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HomeMy WebLinkAboutMiscellaneous - 164 JOHNSON STREET 4/30/2018 (2) J164 JOHNSON STREET 210/097.0-0006-0000.0 \ i Date. 1 oil �T:1�o TOWN OF NORTH ANDOVER ° : p PERMIT FOR PLUMBING f SSACMUS� This certifies that . . .� . ,. 24 . . . . . . . . . . . . . . . . . . . r has permission to perform .!.�1.//... . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . l . . . . * .. . . . . . . . . . . . at . 1. j?�. �'�✓f�//�. i1: . . . . . . . . . .. North Andover, Mass. Fee.'��'s .l U.Lic. No..,!.��,�1�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR +I Check ff �LJ f � i 5 ; 6 � 1 MASSACHUSETTS UNrYORM APPL/ICAON FOR PERMIT TO DO PLUMBING (1*or pont) t�i l0 - MASSACHUS ►"IS DateBuilding Location Permit # n Amount Owner's e New 13 Renovation Replacement ❑ Pians Submitted 1 1 FIXTURES � A A SU38 IC fl441V1F1Vf I ISC Him NORLM 3M RDD Oat ROM SWR= Bat Rim Tat RM Sat FLCM (Print or type) Check one: Certificate Installing Company Name Gallskv Plups neHea �Heating � El Corp. I Qn,r%,��,� Address P.O. Box 1701 Parpier, Business Telephone i97§-174-1743 Firm/Co. Name of Licensed Plumber: '' Stephen C. G a,l i n s k ` Insgrance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity Bond lnsumnce Waiver 4 the undersigned have been made aware that the licensee of this application does not have any one of the above three Insurance Signature Owner Agent I hereby certify that all of the details and information f twe submitted(or entered)in plication are true and accurate to the best of my knowledge and that all plumbing work and. astailations perfo ed der ued for this application will be in compliance with all pertinent provisions of the Massact.usetts State P C r of the General Laws. By: I a Tye,:a of Plumbing License Title ; City/Town UITIOW Master �x Journeyman APPROVED(OFFICE USE ONLY l J Date. ,/. NORTH 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SA OS This certifies that - < ,:....�.....� ............................. . .............................. has permission to perform•............ ................................... � �, .� .� wiring in the building of.............................. ............................................... .. ,North Andover,Mass. Fee. �✓....... Lic.N0'q' '. ... a o......................... I ELECTRICAL INSPECTOR Check # 4 �- 74 -- - l lit IYIQJJCLIiUJG'lW Vu+�« ubcVlllj Department of Fire Services Permit No: �j'rc f BOARD OF FIRE PREVENTION REGULAT ONS Occupancy and Fee Checked [Rev. 11/99] Ieave blank) APPLICATION FOR PERMITTisaichuserts RFORM ELECTRICAL WORK All work to be performed in accordance with Electrical Code(INIEC),527 CMR 12.00 (PLEASE PRI 1YflVK 0R TYPE ALL P.VFORMA170h) Date: j - 2 i - y City or Town of: /z/ yQ� To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) � -- Owner or Tenant G,� lis �o� ,1 Te! p one No. 05-'3 Owner's Address , Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building— * � !- - Utility Authorization No. Existing Service U Amps lZo 2 o Volts erhead -ndgrd❑ No.of Meters New Service _ Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the tbilowing table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)FansNo' of Total (Transformers KVA No.of Lighting Outlets Z No. of Hot Tubs Generators KVA No. of Lighting Fixtures Z Swimming Pool Above ❑ - ❑ i o. or mergency Lighting Qrnd. rnd. Battery Units No.of Receptacle Outlets l0 No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches �/ No.of Gas Burners No.of Detection and i Initiating Devices Y No.of Ranges No.of Air Cond. Tons TotNo. of Alerting Devices No.of Waste Disposers eat Pump I N umber I TonsXWNo. of Self-Contained Totals: - _ Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local Municipal ❑ Connection Other Connection No. of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water No. of i o.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP elecommunicationsWiring* No.of Devices or E uivalent OTHER: -- r Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSUPWNCE ND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: /- a 2_ -o y Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete. FIRM LIC.NO.: �3 Licensee: , _Signature ��C. 0.:� Address: , e,a er "exempt"in the license number line.) Bus.Te Na.: Address:, i lT s �001 Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the L& ease does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑owner's aeent. Owner/Agent Signature Telephone No. FPEMWT FEE: Location No. 03 Date d NORT1y TOWN OF NORTH ANDOVER O * Certificate of Occupancy $ �s cMus C E<� Building/Frame Permit Fee $ s�► Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r U Building Inspector i I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING may:. .. s SAP'moi BUILDING PERMIT NUMBER: DATE ISSUED: ��`� 19691 69j -/ SIGNATURE: 1011111ff_j�,2� Building Commissioner/I for(WBuildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: o Jz>N NSaw . ire e7i q . 7 (.11 IV 1i o 2„nt /�TTX;Dt?V6C 10il 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 RegWred Provided Re red Provided a f I 1.5. Flood Zone Information: 1.8 Sew sal 1.7 Water Supply M.G.L.C.40. 54) � Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ aaaal SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 1 Owner of Record ��-rM � i�e�;tah-.f• ©se,o,.,L9 f6LI �S�t-tt�1s�:>s Staee� kIJ Address for Service tgtu Telephone ^ 2.2 Owner of Record: `��• Name Print Address for Service: .®y l6y Signature Telephone e 1 SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ �C2-r1�- Licensed Construction Supervisor: License Number Address { Expiration Date ic Signature Telephone Fam 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number M Address Z Signature Telephone Expiration Date i 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.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Aherations(s) 71 Addition ❑ I Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description`of Proposed Work: 1/ 1�ep`cc E_ t°Xts j dry DQ1 tL -�-Irk I Z� K -?q pc'c K SECTION 6-ESTIMATED CONSTRUCTION COSTS Mn Item Estimated Cost(Dollar)to be DF, Oi,Y ' Com feted by permit applicant , 1. Building (a) Building Permit Fee Y ( ;-o. c r� 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 t A 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, B'e X1 c.�.:n C (91'5 tom` ,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 Be-Vii Qvr,� c �S�o� 1:Tf Pr' t Name Q Z 6 i a e of Owner/A D to , NO. OF STORIES SIZE , BASEMENT OR SLAB SIZE OF FLOOR TEABERS 1 2 ND 3 SPAN DIMENSIONS OF SILLS DMdENSIONS 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 Building Department 27 Charles Street *a • North Andover, MA. 01.845 ----�� D. Robert Nicetta C�„,5 tig Building Commissioner (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE 2310 1 JOB LOCATION_ LI �fl t-tlpS,a,� n RT I-Itir Number Street Address Map/lot „HOMEOWNER e NameMt Zc�- 65-e'3 F78-686 Home Phone 6� Work Phone PRESENT MAILING ADDRESS _-,,a�.� City Town State Zip Code The current exemption for"homeowners"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 j 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, bylaws, rules and regulations, The undersigned"homeowner"certifies that h&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 Town of North Andover NORTH .� . ot¢D ,6Y Al, Building Departmento . 27 Charles Street North Andover, Massachusetts 01845 9 (978) 688-9545 Fax.(978) 688-9542 �.4 044TED }P�`y�5 SSACHus DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, anda condition of Building permit-# 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: Cres Facility ocation _'S igna re of Applic — 7123 jpl Date --- NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. gh 22-141 50 SHEETS an PAD 22-142 100 SHEETS 22-144 200 SHEETS 5'(7d0Ztd / rr 1 � i t � k n 0 " � !-s dd .,b�..f► til 1 cYl -59S N-1- oNo 5; 1101 ,fi Z FORM U - LOT RELEASE FORM 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��ytiaw.tg C �s�,�v� J2 PHONE-9-L8 3 ° LOCATION: Assessors Map Number PARCEL SUBDIVISION LOT (S) STREET 14�, W Z ovAWST. NUMBER *********** ***********OFFICIAL USE ONLY****** R M F TOWN AGENTS: r C ATI A NISTRATOR DATE APPROVED Yll 7-101 DATE REJECTED COMMENTS 10J / TOW CANNER DATE APPROVED 7 DATE REJECTED COMMENTS i 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 9197 jm NORT' Town - of Andover No. 103 o dover, Mass., 8—I � —o7D��C o ?ArED P'?V" BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT........ ........................ ...... Z�Iev. ............ '>7 .................................Z) ........................................................ Foundation has permission to erect..... buildings on ....... ... . ....................................................... Rough to be occupied as.................. . . p AS /V e- 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-Lawsreiltlng to the Inspection, Alteration and d 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 UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 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. GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain- pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge& Hip- Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations "air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0" clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. YZ of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber- Finish Smooth parging, clean joints, 8"solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8' above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee-$25.00(Be Ready). Certificate of occupancy required prior to occupying structure �r Location /� r-,io IlVSa/V � No. � Date NORTIy TOWN OF NORTH AN-DOVER f s e Certificate of Occupancy $ MUS Building/Frame Permit Fee $ �a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a` Check # a 7. fvl 15 5 3 Buildind Inspector I i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: �—� DATE ISSUED: / oZ X SIGNATURE: l Building Commissioner/InNKtor of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: r(0,t J©i4�S0� sfi> �� q7 6 1\)02T1.-( AA-) Dc� elL l Map Number Parcel Number v v 1.3 Zoning Information: --SA-,) (� 1.4 Property Dimensions: �. \ f `D C G— Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.5. Flood Zone Information: e ion: 1.8 Sew 1 S Q 1.7 Water Supply M.G.L.C.40. If 54) � Disposal System: Public 71 Private 0 Zone Outside Flood Zone Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record `Je vi►C{vni h � lJs�r Oo�X J(L l IL✓i tt N` O s5 c'�•� /f� t21 �I�!�o�S'c�a. S 7—/Lc e Dame( rint) Address for Service: lh ig re Telephone �. 86 -1768 �I 2.2 Own of Record: \ 9ek!OL Name Print Address for Service: 0 z Signature Telephone SECTION 3-CONSTRUCTION SERVICES go y 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number r Address r Expiration Date z Signature Telephone I r r i 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.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building N Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ✓ rivt t+,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 S4? O c5 en Multiplier 2 Electrical (b) Estimated Total Cost of Q� Construction 3 PlumbingBuilding Permit fee(e)a Ind 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) 6-0-00.00 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 r Hereby authorize to act on I 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, ��i c w.,� C Qs CrVc7D �J 2 ,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 nn Print Name S�z/v z r atxfe of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2W 3RD SPAN DEVIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS _f LEfGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM • INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fro m 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 00 `f PHONE 97 LOCATION: Assessor's Map Number PARCEL SUBDIVISION STREEST. NUMBER T�� y �!a/9NSO A- �e OFFICIAL USE REVVMVM OF TOWN AGENTS: COATIOINISTRATOR DATE APPROVED DATE REJECTED COMMENTS z 1 T, N PLAN R DATE APPROVED DATE REJECTED COMMENTS_ FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm -- TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,} OR DEM�wpOyLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. L SIGNATURE: Building Commissioner/I for of Buildings Date Z SECTION I-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 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 v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone%formation: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record n u C5 Cyl i[ .. ©r i O-50cX lJ !L �� 7 ����5 3 n 57,? ame(P nt) Address for Service: O Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number r Address r Expiration Date ^z Signature Telephone V i 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.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building IQ Repair(s) ❑ Alterations(s) ❑7 ition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 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(e)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 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 I, ��2j Li c.. ,•^ (f— 0 sy 0-„1�2— :J2- ,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 -e-.g en w. C Pru ame' :3 7— Mature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2ND 3PD 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 TOWN- OF NORTH ANDOWER Noart�. Office of the.Building Department o 1 ;4. 4 CommUnity Development :and Sea-vices 27 Charles Street � A - � • qtr ilb Andover,?�assadausetts 01845 + ry �9SS�1CHU D. Robert Ni.cetta, Telephone(978)088-9545 Building Commissioner FAX X(979)088-9542 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and as a condition of building permit# the debris resulting from the 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 at/in: ©oMtL&/`Z2 49:L), QE-Z) /2uG(, IPt6- cornPf�NN D 8y fl Rt��; g�Lit 2i c/t (Sit)e location) rnlos�x Sijn-atuk of permit appli t Date Michael McGuire,Local Building Inspector James Decola,Electrical Inspector James Dioed,Gas/plumbing Inspector The Commonwealth of Massachusetts Department of Industrial Accidents ` Office of Investigations Boston, Mass. 02111 W 'ers'Compensation Insurance Affidavit - - - Ilk Please Print Name: e✓ii�t...� Location: W W Son ST` City C>o,,-42,� /li1/4- Phone 27 I „`7 am a homeowner performing all work myself. I? 71C3' 01 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 f surance Co, ati .. coWRM name: Address city: Phone# lnsura ce Co. oli # Failure to secure coverage as required urxlar lection 25A or MGL 152 can lead to the W*iosition of criminal penalties.of a fine up to$1,500.00 and/or one years'imprisonment as well as chrtl penalties in the form of a STOP WORl<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 ink of the DIA for coverage verification. I do herby certify under the pains and penaAties of perjury that the information provided above is true and correct Signature Date a Print name ��;a�,�• (�s q coo Q r,1z Phone# ?�S�4'S 9 o se 3 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 ❑ Licensing Board Contact _ El Selectman's 0mce person Phone# ❑ Health Department ❑ Ofher VORKMAN'S COMPENSATION North Andover Building Department Tel: 978-688_954 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 b disposed of irl a properly licensed solid.waste disposal facility as defined b e c 11, S 150A. y MGL The debris will be disposed of in: (Location of Facility) �` Signature of ermit Applicant i Date NOTE: Demolition permit from tt a Town of North Andover must be obtained for this project through the Office of the Building Inspector I - _ 5 The Commonwealth of Massachusetts R Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 =a: Workers`Compensation Insurance Affidavit 'Please Print Name: Location: 11 L4 City M)4Phones 9 ? p,, am a homeowner performing all work myself. 01 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 Cite: Phone - insufance Co. . l Gomt�anv name: - Address city. Phone#- lnsuragge Co Poticv# Paikire to secure coverage as required under Section 25A or MGL 182 can leeidtothek,00sition of aiminal penafties.of a fine 6P to1' and/or one years'irwisomient as'we#as clvfi penalties in the form of a STOP WORK OROM and a fine of($100.w)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 pena ties of perjury that um i)fwnatdov►pr&A*d above is bue and correct. Signature Date '? o Z Print name ,t h ; o ,, 3 A2 l Phone �7eC l7r;g 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 ❑ Licensing Board Contact ❑ Selechman's Ofrfcc person: Phone# ❑ Wealth Department ❑ ot3Ter RAf WORKMAWS cOMPENSATlOv NORTH Town of ...4 over � V% No. rS8,6 o LA o dover, Mass., =/6 -a as a COCHIC ME WICK 21,95 RATED PP Cl BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......?..V./V........40..ZCP.DaPf...................... Foundation r�o M�1 6...���....., ..�'1. .a��.�......�� Rough has permission to erect.,S�A,t....................... buildings on ..... to be occupied as.. y t.r....g..ytl�f/N G...../..•Z. /.'t...DF C lC..'�...3.'f A?.* /t tt Nr0 t& 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 th Inspection, Alteration and Construction o Buildings in the Town of North Andover. 90 '/` sox Mumma RMy/ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION S ART ELECTRICAL INSPECTOR 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. Smoke Det.REVERSE SIDE Location tie)-A) No. a Date 81,5 o 4 MOATN TOWN OF NORTH ANDOVER 0? •. • O� • ; . Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s�CHust 9 Foundation Permit Fee $ Other Permit Fee $ !1 a TOTAL $ �aV Check # ► 666 .: / Building Inspector 1 113 - 0,3 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: /ate 8 -aa-ad©3 70 SIGNATURE: � c ic Building Commissioner/IEyector of Buildings Date Z SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Ito,) 3r�> KOs T, '17 06 N2 j H A&)9 o oa Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 11.E RCSi�'Cl�GIG;' �»'r41C. �Gm� �Jl r7� / l ZJ r Zoning District Proposed Use Lot Areas Frontage ft 1.6 WELDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Re aired Provided 61IV z- 0 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone Municipal X On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes_No rn 2.1 Owner of Record ogq oz . -all I- Name(Ant) Address for Service: i Nl, N,.-> 2 t ty AN o /4 Signa e Telephone z - 6 7c9- 8 ,a6,-/-7& 8 2.2 Owner ecord: Name Print Address for Service: O Z rn Si nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licei}sed Construction Supervisor: Not Applicable 2 OS G a� L3 2' Licensed Constructioxf Supervisor: onO License Number Address D Expiration Date ic Signature Telephone I... 3.2 RcIgistered Home Improvement Contractor Not Applicable ❑ 0 CompFpy Name Registration Number Address _r Expiration Date /Z Signature Telephone V 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.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 5'f'JSZy iADS7��� ,/l Fp /J :LIS- -e JS f SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFkZCIAL USE:ONLy Completed by permit applicant 1. Building (a) Building Permit Fee y Multiplier Ll 0mop_ 2 Electrical (b) Estimated Total Cost of Z v 0 0 Construction 3 Plumbing 00c) Building Permit fee(e) X (b) 4 Mechanical HVAC O n p 1 D 5 Fire Protection 1 6 Total 1+2+3+4+5) coo 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, &19nt�00�` .J'Z' as Owner/Authorized Agent of subject property r Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief �r iL- Print e jam, Si ature of Owner/Agent Date NO. OF STORIES SIZE Z SIr , BASEMENT OR SLAB 5 ,,� SI SIZE OF FLOOR TIMBERS 1 s 2-1 n 2 Z-ig 3 Z x$ SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS „r t DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION g t THICKNESS /a " SIZE OF FOOTING X MATERIAL OF CHIMNEY /V r IS BUILDING ON SOLID OR FILLED LAND SoL�p IS BUILDING CONNECTED TO NATURAL GAS LINE G 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Permi plicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector FORM U- LOT RELEASE FORM 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 �P (�S lsv0_ 2 PHONE t z8-G 8 q-D_C_8 3 LOCATION: Assessor's Map Number 97 PARCEL 0& SUBDIVISION LOT(S) STREET I L{ Dc,)H N7,SaY,3 �( ST. NUMBER. IG C/ ***'►x`*� ' "* i"`y'"`'`i''' `OFFICIAL USE REC MENDATIONS F TOWN AGENTS: CONSERVATION ADMI STRATOR DATE APPROVED C� DATE REJECTED f► COMMENTS T ER DATE APPROVED C� ` 1 DATE REJECTED ECEIVED COMMENTS Z,.j NORTH ANDOVER PLANNING DEPARTMENT FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED. DATE-REJECTED COMMENTS PUBLIC WORKS-SEWERAVATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm Town of North Andover Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. FOR ROOFING, SIDING, INTERIOR REHABILITATION PERMITS 1) BUILDING PERMIT APPLICATION 2) DEBRI REMOVAL FORM 3) WORKERS COMP AFFIDAVIT 4) PHOTO COPY OF H.I.C. AND/OR C.S.L. LICENSES 5) COPY OF CONTRACT 6)FLOOR PLAN OF PROPOSED INTERIOR WORK FOR ADDITIONS /DECKS 1) BUILDING PERMIT APPLICATION 2) FORM U 3) MORTGAGE PLOT PLAN (MINIMUM) 4) DEBRI REMOVAL FORM 5) WORKERS COMP AFFIDAVIT 6) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 7) COPY OF CONTRACT 8)FLOOR/CROSSSECTION/ELEVATION PLAN OF PROPOSED WORK WITH SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT (if applicable) FOR NEW CONSTRUCTION (SINGLE AND TWO FAMILY) 1) BUILDING PERMIT APPLICATION 2) FORM U 3) GROWTH MANAGEMENT BYLAW 4) CERTIFIED PROPOSED PLOT PLAN 5) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 6) WORKERS COMP AFFIDAVIT 7) TWO SETS OF BUILDING PLANS (one to be returned) TO INCLUDE SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 8) COPY OF CONTRACT (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the board of appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with application. NEW ENGLAND ENGINEERING SERVICES -1k INC RECEIVED North Andover Planning Board 27 Charles Street AUG 2 0 2003 North Andover, MA 01845 rLANORTH VER NINE FAF. MTiY 9Nr Re: 164 Johnson Street Addition to existing home Dear Sirs: This office has inspected the above referenced property and hereby certifies that there are no wetlands within 400 feet of the proposed addition. If you have any questions or need additional information please advise. Sincerely, char C. T d,PE President RKXW C. �+ TANGARD y 13021 Q ssioNA+ 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 • 10' WIDE SEWER EASEMENT ro •5A� 30 g �, �' � 0 0 v N YLO (� Y ;d- 6co EXISTINDoG 4T 3 8 I co HOUSE KAREN A. FPO AD S .F. EXISTING IN08.06'30"W GARAGE )4 S.F. I 1.00' THIS LOT 118.10' S.B. >'06'30"W — .124.p0� 30 TABLE �, N06.53.1 WIDTH) �`► 4 #1339 #1340 t � f a f � � a i NORTH of over Town ti S-aa aoo 3 C% ;- Amo dower, Mass., COC..0 WICK y OR4TE0 pPG,`�� v H 4 BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR ,ems Cos a ©v .J _.Jr R.:THIS CERTIFIES THAT.......... .........................................................../.............................................................. Foundation has permission to erect..... ........... buildings on .1.6. ...��o�i.V..S d.!!�.....&.................................. Rough to be occupied as... 5/� Add,'A,)-AJ Chimney a....................... ......... .......................................................................................................................... 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. 9 ,7/ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 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. Butner Street No. SEE REVERSE SIDE Smoke Det.