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Home My WebLink AboutMiscellaneous - 15 ROSEDALE AVENUE 4/30/2018 / 15 ROSEDALE AVENUE 210/047.0-0038-0000.0 PC2.S14eCA le, ' Location s� g� No. 13C� Date MORT� TOWN OF NORTH ANDOVER Certificate of Occupancy $ — ;� MUs E�� Building/Frame Permit Fee $ <tC Foundation Permit Fee $ Other Permit Fee $ TOTAL $ d Check # 16 Ilk • , 9 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING 771 Wo BUILDING PERMIT NUMBER: DATE ISSUED: m / J SIGNATURE: Building Commissioner/InTedor of Buildings Date SECTION 1-SITE INFORMATION I Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O -... V q L Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R redProvided R 'red Provided —+1.7 Water Supply M.G.L.C.40. 1.5. Flood Zone Information: 34) 1.8 Sewerage Disposal System: Public g Private ❑ Zone Outside Flood Zone I( Munibipal ) On Site Disposal System 0 SECTION 2-PROPERTY OWNERSIDPIAUTHORIZED AGENT rilsloric Is rIC : es No rn 2.1 Owner of Record l Name-- Address s for Service Signe Telephone 2.2 Owner of Record: name Print Address for Service: Z Srjnature Telephone rn SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed onstruction Supervisor: 0 0 Y !�4 O C License Number an Address S q,0 M a a> �� '� V t� �/� E iration Date p ic xP Signature Telephone r 3.2 Registei6d Home Improvement Contractor Not Applicable v .4 Company Name M Registration Number r Address r Expiration Date /Z/� Si nature Tel hone Y/ ,e 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 b 'lding permit. Signed affidavit Attached Yes......0 No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: X"t �,J� e 0A/ lig�/� /P h�l:•��ly� � _ .il. Lfi 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 Construction 3 Plumbing Building Permit fee(a)X (b) Q 4 Mechanical HVAC Cly--f 5 Fire Protection 6 Total 1+2+3+4+5 10 4 , Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNEM AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property —V Hereby authorize �/C t. C- w f'� to act on M ehalt,in all matters rela ive 0 work thorized by this building permit applicatiod (�. i nature of O Date / SECTION 7b OWNERJAUIYORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject 4 pr He y declare that the statements and infomnation on the foregoing application are true and accurate,to the best of my knowledge and belief s/ / Print Nome Si ature of Owner/Agent Date/ / NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2JD3RD 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 NORTh TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street A.,° North Andover Massachusetts 01845 ss,�c�st� D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print JOB LOCATION: /Sn Number Street Address Map/Lot HOMEOWNER,; Y/„-T f s� ( Name Home Phone Work P one PRESENT MAILING ADDRESS &0 j f n)"o/e ,9 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 I - requirements. '4" HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL BOARD OF APITALS 48£+-9541 CONSFRV ATION 698-9530 111:1,M111 6SR-9540 PLANNING ORS-9535 TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: 114,, Xli� I�A S, ;�,� �` SS�n_ J' r- Est. Co6 c;d , CIO Address of Work 9-<-e '� Owner Name: - a ,�,p� �� a 4 _ le-6 Date of Permit Application: � � o I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner-occupied —7—Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: hereby apply for a permit as the agent of,the ownor: S' 1 �. Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: y !y /J Date / 7 ner Name AORTH F Town of _ _ over No. 138 dover, Mass., Q LC E COC HIC HE WICK y D)�ATED P`PG �47 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System /�Z s � O ��S BUILDING INSPECTOR THISCERTIFIES THAT........ 8r.i�...................................................................................................................................... Foundation has permission to erect... ........... ...........r... buildings on ........... ......... ... ..... Rough to be occupied as..XS*A p 1N1 JaS S tat!0 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. C/.' ,03 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARS Rough ..........6411.. .... .. ... .... Service .... ... ....... ... ........ BUILDING INSPECTOR i 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. r SEE REVERSE SIDE Smoke Det.