HomeMy WebLinkAboutMiscellaneous - 102 Second Street1
Location
No. 3 / Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
^�
S tt�' Building/Frame Permit Fee $
MU
Foundation Permit Fee n $
Other Permit Fee k O Jcy $ a �=
TOTAL $ ,2 -
Check
Check #
`i 5'i 95
/M' (6 --
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: I - DATE ISSUED: /
SIGNATURE: AA ' q
Building Commissioner/Inspector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Addr
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area
Frontage ft
1.6 BUILDING SETBACKS 00
Front Yard .
Side Yard
Rear Yard
Required Provide
Required Provided
Required
Provided
1.7 Water Supply M.G.1-C.40. 54)
Public 0 Private ❑ Zone
I.S. blood Zone Infomution:
Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
0 On Site Disposal System ❑
JL 1:11UIV Z- rKU]rEK 1 Y U W Ir EKbIUF/A U 121UKIGED AliE.N 1
2.1 Owner of rd
Name (Print) Address for Service .
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor.
Licensed Construction Supervisor:
Address '
Signature Telephone
3.2 Registered Home Improvement Contractor
Company Name
Address
Not Applicable ❑
License Number
Expiration Date
Not Applicable ❑
Registration Number
Expiration Date
ge A
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 ....... 0
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
'_
Accessory Bldg. ❑ Demolition ❑ 1 Other ❑ Specify
Brief Description of Proposed Work:
I SECTION 6 - F.STiMATFn CnNSTRUrTinN CnST.q 1
Item
Estimated Cost Dollar to be
Completed by permit applicant
(a) Building Permit Fee
Multiplier
_...
1. Building
2 Electrical
(b) Estimated Total Cost of
Construction
3 ' Plumbing
Building Permit fee tat x (b)
!w
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
JEG11V1N 7a VW1NEXAU1110KLZAIIVN TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit 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
Sig2ature of Owner/Agent
NO. OF STORIES
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS iST
SPAN
DIMENSIONS OF SILLS
DIMENSIONS 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
Date
SIZE
2ND
THICKNESS
X
3
N°1021
Date... 2... .......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
..........• ...............
has permission to perform --el '-0'. 'Q� '.
...........................
wiring in the building . . . ....................................................
North Andover, Mass.
at//, ............. .......
I O -r/
Fee .... . .... Lic. NoAl-,2,�'4� .........
.............................
ECEMICAL INSPECTOR
08/10/99 15:07 125-00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
,o WOOD STOVE INSTALLS HON CHECKLIST
Permit
A building permit is required for the installation of any solid fuel burning appliance. The building permit and
installation inspection are limited to the stove installation and not to the stove construction.
l Stove '
A. New
B. Type/ra nt Circulating
C. Manufacturer b. No.
Name/ Model No.) nliarsize
Olmensions/Heigh __L�ngth Width
Chimney
A. New -
Existing
B. Size (flue area)
C. Other appliances attached to flue (Number and flue size)
D. Prefab (Manufacturer—name and type)
E. Masonry/Lined Flue liner
HYD• 6 manufaccuroo
Unlined
F. Height (refer to diagrams) cap
CHIMNEY HEIGHT
Hearth (non-combustible)
A. Materials
B. Sub -floor construction
C. Minimum dimensions (refer to diagram)
Clearances and Wall Protection (,see stc-ie in-szallarcn c!earances chart)
A. Type of wall protection provided
B. Clearances (refer to diagrams)
FIREPLACE
CORNER
ht1\hIH
WALLCENTER.
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TRF(j9AIM0NWE4LTH0FM SSACHVSE77`.S Office Use on).v
,a
DEPARTAtE7�T0FPUBLICS4= Permit No.
BOAtDOFFNEPREY=ONREGUL4TlONSS?7CMR 12-00
Occupancy 8 Fees Checked ;?(S
r�
APPL.ICATIONFOR P RAVT TO PERFORM ELECTRICAL, WORK
AL! WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(-PLEASE PRLNT INr INK OR TYPE ALL INFORMATION) �/347�3r,
• ' - '
Town of North Andover MAP the lnspector of Wires:
The undersigned applies for a permit to perform the electrical work described belo PARCEL
Location (Street & Number)
Owne- or Tenant e •
f
Owner's .Address Z.� / Q ✓ .�
Is this permit in conjunction with a building per/mit: Yes 12f No (Check Appropriate Box)
Purpose of Building /y��G"ciol�gZ,-, ��/7 UtiliryAuthorizationNo.
Existing Se -,-ice AmpsfjVolts Overhead Underground No. of Meters
\e.v Service-.4ZQP — Amps 'jg/ Volts Overhead Under --round= No. of Vfeters
Number of Feeders and Ampaciry
Location and Nature of Proposed Electrical Work 7f / 4,*".P a
No of Lighting Outlets
%L
No. of Hot Tubs
No. of Transformers
Total
T
KVA
No of Lighting Fixtures
Swimming Pool Above
Bel
Generators
KVA
and grouow nd
No of Receptacle Outlets
No. of Oil Bumers
No. of Emergency Lighting Battery Units
No 01 Switch
FIRE .ALARMS No, of Zones
No of Detection and
No of Ranges
No. of Air Cond. Total DU� v/ V
Tons U
N'o of Disposals
No: of hent Total Tota!
Pumps
Tons KW
initiating Devices
No. of Sounding Devices
No of Disci asners
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Locala Municipal j"""]
Connections u
Other
No of Dryers
Heating Devices KW
',u of'.taitr Hearers KW
No. of No of
Signs
Bailasts
VHero .Massage 7 uos
No. of Motors
Total HP
l
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0 T HER 14,
�,� Co.ea� Ptdsuar•[ ea � rec�menaz6 d>�ls Laws
I hate a asreit Lim ry 6srar= Rcii�y ricixiaig CcrrTk a? Opg&cm Cosa or its stismirmai ec, z Wm YES tio
11-a e su1xniued ,,afid ?LUfof same io the Offim YES NO j'j If c t hate d eSed YES, p6se rdcae the type cfmwage by d=kq ti,
u
INSURANCE ED/ BOND
`✓/ Estyr Val ed`El= .l Wait S //J,0,0
Wait iD Stat k spin 1m R Raigh Fatal
Sill urs re PeBhies-pelf y' 1
�.tii NAIL ra.� 7Dn�f C/���� L�a-seNa
l l p atzes Tei "a
A,2 T, tia
OWNEl"S L� RAS W.4IV '2 1 am a vote that Liter Q t r�ct htave ttte it:xrax: mt�c sgexa spa gale ass rci fT v� C til Lasts
atsi t1 ><t my �=�� � at the pars �ci�� wanes th.5 reat�tenet[.
(Please ;.heck one) Owner A2entf� j
Telephone No. PERMIT FEE S ���
MASSACHUSETTS UNIFORM APPLICATIW4 FOR PERMIT To DO GASFITT111O
(Print or Type)
�_ NORTH ANDOVER Mass. Date �. .7 U
I} buil ing Location �/j' l�n,z/d J'
PerJmit # 531,
Owners Narne��,`
= New 71 Renovation D Replacement Plans Submitted (�
FIXTIIP' Q
(Print or Type)
Installing Compa
,Address 15-0 6 '2020^ J7.:
Business Telephone: , /7-sZ
Check one: Certificate
1-1 Corp.
ID Partner.
c. -Irm/Co. 1/
Name of Licensed Plumber or Gas Fitter ii -16
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy �ther type of indemnity [_1 Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
ignature of owner/agent of property Owner I ! Agent LJ
Olt U114
I hereby ecrfify that all of the details and information I have Submitted for entered) in above application are true and accurate to the best of my
knowledge and that aU plumbing work and tnstaUations petformcd under f esmif issued for this application will be in compliance with all pertinent
provisions of rho ? assachusetts State Cas Code and. Chapter 142 of tho General Laws.
TYPE LICENSE:
By. 4uir6er�
Title Gasfitter tu of Licensed
City/Town: s t e r Plumber or Gasfitter
Journeynian ____J ^
APPROVED (OFFICE use ONLY) License Number
Date. ............... .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ............................................
has permission for gas installation ............. ............. .
in the buildings of ..........................................
at .................................... North Andover, Mass.
Fee......... Lic. No......... ....................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Trp-
Location 12a� & V- C J ti A U ,-- -
No. (:�,) C Date % A/ A/
NORYN TOWN OF NORTH ANDOVER
p f Certificate oOccupancy $
- .
• % ; ; Building/Frame Permit Fee $
E Foundation Permit Fee $
sACHUS _
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $ r
TOTAL $
l� Building Inspector
i J �0796/99 14:21 32.00 PAID
Div. Public Works
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WILLIAM J. SCOTT
Director
(978)688-9531
Please print. C�
DATE
JOB LOCATION
`Town of North Andover NORTH
OFFICE OF 3�1
`,
COMMUNITY DEVELOPMENT AND SERVICES 0 -
27 Charles Street
North Andover, Massachusetts 01845 9�.... o
er
"HO,\/1=V. r R"
Name
PRESENT MAILING ADDRESS
HOMEOWNER LICENSE E LE�IPTTON
City/Town
Fax (978)688-9542
Ona..A took
Street address Section of town
ome phone �Vork phone
State Zip code
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 who does
not possess a license, provided that the owner acts as supervisor. (State Building Code Sec-
tion 109.1.1)
DEFINITION OF HOMEOVVNER:
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 structures. A person who constructs more than one home in a
two-vear period shall not be considered a homeowner . Such "homeowner" shall submit to
the Building Official, on a form acceptable to the Building Official, that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
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 To of Vo. Andover
Building Department minimum inspection procedures and requir en d that he!she will
comply with said procedures and reauiremen . A,
HONI=VNER'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 633-9541 BUILDING 688-9545 CONSERVATION 683-9530 HEALTH 683-9540 PLANNING 683-9535
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