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Home My WebLink AboutMiscellaneous - 147 MASSACHUSETTS AVENUE 4/30/2018 �` 147 MASSACHjU, ft S sETA VENUE 2101006.0_00 x-0000.0 Location 147 No. 54-1-2 Date NORTq TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ ••� E Building/Frame Permit Fee $ 45 Qp sAC MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 4"3 Check # r, ;� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r Ttis' ':f6!'' I<iq BUILDING PERMIT NUMBERr+13 DATE ISSUED: O SIGNATURE: \01 a ice. ic Building Commissioner/ImeEtor of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O '17 )'USS 4L) ods y,/, ABX U V rlK A Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronta e ft 1.6 BUILDING SETBACKS 00 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: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record 6 o�Ac �13J-X w s� � J `l '7 kill /4s g ,9 urs, t Name(Print) Address for Service 0 Signature Telephone 2.2 Owner of Record: D Name Print Address for Service: O Z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ TE &oi T7- Licensed Construction Supervisor: V y 7 y�/ O 3 ...L J C LA D A-10 if U,44 License Number on Add s � (,,03-3��-��ys� - /� -�� - avid � 77Expiration Date s Signatur Telephone ra 3.2 Registered Home Improvement Contractor Not Applicable ❑ v �uyL/ry 0-'VS7leU ?- Company Name )S O /00 k.-40 ya v Registration Number r. Addres j l ft)SGAJ 03 o/ Expiration Date ^ Si nature Telephone G) 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 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building 0 Re ir(s) �, Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: Jz t" Uy/i A L L D/ /IV6 L F / y✓ /T 0 o f C lzt J� %/z�T 9/-/)IL /J 4<) SI-1 I At'6 z/es T SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of / G G 6 r 0 0 Construction 3 Plumbing Building Permit fee(a) a (b) 4 Mechanical HVAC 4t.00 5 Fire Protection J 6 Total 1+2+3+4+5 Check Number `Az)CP SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, P91 Z //J �- _ Di ��7-7— as Owner/Authorized Agent of subject property Hereby authorize RR IL//0 ( , S-9 Luiz 7 T to act on My beha all ma ers relative to work authorized by this building permit application. Si tature of Pwner Date SECTION lb OWN 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 Signature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIN4BERS IST2 No 3 RD SPAN DIN ENSIONS 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 BUII.,DIN ONk: CTED TO NATURAL GAS LINE Town of North Andoveraf NORTH Building Department o 27 Charles Street North Andover Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 7 Q�R�T60 Pp`v(h �SSAC}NS�� I I 1 f i DEBRIS DISPOSAL FORM a In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# 5-4t-) the debris resulting from the 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/at: Facility location Signature of Appl' ant )0/ _le _ C� 00 0 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. j V B t �✓fie-�animazui�,all/ a�.��a3;7ca � ; �f.. ..G BOARD OF BUILDINFiEGULATIONS, ,1j License:-CONSTRUCTION'SUP.ERVISOR 3 f Number: CS 024744 ! Birthdate X10/21/1947 Expires 10/21%2001 Ti.no: 8172 e J' _'Restncted To: 00 PHILIP L JEWETT;; 13 ISLAND POND RD: ATKINSON, NH 03811 Administrator e The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: ��} L 1 � , TIF Wj 7- l Location I L�� f�O�✓✓J %� UA City Jj(y"S O-zJ Y Phone 03 am a homeowner performing all work myself. i�m a sole proprietor and have no one working in any capacity aI am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone# Insurance Co. Policv# Company name: Address City: Phone# Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct l r Signature Date 16, Print name t� L[I J ws L 7— Phone#—a_ Official use only do not write in this area to be completed by city or town official' Building Dept []Check if immediate response is required Building Dept p Licensing Board F1 Selectman's Office Contact person:_ Phone# Health Department Other FORM WORKMAN'S COMPENSATION r10RTH Q n b Town of ovepe- amto* 1 No.jq*.; yh T CO LA o dover, Mass., oQT• /O,. o COCMICMEWICK 7q AORATED S H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT........! ... .. ................................ .... . .. !... .. ..�i ..... *.N...7(k0 ..M/Y/.. Foundation has permission to a at.... .rA.t.(............ buildings on l*7M.� i....................................... Rough ..... to be occupied as', s.P... sl�1 !�! ' ., �1. ..�! �n! IN�A ' �A/. Iney Chim 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAR S Rough 7 W� ........................... ... .�..... .. Service . . . .. .. ... .. ...... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner �• s• '�V024 70- — of s-39— Street No. SEE REVERSE SIDE Smoke Det. NORTIyMm, aers oTwn of _ 4 over? - no s....�„ . 0 No.C4rw y _ y T CO - - LA o dover, Mass., o&T. / llaoca COCMICKEWICK V 7 RATED '9S H BOARD OF HEALTH PERMIT T . D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ........! ... .. ............................: ��M.. Foundation has permission to seat... M.AiM........... buildings on ....1.47AIM.04.. W.C.9................................... Rough to be occupied as sP. &.6S*�.JA'W.. !�..�!!! ! ... IM�!! �� QED% Chimney ........ . . .. .. . . . 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR .C...... .r.A..... AA:5 UNLESS CONSTRUCTION STAR S 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner R �• S• �a0�4� - — t�s-��— Street No. IF SEE REVERSE SIDE Smoke Det.