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HomeMy WebLinkAboutMiscellaneous - 165 WAVERLY ROAD 4/30/2018A r Location No. Date AOL �"s TOWN OF NORTH ANDOVER Certificate of occupancy $ Building/Frame Permit Fee $ MU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 186�8 Building lnspecfc'h L/ ` T®WN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING WNW DATE ISSUED: BUILDING PERMIT NUMBER: 300 SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ©/y Map Number Parcel Number 1.3 Zoning Information: Zonin District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Reqttired Provided Reqwired Provided 1.7 Watar Supply NCGL.C.40. 54) 1.5. Flood Zone Faforniation: Public ❑ Primte ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owners of Record /� ��"�"/C � ��%. ���%�� G� SC ��S tet/ � Name ( ' t) Address for Service Z9 Signature Te hone 2.2 Owner of Record: Name No", Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: (;On &/ a6icl —�h� Licensektonstruction Supervisor: Ad r, / I Z� 9 4 � 4, �/,/ (/ U ��r' d' (g A lD 73 7 Signature elephone Not Applicable ❑ License Number Expiration Dalk 3.2 Registered Home Improovvem�ent Contractor Not Applicable ❑ Comk ame �✓� i i � yL Li`�fjJ� Registration Number Expiration baW Add Signature Telephone 00 M X Z .O SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2506) 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 au applicable) New Cort on s.0' 64� Existing Building ❑ Repair(s) ❑ AlteratAs(s) ` ❑ Addition ❑ Accessory Bldg. 0 Demolition ❑ Other 0 Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item 1. Building Estimated Cost (Dollar) to besy(IC][USE Completed by permit a licant (a) Building Permit Fee Multiplier ONLY 4 mc5' 2 Electrical (b) Estimated Total Cost of Construction Ow j 3 Plumbing Building Permit fee (a) X (b) D= 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,aw_'z 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 knowledfe and belief Pri Signature of O /A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIv1BERS 1ST2ND 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 O z a • W rA m W4 A :.2 CD w z Ocm c w CL R a OCD �' N N x a `� cn CD G � _ m t� � v O LE u v cn N LQ o � c O inn O v .0 U G w a m O G W a w O Q p C w v E o z cn i O cn C O m G . C O � G H O G O OLD '•nC cc la W O � CD m N � EQ :_ o n N E c Q F - y W H ac W V COD C=' E N Z N N C cm m cm m 0 cm c M N m Z 0 Z 0 cm 0 .� Q E Q ` Z a O y � C O cm I O O G gca m m CD Cl CD CL �+ CD ca Z O � 0 Q L cts O d CL coQ c C,* c ev Q 'v CL oca ; C Z ai Cl O. �..� CO) O C C C c COD is Y/ LU U) W W W U) :.2 CD Ocm c CL R mm OCD �' N N cn CD G � _ m O W 'D N LQ Q F - y W H ac W V COD C=' E N Z N N C cm m cm m 0 cm c M N m Z 0 Z 0 cm 0 .� Q E Q ` Z a O y � C O cm I O O G gca m m CD Cl CD CL �+ CD ca Z O � 0 Q L cts O d CL coQ c C,* c ev Q 'v CL oca ; C Z ai Cl O. �..� CO) O C C C c COD is Y/ LU U) W W W U) CS # 022680 HIC#103358 A. J. Walsh & Sons 55 Pleasant Street North Andover, MA 01845 # of pag 978-688-6737 or 1 -866 -AJ WALS H Proposal Submitted To: Job Name Job # Address / a Job Location o�i Date / � `, �..�' Date of Plans Phone # Fax # (Architect We hereby estimates for: We propose hereby to furnish material and labor — complete in accordance the above specifications for the sum of: $�� Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully i2%/�^�;��L�it`C� tel/ executed only upon written order, and will become an extra charge over and submitted above the estimate. All agreements contingent upon strikes, accidents, or delays l beyond our control. Note — this proposal may be withdrawn by K if not accepted within days. 01cceptan�ceeoof Propogal The above prices, specifications and conditions are satisfactory and are !/ g (/ Si nature hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature s- NC3819 MADE IN USA NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the prov'sion of MGL c 40 S 54, a condition of Building Permit at: (L� aLa&&X is that the debris resulting from this work shall be disposed of in a pro rly licensed solid waste disposal facility as defined by MGL c11,S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location Facility) Signa a of Permit plicant Fire Department Sign off: �� Dumpster Permit Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Aflydavit Please Print City / ldU �yC ///� Phone # 0 I am a homeowner performing all work myself. aI 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. Comoany name: h47F� V S G . S Address es 1%JZ City. 'Ad Alllod al!°� 22/1' Phone* 7l Y .S (�2)Policv # W- -1-173 i-1, 77 Address Phone #. 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 $1,51)O% aruftor one years' iniprisonment.as.yell_as_cbM.peaafttas In lhefoQnde.STOP WOMORDERAnd_a.*0 of.(3I0D.0M aIMW agalnat-me, I understand that a copy of this statement may be forwarded to the Office of Investigations of the DW for coverage verification. I do hereby cerfify/anider the pains and penalties of pe►jury th a information provided above is true and coned. Print name A/elllw r -;�F Phone # % -e737 Official use only do not write in this area to be completed by city or town official' City or Town Perm si Check if immediate response /s required 0 Building Dept [] Licensing Board p Selectman's Office Contact person: Phone #.^ n Health Department Other Location v ,P—r 1', No. Date �— 10 — iq TOWN OF NORTH ANDOVER Certificate of Occupancy $ Ar- I CHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 01 oo TOTAL $ 30,00 Check # I D�l 1� 15875 Building Inspector TOWN OF NORTH ANDOVER 4 BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWOFAMILY DWELLING. )hag. � ���..� BUILDING PERMIT NUMBER: ��.:_ � P'�1�,t�i G� ,.�.. � c.� t�. 5"..• j' DATE ISSUED: SIGNATURE: Building Commissioner/I or of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: /G -5- l✓� v,��L 1.2 Assessors Map and Parcel Number: ,> Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water SupplyM.GL.C.40. 54) Public ❑ Private ❑ Zone 1.5. Flood Zone Information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service: 7 G72�- Z gnature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address t Signature Telephone Not Applicable 0 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 00 M M E Z O 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 Pro osed Work check all applicable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ T7�dition ❑ Accessory Bldg. )K Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: J - `3X7, V/ � 01F lYf)6Hr - io /if 11wXLiLo - 1SFr �r� l�7- Lm))E , SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed bV permit applicant (} C.IA �JSE OieTL�'� ... �.. 1. Building(a) U Building Permit Fee Multi lier 2 Electrical 10 (b) Estimated Total Cost of Construction 3 Plumbing Nd Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection /v-0 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, JAI 1 k'5 L f ry /h -x as Owner/Authorized Agent of subject property Hereby authorize .5//,C_?S �/ SX� to act on My,e lf, in allutter pen -nit to work authorized by this building petit application. Sigdature of Owner ` Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I,141y I .5' LF / X 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 j�4 t, ii s L /z to / /r, v x Print e Si ure of Owner/A ent Date NO. OF STORIES / SIZE $ ' BASEMENT OR SLAB 1h i' PL ti 1N v vv SIZE OF FLOOR MMERS Z X 9 X 1 ST2 ND3 RD SPAN � P 7- DINIENSIONS OF SILLS DINIENSIONS OF POSTS DHAENSIONS OF GIRDERS HEIGHT OF FOUNDATION GrkiL NT jsC 6ch S THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND 56til, 114ND IS BUILDING CONNECTED TO NATURAL GAS LINE l EIf SGl___ C� FORM U - LOT RELEASE FORM h 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 % w( �_ C61 % e- LOCATION: Assessor's Map Number C SUBDIVISION f STREET 0) ` PHONE PARCEL LOT (S) ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TQWN AGENTS: CONSERVATION ADMINISYRA 1 COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED .5l_. PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm ,TE rA rb r� S. 7�C w o wo � a cin 0 z � w° P4 Ecz U w 0 ao' CIS w O U W W W b wo' u c) w W: O U w m �, w Z W w G rA ° z cn Q x o cn L O v O C. CO2 C 4.4 2 H O .E C O C Ci 0— 0O3 O C3 .CL CO3 C O C.3 0 co 3� Lftco � O O C. Ce cm < cc J .O O CO Z CD C. CO) C : C m C ;;C O s+ C h O_ i�.0 C . r.+ O v V :V C mc �o CD E e 3 ®-CD 4�C., m ..r N E s m CM m C N L C N N N m cm m N C C N O O `� cm N m ; 12 :=O Of ,... U c cm— 2 • acs ao A:®off E Lcoao `o va •-� c CLO c ~ i o m N ® C •O m Or N _ m COD LJJ C = O C a.+ O •CNA 6CLt m C E o LU U � CD c m c Cm m O �0='� c �. R � �.,- L O v O C. CO2 C 4.4 2 H O .E C O C Ci 0— 0O3 O C3 .CL CO3 C O C.3 0 co 3� Lftco � O O C. Ce cm < cc J .O O CO Z CD C. CO) C T 11-j Lo cation ir 61j— No. Date TOWN OF NORTH ANDOVER 0 Certificate of occupancy $ Building/Frame Permit Fee s ACMU Foundation Permit Fee $ Other Permit Fee $ Owl' TOTAL $ Check# 14, 3 0 '418486 Building Inspectir/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAK RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 6W BUILDING PERMIT NUMBER: DATE ISSUED: `r h 11 /d SIGNATURE: Building Commissioner/InaWoT of Buildings Date / d 1 ar%-AIVl'q a - Jail' ll'lrvxmAlivir 1 1.1 /Property Address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronta ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R 'red Provide ReqWred Provided Regilired Provided 1.7 Water Supply M.G.LC.40. 34) public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ Ou Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT " I S r • 2.1 Owner of Record Name/ /) s�� r),, , %% Si.iature (/ Telephone 2.2 Owner of Record: Name Print /66�- �-Y Address for Service Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Licen,p,d Construction Supervisor: Not Applicable ❑ (� , Licensed C#ftruction Supervisor: 0 2— 2,6 License Number Add s / �✓ ®� q 7c�-66d— -j�; 737 Expiratigfi D e Signature Telephone Ho pro�e/enlntractor - �� at,71 Not Applicable ❑ Registration Number Expiratio Date v rn �0 L rn 90 0 ic v M r r z 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 ....... ❑ SECTION 5 Description of Proposed Work check all a cable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction �I 3 Plumbing Building Permit fee (a) x tbl ay ! i 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 f 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. of Owner Date I, / CI,- as Owner/Authorized Agent of subject property JIF Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief _ of Ow�t Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH VINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r E 4 17, I ri OD cc 6 w CjQ c9� o u w rx u U w a w r4 C x as w o a: la 0 o rx G w" W w o cn E cn 6 c o m c <v W o � r O y If ` Noo C V V :. c. c ev o� CD NJ = Ea y _O :w v o o . CO O O v cm - C O m C• �T _m a = c h W L" CO m o aIS t. w � O C a mc.p,ct v a O Z c o 0 Q m c � O v� apF- ... o .r ui � � E o.t"c U am�LU y a m� �-0 am D J 0 N 0 z E VJ Z N y c O cm s cm c m 0 CO I 'c N • t 0 Z 0 s 0 .v 0 Qr 2 O co Z O G I y MI a O C O as v ev rL C42 O C3 .y c O V O C CA CM C O C D � H =_ ev �' 3� O o C- a ca J O O Z � CL y C _ LLI N LU U) W W ce W U) o� <v W 10 0 r If ` Noo 0 N 0 z E VJ Z N y c O cm s cm c m 0 CO I 'c N • t 0 Z 0 s 0 .v 0 Qr 2 O co Z O G I y MI a O C O as v ev rL C42 O C3 .y c O V O C CA CM C O C D � H =_ ev �' 3� O o C- a ca J O O Z � CL y C _ LLI N LU U) W W ce W U) CS # 022680 HIC# 103358 Proposal Address = Propogal � A. J. Walsh & Sons 55 Pleasant Street North Andover, MA 01845 Job Name Job Location # of pag 978-688-6737 or 1-866-AJWALSH Job If I We propofe hereby to furnish material and labor — complete in accordance with the abov cifications for th um of: $ Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. Note — this proposal may be withdr,w4by us if not acc ed within days. 2cceptance off Propozat The above prices, specifications and conditions are satisfactory and are c'Signaturef'),Vv hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance NC3819 MADE IN USA Signature The Commonwealth of Massachusetts Department of Industrial Accidents Off/ce of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Afliidavit Name Please Print Name: coir MD Phone # aI am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capackty I am an employer providing workers' compensation for rry employees working on this job. Company name: Address���,Sf,� Citv: 111d f7L/V )J0 U-�i�� M/4- Phone insurance Co. 2, Policv # %Of Y6 `��� /.�60 Comoanv name: Cu. Phone #: Insurance Co. Policv # Failure to secure coverage n required under Sedan 25A or MGL 152 can land to the imposition of criminal penaltlas of,e tine up to $1,500.0D andfor one years' imprisorm Mt_as WGd-as.c bA4WoaldesJolbsfmm dASTOP VVDW.0RDER.and.a.fine af.(:1o0.w)-nAWr apalw ms. I understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage veriRcom. Official use only do not write in this area to be completed by city or town official' >37 City or Town PemiWl.icensina Building Dept []Check it immediate response is required Lkensirlg Board [] Selectman's Office Contest person: phone # [] Health Department [] Other NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM L . In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Signature f Permit Ap cant Fire Department Sign off Dumpster Permit Date