HomeMy WebLinkAboutMiscellaneous - 197 WINTER STREET 4/30/2018 (2)a
Location % 9(2 GUIN7 £IZ
No. f?D
Date S / 5 D a
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $ _
Other Permit Fee PDO! $
TOTAL
Check # 3 .S
15526 y Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
_. Tt�=Secbo»..1for U#i">Eciz}I'Use'OaI - ; -
BUILDING PERMIT NUMBER: �! j'�
DATE ISSUED:
SIGNATURE: /U C
Building Commissioner/I for of Buildings Date
SECTION I- SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
q% �i i r��-►Z, �� Dpi c � 5
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zonin g District Proposed Use Lot Area (so Fronts aft)
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Reqwred Provided Reqwred Provided
1.7 water supply M.c.t_.c.ao. s4)
1.5. Flood Zone Information: 1.8 Sewerage Disposal System: -
Public 0 Private 0 1 Zone . Outside Flood Zone 0 Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
me (Print) Address for Service:
Signature
2.2 Owner of Record:
Name Pnnt
Signature
Telephone
Address for Service:
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable 0
y
Licensed Construt-gion Supervisor:
License Number
Address
Expiration Date
signature Telephone
.2 Registered Home Improvement Contractor
:ompany Name
.ddress
u re
T
Not Applicable ❑
Registration Number
Expiration Date
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 ....:..0 No ....... 0
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:
fig'
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed b rmit applicant
_ r r. f
1. Building(a)
t
Building Permit Fee
Multi lier
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
C*1—y S�fl7.P `�� as Owner/Authorized Agent of subject property
fHereby authorize to act on
behalf, ii 11 utter relati to work authorized by this building permit application.
g b O -z --
Si nature of vnrer Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
] as Owner/Authorized Agent of subject
property
Herebv 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/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
77
SIZE OF FLOOR TTMBERS I ST 2 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIN ENSIGNS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIIVINEY
IS BU11,DING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL. GAS LINE
Eej �3�) 1J03000N c�
FORM - U - LOT RELEASE FORM - 9 - c-;�,
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
jC1 APPLICANT C4LI S ��
990 , w-5� 7
_..Oie-ASSESSORS MAP NUMBER 1 O � C- LOT NUMBER t
�G SUBDIVISION LOT NUMBER
YSTREET ...U................................ STREET NUMBER ... .�.f ..� ..... .
OFFICIAL USE ONLY
............................................................................
RECO NDATIO F TOWN AGENTS
..... ■ .. NDft ... .. ................................
......■......................■ ... ....... .
DATE APPROVED O 2,-1
CONS7NA11ON XI5MMSiUf0R
Dt� —11- REJECTED
COMMENTS ^ -
DATE APPROVED
P R
DATE REJECTED
COMMENTS
DATE APPROVED
FOOD INSPECTOR - HEALS DATE REJECTED
DATE APPROVED _
SEPTIC INSPECTOR - HEALTH
DATE REJECTED
COMMENTS
PUBLIC WORKS – SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR DATE
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Date... � ...............................
NOR7M
°f'"`° :•'"� TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
.......................................................................................
has permission to perform.`I.....................................................
wiring in the building of ......... !---........--!. �- -.......................................
at . .h. ......................................... . North Andover, Mass.
Fee.........'.. ... Lic. No, �' k
ELECTRICAL INSPECTOR
Check #
Official Use Only
Permit No. 3
e?;71 057
amt 4 P -P& S*rf Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CT 12:00
(Please Print in ink or type all information) Date
To the lnskdof of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number
zcOwner or Tenant
Owner's Address 1-14/�/ !3 :�
Is this permit in conjunction with a building permit Yes C� No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing ServiceAmps Voits Overhead ❑ Undgmd ❑ No. of Meters
New Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
C-'%
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy includin pleted Operations Coverage or its substantial equivalent YES = NO =
E�FCND
proofof same to the Office NO = ff you have checked YES please indicate the tyRe qfi� rage by checking the appropriate box
= OTHER = (Please Specify) /
(Ex ion Date)
Estimated Value of Electrical Work $ +���
Work to Start Inspection Date Resquested Rough Final
Signed under the Penalties of perjury:
LIC. NO.
FIRM NAME 47
LIC. NO.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses goes not nage cng 111surd]
General Laws. And that my,signature on this permit application waives this requirement.
(Signature of Owner or Agent)
Owner
Agent (Please Check one)
No. PERMITVEE $ cyk6—�
Total
No. of Li htin-q Outlets
No. of Hot fuse
No. of Transformers KVA
Above ❑ In qe,-�
No. of Lighting Fixtures
Swimming Pool gmd ❑ grnd ❑
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges -
No of Air Cond Tons
Initiating Devices
Heat Total Total
No. of Di sal
No. Pumps Tons KW'
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Spa ce/Area Heating KW
Detection/Sounding Devices
❑ Municipal ❑ Other
No. of Dryers
Heating Devices KW
Local Connection
No. of No. of
Low Voltage
No. of Water Heaters KW
Si ns Bailases
Wiring
No. Hvdro Massage Tuds
No. of Motors Total HP
C-'%
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy includin pleted Operations Coverage or its substantial equivalent YES = NO =
E�FCND
proofof same to the Office NO = ff you have checked YES please indicate the tyRe qfi� rage by checking the appropriate box
= OTHER = (Please Specify) /
(Ex ion Date)
Estimated Value of Electrical Work $ +���
Work to Start Inspection Date Resquested Rough Final
Signed under the Penalties of perjury:
LIC. NO.
FIRM NAME 47
LIC. NO.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses goes not nage cng 111surd]
General Laws. And that my,signature on this permit application waives this requirement.
(Signature of Owner or Agent)
Owner
Agent (Please Check one)
No. PERMITVEE $ cyk6—�