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HomeMy WebLinkAboutMiscellaneous - 1782 SALEM STREET 4/30/2018u V N W C/) � D om A K 90 co o ml o m', b Location /J G.;t No. 4� 2 Date TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # i-7,3 % 18 '1 5 ,1 Building In215-Etor v 6 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 111k see"� V* . BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Colnmissioner/lpgwor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: »ser sa�,t,, � of ��ao>,�r-. M11- 1.2 Assessors Map and Parcel Number: a,,, bI!��� Map Number Parcel Number 1.3 Zoning Information: Zoning Dii;ic-1 ProposedUse 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Regaired. Provided ReqLiired Provided 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: 1.7 Water Supply M.G.L.C.40. 34) Zoae Oalside ❑ Manicipal ❑ On Site Disposal System ❑ Public ❑ Private ❑ :> i. U i i i; t •` t! ' C;t: `,'=: !'! O SECTION 2 - PROPERTY OWNERS /AUTHORIZED AGENT 2.1 Owner of Record L/Ay-d i elm 'Sq c c-0 -J-7 8j2 S Q 1 e -PA 6-F , ttl. &d4lo t/o-✓ Name (Print ��Address for Service &AIJ ignature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele on SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor AvN&ev3 5giccc C�cf 11pa Not Applicable ❑ 1.31y Company Name Sgrgv1 1�v �d'd I w�►� o(_, 36 Registration Number l`7 A5�/T�8'1- D -I I- 13 3 R, Expirdtion Date Signature Telephone 00 M M Z O SECTION 4 - WORKERS COMPENSATION (XG.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 .......0 No ....... 0 SECTION 5 Description of Proposed Work check ad a cable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Descri ion of Proposed Work: ...� , Sfrt o 4iaa-� a 11!2, S f��pl�� 2c� a►�d �,,1��-�� sh�1�. Ahd r.�i-� �®ter ►4Pt� !�/ 30 Yr -,t r S �v i nct/ - ci ka 1,09 Vey+ I SECTION 6 - FATIMATFn rnNQ7V1Tf•T7nN rne•re Item Estimated Cost (Dollar) to be Completed bpermit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical / (b) Estimated Total Cost of Construction r 3 Plumbin Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 CL`r1ri/V►i'7 1%%W?ZV1M A7TTiIATirf TTAv Check Number -•^aavaav ur. <, vll.f LL' 1L'L h'111:1\ `: I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ./ i�}tn�] �'Cit1 �Q C CO , as Owner/ uthorized Agent f subject property Hereby authorize to act on My behalf, i i ail mattrAs 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 Lrue and accurate, to the best of my knowledge and belief Print Name of Owner/. NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR TII413ERS 1' SPAN DM,1ENSIONS OF SILLS DIMENSIONS OF POSTS DEV ENSIGNS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CH MNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Date SIZE ii, X wA D D Mzz0 > 0 0 o m m uq il'!ii o z g <cf) D"' n w = w o nD M O d 4 O n K m a w On y T o � C _ 3 m 3 � p a m °O n co A 3 as D w m e Zo o -Zi O 1UT 0 06 zH o � a � m a O m M Ns O �z h W cd w u W W q m 0 a a z a �W.1 W Z a) Q. u Ow O � MCy W �, z Q CO3 W H s W L3 co CIS m c 4g OC4- 0 O ` y C U C3 d� CL C W O =ID CC :4-.- 22 -.-a 4 o _ ts o c E c co '" O C CL:i • L m o m 3 Co; O a .m :r m y E t 45 r.+ NJ Z. y CO O c m 0 cm C C s m t O 2 O O m O m 0 L z Z a) Q. CMZ a O � MCy ID Of 0 a= Cie C O m N O C m m 0 C W 3� • C � COL W C E .. d ��flcmi � C ` o a O� O • cmQ a4m E t 45 r.+ NJ Z. y CO O c m 0 cm C C s m t O 2 O O LLI 0 U) U) W W cz W N O L Z a) Q. O � CO) C Cie h m m 0 C W 3� o 4-bcc ` o a cmQ y o C.0 A., CIO �• c co Z CD 0 CL �..� CO) C O C _c d CO) 0 LLI 0 U) U) W W cz W N The Commonwealth of Massachusetts Department of Industrial Accidents Office of InvesHgaftns Boston, Mass. 02111 Workers' Cw perlsadw Insurance A Name Please Print Name• 6Lc ISP UJ gCCn Q at-c`� _ Phone # '"l �i - a� ► - �3 g I am a haneowrter perforating all work myself. I am a sok proprietor and have no one worldng in any capacity aI am an employer providng workers' compensation for my employees worldng on this job. COMO v name' Address CMG Phare It fin)A f it Ln Poticv S ,N4 -Iq C�DBrN n�rte: � Addmu coz Phare: Po1w a FA" to MM oro WqR n requked under Sectlan 25A or MOL 152 cin Iead to rhe krpattion of abdi pinaN d,a fh* up to:1,5W.W andsaneyss.s'imprficrmient.n.wd.n.cfiM.pa mbnJnAwl= dA STDPVIIDRKOROERindAfkrd.f;:1oDAMAAMa901W.Ma. I understand that a copy of this titemint may be farwrded to the Offbe of Inveadge ns or Mie DIA far coveripe verMbow. 1 do hereby curdy under ft pakib wWtppnaltfea d psdfury dW tM kft,, n provldad above li bus an0 ccinect Print name -"VLeAd Sq ec O Phow it of 1cm up only do not wrfte In this res to be completed by city or town Adel' City or Town ParmMIL inp ❑ Bufi ft Dept ❑Check If immedlsts nmPonse IS requked ❑ Lxeroft Board ❑ Selectmen's Ofte Contad person: Ftw* tfr ❑ HeaNh Department 0 Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provisionis that the debris�esult ng from this workn of shall Permit Number 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: T 1---v e-rf--e+I m (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 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. -- - NUMBER DRIVER'S LICENSE S_E 026623546 ' DATEOFOIRTH"^- CLASS HEST HEIGHT � ,. 110-01-1974 D sos SIX ..EXPIRES M it 10-01-2006 SACCO x ANDREW W f i 4 SARAN AVE BEDFORD, MA i iaol u�`J i I 01730 j Page # Sara •� ��e . �J eCTCXd W1 i`� 01"13C OF 1) -IS 39, Proposalubmi ed To: .. Job Name Job # Gv WI�r Address /71). 11a Job Location Date Date of Plans Fax # Architect 1 � 61 We hereby submit specifications and estimates for .............I. _. ___..._ ^ .. y .. __ __ __ ........_ _._ _ _ ._... _ _ ____ ..____.............................. ......... ... GG nn 49.9 v `-C-) ._ ..... __. d .. 1f CCau.. �� w 1 O_ Ccr_4 n.'.�_:�-�1_ ��... _..-- _— __ ...... ....... _ .—_.. ` C I 011I.- __--- _ I _1 . __ `� G S _. .. _...................... _ .. ..... .. .- _ ......... VC -1 4 vlrti c- Joc�r Poe We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of: g L with payments to be made as follows: 113 ,Dr o r ds V Don Cr— "A, 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 withdrawn by us if not accepted within 0cceptance of Propool The above prices, specifications and conditions are satisfactory and are Signature A hereby accepted. You are authorized to do the work as specified. Payments will be made as outl)no O�. Date of Acceptance 9 //�'S� Si nature C&', NC3819 MADE IN USA Dollars days.