Loading...
HomeMy WebLinkAboutBuilding Permit #021-2011 - Exception 7/1/2010 BUILDING PERMITo� No DTH qti bbtt •y TOWN OF NORTH ANDOVER F - °� j APPLICATION FOR PLAN EXAMINATION w 1� Permit N0: f� �� * ° 2 � Date Received �'9'°pq�Ttp'p,,��41 �SSACHUS�� Date Issued: 7// (7 IMPORTANT: Applicant must complete all items on this page LOCATION 23 Ar O V Q(— asS PROPERTY OWNER Print S1�r «�, �•- Print MAP 210 7 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village Vires no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne famil Addition Two or more family Industrial Alteration No. of units: Commercial Repair, re lacern Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 1`ecwo.lp— s P.oCa of�n�w S A0 r- \�%A el- R,2n reA�cs e CA) N new Identification Please T e or Print Clearly) OWNER: Name: a nye c; Phone: 4q1F 92'9 614-1 Address: CONTRACTOR Name; �exu5 ,1L S ery�c2S G e e Phone: '7F 760 20 3 wti, I D Address: r 0• fox 2IR23 V4 o6 n M 0«sem Supervisor's Construction License: Exp. Date: 1+1"7�2012. Home Improvement License: l 2 Exp. Date:____7Z I n A4 l ARCH ITECT/ENGINEER— I , Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Do Total Project Cost: $ -7 SO 6 FEE: $_ �0 Check No.: Receipt No.: aU 06 NOTE: Persons contractin ith regist ed ontractors do not have access to the guaranty fund �r&Zg_naj�_qreof Agent/Own - ignature of contractor Location " Ass No. 00? Date 701 / D 40RTN TOWN OF NORTH ANDOVER Certificate of Occupancy $ swCHus Building/Frame Permit Fee $ D Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 0 6 Building Inspector 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: '= Zoning Decision/receipt submitted yes 4 I Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS Building Department i The following is a list of the required forms to be filled out for the appropriate permit to be obtained. f Roofing, Siding, Interior Rehabilitation Permits ,d"Building Permit Application ,ar' Workers Com Affidavit t ,L-.' Photo Copy Of H.I.C. And/Or C.S.L. Licenses ,ja' 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 pp 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) o 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:Building Permit Revised 2008 f i Date. . (�� TOWN OF NORTH ANDOVER - PERMIT FOR PLUMBING ,SSACMUS� f This certifies that has permission to perform plumbing in the buildings of . /. .` .`. . . . ..`. . . . . . . . . . . . . . . . . . . . t; . . . . . . . . . . . . . . . . . . . , North Andover, Mass. Feer� . . . .Lic. No.. .. 2 Z. . -. . . . . . . . . . . PLUMBJI 6 6.4SPECTOR Check # �•S�zT' � 6011 ORTH TOANM of No. 70 ' LAK dover, Mass., COC MIC ME WK 7�ADRATED i `S BOARD OF HEALTH I PERMIT T D Food/Kitchen Septic System ,l THIS CERTIFIES THAT BUILDING INSPECTOR �-�' t� .�'�+!::o.......•y��...... "', """"" Foundation 40j -30 � � Ps has permission to erect........................................ buildings on /�� Q �'... ......... Rough ............... ................ ............................................. ......... to be occupied as F ..S"' �eJe,�...:,o�✓} f �o©/ Chimney ................................... ......... ........................... ...... .......................... ............... y 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-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 WRTS Rough ��" ! ............................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done E FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i The Commonwealth of Massachusetts Department o f Industrial.Accidents Office of rnvestxgations 600 Washington Street Boston, 14A 02111 . -. w►v►v:»zassgov/din Workers' Compensation Insurance Affid vit Builders/Contractors/EIe A licanf Information ctricians/Plumhers Please Print Leaibl Nalne(Business/Orgaaizabon/Indi Adual : 11;�4 LIP S . Address: ? . Q 'BOX. %23 City/State/Zip: .(Ob uJ(� ("A 01T F' �� Phone#: � $'� 766 2a30 you an employer?Check the appropriate boa: I am a employer with 4. ❑ I am a a Type of project(required):beneral contractor and Iemployees(full and/or part-time).* have hired the sub-contractors 6 ❑Newconstruction. I am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling I s and have no employees These subcontractors have working for me in any capacity. g• ❑Demolition workers' comp.insurance. [No workers'comp.insurance 5. ❑ We are a corporation and its 9' Buil ' ❑ ding addition required] officers have exercised their 10❑Electrical repairs or In 3.0.I am a homeowner doing all work right of ex additions myself emption per MGL 11.0 Plumbing repairs or additions Y [No workers'comp. c. 152,§1(4),and we have no � insurance required.] t 12•7 Roof repairsemployees. [No workers comp.insurance required] 13•❑ Other I *`- )'applicant that checks ", bov r.. must aso Crr?cut the ser-tioa b�toa�shove^,..+s, •„ ° 'Homeowners who submit this affidavit indicating tbe; are Being all work and _.ei worke s'C omp =wcn � 'Contractors that check this box must attached an additional sheet showing g the then hire� de""s must.submit a new affidavit indicating such. name of the de and their workers'comp.policy information. I am an enePlnyer that is providing workers'compensation information. insurance for my employees. Below is the policy and fob site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Sob Site Address: Attach a copy of the workers'compensation policy declaration page(showing Failure to secure coverage as required under Section 25A of MGL cp. 152canlead to the impothe policy number ti nbof criminal expiration date). penalties of a fine up to$1,500Ad 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 o f this Investigations of the DIA for insurance coverage verification statement maybe forwarded to the Office of i I do hereby certify under d 'ns and penalties of perjury that the information p►'mrided above is true and correct Si atwe: Phone#: 76o 203 Official use only. Do not write in this area, to be completed by city or town offciaL City or Town: Permit/License# Issuing,Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbia� 6. Other b Inspector I Contact Person: Phone#: i Information an d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including tare legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association ox-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do mathtemance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co=mpliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the.perfoffiance of public work ung acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the co " quu'em p Pres ntractang authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, 1 sub-contra s names address es and supply �{ ) ( )� address(es) phone number(s)along with their certificates of insurance. Limited Liability Companies(LLC)or Limited Liability partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers'comp enation incnrance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pert�it or license is being mquest-4 not the Department of Industrial Accidents. Should you have any questions re ard' qu g uag the lea or ifare ou required to obtain a workers Y compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-;na�rance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"'the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you.have any questions, please do not hesitate to give us a call The Department's address,telephone.and.fax_number._ The Commonwealth of Massachusetts - Department of ladustria:l Accidents Office of Invesdbatians 600 Washington Street Boston,MA 02111 Tel. #617-72.7-4900 e3.-t 406 or 1-8 77-MASSAFE Revised 5-26-05 Fax#617-72.7-7749 VrVrV7.mass..0,.0v/die. rd lel.lttti- l7L'i2;11'tlllCilt (ffPublic S;ltCt, ? i,Fa' Boar(! of Bilildin't; lR(.';mations an(1 �t;lntl;li'tIN —"•1 Construction Su pE'fVISOf L:t:ensQ License: Cs 73991 i?estricte:l to: 00 GERALD WHITE - ,' 23 GLENDALE DR ~_ ' DANVERS, MA 01923 i_xpratio;5: 4/7/2012 ( cnati..@ ,:�•: 2 Ti--: 2470 [1 Address � Renewal � Employment DPS-CAI 0 50*0410t-G101216 Ole&0anL»z&wwealU o1✓&djac/ruaeiZ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only t ''. HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation =_ — Registration:_ 129177 10 Park Plaza-Suite 5170 Expiration: 7/19/2011 Tr# 287930 Boston,MA 02116 Type: - Individual Gerald White Gerald White 54 Emerald Drive Lynn,MA 01904 Undersecretary of valid without signature I 06/29/2010 10:08 FAX 9785322217 BKM,Inc 1001 ACO® DATE MMID CERT ( DIYYYY) � CERTIFICATE OF LIABILITY INSURANCE. 6 PRODUCER /29/2010 (978 532 _ 5445 FAX: (978)532 2217 THIS CERTIFICA TE IS ISSUED AS A MATTER OF INFORMATION H.K. McCarthy Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10 Centennial Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTENDR west Entrance ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Peabody MA 01960 INSURERS AFFORDING COVERAGE NAIC ii INSURED INSURER ANations Builders Insurance Nexus II Services LLC INSURER B:Safety Indemnity 33615 P.O. Box 2823 INSURER C: INSURER D: ' Woburn I MA 01888 INSURERS COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. S•EXCLUSIONS AND CONDITIONS OF SUCH INSR ADFL TYPP POLICY NUMBER POLK:Y EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 X COMMERCIAL GENERAL LIABILITY AMAGE ED PREMISES Ea occw ce $ A CLAIMS MADE o OCCUR NDS023141 8/12/2009 8/12/2010 MED EXP(Anyone rson) $ 5 000 PERSONAL&ADV INJURY S 1,000,000 GENE RALAGGREGATE $ 2 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 1,000,000 X POLICYFI PRO- LOC AUTOMOBILE UAWLITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) S B ALL OWNEOAUTOS 3116632 11/10/2009 11/10/2010 BODILY INJURY X SCHEDULED AUTOS (PerPenton) $ 250,000 X HIRED AUTOS 1 BODILY INJURY X NON-0WNED AUTOS (Peracciderd) 9 500,000 PROPERTY DAMAGE (Per accident) 3 100,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR FICLAIMS MADE AGGREGATE s S DEDUCTIBLE . S RETENTION S loot WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC STA OTH- ANY PROMEMBERIEXCLUDRIE7(ECUTIVE YIN TORY I-I EA.EACH ACCIDENT $ OFFlCER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S It yes,descrae under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER DESCRIPTION OFOPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: windows and Door Replacement CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Stephanie Harrington DATE THEREOF,THE ISSUING INSURER VALL ENDEAVOR TO MAIL 10 DAYS WRITTEN 230 Andover Bypass NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO Do SO SHALL North Andover, MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR I REPRESENTATIVES. AUTHORIZED REPRESENTATIVE John McCarthy/LG4 � ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200901) The ACORD name and logo are registered marks of ACORD 06/29/2010 10:09 FAX 9785322217 BKM,Inc Z006 IMPORTANT If the certifi to holder is an ADDITIONAL INSURED, the polic (ies) must be endorsed. A statement on this cerci ate does not confer rights to the certificate holder in li u of such endorsement(s). I If SUBRO ATION IS WAIVED, subject to the terms and conditi ns of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ii u of such endorsement(s). DISCLAIMER This Ce ficate of Insurance does not constitute a contract between the issuing i urer(s), authorized represen alive or producer, and the certificate holder, nor does it affirmatively or ne tively amend, extend o alter the coverage afforded by the policies listed thereon. ACORD 25(2009101) INS025(200901) r' 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 drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21 A—F and G min.$100-$1000 fine I NOTES and DATA— For department use I i i ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 I MASSACHUSETTS UNIFORM APPLICATION OR PERMIT TO DO PLUMBING (Print or Type) elm... Date �Permit #60 ' Building Location Owner's NameG ��f` r%Yl Type of Occupancy Residential New ❑ Renovation ❑ /Replacement IN Plans Submitted: Yes❑ No ❑ FIXTURES N Z le PQ � F- N J N O Z h W W X J N Q V hQ z Z = O tX •i•' i� i•' u� rn � ¢ i rn = G O - -� N W V) u) x Q ~ a w yr Y a a c 3 rd b ¢ w o W d ro y Q ¢ W N ° a 2 0 `� a x x W z a = 3 3 o Z = X a 0 0. r a Y Q W w Y a ~ a a z �' �' a a o a o ° a a a a o a P I- N LL l7 n :2 Q LL N SUB—BS MT. s BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR r Installing Company Name Heritage Htg. &P1g. CO. Inc. Check one: Certificate Address Street EX Corporation 714 0+ Stoneham, Ma 02180 ❑ Partnership Business Telephone 781 —438-7776 I1 Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy IN Other type of indemnity ❑ Bond ❑ I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. G@neral Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 14 of thR General Laws. By— Title y Title Signature o cens d lum er • City/Town Type of License: Master[X Journeyman❑ APPROVE O IC ONL License Number 8322 r - I BELOW FOR OFFICE USE ONLY I I FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING i\ PLUMBER PERMIT GRANTED DATE 19 i PLUMBING INSPECTOR 1 t r I n Date. . .7. . .z. . .... NORTH o TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ••th SACaHUSE� l This certifies that . :. ........ . . . . . . . . . . . . . . . . . . has permission for gas . . . . . . in the buildings,of . . ... .�. . . . . . . . . . . . . . . . . . . . . . . . at C;;� f . . . ... - .- .�,.' (?., North Andover, Mass. Fee:??J. . . Lic. No../c'`7�.. . . ` ,� : C GAVINSPE&, Check# o 4217 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) / Mass. Date ` a-� 20-!® Permit # Z/ Building Location o2JO°'t- �N��� Owner's Name Type of Occupancy New/ Renovation Replacement ❑ Pians Submitter esY ❑ No N ¢ H W y Y Z ¢ df N W V N ¢ N ¢ O W W ¢ O 10 J_ N W �- 2 0W ~ < ¢ _ O W S W O W < = Z H H O ¢ > W V W y < ¢ O WW a J Z < W ¢ Q W Y < W ¢ O O W O G < W G d SUB—BSMT. BASEMENT 1ST F100R 2ND FLOOR ' 3RD FLOOR 4 4TH FLOOR STH FLOOR 6TH FLOOR TTH FLOOR ` 8TH FLOOR Installing Company, Name '/ �e- " Check one: Certificate Address �— t1IJ Corporation 414 6WA llk,4 D O ❑ Partnership Businejs Telephone `Z 7� J ��02,f(F / ❑ Frm/Co. Name aff Licensed Plumber or Gas Fitter � INSURANCE COVERAGE: t 1 have acu ept liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch` 142 . Yes R, No 0 If you have checked ye , please indicate the type coverage by checking the appropriate box A liability Insurance policy Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement Check one: OwnerO Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By 1 �r T Plumber Signaturd Li o censed Plumber or Gas utter Title Gasfitter Master License Number City/Town Journeyman APPROVED(OFFICE NL i t TOWN OF NORTH ANDOVER BUILDING DEPARTMENT TI ENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING« PERMIT ! , NUMBER: DATE ISSUED: ' I SIGNATURE: Buildin Conindssioner/I for of Btuldings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1G��t.7 Map N Parcel Number { IN Tro 1.3 Zoning Wormation: 1.4 ` Zonin Dis4rid osed UseI Lot Area fsf) Fronts e ft i.6 BUILDING SETBACKS.ft Front Yard Side Yard Rear Yard Required Provide R red Provided 'red Provided 1.7 Water Supply M G L.C.140 341 1.5. Flood Zone Information: 1.8 Sew aosal System tem P Public ❑ pmt ❑ Zone Outside Flood Zone D Municipal ❑ A+ On Site Disposal System ❑ eg SECTION 2-PROPERTY OWNERSHIP/AUT IORIZED AGENT �1 2.1 Owner of�Record Address for Service 1 GSigna re Telephone 22 Pwner of Record: 70 NaPrint . Address for Service: r�7� �7 - 000 y Si nature Tele hone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: i License Number Address Signature Expiration Date Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ .00 �ompany Name Registration Number address i naturExpiration Date e g _ Telephone r _ A 4' 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.......0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition 0 Other Vspecify Brief Description of Proposed Work: ` SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be - t Bl `'. �' lig , Completed by permit applicant IN 1. Building (a) Building Permit Fee Multiplier 2 Electrical _(b) Estimated Total Cost of Construction 3 Plumbing .Building Permit fee(a)x(b) 4 Mechanical AC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENJ ORCONTIRACTOR APPLIES FOR BUILDING PERMIT OZ02 '-- ,as Owner/Authorized Agent of subject property Hereby authorize !'( to act on hal ,in all-ma relativ to work authorized b building permit application. 0 0 Si tore 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 Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVBERS iST2 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE MORTGAGE.INSPECTION PLAN ,1 FACTUAL DATA TEL (781) 272-9100 • FAX (78 I ) 272-6900 "AGOR: STEVEN A.NOROICEN & DEED REF. . STEPHANIE J.HARRINGTON PLAN REF. #12178 ATION: 230 ANDOVER BY—PASS (ROUTE 125) SCALE: 1"=30' STATE: NORTH ANDOVER MA JOB #: 99/10253 DATE: DEC.27,1999 Z 5190• Ijl LOT 16 45-00 i it 5q 89 10, VA EASEMENT -: PRop UTILIT PORCH 7_.± �`_•. cu 2 STORY WOOD rn A #230 ` SOT C M LOT B LOT 15 l co 10376 SF± I PROPOSED �a DRIVEWAY EASEMENT �N 30.00' w 92.75' ii ANDOVER BY—PASS (ROUTE 125) -� 'Al pdHTti Zoning B law D 9 Denial Y Town Of North Andover Building Department �4SSRCHtfs 27 Charles St. North Andover, MA. 01845 Phone 978488-9545 Fax 978-688-9542 Street cs73C�.. �du.,� Map/Lot: 02 — 3 (� Applicant: R,,, . , a- �1(0 .°Request: ® ,� • C moC>ofDate: i . r '�ec_K SiCQew r Sfao�{c:i�- Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zoning Item Notes A Lot Area--- Not Item es F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 1 Lot Area Preexisting S 2 Frontage Complies 3 Lot Area Complies 3 Preexisting frontage e 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required y S 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height �S 4 Right Side Insufficient ' je S 4 Insufficient Information 5 Rear Insufficient �5 I Building Coverage 6 Preexisting setback(s) .4 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed --Cf-e-S 4 Insufficient Information Z �InWatershed j Sign 3prior to 10/24/94 (V lA _- 1 Sinn nn+ nilnwcd I Id3a Maims -191410uolssluawo0 leauols1H sil.loM ollgnd to luaw}ie ap uluueld pjeoe uluoZ uollen�asuo� ylleaH aollod and :ol pauajab 3 Plan Review Narrative r The following narrative is provided to further explain the reasons for denial for the application% permit for the property indicated on the reverse side: y}����t^�a&��yG,r'v+/'�7,{���.7:�,� � a ��y ' /y(y �s�, ��q �<:����b��.tiFi>.�+eY X43 y��It,✓ 4s�.�h�}?hip �'L ye.. �� '�x ? �a j!. j�y2.�.Y 's h(��,C^,�fik4�t,�b�'•.� '4P �� 1/ ��e��T'c�5 � �"� t�r .3 ��l J ! 3- ..<I>� a 'S.y iy. �tEyY,�'^Fkskv '9 f k�1aH\2Pt F.�5""Ri"��Si SA �`>I 4F `dip�'e 3 aTF Y.. is�t/.<.�✓'L Sn rt7 S�.3 ktsKY �. ,. �.a � �d� s L�' (��! '� i�4•\Y's ted . .W.��>n.�})N aRF � 2 t i ""7 /'r— Y/S 0 ./UCSD COV 4rkqI,-- C- ur�S