv.+/�r ✓`;, ..�'�^s`�9' �b u�m,+�',ra�s � " '�,,, '��T� � r �?
COMMENTS � '
0
r
I
I
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 droprequires 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)
❑ Notified for pickup Call Email
f
Date Time
Contact Name
Doc.BuiIding Peimit Revised 2014
OORTH '9
Town S
of :, IT b ndover
®
No.
�C* i^�F h ver, Mass, 3 O
COCMICMI WK
S U
BOARD OF HEALTH
Food/Kitchen
PERMI -T -T LD Septic System
��THIS CERTIFIES THAT ....-POW....... .:......... . ..........., . .. .......,........................ BUILDING INSPECTOR
has permission to er ............ ;permit
ldings on .... .9.... N� sr. ..................... Foundation
Rough
tobe occupied a . . .. ........................................................................................... chimney
provided that a pe son accepti t Is 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
p�
Final
PERMIT EXPIRES 16 THS ELECTRICAL INSPECTOR
UNLESS CONSTWIO S Rough
Service
. . . . ......... ..,. ,..
" Final
BUILDING IN9PECThR
GAS INSPECTOR
Occupancy Permit Required t® Occupy Buildin 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.
De Commonwealth of Alassaclausetts
Department of Tfdustrial.�l ecidefits
,.� X ,ongt^ess Street,Srxite X DD
v" rn d Boston, M 0.2.1X4?0X7
.1
www mass.gov/ria
'1A gH�
' yP'akkers'(;'arrxlrensationXnsurance Affidavit:Bn7.der3fCoxxtx'actors!.L�,'lect�•icians/l'Xx�,n ers.
T0BEFffEDVAXrE(TMl?"MfT�NG.A.U` iT0)iA' -
i
A �licant information
1Tle (}3usiuess/(5rgannizationflndividual):�
N
Address:
City/state/Zip:—'L '-C
— <--- r9.
pe ollPraject(required);
Areyouan employer?Clrec(ctlze appropriatebox: lei'donsteuciian
1.r I am er employer witty_._ employees(.dill and/or part time).*
E�
y
[:]I am a sole proprietor or partnership andhave na ernplayees working forme in ��1Zexnadeliil
any capacity.[l aworlcers'comp.insurance required.] Ll Demolition
3.�I am a homeowner doing all work myself.[No workers'comp,insurance required.]' 10 F-tt Building addition
4. am a homeowner and will be hiring contractors to conduct all work on my property. 'Will
11.[]Electrical xepaizs or additions
ensure that all contractors either havo workers'compensation insurance orate sole lai � g recall 9 0� additions
proprietors with na employees.
5. I am a general contractor and Drava hiredthe sub-corrtractors listed on the attached sheet.
3'. " 1Zbof airs
These sub-contractors have employees and have workers'comp.insurance 14 Othe
6,n We are a colporati9}i and its.of cers,havo exercised their right of exemption pe.1
1dlCsL c. 1
152,§1(4),and we have no employees.il'7o workers'corap.insurance required. (J
_ �— --- theirworkers'compensation.policy information.,
*Any applicant that checks tsirx ].must alsci fill out the section below showing
affidavit indicating such
fi Ilorneawnoxs who subzrut oris affidavit, icatiog they are doing all work and then hire outside contractors must submit a new
tContractors that check this b6,cis attached employeeaddition s,they ma,sheet ust 1 z Vide ti showing
tw wohe rkers'comb 7.policy number.he sub-rontractors and state whether o zrat those,enti es have
employees. Ifthe sub-con s _ _ — —
fane an enpl'oyer tliat isproviding-vorlfersy'compensation insurancefor°racy ernplayees, Peiaw is thepolacy anri ati site
infer oration.
frourance Company Marne: —
i
Policy#or Self xtxs Lio.
�_ Ci /State/Zi �'/ �:
lob Site Address:
�I Attacha copy Of the vvozkex�s n Pag
coxnpexxsatxan�olxcy declaratioe(showing the Policy number and expxx atiaxx date).
lrailixre to secure uovcxage e t,as required under iil penalties i n the form of Criminal OP violation
WOliK(JXDEr�.and.a fine 1:UP to $250.00a
and/or one-year-imprlsonmcnt,as vrhil statement
civil P
day against the:violator.A copy of this statcrxxerxt nxay be forwarded to the Office)a:ETnvestigatians of the I).[�1.for insurance
coverage verification. __.
X do Iier'eby cert y under thepa' ,andpeyiatiies ofper%ury Haat the inforraaatiort;prrovided above ry true acrd correct
-
-i —
[I.
ffxciaX use aniy, l)v not write in t/rxs area,to be completed by city or town of""k
ity or Town:
permit/License�
ssuing Axxthoxity
circle ane):
3aaxd of T1<ealtlx 2.f3xxilding Deaxtxnent 3.Cityf.l'own Clerk �.Electx°icaX Xxrsl�ectrrr 5.f'luxri�ing Cxxspectar
6.Other-
Phone
Contact
Naarw TOWN OF NORTH ANDOVER
Sit OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street, Building 20, Suite 2035
Noi-th Andover, Massachusetts 01815
CHUS
Donald Belanger
Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542
1-10MEOWNER.LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE:
JOB LOCATION:
,Aa� _S1 ---------------------------
Number Street Address Map/Lot
HOMEOWNER z_01 eA fi z 7
Nahfe Home Phone Work Phone
E,
PRSENT MAILING ADDRESS-6 L
A I
IU'� cr) P
,)t).P
CityTown State Zip Code
The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family
dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided
that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures.A
person who constructs more than one home in a two-year period shall not be considered a homeowner. (780 CMR
Section I I O.R5.1.2)
The undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable
codes, by-laws, rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
----------
APPROVAL OF BUILDING OFFIC, IkCZ'
------------- --- -------------
Revised 8,2015
Form 1-foincownefs Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEAUH-i 688-9540 PLANNING 688'9535
Residential Property Record Card
Parcel ID: 2101009.0-0007.0000.0 MAP: 009.0 BLOCK: 0007 LOT: 0000.0 Parcel Address: 69 UNION STREET FY: 2016
PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 10685 Road Type: T Inspect Date: 01/03/2011
Owner. Tax Class: T Sale Date: 0312712007 Page: 330 Rd Condition: P Meas Date: 01/03/2011
BANDLE,JANET Tot Fin Area: 1777 Sale Type: P ...Cert/Doc: Traffic. M Entrance: C
Address: Tot Land Area: 0.290 Sale Valid: A Water: Collect ld: RRC
1401 GREAT POND ROAD 11:12 Sewer: Grantor. TURCO,KATHRYN Sewer: Inspect Peas: C
NORTH ANDOVER MA 01845 Exempt-BIL% 010 Resid-BIL% 100/100 Comm-B1L% 010 Indust-B/L'/. 010 Open Sp-BfL% 010
RESIDENCE INFORMATION LAND INFORMATION
Style: CP Tot Rooms: 6 Main Fn Area: 1309 Attic: NBHD CODE: 4 NSHD CLASS: 4 ZONE: R4
Story Height: 1.50 Bedrooms: 3 Up Fn Area: 468 Bsmt Area. 1247 Seg Type Code Method Sq-Ft Acres lnHu-Y1N Value Class
Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 773 1 P 101 S 12596 0.290 N 151,000
Ext Wall: WS Half Baths: 1 Unfin Area: Bsmt Grade: DETACHED STRUCTURE INFORMATION
Masonry Trim: Ext Bath Fix: 1 Tot Fin Area: 1777 Foundation: ST Str Unit Msr-1 Msr-2 E-YR-Bft Grade Cond %Good PIF1ElR Cost Class
Bath QuaC M RCNLD: 224966 Kitch Qua]: T EffYr Built: 1970 PV S 648 1988 A A 1501142 12,800 1
Mkt Adj: Heat Type: HW Ext Kitch: Year Built: 1940 SE S 96 2000 A A 11191 1,600
Sound Value: Fuel Type: G Grade: AG Cost Bldg: 225,000 VALUATION INFORMATION
Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Val1: Current Total: 390,400 Bldg: 239,00 Land: 151,000 MktLnd: 151,000
Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Prior Total: 378,800 Bldg: 224,000 Land: 154,800 MktLnd: 154,800
Att Gar SF: 312 %Good P/FIEIR: /100/100f75
Porch Type Porch Area Porch Grade Factor
E 20
Sketch Photo
13
13
35 12 G2 F
E MI
11
f
20 FLP0.5 jFM jB 18 216 F11:13
2; 936 Sq.Ft
19 19
12JB
w
. a
95 S .Ft
23
2 -
t3F` Fes; - 5 YiF' ., 3ja
69 UNION STREET