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Home My WebLink AboutMiscellaneous - 14 SALTONSTALL ROAD 4/30/2018 Location No. Date '' A NORTIy TOWN OF NORTH ANDOVER 0�� . o ,o,1•C h 9 ± Certificate of Occupancy ' $ • i : i z ACM Building/Frame/Frame Permit Fee $ } sswcMusE 9 _ Foundation Permit Fee $ Other Permit Fee $ n TOTAL $ /Ca t I w Check # 18934 Building Inspector T. i } TOWN OF NORTH ANDOVER WELDING DEPARTMENT APPLICATION TO CONSPRUCT REP RENOVA OR DEMOLISH A ONE OR TWO FAMILY DWELLING - _. BUILDING PERMIT NUMBER DATE ISSUED. (74SR ^ & SIGNATURE: Building Commissioner r of Buildings Date 2 SECTION I-ME INFORMATION 1.1 Property Address: 1.2 Assessors Map and Pared Number. C A- S A.L- o k—A.LL QI R-D �69rl" nue,n� Map Number Pared Number1.3 ZoninggInformation: / 1.4 Property Dimensions: MONO Zoning 'd Proposed Use Lot Area Fronts fl 1.6 BUILDING SETBACKS B Front Yard Side Yard Rear Yard Required Provide Required Provided Reqwred Provided C 1.7-Water Supply M.c.1,.c.40. ser) 1.3. blood Zone Monnation: 1.8 SewerW Disposal Sys— Pebtic ❑ Private ❑ Zone Outside blood Zone ❑ Municipal ❑ On Site Disposal System ❑ s SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record l4 5AL16IVS u�-�.� TRUS1 \A- SAuToss-tRc.L P,D, Name(Print) Address for Service: AAf Signature Telephone e 2.2 Owner of Record: o Name Print Address for Service: C. 2 n Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Not Applicable ❑ � �A$2 1� mUle��4 t �f2. CS, 3 B Licensed Construction Supervisor. 041) C License Number � 7115146 Expiration Date Signature r Telephone `. 3.2 egistered Home Improvement Contractor Not Applicable ❑ C Company Name l�f,Q / � 96-83 n Regi Number r d � � I a r `L7F �7" f�4 Expiratmon Date G t ui�mxcurc i cicpuvuc 1 1 • t I' SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit glust be completed and submitted with this application. Failure to provide this affidavit wilt result in the denial of the issuance of the buildipdpermit. Signed affidavit Attached Yes......V No.......0 SECTION 5 Description of Proposed Work check ail applicable) New Construction 0 Existing Building 0 Repair(s) Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition 0 Other ❑ Specify BripY�I�e scription of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building �` / pp (a) Building Permit Fee FP (� Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)R(b) 4 Mechanical HVAC f 5 Fire Protection 6 Total 1+2+3+4+5 Check Number r09 41: SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I �AR6( • os E: as Owner/Authorized A property P Agent of subject D A � g J Hereby_ authorize 'POUR-T _b, MVIR6'A Tr- to act on J My alt;in all matters r tive t ork autho ' ed by this building permit applicatio St nature 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 A RoLD Print Name Signature of Owner/Agent Date rim; i I 1051 INN NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IS12 ND 3 RD 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 F XAORTH own of tAndover No. � C% over, Mass., COCMICMEWICK ��• �d ADRATE D `r BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR PECTOR THIS CERTIFIES THAT....... � � At, .46414-01-60 ............. .. .............+.../). Foundation d has permission to ... .. . .� . b cn� . .. g �... �. ..�� .. Rough A ' Chimney to be occupied as.. 11 ......:. .. !!rl./.. : �..II �. . R. ... ............................................................... y provided that the person Apting this ermit sha every respect confore the terms of the application on file in Final this office, and to the provisions of the Codes and y-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ................................................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous--Place on the Premises - Do Not Remove Final 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. i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ivivw.mass.sov/dia t : Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers applicant Information Please Print Legibly Narne ZmeQ•r x Mop t 7P, Address: S%R ,E7 City/stateiZip: U R W. Phone #: ?'7A Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I atn a general contractor and 1 6. ❑ New construction Xemployees(full and/or part-time).* have hired the sub-contractors 7. Remodeling 21 am a sole proprietor or partner- listed on the attached sheet.'+ ❑ ship and have no employees "These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers'comp. insurance. Y P ty� 9. [] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.0 Electrical repairs or additions required.] ;.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself. No workers'comp. c. 152,§1(4),and we have no 2 y [ p. I_❑ Roof repairs • insurance required.]t employees. [No workers' 13'0 Other O"IR r46"176comp. insurance required.] Any applicant that checks box d 1 must also till out the section below showing their workers'compensation policy information. *Homeowners who submit this attidavit indicating they are doing all work and then hire outside contractors must submit a new affidavil indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy ..4 or Self-ins. Lic.It: Expiration Date:_ _ Job Site Address: City/StateiZip:__________ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of ti1GL c. 152 can lead to the imposition of criminal penalties of a fine up to$1.500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a brie of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ilo hereby •,rtif}-ander the p itis and enallies of perjury that the information provided above is trite and correct. Si mature: � nate: �¢ 6 Phone 1: 7_—LCL`yik -- -- — – t)yjic•ial use only. Do mol write in this area,it)be completed by city or town g1ficial City or Town: Permit/License# Issuing.Authority(circle one): 1. Board of Hcalth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: . Phone#: s <_ t' TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: 7 Z JOB LOCATION: -�'� G^'sti 14umb6r Street Address Map/Lot yy J. !J HOMEOWNER / ,( /�� ✓ ~ �� Name Home Phone Work Phone PRESENT MAILING ADDRESS //)/o City Town . State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to 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 HOMEOWNER 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 structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner" assumes responsibility for compliances 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 North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE _ APPROVAL OF BUILDING OFFICIAL Rwised 10.2005 Form Homeowners Exemption 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 at: 14 Sa_-TAns-�Au �D- is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL C 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: vi-To �. 'bWCXL Zl%b �ALFM (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date �, ✓lze�omrmzo�zaea� a�✓�aaaoclucaella .. BOARD OF BUILDING REGULATIONS - License: CONSTRUCTION SUPERVISOR Number CS 042493 Birthdate 07115f1957 Expires:-07/1312006 Tr.no: 690.0 Restricted::00 ROBERT D MURGIA JR'' 8 CANTERBURY ST, C ANDOVER, MA 01810.' Commissioner Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration:_109583,p One Ashburton Place Rm 1301 Expiration: g/2.1/2006 Boston,Ma.02108 Type: Individual ROBERT D MURGIA;JR ROBERT MURGIA,JR 8 CANTERBURY ST ANDOVER,MA 01810Administrator Not valid without sig ature -i�lnARD D: r U1Lt (NG�E6-I��.A:ZIOrIS �- Residential Property Record Card#1 of 1 s PARCEL ID: 210/015.0-0034-0000.0 MAP 015.0 BLOCK 0034 LOT 0000.0 PARCEL ADDRESS: 14 SALTONSTALL ROA as of: 1/11/2006 PARCEL INFORMATION Use-Code: 101 Sale Price: 0 Book: 00091 Tax Class: T Sale Date: 8/5/1994 Page: 0005 ' Tot Fin Area: 1673 Sale Type: P Cert/Doc: 12000 Tot Land Area: 0.14 Sale Valid: F Owner#1: 14 SALTONSTALL ROAD REALTY TRUST Grantor: DUSHAME,HAROLD Owner#2: H A DUSHAME&D CHAMBERLAIN,TRS Address#1: 14 SALTONSTALL ROAD Inspect Date: 8/16/2005 Road Type: T Exempt-B/L%: / Address#2: Meas Date: 8/16/2005 Rd Condition: P Resid-B/L%: 100/100 NORTH ANDOVER MA 01845 Entrance: X Traffic: M Comm-B/L%: 0/0 Collect ID: SGC Water: Indust-B/L%: 0/0 Inspect Reas: M Sewer: Open Sp-B/L%: 0/0 RESIDENCE# 1 INFORMATION LAND INFORMATION NBHD CODE: 5 NBHD CLASS: 5 ZONE: R4 Style: CO Tot Rooms: 6 Main Fn Area: 1067 Attic: Seg Type Code Method Sq-Ft Acres Influ-1/2/3 Value Class Story Height: 1.75 Bedrooms: 3 Up Fn Area: 606 Bsmt Area: 1067 Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 6000 0.14 100/ 156950 Ext Wall: AB Half Baths: Unfin Area: Bsmt Grade: Masonry Trim: Ext Bath Fix: Tot Fin Area: 1673 Foundation: ST Bath Qual: T RCNLD: 128716 Kitch Qua]: T Eff Yr Built: 1962 Mkt Adj: 1.2 Heat Type: HW Ext Kitch: Year Built: 1928 Sound Value: Fuel Type: G Grade: A Cost Bldg: 154500 Fireplace: 1 Bsmt Gar Cap: 1 Condition: A Att Str Vail: DETACHED STRUCTURE INFORMATION Central AC: N Bsmt Gar SF: 209 Pct Complete: Att Str Va12: Str Unit Msr-1 Msr-2 E-YR-BIt Grade Cond %Good P/F/E/R Cost Class Att Gar SF: %Good P/F/E/R: /100/100/76 Porch Type Porch Area Porch Grade Factor P 118 E 25 VALUATION INFORMATION SKETCH Current Total: 311500 Bldg: 154500 Land: 157000 MktLnd: 157000 3 1 20 Prior Tot: 290400 Bldg: 145100 Land: 145300 MktLnd: 145300 5P 5 6 1 31Ft. 1 PHOTO FgU'50.75 80PApBFt. 1067 Sq.Ft. , Lj 27 w" 35 t# � 5 11 5 E 5 P 8 , ,. 5 t' 103 Sq.Ft. a 3 14 SALTONSTAL AD 41, Location �� A No. C Date v 41�oRTN TOWN OF NORTH ANDOVER F 9 ' Certificate of Occupancy $ ITS CHUS• ta Building/Frame Permit Fee $ .r s� A Foundation Permit Fee $ 4 Other Permit Fee $ TOTAL $ Check # 13 Building Inspector rte' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissionerfl for of BuildingsDate SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 14 Sat&rw.;ta U Road 015 034 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record #aao, d A dui/tame 14 Sa.G orw.&U /goad � Name(Print) Address for Service: 8 682 8i27lW„ Signature Telephone 2.2 Owner of Record: Name PrintO Address for Service: 7.M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ 4 icensed Construction Supervisor: License Number m *Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M�p�pqq Registration Number rM Address Expiration Date ^� Signature Telephone �/ SECTION 4-WORKERS COMPENSATION(1VLG.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 ❑ Existing Building XO Repair(s) N1 Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: New �hlnqL'4 011 en,4j,74- a04)4 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to bet�T3�CALUSE+ ONLY, Completed by permit ap licant 0 &m a 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 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 permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, �� 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 �2 �Q W 1 /ice Si attire of Owner/A ent Date y NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number r Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Signature of Permit Applicant �Ijnxe 2000I Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector r s ' ,ORT, Town of Andover ry O _ • o " dower Mass. 46- 13 COCHICHEwICK A0RATEO BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....../t,I�4. O...�..........7..t�.S.....A ................................................. . Foundation has permission to erect...+., .� .�..�......... buildings on ......�.......S.d..N&P.W.4Y .4P................ Rough 0S�a Chimney tobe occupied as................................................................... ..... ............................................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. A /s p 4? t/ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 7 Rough �a a Final PERMIT EXPIRES IN 6 MONTHS e� ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N S �\ Rough ` ...................................... Service ......... .... .. .. .................. BUILDING IN Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final 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. NORTH own of 4Andover . o �ILA o dover, Mass., 6' 13' O a COCMICMEWICK V A�RATEO S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....../.....�4......Q. `�.. ......... �. .. Foundation . ..................... has permission to erect...S. RAJ ............ buildings on ....... ..........SA.140...�.�fo...,(�................ Rough 0 z� � Chimney to be occupied as......................................................................R.............................. ........................................................ y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 0% PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI NELECTRICAL INSPECTOR 4SS. Rough ...`.... .......................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final 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.