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Home My WebLink AboutMiscellaneous - 161 CAMPBELL ROAD 4/30/2018 (2) / 161 CAMPBELL ROAD 210/106.B-0079-0000.0 \\\ i i I f i i I i � Location 1 No. 5 Date 4 NORM TOWN OF NORTH ANDOVER i 0`? : • L9 ' + Certificate of Occupancy $ Building/Frame Permit Fee $ � ACNUS Foundation Permit Fee $ F Other Permit Fee $ F TOTAL $ 42E Check # r i 1748 Building Inspector I' I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1 n�Vaa�VDG Y7tst BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/1for of Buildings Date ' SECTION 1-SITE INFORMATION I Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O r� 1 Mpb4e-�! Map Number Parcel Num 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 R red Provide ReqWred Provided Required Provided v � 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 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT htsturt Disrrict: Yes 110rn 2.1 Owner of Record Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z m Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ rLicensed Construction Supervisor: O License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 v Company Name m Registration Number r Address r Z Expiration Date P1 Signature Telephone v, R SECTION 4-WORKERS COMPENSATION(NLG.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 ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: r\ Seng f o / 301, 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 of0 Q Construction 7 3 Plumbing Building Permit fee(a)X (n) 4 Mechanical HVAC 5 Fire Protection j 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 1, ;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 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 Print Name Si ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS iST2ND 3RD 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 s FORM U v LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fro Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. i *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT (�t�i��/�/t2 H'1 GCS r-i' h(� PHONE LOCATION: Assessor's Map Number _/01� /3 PARCEL 00 ?9 SUBDIVISION LOT (S) STREET �4 M ST. NUMBER �6 *****************************************OFFICIAL USE ONLY******* **** ******* REC MENDATI � O TOWN AGENTS: CONSERVATION ADMI STRATOR. DATE APPROVED DATE REJECTED COMMENTS SfQ_e._ �"4 i n GnSerjAro_ Folder TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS Q� �� l `P PUBLIC WORKS -SEWERMATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm � h,UFYYFt� Town of North Andover Building Department 27 Charles Streett North Andover, MA. 01845 ,q sACHus£ D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542.Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE 0- JOB LOCATION G t ^` �Obe �� 2D�-1 /06 !3 79 Number`` Street Address Map/lot "HOMEOWNER �-t1 i t ti MA 7 S'- Name '-fiome Phone Work Phone PRESENT MAILING ADDRESS (C L te o 4 d City Town State Zip Code The current exemption for"homeawners"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 one home 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 procedures and requirements. HOMEOWNER'S SIGNATURE 67 z APPROVAL OF BUILDING OFFICIAL a The Commonwealth of Massachusetts a d Department of Industrial Accidents Office of investigations Boston, Mass. 02191 Workers'Compensation Insurance Affidavit Name Please Print Name: W/ a,r+k. Location: ( r!o I CG- ►'�UJ (o e ( R o o d Ci rfk naJ60c Phone # 9 7 f" 9 7 5-- I I am a homeowner performing all work myself. . I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone- insurance. hone Insurance.Co. Policv# Company name: Address City: Phone#: Insurance Co. Policv# Faiture to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonment_as_w.ell as_civil.penattiesin.thefnrmofa_STOP.W.ORK ORDER.and a fine of.(.$iD0..00.)aday. 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permitil-icensino Building Dept ❑Check if immediate response is required Licensing Board ❑ Selectman's Office Contact person: Phone#: F� Health Department Other 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 c 11, S 150 A. The debris will be disposed of in: (Locatioh of Facility) Signature of Permit Applicant -�y-a/4/ Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTH 0VM Of _ Andover No. LAK V� dower, Mass., A. COCMICMEWICK ORATED P\' Cl S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......................e..!!�..A./. 4.. ..........�..9...C..�..��..�...................... Foundation r // oA has permission to erect.. .�.. ..a. ..�.... buildings on .....I.. ./..... A.1" ........ ................ ............. Rough to be occupied as 400...I"DIV T FA R..m E s O * G 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-Law relating to the Inspect' n, Alteration and Construction of Buildings in the Town of North Andover. � 94608 L 08/ /f 9p PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ARTS Rough ...•.........................../.... 4.6 ........ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, 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 j II . � � 1 b / I f 6 1 °7 f+ No. 'i64 ��C �O��P _ Os •I / N� X J� �F\`Ti \gyp, M O 1 i C17 I A VL VV Vl./I.1V kL-I NSW GA�� r;00r ° MA1�I-I �XI51"ING t?OOr SI�OpC - - - - - - - - - - - - - - - - - - - - - - - - -_ _ _ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ICF-/ WATF I? 5N1 E L P ____ __ - _-_______________ _ _ ___ ___________________ VALLCYFLA5NING �pOV I b� GAI3� OVA pNANG - - - - - - - - -_ _ _ _ - ___— _____ xl S�rI NG IN��I?IOI? CQLIAL �OUAL FAMILY FOOM WA-1-5 NF-W P.H. WINDOWS NrW POOPI/ 51PE�LIGI-IT UNIT I FOYr-IP, CXl5TING 2NP FL-C)O2 'ANPF-p5l%N' C� OVF-�I2NANG C Ar:5OVr> TW 2646 Nr--w 2 - 1 ?5/ 4'' X51/ 2'' O, MICf;OLAM LVL 51- SL I I I I- F-O, FU ----------------- • __I I 1I NCW GA13LF- 13AY Pr:OJF-CTION M30V-�> I I pl aN15 FGf'. MCCAFTHY F�51 b�NCS pAILING 161 CAMP[3�LL t?0AL? .' Saps llr? � 4 4 A, e X WOOF P05T NOP.1"N TO �I N I SFIN15N G�'AI�� ANPOVEF, MA �Ar> ppOVlpr FINISH T WOOF r5"IM �NCLO5UrlC T FIP5f FL00P ftAN xA,EV,q" - 1'-O" Ail, 6/i:/O? < ppOr'U5C1�> I M t 4 I pI ANsFOP OU1 LINA O� NFW t701?Mr-I- Y A� MCC I C I CAMpL3� I?OW �bOM" MA NO�� I' „ �� bA1E•.6/13/Oa I NSW WINDOW N�At��M 2 ' 2 X 8 CI X r L_yWOOe INC I z II � 2X6A�" I6"OC I 1 V LAST o T>O�)x INC �MAMINC 1'YpICAL CAVCS ��'AIL�, ,� FASCIA & 50F1'11- l"0 MA�CN �XI51'INC CONTINUOUS 5O'I%IT VONT / METAL bMIM - - ICS/ WADI? 5NILLb \ r-XI5-nNG Hr-AM-Z WE,kMj�1': I'ZL 5151'AN'r WOOD I��CKINC ' CON�'IN3OUS `�001� r3�M "'� 2 � LX'I l MIUM r'LYWOOI2 FL-A51-1 r3C1WCl%N CXI5TINC/ NCW MAILING �t;A1�l� LATTICE WOMK bA TM�A��I� 2 X 6 LCbCC : . "'`: LAG BOLT TO EXISTING rMAMING , ' r y: -�-� 6 Al16" ,C' 2.x X 12" nIA• noupr.:r� cONcpr-.-r� plrr�• ,,,� ••j�., Gp,I,VANIZ�b POST ANCNO� J 1,�^ �� 4 X 4 Ti'CA1r b \N000 i �XIs�INr• pp0i'O�n I' 11�ICW- Cp055 5�C(ION A I r _ . FLAN5 ra, FFMCCAMY P,�5M NCS I�OF?M�p �1�p5 2 X 6 AT 16" OC 161 CAMPf3��L f?OAb NOPTH ANPOV�P, MA TYPICAL F-Xlr--PZOP WA-l-: 51PING TO MATCH F-X15TING EULf21NG WP.AP 1/ 2'' COX PLYWOOD 5HF-ATNING I I NSW 13�AM;2 -I �/� X 9 1/z" 2 X 4 AT 16" O.C. I I MICIPOLAM LVL. t?-15 FTr32G l 1LA5 IN5UL.ArION rI20VIpl� .1 X .4 W0017 1005T POLY VAPOR f3APplF-l? 2 I AT EACH F-NIS OF 13�AM I/ 2" 6M3 12rMOVC C-XI5TIN6 WALL IN5ULATC 1"0 I I �/ T&6 PL-YWOOP JIrCKIN6 F=ULL rCpTH OF NAIL & CAL-UG TO FPAMIN6 �pAMING NEW C3F-AM; 2 -- I j/a" X 5, 11211 MICPOLAM LVL 2 X 6 Al- 16 ' OC ALIGN I�IhCCTLY UNI�Lh f LOOK J0151"5 NEW POPMI;I, WALLS - XI112CA1'Cb WOOD P05T rXI51-IN6 F:X1"F-�Il101: WALL 2 X 6 Lr�PGF-F? LAG 1301--1' 1"0 CXI51"I1\16 FPAMING USC J0151- HAN6CI,5 �INISN GP.ACJ� �'�e• ,�•r FOUpCp CONCP2C1- L-1 TYPIC& CF055 5�CfION 13 - 1� �X15TING I Nle 121 OP, WA-1-5 CL, FOYER FAMILY DOOM 0 I ________________________J PLM5po1, F-XI51-INCA 2N(-2 FLOO2 OVFpNANG < Ar�OVE> MCCAPTHY F�5M MCS P�fws rce 161 CAMPI�FLL POPV MCCAMY PT 5M NCC NOP,T]d ANPOVCF., MA FIP5f FL00P PLAN 161 CAMFI�FLL POAP c cxlsn�� NOt?11-I ANbOM, MA Date.... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 40 S C14US This certifies that .... ....... ... . .. ........................ 1 a'4k-z'+%Ajs has permission to perform ........ �6 rc In S IA2('4j Ic C. : .................................�;..;�.wiring in the building of........m C- CA r+h..Y.................................... .................. .......... at.... Z"...C ........................ .North Andover,Mass. Fee..s3,5........ L i c.No.h..Jj,�f.......B:Nv�l�rI*A.Z ....... ELEcriucAi INSPECTOR Check # 5434 TBE COMMONWF4LM0FMS94CHUSE'77SLNo. Office Use only DEpARTmwoFPux1CS4FE7Y BOAMOFFMPREVEMON NS527CMR12(�Il Checked APPLICATIONFOR PERMIT TO P ORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH TVescribed CHUSSTS ELECTRICAL CODE,527 CMR 12:0Date (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical wobelow. Location(Street&Number) y��Ci� Owner or Tenant Owner's Address �T Is this permit in conjunction with a building permit: Yes o (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service �d Amps 2CL / OVolts Overhead Underground No.of Meters New Service -god Amps Volts Overhead Underground ®/No.of Meters Number of Feeders and Ampacity /�- Location and Nature of Proposed Electrical Work No.of Lighting OutletsNo.of Hot Tubs No.of Transformers Total KVA f No.of Lighting Fixtures Swimming Pool Above Below Generators KVA �Z round eround No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local --J Municipal Other Connections No.of Water Heaters KW No.of No.of ` Signs Bailasis i No.Hydro Massage Tubs No.of Motors Total HP IIII f OTHER• ItlSt==Covaage.RuaEnttothe tagt>mTlCW ofMMXhMM Cf wallaws i Iha%eaama1Liabt7ityh>Surm=R&y=ltftC0nT&W aati' NO Iharea tnimdvaaliddptoofof &OMca YES Ifyvuharedrd®BYES,pleaseirr)icaleftl)peofC0NaWby drdangthe bo WSURANCE BOND = OTHER (Please Spaffy) ExphafimD* E0rntadVa1xofEbcmcal Wc&$ WodctDStaRZ Ail =/yam Rao Final FMMNAW �' v `' ` CC/ Lio wNo. L'a ae •�/ �`rc�i %1�•� Signartue LkawNo Busffm Tel 11b. Alt Tel No. 1g OWNER'SINSURANCEWANE,;IamawarethattheLmwduesnothavetheitmtmmoovaageoritssubstantialegnvaa astegtmedbyMassactxilsCtnaalLaws and that my signahne on this pmPA apphcariotl wanes do mwieanat (Please check one) Owner 0 Agent Telephone No. PERMIT FEE$ Signature ot Owner or gen T7mCOMMONWEALTHOFMASSACHUSE77S Office Use only . • ' DFPARTMEVle Z Permit No. a---f-� BOARDOFFMPRENS527(M12.0 G� Occupancy&Fees Checked ,-L APPLICATTONFOR PERMIT ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITELECTRICAL CODE,527 CMR 12:00 PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical .Location(Street&Number) (�s�f Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes o m (Check Appropriate Box) Purpose of Building ,; � Utility Authorization No. Existing Service a0 Amps 2l.1 «&Volts Overhead Underground -No.of Meters New Service Cd Amps / Volts % ' Overhead Underground No.of Meters --- � 0 Number of Feeders and Ampacity 7-4-570 Location and Nature of ProposedElecfiical Work '41f�'� No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above. Below Generators KVA round 2round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons of Disposals No.of Heat Total Total No.of Detection and Plumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices _ No.of Dryers Heating Devices KW Local � Municipal Othe Connections f Water Heaters KW No.of No.of Signs Bailasis ydro Massage Tubs No.of Motors Total HP Co,erage.Pt>t�aantk�thetequrtanats�Ga�alLavus Liab&yhmaano Poh yi ducirgcmvi - s�vwornsakamt alegttivalat YES . validptoofof drOlhoe YES (� F)Doha,edled(edYES,ple gdc*tbet peofcowrWby IJ BOND � GII � (� ) Fxp><ahortDate Es&n*d VakrofEbcftical W«k$ Swit lZ hq)ecfimD*Reques1ed Rao Final Sie ofAME 1-7- LimwNo. . Sigtaae LiourmNo Businm Tel.No. GJ ��+C Cly C�- met' Alt Tel Na 12rd g LSINSURANCEWAIVE[t;IamawatedxtftLmwdoesnothawtheirmaanoecovwjWailsaksmn le nvalattast gmedbyMa%adiEmCalaWLzws sgnaaneonthispem>itapplicafralwai,esthistagttitattatt C heck one) Owner Agent Telephone No. PERMIT FEE$ Signature or Uwner or Agent '�j�2 V t t (�►" N&T G I4 L L LA 3 - 3 / CC5— M87�R- So c&r T .i Date. . . .. . .... . HORTFI pf �.io 1ti0 TOWN OF NORTH ANDOVER F D • PERMIT FOR GAS INSTALLATION / '�s,SSAC NUSE�S� This certifies that .i'''' 1-P-"e A f4 ^. `" . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . .///.r. l . . . . . . . . . . . . . . . . . . . . . at . . .� . . . . .. ., North Andover, Mass. Fee. :) .'. . — Lic. No.,2... . .. :: . . . . . . �,.---. . . GA�INSPECTOR J Check# C 44 r 52/- . ATONFORPERMITTO DO GAS FrFMG MASSACHIISEI'is UNIFORMAPPLIC (Type or print) Date e�— 31- NORTH ANDOVER,MASSACHUSETTS Building Locations �,�r�p /i �4� Permit# Amount$ Owner's Nameti New11 w jenovation ❑ Replacement ❑ Plans Submitted ❑ O kF7 G O D O W F oa E„ a a z F z Ow OG °' a a 1% a ow HcFn o 1 j SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR (Print or type) Chec ne: Certificate Installing Company Name �� lV oar,,e '? Lj Corp. Address %� �y7r?J�Oy'' �.S�P Jrl/7, Olr03 ❑ Partner. Business Telep J41< ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �✓�oT��dn �! - N/��C� ��!—� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No UZ If you have checked yes,please indicate the type coverage by checking the appropriate box. 13Liability insurance policy ❑ Other type of indemnity ❑ Bond 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,4nd qhat my signatuthis permit application waives this requirement. Check one: Signature of Owner or Owner's Agent 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stat Gas Code and Chapter 142 of the General Laws. Signati f Licensed Plumber Or Gas Fitter By: ❑ Plumber 27o4sl Title Tity/Town VGjas tter icense um er rAPPROVED(OFFICE use ONLY) yman