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HomeMy WebLinkAboutBuilding Permit #799 - 162 HILLSIDE ROAD 6/28/2005 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Seciim,forbitidd-use oily: BUILDING PERMIT NUMBER. ,}��r� DATE ISSUED: � a® �.. SIGNATURE: '� C `"' ••� Building Commissioner/I for of Buildings Date Z SECTION I-SITE INFORMATION O 1.1 Property.address: 1.2 Assessors Map and Parcel Number: Cy Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage R) 1.6 BUTLDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided v 1.7 Water Supply M.G.L.C.40.§54) 1.5. Flood Zone tntoraution: 1.8 Sewerage Disposal System: D Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record MAC)(, �, 1MA\3g C-EN AV,—R I(0�z 1ANo 5 ibE R^Z� Name(Print) Address for Service: 4 �'+ S (0 BS-fin o 'nature relephone 2.2 Owner of Record: t Name Print Address for Service: O z M Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licerpsi d Construction Supervisor. O License Number 1 Addre., D Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 v Company Name I ,1 Registration Number Address r z Expiration Date 0 Signature Telephone Y I SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work check all applicable New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ Other B Specify L rdv I ) o0 \ Brief Description of Proposed Work: lel-D-0 A 15 x 34 YaT3oy L SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Ih ©1CIA ,YJSEONL , Completed by perrrdt applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost ofgo® �. Construction 3 Plumbing Building Permit fee(,)x (b) 4 Mechanical HVAC .�� 5 Fire Protection Avo .10* 6 Total (1+2+3+4+5) Z 11 ©0 007 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, /�rn �x ff}e.%t)e1 ci as Owner/Authorized Agent of subject property Hereby authorize to act on My beh Ila ers re ive to work authorized by this building permit application. Si ature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS Is2 3 SPAN RD DINIENSIONS OF SILLS DIMENSIONS OF POSTS DDAENSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFMANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Location No. Date HpRTM TOWN OF NORTH ANDOVER 0� ..o .•,tip 3? • • OL I to 9 ' Certificate of Occupancy $ +ss�cMusEBuilding/Frame Permit Fee $ Foundation Permit Fee $ Y Other Permit Fee $ TOTAL $ k Check # f 8356 V Building Inspector FORM - U - LOT RELEASE FORM INSTRUCTIONS: .This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ..............,./.......................................................p..owns � APPLICANT 1`t I.1 \ PHONE Cl-"b C9 C1 - c�I Z' ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREETh-11 L L 117 STREET NUMBER L ............................................................................ OFFICIAL USE ONLY ............................................................................ A NS OF TOWN AGENTS DATE APPROVED CO ERVA O MRa— OR C DATE REJECTED l CONnvIEN"I'S DATE APPROVED TOWN PLANNER DATE REJECTED CONOJENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMNMENTS RECEIVED BY BUILDING INSPECTOR p" --Ld- a4�� ilC �- DATE r of No DTN 1 TOWN OF NORTH ANDOVER �: ��'.A '•/�f��L OFFICE OF . A BUILDING DEPARTMENT 400 Osgood Street �'•�:;*,o:� North Andover, Massachusetts 01845 1SS^C�St1 D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE:xI'b O�JN2 C)5 JOB LOCATION: )CMZ Number Street Address Map/Lot HOMEOWNER WAf22,(- '►4L�Z-dab (Ci� �n vZ� Name Home Phone Work Phone PRESENT MAILING ADDRESS S/�a'�9 L City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) 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 structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the 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 d that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL BOARD OF AI TEALS 688-9541 CONS IiRVA'I ION 698-9530 11EALT11688-9540 PLANNING 6889535 . MORTGAGE PLOT PLAN (9 EK SURVEY 31 n� � 17 ROYAL. STREET, LAWRENCE, MA, 01841 Tel. 508-975.-1413 MORT0A(;OR &:.&Ili DEED REE ,, E _ PG. .__ ADDRESS OF PRINCIPLE SUILDMG PLAN REF. 2719(o8'� _ t9 A ,OF_ySPEC14l2y, .l4Pb ••• IVi•. !t/ODt/ W000 • � II A 'z ti 170-00 � TE: This mortgage tnspoc-ion was prepared 3ti I F.U117HER SA'i>; 71iA7 IN MY PROM=OVAL ndMcdly for tnortgage purpocns and Is not tb o� T• OPINION the pdn le vtruyttnr/s and acoessory rolled upon as a twrvaK Fit �S'Ul'Z�I�Y aocipb AUDEL wAbuAd Inya, _tbn1@ 11rMZ1 9?wc.'r —. tampons bflty for dwnagas N0.�68es y with. the sotback roquOwnenta of the -local lance by anyone outer than the sold ma^tga9 c� ran" wd{nances.-and that it* enchroiavitrimb i fttt eiw" In cohnscttb h trtth its plr d .4 � 'r£cl5lta`� �, of tno)or Improw�rnents way awvss �rtgage financing to sold mortgagor. `�ONAI IRNQgJ Property Mes ottaapt as slwinrt. RTIFIc"ON TO: p; ol. Pvapatiy to not In a Flood Haxsnd Mea. is ;+tttflcotlon is based on the locsttlan of saevtsy markers 13 x' prop b In a !Toad:Balton! Arsw ' athero, atl dbaa nbt rpseatt s curve tharolore L3 3. Information III IA4uf dVkt to AgtWmips hoard Hozard. bets s, an aro not ta� UlNsd fort yiiobtt�►meth of Flood µ°ms detelminad � ��htti• w} Mad" Moad )perty Itnue. Inuuronce Harte Map Panat# Z.Svop&-vw&c,,: &Izl,?3 NORTH Tow- n of over No. �9 mama 0 A dover, Mass., L COCHIC KE ORATE P'? BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT.... AH*e- # s BUILDING INSPECTOR .... ....................if............................................................................................................................ Foundation has permission to erect..... .*)tow ?0/ ......................... buildings on ..... 4T ........A..../.#...../V...&....1.0.........*............/.......................... Rough to be Occupied as..... ......af!!!�a#f*04 APOY...... fleaollft Chimney ............................Y.#!rq�.............. Provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-I-jws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. ?8C /%a I PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .............40. .... .. ........0100W .................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Oxivy 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 Smoke Det.