HomeMy WebLinkAboutMiscellaneous - 12 WATER STREET 4/30/2018Location ~ « A S4 W AA e
No. r7 Date -
,.ORT#1
TOWN OF NORTH ANDOVER
° OL
A
Certificate of Occupancy
$
s',^°''��
,I "ust
Building/Frame /Frame Permit Fee
9
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check # I b
'175 u 8 N AA
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATf2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: 1 -7e -I DATE ISSUED:
SIGNATURE: Itt
Building CommissionedI for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Numbed Parcel Nurfiber
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
3 Com. � � `✓� � r 1° �� Cis'► jgr� cS
Name (Print) Address for Service
Signature Telephone
x,2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable
1
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
R
Not Applicable 0
Company Name
I
Registration Number
Address
Expiration Date
Signature Telephone
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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.
affidavit Attached Yes .......❑ No ....... ❑
-Signed
SECTION 5 Description of Proposed Work check sv
applicable)
New Construction ❑
Existing Building 0
Repair(s) ❑
Alterations(s)
Addition ❑
Accessory Bldg. 0
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
replt,c'eAV(1t �1` ���3 cif �d�rtr) s>
r r�wd�l 2
SECTION 6 - ESTIMATED CONSTRUCTION
COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
UFF)<CIAL USE ONLY
1. Building
2_1J
(a) Building Permit Fee
Multi lier
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 I4umber
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 permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENMDECLARATION
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
QA
Print apr► � �f _ _ T 7/.4
Signature of Owner/AgentDate �f
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIlvIBERS 1 ST 2ND 3 Fw
SPAN
DIMENSIONS OF SILLS
DIN ENSIONS OF POSTS
DIMENSIONS OF GfRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUII,DING CONNECTED TO NATURAL 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:
r G6rzz- t '>o
(Location of 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
Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 01845
D. Robert Nicetta
Building Commissioner
(978) 688-9545
(978) 688-9542. Fax
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE
JOB LOCATION
Number Street Address Map / lot
"HOMEOWNER
Name
PRESENT MAILING ADDRESS
INC14h,
City Town
Home Phone
State
Work Phone
,
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 onehome 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 procem
HOMEOWNER'S SIGNA
Zip Code
APPROVAL OF BUILDING OFFIC
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Date. -,��/....'.4.. �.�....
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation .................... .
in the buildings of ..... F: .......:...!........................
at�.... r...:.!. �.. ,
.............. .North Andover, Mass.
Fee..:.... Lic. No...... .
Check #
.................... �....
GAS INSPECTOR '
J%!�V�e
MASSACHUSETTS UNIFORM APPLICATON FOR PfRNffrTOW GAS G
or print) Date () 3�
NORTH ANDOVER, MASSACHUSETTS
► ff '� � ✓ ��
Building Locations Permit 9 -- W�
Amount S 'LJ
Owner's Name /Db -Z JZ S
New C�/ Renovation Replacement Plans Submitted ❑
(Print or
Name_
Name of Licensed Plumber or Gas Fitter /T /E(J/ C-/I'(-L1}-164A�
Check one: Certificate Installing Company
E-Iebrp. I ; =
Parmer.
❑ Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑— No❑
Ifyou have checked Nes, please indicate the type coverage by checkingthe appropriate box. Bond
❑Liability insurance policy ❑— Other type of indemnity ❑
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
N/fass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Sianature of Owner or Owner's Agent Owner ❑ Agent ❑
i hereby certify that all ofthe details and information I have submittea (or enterea) in apove appucauun .LIQ LILLY. 1.1 111--- -
best of my knowledge and that all plumbing work and installations pertbrmed under Permit Issued For this application will be in
compliance with all pertinent provisions of the :Massachusetts State Gas Code and Chapter 141- of the Gene. -al Laws.
By:
Title
CityiTown
APPROVED uErici. usF )NI.v)
Sienature of Licensed Plumber Or Gas Fitter
❑ Plumber t - 3 yy (�
r—,4,-(!Tas Fitter icense ;Numoer
Eilvlaster
❑ Journeyman
F
(Print or
Name_
Name of Licensed Plumber or Gas Fitter /T /E(J/ C-/I'(-L1}-164A�
Check one: Certificate Installing Company
E-Iebrp. I ; =
Parmer.
❑ Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑— No❑
Ifyou have checked Nes, please indicate the type coverage by checkingthe appropriate box. Bond
❑Liability insurance policy ❑— Other type of indemnity ❑
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
N/fass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Sianature of Owner or Owner's Agent Owner ❑ Agent ❑
i hereby certify that all ofthe details and information I have submittea (or enterea) in apove appucauun .LIQ LILLY. 1.1 111--- -
best of my knowledge and that all plumbing work and installations pertbrmed under Permit Issued For this application will be in
compliance with all pertinent provisions of the :Massachusetts State Gas Code and Chapter 141- of the Gene. -al Laws.
By:
Title
CityiTown
APPROVED uErici. usF )NI.v)
Sienature of Licensed Plumber Or Gas Fitter
❑ Plumber t - 3 yy (�
r—,4,-(!Tas Fitter icense ;Numoer
Eilvlaster
❑ Journeyman
Datel~..: ......
y N°
TOWN OF NORTH ANDOVER
' PERMIT FOR PLUMBING
This certifies that ......:...........................
has permission to perform .....: ....... ..................
plumbing in the buildings of ................
at ...........'. `.. '.�-. � ............ North Andover, Mass.
ov
Feel ......
Lie. No m? .... ............. fl............
PLUMBING*INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
nx MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
IN
1J i N�fl �1 e�g--- Mass.
Building Location a E
Date..NI'd-LV2,.CSA
;JP Tefz S ( U
New ❑ Renovation ❑ Replacement
FIXTURES
Owners
Permit #
g4fMIc,PACL -Q
Type occupancy
Plans Submitted: Yes ❑ No ❑
010
installing Company Namef' 0t'>EeT a - SPM MATAeQ Check one: Certificate
Address_ Cc i4C H ma n) '�. Pi ❑ Corporation
IY) E! N 0 FA) Y11 Ay IT VL,/ ❑ Partnership
Business Telephone _ /Ic, Z -c/q7 L.t"Firm/Co.
Name of licensed Plumber 'Z 6 F e- T fhb-
INSURANCE
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INSURANCE COVERAGE:
I have aY usrrent jability ❑insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
If
It you have checkedsYLe, please indicate the
. � type coverage by checking the appropriate box.
A liability insurance policy 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. General Laws, and that my signature on this permit application waives this requirement.
Check one:
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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws.
�' 'ZL•L
Title koMre o censed Plumber
City/Town
Type of License: Master Joumeymab E]_
APPROVED OFFICE US ONLY) License Number
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installing Company Namef' 0t'>EeT a - SPM MATAeQ Check one: Certificate
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Business Telephone _ /Ic, Z -c/q7 L.t"Firm/Co.
Name of licensed Plumber 'Z 6 F e- T fhb-
INSURANCE
hb
INSURANCE COVERAGE:
I have aY usrrent jability ❑insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
If
It you have checkedsYLe, please indicate the
. � type coverage by checking the appropriate box.
A liability insurance policy 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. General Laws, and that my signature on this permit application waives this requirement.
Check one:
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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws.
�' 'ZL•L
Title koMre o censed Plumber
City/Town
Type of License: Master Joumeymab E]_
APPROVED OFFICE US ONLY) License Number
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Location
No. '
Date . - -, -
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$_
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
M
Ea
TOTAL
$
Building Inspector
r,
Div. Public Works
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Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
v DATE f i' �� 7
SOB LOCATION
Number
� r
''"HOMEOWNER
ame
tr.eet Address
Home Phone
L, RESENT MAILING ADDRESS S (r411? .F -
Section of town
Work Phone
IL
City Town 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, Section 109.1.1)
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
:-eside, on which there is, or is intended to be, a one to six family dwell-
io , attached or detached structures accessory,to such use and/or farm
_ructures. A person who constructs more than one, home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
to the Building Official, on a form acceptable to the Bulding Official,
that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
he undersigned "homeowner" assumes responsibility for compliance with the
i.ate Building Code and other applicable codes, by-laws, rules and
,-egulations .
The undersigned "homeowner" certifies that he/she understands the Town of
North Andover Building Department minimum inspection procedures and
requirements and that he/she will comply with said procedures and
requirements.
A
L460MEOWNER'S SIGNATUR
PPROVAL OF BUILDING OFFICIAL
dote: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
Control.