HomeMy WebLinkAboutMiscellaneous - 105 HILLSIDE ROAD 4/30/2018Location
No. C-/> 1 / Date —f,S
NORTH TOWN OF NORTH ANDOVER
OL
9
' Certificate of Occupancy $
ro 41
*Ale. Building/Frame Permit Fee $ c-? Q
J^CHUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ ntQ
Check # a (S Y
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Aks..�c.a i ,.,s�. i.�. ax��'cP`x'a��C .0 s , �'� t �sz „ , ''�y�`�. �x a ��'; nt� sy""�"'a`�.w.._ •�..
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/IdEtor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel Number
1.3 Zoning Information:
�e5i�,ah.•�,.t
Zoning District Proposed Use
t
1.4 Property Dimensions:
Lot Areas
Frontage ft
1.6 BUILDING SETBACKS ft
Name (Print)
Front Yard -
Side Yard
Rear Yard
Required Provide Required
Provided
Required
Provided
2.2 Owner of Record:
1.7 Water Supply M.G.L.G.40. 54) 1.5.
Public ❑ Private I 0 1. Zone
Flood Zone Information:
Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
'p
/0s�1
Name (Print)
Address for Service:
Signature
Telephone
2.2 Owner of Record:
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
YU5,Se�121
Licensed Construction Supervisor:
License Number
}} + d
a, ltiaV a- /ter ! "y� l t4l vt
Address
/
q�d d[6
T�
Expiration Dat —
Signature " J
Telephone
r
3.2 Registered Home Improvement Contractor
Not Applicable ❑
{��%SS _0 /"y
{�
Jl'(a/i�t0Ui olroS.
/
Company Name
Registration Number
Address
O"'"'"'�"
q�p �� • �O
7 /
/`6
Expiration Date
Sr nature Tele hone
f
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 .......❑ No ....... 0
SECTION 5 Description of Proposed Work check au applicable)
New Construction ❑ ,EYistin&Building Repair(s) ❑ Altepati") D Addition ❑
Accessory Bldg. ❑ Demolition 0 Other 0 r Specify '
Brief Description of Proposed Work:
j f �
I SECTION 6 - ESTIMATED CONSTRUCTION C'OCTC I
Item
Estimated Cost (Dollar) to be
E}IC
'„qt'
USS O1.Y' �Q°x5
Completed b permit applicant
X �,
(a) Building Permit Fee
av
„rx�
1. Building
3 D iU
Multiplier
2 Electrical
(b) Estimated Total Cost of
0
Construction
3 Plumbing
O
Building Permit fee (a) X (b)
4 Mechanical HVAC
0
5 Fire Protection
p
6 Total 1+2+3+4+5
ri p o
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 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
I, , uss e Vl P 9- i l ro" ' 4 Ka" l (A �Y LS Cb sa Co-, SM( -,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
�055C l a� Ilov
Print Mile
AAAaw )y0a. ' -' g % IG
SiNature of Owner/A ent Date
NO. OF STORIES SIZE
(LTASEAOR SLAB
SIZE OF FLOOR TIIVIBERS 2 X to iST-Lt C3 2ND 7-x 1 b 3
SPAN 42
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS <[ 4
DRvIENSIONS OF GIRDERS (o j 1 • ' t '
HEIGHT OF FOUNDATION J Q g THICKNESS `a
SIZE OF FOOTING /0" V 2, o' , X. i
MATERIAL OF CHIMNEY r ; (�
IS BUILDING ON SOLID.OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE n�
J
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax. (978) 688-9542
DEBRIS DISPOSAL FORM
¢n ,9
y'.2 °
��' y.. • d '� Y4 0
o 0
ry� 4
�2O�e cocn�i�w.�.ncr ��m
In accordance with the provisions of MGL c 40 s 54, and.a condition of
Building permit• # the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL c 1, sI50a
The debris will be disposed of in /at:
r acilii_V location
Signature of Applicant
��/s� O
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name J?v ss C.lt I" z0(ov� mot Ca•-s,�, (e, -ThC,_Please Print —
�a Mo rJY a C as , Cok ,rl
Location: 5'S CAP- s -e I Lor A; /(;4V,_ e ll
City Phone # q?,? - G -'G ^ 7 /4 �
FI am a homeowner performing all work myself.
0 I am a sole proprietor and have no one working in any capacity
E / I am an employer providing workers' compensation for my employees working on this job.
Company name: maf C-ou x b y e s C"t
Address S Case -
City:. A Phone#. `�7cP"'G8�--7ty7
Address ti
City' Phone-*:
Insutanc e:Co.zin r. S'.. CO Policv.# . o9 -79, 1 519'
and/or one years' in prisonment.as iii[ell_as_cL%il_penalties.inst eiarm cf-a_STQP. WDRK--ORI)ERand_.a_finecf- $IIlO DL,a-day againsime. 1
understand that a copy of this statement maybe forwarded'to the office of Investigations of the DIA for Coverage verification.
l do hereby ceitiLy
the pains and penaltiesofperjury that the information provided above is true and correct.
Date g u
Print name Phone.#
Official use only do not write in this area to becompleted by city or town official'
City or Town Permit/Licensing
El Building Dept
[]Check if immediate response is required El Licensing Board
p Selectman's Office
Contact person: Phone A. Ei Health Department
Ej Other
A
YtC
fie loanvrnoouuea� o�✓l%aaeac�ivael�a�
BOARD OF BUILDING REGULATIONS
j License: CONSTRUCTION SUPERVISOR
Number CS 04823-1
Birthdate `02/1171964 1
o
.z ,� Expires 02/11/2002 Tr. not 15048
Restricted To: 00
RUSSELL J MAILLOUX,//�,��f
55CHASE ST Y G •+E. �i !�/T r''
METHUEN, MA 01844 Administrator. t
HOHE;IHpkOVENENT CONTRACTOR '{
� 4;, Regstra i�on� 10307]°
Expiration: 7/6/02
Type: Private Corporatio
NAILLOUX BROS. CONST. CO.,
Russell eailloux
55 CHASE STREET
ADMINISTRATOR METHUEN
HA 01844
I a
m
m
m
U)
0
m
y
d
CO) Cl)
n Z y
CL F,
r
c
? c
C. S y
O
000
CDCL
o
cr
d CD
CD o CD
w w P.
C. CD co)
CD
CL v CO)
o
cC C
W*� 0
C S• N 0 Q H =
dc CD .0 VA
m 0 m C)
C yc'aC m
Z • o �= H
Oy. ._.► = .dim y T
? a -+ a. o
a -4CD 0 D y p y
N 0=m ® 2
a �CD c C
O m c=:
n o y n �r1
'tt a n y 5: c V
R aU2 0
`�Z?S
C CD
JD
sem.
n
ll, 0 d
cn
CD
CD
CA
CD
CD
O"CD 0
0 �o
z= �:
OCD�Q
z CD
bdC
s�
0 '+
vc • CD itJ
dam:
zCL. M
b
c o
O _CD
0-
o
OZ
r�r
w
aha
y
p'-
�
Ct7
�
N
wG
?
r
°�
n
D
z
oGc
z
A.
rt
cn
ft
^
C/
�
91
O.
x
�
a
0=3
09
GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW
POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections
INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final.
FOOTINGS: Continuous Full 2x4 Keyway
Continuous strip footings for interior columns
FOUNDATION: Rebar as required
Anchor bolts or straps
Damproofing
Foundation drain - pipe/stone/fabric filter/cover and outlet connection.
FRAME: Fireblock - over girts/plates between floor joist
Penetrations for plumbing, heat, elec, etc.
Walls at stair stringers.
Windbrace corners and center bearing partitions.
Size ridge to provide full bearing at rafter cuts.
Hip and Valley rafters - watch bearing at walls.
Ridge & Hip - Provide proper connections.
Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate.
Stair stringers - watch cuts and heal support.
Joist hangers - fully nailed w/ hanger nails.
Sill plates 2-2X6 (1 PT) w/sill seal.
Girls solid brick or steel plate bearing at foundations
" air space at sides in foundation pockets.
Lateral bracing at ends.
Certified calculations. required for Beams/LVL's Trusses.
Solid bearing support for Headers/Beams etc.
Check headroom clearances - stairways, under beams
Attic Access. (min. 22x30 w/3' headroom above).
Crawl space access. (min. 18x24).
Bath exhaust fans to have metal duct to exterior (not in soffit).
Firecode S/R wood frame of "0" clearance fireplaces & stoves
Window Schedule or Every Habitable Room Must Have:
Natural light equal to 8% of floor area.
'/ of required glazing shall be openable.
Bedrooms required min. 20x24 egress window or door.
Vent attic spaces - "proper vent", soffit and required ridge vents.
Firecode under stairs if used for storage
FIREPLACES: Separate permit required.
Inspections at Footing - Smoke Chamber - Finish
Smooth parging, clean joints, 8" solid @ combust. Surf.
DECKS: Separate permit required:
Lag to house, provide flashing.
Rails min. 36 " high, Baluster max space 5" on center.
Over 8' above grade, use 6x6 posts w/lateral bracing.
Lag all posts and rails.
Pier footings down 48", Conc. pad at stair base.
FINISH: Handrails returned to wall/newall post.
Guardrails required alongside open cellar stairs.
Exterior grading complete.
Certificate or occupancy required prior to occupying structure.
Temporary Stairs required for inspection.
Re -inspection fee - $25.00 (Be Ready).
Certificate of occupancy required prior to occupying structure.
339 9
Date. � .:- ..... . G ...... .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that/ .............. .
has permission for gas installation .. r./.. ! :5 .........
in the buildings of .. /�- ? -t.... ....................... .
at .. �.rj.l.. .l../.� r . �......k:�.��... ,v North Andover, Mass.
Fee. i.> .... Lic. No.. �.�?.�..�.- :.'......
XGAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
ijn t
Mass. Date y�/ r����Permitq
Building Location wner's Named �1
Type of Occupancy
New ❑ Renovation ❑ Replacement 44
Plans Submitted Yes ❑ No ❑
Installing Company Name ��. �- C"y !:_V4& y [% Check one:
Address �nn n Lz A !1 ❑ Corporation
/Jy e -Q ( c - -0 ( t • ❑ Partnership
Business Telephone .5 % - / 4/ S- 7Firm/Co.
Name of Licensed Plumber:. or Gas Fitter A4 r C. keep C / A4 it 1/ e 61 %1 ,k_
Certificate
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 of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNERS 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:
Owner L7 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 142 of the General Laws.
i
Byof License
`
NPlumber
Title ❑ Gasfitter Signature of Licensed Plumber or Gas Fitter
Cit�/Town 'Master
❑ Journeyman License Number 10917
O5/
_e..o.QovGo rnccicc_r_i_ G onrr�n --
■■■■■■■■■■■■■■■■■■■■■■■■■■■
pool
Installing Company Name ��. �- C"y !:_V4& y [% Check one:
Address �nn n Lz A !1 ❑ Corporation
/Jy e -Q ( c - -0 ( t • ❑ Partnership
Business Telephone .5 % - / 4/ S- 7Firm/Co.
Name of Licensed Plumber:. or Gas Fitter A4 r C. keep C / A4 it 1/ e 61 %1 ,k_
Certificate
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 of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNERS 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:
Owner L7 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 142 of the General Laws.
i
Byof License
`
NPlumber
Title ❑ Gasfitter Signature of Licensed Plumber or Gas Fitter
Cit�/Town 'Master
❑ Journeyman License Number 10917
O5/
_e..o.QovGo rnccicc_r_i_ G onrr�n --
O
z
w
W
w
0
z
H
H
H
H
W
Ch
O
A
O
H
H
H
Pa
�i
O
W
z
O
H
H
d
U
H
a
a
d
La
z
W
z
W
�U
H
a
ON
A
W W
H H
P4
O
H
U
W
a
w
z
H
;:Iel TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...........!/. `� �S ........................ ....
has permission to perform......... . A ... lq..12......0 ... 5 ...................................
...... ....
wiring in the building of ....
at ... .... ........ .
.... . ........ ....... North Andover, Mass,-;�,
d &I 7
Fee .%...�6 ......... Lic. No./�Wc .......... //-?
//ELEcrRicAL INSPECTO'
Check # K/ T
4544
Commonwealth of Massachusetts
Department of Fire Services
OARD OF FIRE PREVENTION REGULATIONS
Utliciul U. -,c Only
Pcrmit No.
Occupuncy and I"= Checked
APPLICATION FOR PERMIT Rev 1 I/99) Ir�:tycl�l:tnk, i --
All wurk to lk pertonned in accordance withthe TO,P`ERtFEQ`RcM ELECTRICAL WORK
/�/ t Cod
( E,4SL 1 l21AT iN INK UR TYP ;4LL iNFUKMATION) U,ttc: �Jc2l z� ��^tt l2.utl
City oi- Town of:
By this application the undersigned gives notice of his or her intention to Perform the ele ,cTo the ine ��% Wtrc.�:
Location (Street & Number) //L,1 i1 //e -I I -^ l work dcscribcd below.
Jwncr or Tenant
Dwncr-'s Address
s this hermit in conjunction with a building permit?
'urpose of Building_
;xisting Service Amps /
Vults
4ew Service Antos _
/ volt
lumber oriccders and Atapacity
.oration alid Nature of Proposed Electrical Wurk:
Vo. of Recessed Fixtures
�o. of Ltgltttttg Outlets
Vo. of Lighting Fixtures
qo. of Receptacle Outlets
lu. of Switches
lo. of Ranges
to. Of Waste Disposers
Io. of DisLivashers
:`o, of Dryers
o. v ater
Heaters
TclePltone No. �`7937 .
Yes ❑ N0 (Check Appropriate f3ox)
Utility uthorizatiorr No.
Overhead ❑ Undgrd ❑ NO, of Meters
Ov,.r;rcad❑ LJndbrd ❑
Nr,. of rrlcters
Completion a tile %llowi
No. of Ceil.-Susp. (Paddle) Fans
--------------
No. of Hot Tubs
S,vimming Pool rioove 1-11.
�rttd. 1:1Qrnd. ❑
INo. of Oil Burners
INo. of Cas Burners
INo. of Air Cond. I otal
Tous
cat amp um er I Cons
Totals: I
SPacelArea Heating KW
Heating Appliances KW
KW I o.o 1 0. of
Signs Ballasts
o. Hydromassage Bathtubs
THER
No. of Motors Total HP
labile may be waived by rhe inspector o% %Vires.
t o. of ataI
Transformers KVA
Generators KVA
o. o mergency Igtittng
Battery Units
FIRE ALARMS No. of Zones
o. o Detection and
' Initiatirt Dcviccs
No. of Alerting Devices
o. o Sc f- ontained
Detection/Alerting Devices
{.oral 71 untctpa
tort � Other
curity 'ystems:
of Deviccs o Equivalcut
Data Wiring:
No. of Devices or Equivalettt
::Tf,c:,j,nonuntcattons r tag:
o. f Devices or Fivare;.l
Attach additional detcil tjdesired. or as required by the Inspector of
SURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
license-- provides proof of liabdiry insurance including "completed operation" coverage or its substantial equivalent. The
lersK O certifies chat such cov ra'e is in force, and has exhibited prcnf of s: mz to the permit issuing office.
ECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:
j
rotated Value of L iectrical Work: (tiVhen required by municipal policy.) xpintion Oat.)
rk ;o Start: Inspections'to be requested in accordance with MEC Rulr. IU, and upon completion.
rrrjy, ander r tirr.r and perra/ties ojperlury, Aa1 the(njororatiort un Nr is app(ic lion r true (ucc(cunrp(ete.
:M NAME:
_nsce:
LI.C. NO.:
� / Signator
oplieable, a ter 'exe pt" in the licence rru r (i e.) IC• NO. QGYJ%Z�C
1rr_ss: S'M 774,1 13 ]. Tel. No.: �3
'�` 51'S {tVSL14Z �iVCG VI` A(V R. lam �wace thu ULe iceace doer nor nave rile I ability tn1. d— N overage norma v
tired 'by law. By ,try si,ynature bclew. I hereby waive this requirement. i am the (c eerie one) ❑owner
1cr/Agent ❑ O -per's at?e�t.
()A
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
e
.Y
vO
I
Y Vo
131'
1. NAME
� kk :ve. TY 11i i1 ..� IV et DATE Cr A /� s
2. ADDRESS x LOT N0.(-
3. NO. OF BEDROOMS-- DEN YESD NO c..-
4. GARBAGE GRINDER YES NO
5. SHOW DIMENSIONS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS OF LOT '
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL qq
9.- NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 6Q,.K
10. SHOW LOCATION OF BROOKS, STREAMS, BITCHES LEDGE OUTCROP, ETC.
LE —
11. SHOW DISTANCE OF SEPTIC TANK OR CE y.
SSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. 0