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HomeMy WebLinkAboutMiscellaneous - 120 STAGE COACH ROAD 4/30/2018 120 STAGE COACH ROAD _ �- 210/065.0-0159-0000.0 3 ' Location NO v4l d 6 © S No. 4� ( Date NORTH TOWN OF NORTH ANDOVER Of,•�•n •,h0 J ` Certificate of Occupancy $ • i .; # 'fir#"••„.�'",�i �../ � �SSACMUstt Building/Frame Permit Fee $ Foundation Permit Fee $ j Other Permit Fee $ TOTAL $ Vis" Check # � �P �t 185 ) .j ✓ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 77 BUILDING PERMIT NUMBER DATE ISSUED:' SIGNATURE: (!/�"` r Building Comnu"ssioner/In for of Buildings Date SECTION i-SITE INFORMATION O 1.1 Property'Addresa: 4 1.2 Assessors Map and Parcel Number`:. Co^c h !2d = Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: \ ,es(LL Zonisg District Proposed Use Lot Area Fronts R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide Rapfilmd Provided RcqWred Provided v 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OW NERSIIP/AUTHORIZED AGENT l i`t i 1 ot: 'yrz', -No o rn 2.1 Owner of Record yOMAS Name(Print) Address for Service nature Telephone )2.2 Owner of Record: \ Name Print Address for Service: z M Signature Telephone SECTION 3-'CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: 0 License Number n� Address Expiration Date 3 Signature Telephone r .2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number r Address Expiration Date i Signature ___ 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 will result in the denial of the issuance of the building it. Si ed affidavit Attached Yes.......❑ No....... 0 SECTIONS Description of Prosed Work check a8 a bk New Construction ❑ Existing Building ❑ Repair(s) ❑ J Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition K Other ❑ Specify Brief Description of Proposed Work: k! Qkh av{ Ex�s�ihc pec/�T�'` ! ,c�e� �sLcLos� G1ec - S A,tlr S P � � �o?� f D ( 41 �? SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed bpermit applicant 1. Building (a) Building Permit Fee g oo a 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+5 000 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT w I, ��•� as Owner/Authorized Agent of subject property. Hereby authorize to act on My behalf,in 1 matters relative to work authorized by this building permit application. Sr a of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION j i I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are Prue and accurate,to the best of my knowledge and belief Print Name Si cure of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IS r2' 3RDl SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GMDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY 1S BUU DING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE • C2eplAc� �-� ( 14 h�362 '� <�CIOQJ"� 19n9ts¢eP ` L-/ FORM U - LOT RELEASE FORM ( ` 2- INSTRUCTIONS: 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_7ROM65 munA1,aH PHONE 2f-- 27�q LOCATION: Assessors Map Number . PARCEL DOa /3 9 SUBDIVISION LOT(S) _ STREET,2 Q 6t&&E CO p CA � ST. NUMBER /90 OFFICIAL USE ONL TO NTS: CO RVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS W C i TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9W Jm CERT/F/ED FOUNOAT/ON.P4-A LOCATED /N; r� �1 saE ; ►�-�A ..SCALE.%"_ DA7�89 o� SL.G/LES R.L.S L AWRENCENORTH ANDOI/ER; 2 I : S.- '�4 t g� w 6 ry e A.: J t \ ' ' I �•'7 r 4'� f .J 2 A t � 4 ' _ a ti� - a a• CE TF'Y THAT TH OFF5E7'S S./-�OI�YN ARE#FOS? I HE' 1SE D ssti ; �.... ,fr: THE BU/L D/l�/�Y�i//I/ P' f� N��Y 4��vSfJC �x �OFF.SE TS SHOtN,N'' 4 �. ECT© � _ �� ��� i s� ri -'.,`fix *�' *�' rn,. .t3.s_`. ids.5`a�'t irk R'e Ys ��::� ��+� �R *�•`r,4� �„..,'"� y�M -:Fi, r $�. �`7�e� 4.?< "j * CONFORM TO Ti�1EC/. *E /S FOR€DEER /� iA�T/D / Dili/NCS f 7:N-A f �, a _ZO/I/%NG B Y L A'�W(7F CDNFOR1977 �Y OR %I/ONCDII�iDR /gipp`Y � '- ��' xx-' � f ` r Gt�/1STRUCTEOxs AORTil q r O Stereo .,6.1'� O A Town of North Andover Building Department 27 Charles Street 4"s CHUs North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE 7 A2 JOB LOCATION m Number Street Address Section of Town "HOMEOWNER 1? 92- 7J?/— X33- x'407/ Number Home Phone Work Phone PRESENT MAILING ADDRESS /,Q0 S-taEa7 Coa,[ aej- 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 e e dual for hire who does 9 9 not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) 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 to six family dwelling,, attached or detached structures ac- cessory to such use and and/or farm structures. 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, 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 Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. 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: . pVv,�ps*gin 01w�a� n�,�4.•,��tl � (Location of Facility) Signature,16f 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 t Bio WHE 41 1 Ig I �G l weuww' iv�.nw�ra 'w+uww',"�m 4 1 { to L �- •_ tbppyy4y!" ��h .. F;" div � + ry� a dh ,:YiG ,p� �1.• F. er~ A d g , T } f jS R , ._.._._ ..c.6 Ar V R xaI C'Kp y�� y! 4. r -PH . . r W L 1� tioo_ r a D C, LA P BOA RD5 j c �0, (c+c A if 41-c3 _.- Z , BID pS fir.._.. .. .� -. - ......o......d../� / X IO / d - o e tY f m d /i �I r ' pin. D LcpD m PU 646,--,e ROO-? l'-0 16 r NT ORH '9 TO" Of s . .. 4Andover No. .,�..�.,.. �o * _ _7 _ Qr ® 8 O T LA C�OVer, Mass., J COCHICKEWICK y1. 7�AORATED S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT o.�.A a '1 vrr ............................................... .......... ...... Foundation has permission to erect....1.9043 P.... building on...�a S /Upi C.0 1 C � Rough ,..................... ...... .................................. to be occupied as....: .p�N ... 10 C (4`t I ft, Chimney provided that the person accepting this permit shall in every respect conTorm to the terms of the application on file this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. 6S� 9► PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTI NT TS � 4% Rough .... ..IN . .... ... service UILD G INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove h Rnal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.