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HomeMy WebLinkAboutMiscellaneous - 101 MARBLEHEAD STREET 4/30/2018/rte Location a►; : l i Date C NORTH TOWN OF NORTH ANDOVER � • OOL Certificate of Occupancy $ �'�s''•°•E<� Building/Frame Permit Fee $ swcHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ > i Check # 14745 Building Inspector —,oQ bg # IOOLID -dOl3HdSNI -IVZ)IW0319 ........ ff act..................... aod ssey�'.ianop I ...... ................................... .... jo Sui "e* pl!nq aql ut Suillm ............................................. ........ -atez 4 ...... moji;;d of uoissiullad s7eq ......................................................... I-t� ................................ , jlaqj sag!:PO3 ST ONINIM MOA -LIW63d E13AOC3NV HIMONJO NMOl. 104 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING M-- BUILDING BUILDING PERMIT NUMBER: DATE ISSUED: �...... SIGNATURE: BuildingCommissioner/I for of Buildings Date 0 M M SECTION 1- SITE INFORMATION 1.1 Property Address: - k, � E.sr 1.2 Assessors Map and Parcel Nu er: Map Number Parce[ Nu ber �/ fdl 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage tt 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R mired Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHM/AUTHORIZED AGENT 2.1 Owner of Record. - -- - - - --- -_ - -- // - -- tree rz 1� 5 e cU �- i D / ��%�� IC4,rl S ?; Name (Print) `A]ddreesss`for rSService : Signare Telephone ` ' 2.2 a,_i�ner of Record: 0 Name Print Address for Service: z M Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ LicensedrConstruction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Imp ovement Contras r Not Applicable ❑ c � , Company Name % /�� 3 Registration Number Address 'h 10,2 Expiration Date siinature Telephone 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 %vill result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicablel New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. 0 Demolition ❑ Other X Specify /-,i } I° I ->A Brief Description of Proposed Work: Q b � 5 - �, 0 ez rj_,� �I�( �' �7 G C ` SG f F, -r 1� i� b f Cu I C�,��'f�7 F 6' orry-e T, r (fir (6ver4bol i'h t=��eTe� Slc>c SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be 1. Building'_....._ .r ............ .„, ,..ns=x., (a) Building Permit Fee QUO D` ©O lO� Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 73 OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to ac on My behalf, in all matters relative to work authorized by this building permit application. W Signature of Owner Date SECTION 7b OWNER/AUTHORIZ)ED AGENTT%DECLARATION / I, :T � 0 R61 b l ' / � �`'� as Owner/ uthorized Age t 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 Tor�1�.s c� r Print Name // /1 ✓l ., of NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 sr SPAN DIMENSIONS OF SILLS DIN ENSIGNS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 3/D Date SIZE THICKNESS X Regisiration:100833 PiTA ioti: 06/2.41' Type: DBA THOMAS 90BILL-ARD SIDlk =as Robillard 11 Filbert St ADMINISTRATOR MethuenMA 01844 I a 0 as g u •v O w E >, E cn O a A a p w O a: v 2 U � G w a o U 0.' °°° O w � r x a 0 w w W O w y cn G ii p H O a: m G w w A a w O W zoj � cn v Q O E cn M z y c c o C) c ` O N O yV •p. J C C A W CD p i m �a CD O_ v N 'o O r V y0•, _O m c co) E L m3 sMo �•' • N C" m N C C O :M C C • N O O jj��� 'Em :m o CLC.)m :its C.5 o� cca ' N CO m CD C.N O m v 1 C3 O ' «:coo C3 a c _ CC ® 1!' m m C N ;a o r0+ N CD ~ W O 4::s t _ uml W I.-•HO.S •`m C 3r m• N Z O V w CM 02 0 O� H V3 'D .- �oy•o O _ .030- W, 2 0 CO) C13 L CLO C O CD V _m CL CO) O O O R .Q y C O R ■C COD .do 0 V co C. CIO c Q co ev �` �D O L O CL. C. Q C 4-9 C O !O J.O Co Z CD C. CO) C 0 ErW w cr w U) N22024 Date..//.-.,12.-...ZY TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that............ ............................................. has permission to perform ...... ............ ...................................... wiring in the building of ,.. r:-:— ...................................... North Andover, Mass. Fee.- ... Lic. No ................. ECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TIM C111WONWFA�THUFNIA.SS4(.MS=77S Office Use.only ; DE NM21lgVTOFPUI L.KC�4 QTY Pcrm_ it.No. ' BOARD OFI7REPREYEMl ONREGUTA770M527CY1R12 LY) Occupancy c4G Fees Checked TIONFO1z. EZAz flT T -O P�ORMELE=CAL MOCK APPLrcA ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THRMASSACHUSSTS ELECTRICAL.CODE,.527 c&m 12:00 (PLEASE PRINT IN INK. OR TYPE ALL INFORMATION) Date .-%l ` Z % Town.ofNorth.Andover To the Inspector of Wires:.. The undersigned applies for a permit to perform the electrical work'&scribed.below." PARCEL 0 Location. Street::&Number 0 Owner or Tenant.��„� Owner's Address 6 Is this.permit ln.conjunetion with a.building.permit: Yes -No (Check Appropriate Box) . se of B Purpose ulldtng .g.c,�� i� - _ _Utility Authorization No. = . Existing Service 7-00 — Amps l ZO l ZIO Volts Overhead. Underground No. of Meters ':1, New Service Amps -/ Volts Overhead r Underground No. of Meters Number of Feeders and Ampacity 3 ADO - -. Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No:ofLightingFixtmes -Swimming Pool Above- Below Generators' - - KVA ground and No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units y - No. of Switch Outlets No. of Gm Burners FIRE ALARIv1S No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local�j Municipal Other No. of Dryers Heating Devices - KW uCormcctions No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER' n.� .nr r v:u e,�.a n.• ,rnr 'fie ur ui ! •an:ar •�:.u,• . r :n,r • is am .� :• �• unci , i• � •�: r a �- �� � - �irr^ .� � • .� - a:r�:a r� �- naso- ��- •' �: ��- _- • • :r�i .: i - MSG(•0.1-11- 00 INSURANCE BOND OTHER ?aseSpady) ET=mDate WoktoSbtt t/ a 9 9 9 hipecdouDateRPxugh SijMduoderTePa3altir+s ofpajtuy. FIRMNAM6 Lioa>9eNa Liar>seeF,n�a.< s;grrmue LiceNo /G Z 3 9 %p7�1 Z(,5?C % 9 Alt TeLNa -197-,0175 OV/1' 2SIr1SURANCEWAIVEi,IamawatethattheLiarredoesnothawdr't>St:um=. critsa±stzn eguvaleatasiega byfMimdmsetG=mlLaws atrlffia ryskniinmthisp=it apphicatirnwaiwsthis m#=at (Please check one) Owner Aoent ®�t7 Telephone No. PERMIT FEE "ate umature of Owner or gent Location A% No. Date 8` 0 Q a pf NpRTFi TOWN OF (NORTH A,NDOVFR p Certificate of Occupancy $ Building/Frame Permit Fee $ o y Foundation Permit Fee Other Permit Fee Sewer Connection Fee Water Connection Fee l / TOTAL Y X5336 $ Building Inspector Div. Public Works a W r /4 0 C z n j - j v O - s= \ IS. I N Ln _ 1 m o, o z n z V En `j M V z r �G-va a W r /4 0 C m m G m 0 m = 'O C. y Cl) 10 0 CD n Z .y O O a' r C. C.) O OCD ccCL O =r CD CD Q CD w co a C CD y� CD CZ O y CG = CD v CA O 'O Z CD o CD 0 C CD OC N Q co A d O m �o N Oc') C') O y W n C C3 cl) m a?� m O m CD Gj O• C = �i7 O C N' C09 . r rn a = CL to 0 m C',CD m C)= : o to O m n \ J m O = N �: er • O N d �.:� C• :� t CD ►�.1 N :E C .� m N �•.� ? N O C m d y •� colCDo o O coo O z = 3 o• z CD W: m T N .� e-. O r: C-) C.)oM c o CD cn cn o7 c z ?? 7� o ?? y 7� o aq CT7 i� Cl) m 0 �? m 7y 0 � C31 Z m � 0 ?l w n 7y o T `Tl a aRi o r.1 Cb d z � a 0 Cn n f cn 3 o o R x a O o x FORM U - LOT RELEASE FORM 4 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION************** APPLICANT S h 1/!/ I"' ct, r",PHONE 3 6 LOCATION: Assessor's Map Number 0,4 SUBDIVISION STREET '//G�Gt r_/� �e I�Z-e Q f7— ""OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CON VATION ADMINISTRATOR DATE APPROVED DATE REJECTED_ n , 0 r� COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS W DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT PARCEL D G yl LOT (S) 00. G tl ST. NUMBER /0 M",. 101' 1 BUILDING DEPARTMENT RECEIVED BY BUILDING INSPECTOR ATE Revised 9W jm .; Town ofNor-th-Andbyer . y. OFFICE OF _. . COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 a .e1 WILLIAM J. SCOTT SACMUSr Director (978) 688-9531 - - Fax (978) 688-9542 HO"vfEOWNER LICENSE EKE IPTION Please print. _r '9 125 DATE // /� % Y i. JOB LOCATION GL y 12 G� �'1- Cy Q S If Number Street address Section of town "HOMEOWvFER" LI/, f wa r Name ;- -Home phone _Work phone / l PRESENT MAILING ADDRESS ! V /1 4-e ct, Citv/Town State s Zi code p The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual.for hire- _does not possess a license, provided that the owner acts as supervisor. (State Building' Code_ ec 0 tion.109.1.1) DEFINITION OF HOiV1E04VNER: 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 to six family dwelling, attached or detached structures ac-_ cessory to such use and/or farm strsctures: A person who constructs more than.one.home-in a. two-vear period shall not be considered a homeowner . Such "homeowner".shall'subinft!to the Building Official, on a form acceptable to the Building Official, that he/she shallbe''°° responsible for all such work performed under the -building permit. (Section 109:1:11-- The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. `a . The undersigned "homeowner" certifies that he/she understands the Town of -No: -Andover Building Department minimum inspection procedures and requirements and. that he/she- will comioIV with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICL-�L Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. BOARD OF*APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 N x 0 0� • 0 rlu Ul w p `G Ln ro � SQ O Q N C+Er `h ro (0 P LA tA n O n Z N C+ ro bl Q s o r r �0 w LA ro —i NN C) Q o Q �< • N • 3n ro � s Ul m vi S ro ;7 d X -u ° Ln n -i Ul g O rF P S 3 x 0 O n C C S Q �O t in in ro r O rF N x 0 0� • 0 rlu Ul w p `G Ln ro � SQ O Q N C+Er `h ro (0 P LA tA n O n Z N C+ ro bl Q s o X �0 w LA ro C) Q o 90 C3 N O x � s Ul m �- -u ° ,< n -i Ul g O rF 0 3 0 3 _ 0T ro A `F ro O n rs s ro ro Q r Q I rp W N, -A, .A, x r \ N I(PI' Z CD D F� Q Q- 0 < rD c ro� pI NOwiM KAREN H.P. NELSON r_ 4 Town Of 120 Main Street, 01845 Director BUILDING mss, °•;;,:, .9 NORTH ANDOVER (508) 682 6483 CONSERVATION °s,�� s`` DIVISION OF PPLANN NG PLANNING & COMMUNITY DEVELOPMENT CHIMNEY APPLICATION AND PERMIT DATE �0 /& LOCATION OWNER'S NAME BUILDER'S NAME PERMIT #? C MASON'S NAME & / (LAJ MASON'S ADDRESS l a D 7 CJ�� t/ �/� iG] NZ % LIL9 C}l (?dP MASON'S TELEPHONE `7`,5,1q % 2S_ 2 MATERIAL OF CHIMNEY-�� /�%e_/`S C �,C L� )qA)L INTERIOR CHIMNEY ll2r-- EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUE/x !< THICKNESS OF HEARTH Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: S DATE 61, SIGNATURE OF MASON A L' CONTR. LIC. EST. CONSTRUCTION COST/CONTRACT PRICE 45- 0, -C) PERMIT GRANTED FEE ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES v, 'v C EF y n CD n Z H CD O 'O CL r oca Cm. C CZ �• CO) TZ O Oi CCD O CL Cr CD CCD O CCD � W C CD y CD Q O y i CcCD v CA O "o Z CD acm o CD 0 C CD I� 0 O CD N O to 0 ca CL to CD to •Oi. CD O y C 0 a y y 3 O p .Oi. �. y Q O. O O y .a d CL to � n � w Cl) � CA _0 ..� 0 O w =-O N y -i "7l .► 7 .O.► CD W a m , rn =r . CD 'O Co O y oWm �.: � Cl) to to n = CO) : O w O .. to Z <, C-) CD O to, O o C N a == _ o.ta = CL "-+ o =r =r: t9 y CD O m CL CD d y Cr O. d W d �m C CD ,•�/ J tO y C4) J O z 0 m �o O p .Oi. It 5 � d to w „„ Qp ..� 0 O w r 0 0 T rb , G w "►: CO)CD 'O �o. O �.: Cl) oC. CD a 3': .. to CD o C dam,: z 0 m �o O p y O : It c o G 0o _ w o = ' Qp Z w z 0 m �o O p a ^ It w G 0o w < (D Qp Z w r y T rb , G w C z 'O O ?� O 5 ON 0 9 R" ". Location r No. - ? C Date a NORTIy a TOWN OF NORTH ANDOVER p? •• a p� ,mmwft„ Certificate of Occupancy $ 4 ` Building/Frame Permit Fee $ Foundation Permit Fee $ CH jStt -G#vei-Permit Fee $ • S Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �Buildlng ector Inspector 9826 Div. Public Works DATE W /& LOCATION OWNER'S NAME BUILDER'S NAME CHIMNEY APPLICATION AND PERMIT W912FA . 120 Main Street, 01845 (508)682-6483 PERMIT #� D1ey�` MASON'S NAME -i: / aA—j MASON' S ADDRESS /o?0 Z64-7NJ7– %Ol ed � MASON'S TELEPHONE �'LJp2 cI DS�o MATERIAL OF CHIMNEY &/L/D Ckkj� TkLt /4AJ _� INTERIOR CHIMNEY f/"/ec- 2/ EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES �/(%� Id x /� l( THICKNESS OF HEARTH ( _ I D `/ Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: s DATE vi%2 SIGNATURE OF MASON / � CONTR . LIC. #0132(3-b EST. CONSTRUCTION COST/CONTRACT PRICE 1,5_0001 01-0 PERMIT GRANTED FEE ROBERT NICETTA, BUILDING INSPECTOR INSPECTED } REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES °,F "ORTM 1ti KAREN H.P. NELSON n ._ Town of Director`' _ . NORTH ANDOVER BUILDING ass'°" CONSERVATION R`s DIVISION OF PPLANN NG PLANNING & COMMUNITY DEVELOPMENT DATE W /& LOCATION OWNER'S NAME BUILDER'S NAME CHIMNEY APPLICATION AND PERMIT W912FA . 120 Main Street, 01845 (508)682-6483 PERMIT #� D1ey�` MASON'S NAME -i: / aA—j MASON' S ADDRESS /o?0 Z64-7NJ7– %Ol ed � MASON'S TELEPHONE �'LJp2 cI DS�o MATERIAL OF CHIMNEY &/L/D Ckkj� TkLt /4AJ _� INTERIOR CHIMNEY f/"/ec- 2/ EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES �/(%� Id x /� l( THICKNESS OF HEARTH ( _ I D `/ Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: s DATE vi%2 SIGNATURE OF MASON / � CONTR . LIC. #0132(3-b EST. CONSTRUCTION COST/CONTRACT PRICE 1,5_0001 01-0 PERMIT GRANTED FEE ROBERT NICETTA, BUILDING INSPECTOR INSPECTED } REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES Location IDI I )A jeh 1S k p c�� S- -- _ No. �� Date 0! TOWN OF NORTH ANDOVER 0 9 Certificate of Occupancy $ '�b' •° '<�' Building/Frame Permit Fee $ � Building /Frame Permit Fee $ Other Permit Fee $ _ TOTAL $ 6 Check #�" 14 6 3 11111f,1# r caq-,- Building Inspector TOWN OF NORTH AT14DOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: a� ,rte DATE ISSUED: CD -C) CD � SIGNATURE:( Building Comrnissioner/I for of Buildings Date 1 Z rPEUIIUN 1- SITE INFORMATION l t.1 Property Addr zo if6T �edl 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RecIttired Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ Zone 1.5. Flood Zone Information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ J ,UIJI(7N 1 - FKOYER Y OWNERSHIP/AUTHORIZED AUINT 2.1 Owner of Record 571 n K S Pe Q/ t- T- dr -v\ 'e Name (Print) Address for Service tr? ?6 �-3a f & � Signature Telephone 1 2.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES I 3.1 Licensed Construction Supervisor: Licensed Construction Su9jcervisor: Address 4 Signature Telephone j.z rcegisterea home improvement Uontractor % / 60 Q Company Name r Address Address for Service: Not Applicable ❑ License Number Expiration Date Not Applicable ❑ l/--)a-7i 7 Registration Number /, L,"-2, Expir#n Date "- ; "-r SECTION 4 - WORKERS COMPENSATION M G I. C t 1;-7 R 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 .......❑ No ....... 0 SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 4� I Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: t-2 5 TA V1 D < L Rv, U,/1 hexa SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b permit applicant a ht� T '� U>�FrC A u � - (a) Building Permit Fee Multiplier USE O Y {�€ f -MUM k 1. Building 2 Electrical (b) Estimated Total Cost of Construction +-{ 3 Plumbing Building Permit fee (al X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/A orized Agent of ubject property Hereby authorize p0 5 to act on My behalf, in all matters relative to work authorized by this building permit application._ �A Si nature of Owner Date 1 /0 v vvi'4r tvAU lnU.KIZ EU Atrh1V l l)Ei ULARA.'1'ION . I ., as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belie' Print Name � f ��/,/ ZI _ of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1sT ND 2 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 .Y' Cf) m m m 0 m i _2 CA 'O C o d 'O O CD n Z y O n� r _ ? o d =• y O o p CD CD o CLQ CD CD o CD w ca C CD yl !D Q OCD y �CD v CA O 'O Z O O a CD CD0 CD 0 Q b f`p 0 0 O -• 0 0 cr H aO C m -0 y �CD n m Cl)O H n a C') T Z ra _•I =r CD aCL sCL d a y m „� O m y p N p =rm m = > >-0 o n z WN O N. C7 W O m C :� `. r' a n p !^CL �1--ox 4c CD V/ m C7� A: na %t m O d y , C=l C c 00 — cn C2 gym: � U CD cn ca O H q O ^ m m d H :� ` J w 'O cn XO CD C9 b o CD m . �r n s O o: O � m cn D cn o w c � ?i q FL PO o or- nj q w cn Mo �. oda � p E o � rtzcn rA x o �'- n;o o � o � cn C �^ o A. x 9 H 0 0 c THECOMMONWEALTHOF FP3001 alpf l BOARDOFFIREPREVF. MON APPLICATIONFOR PERMIT TO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the electrical work c Location (Street & Number) /0 / �Q Owner or Tenant Owner's Address / o i Office Use on] Permit No. --r� t -J G�1R12:(Xl Occupancy & Fees Checked ELECTRICAL WORK TICAL CODE, 527 CMR 12:00 F-3 3 r Q Date To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes 10 No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service'z� AmpsoVolts Overhead Underground No. of Meters New Service Amps— Volts Overhead ED Underground Q No. of Meters Number of Feeders and Ampacity 3 —2.o4> Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting FixturesO Swimming Pool Above 1:1ound Below Generators KVA round No. of Receptacle Outlets to No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal _ Othe No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs . Bailasis No, Hydro Massage Tubs No. of Motors Total HP kEtX&=Coveraga PtaalanttDftMg=Mlff sOfNL%MJIMMGaaalLaws IhaveaoutraltLiab170y . R�licyindudtngCorrlple� CovQrdgeoritssut�larrialaquivaiat YES[;J NO IbawsubrriWdvaWP100f�6WlDdleOfflM YES r ffyouhawdrelodYES,plea nxbc*theeArcfamrageby WodcmShatt h>SpecrionDa�Regtles4�d Sigrrdun&r Rmakmofpajtuy. F RMNAIv1E Ra* � � �, - O ` wed VahieofDac�d Wodc $ 3 o u Fmal LkffwNo. Lio Sigrhae Fgg Idoa>seNo /f/i ".3 ! BusixssTeL Na Y 7 !/ a q$ 3 prifircc %/ S' �j L� i4►�l � AILTUNo 7 Y d ?'7 S / 9 OWNER'SINSURANCEWAIVER;IamawatedAdrLio wdammthawdlemma=oc)vaageoritsats=WeglriAftasm4medbyMassadximCanallaws andflArrysgnakwcnduspwnt*pbcabmwaivesdwm m mt (Please check one) Owner Agent Telephone No. PERMIT FEE signature of Owner or Agent ILA 4 Location 4D) /A,4 No. �' U 7 Date N09ITN TOWN OF NORTH ANDOVER Certificate of Occupancy $ �1'�0���0 �,',,• ;r ,Ss4CNU5Et� Building/Frame Permit Fee $ n' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 8 41- 17297 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1.2 Assessors M arcel Number: f�ooK6/3 Cl PfG� � 3 Map Number Parcel Number BUILDLNG PERMIT NUIvIB� : DATE ISSUED: SIGNATURE: 1.4 Property Dimensions: Lot Areas Frontage ft Building Commissioner/lEspector of Buildings Date SECTION I- SITE INFOR1dIATION 1.1 Property Address: eS 1.2 Assessors M arcel Number: f�ooK6/3 Cl PfG� � 3 Map Number Parcel Number 1.3 Zoning Information: �y 7oning Distrid Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RegWred Provided Required Provided 1.7 Water SupplyM.G.L.C.40. 54) 1.5 Fl Zone Information: 1.8 Sewerage Disposal System: Public fQ Private ❑ Zone Outside Flood Zone ❑ Municipal Oa Si[e Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT + �ror;CDistrict: Yes rjo 2.1 Owner of Record Name (Print) Address for Service 0l7�i—���p/�� ignature Telephone 2.2 t wner of Record: t' Natne Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor i Not Applicable ❑ Company Name r Registration Number Address Expiration Date Signature Telephone r 4 SECTION 4 - WORKERS COMPENSATION (NLG.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 .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition ❑ —� Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: ,3 A) (00 it Co N,uI C4 6 V"�' i SECTION 6 - F,STI1MlATFD CONSTRUCTTON COSTS Item Estimated Cost (Dollar) to be Completed ermit applicanta2ffM2tft=LM, 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(HVAC)�v 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pen -nit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 TI1lIBERS 15 2 0 3 RD SPAN DIMENSIONS OF SILLS DMENSIONS OF POSTS DME-NSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH ANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAT GAS LINE I North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: .(Location f Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector D. Robert Nicetta . Building Commissioner (978) 688-9545 (978) 688-9542 Fax Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Please print.. DATE A/'I JOB LOCATION / ! 14 le ` e rz S Number Street Address Map / lot "HOMEOWNER a/ t"A P7 A�' 14,1 i Y, e Lc'0- 9 7 G z,16,9 3 Cr c, Name Home Phone Work Phone PRESENT MAILING ADDRESS �U / ��`' �✓ /� h R q/ S City Town State The current exemption for "homedwners" was extended to include owner -occupied dwellings of 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 HOMEWOWNER: 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 ac- cessory 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. The undersigned "homeowner" assumes responsibility for compliance 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 No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements HOMEOWNER'S SIGNATUR APPROVAL OF BUILDING OFFI Zip Code The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Location: %G� / % /- ZQ % P ;r e Ci �' a r G7 /� d !' V �%iT Phone I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #: Insurance. Co. Policy # Company name: Address City: Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment -as _well_as_civil..penaltiesin the form of-aSTOP WORKORDER..and..a.fine -of .(.$l00.00)..aslayagainst.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. .—/z1 /Q y Print name / a yi i� W �/ t�Gr/ r Phone 9, w -,:5- "P2 -6 � �b Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department 7 Other U) m X X m m y 'v CO) CD St X y CLCD O �� CL = co) ® CD CL Q �d CD CD CD = CD CO) v y° o co C 0 F cn cn n 0 L_ z cn cntv y o �, � Q v� a • ti •amO m I CO Cln C! 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