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HomeMy WebLinkAboutMiscellaneous - 212 MIDDLESEX STREET 4/30/20187640 1,41fl 66ilding Inspector Location No. Date 9 TOWN OF NORTH. ANDOVER + 0 41 Certificate of Occupancy $ MU & Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # V 7640 1,41fl 66ilding Inspector TOWN OF NORTH ANDOVER BUILDING DEPAR'TMEN'T APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ti s � � x .t % . �' 9?k� b,'n x3'x'� , l I .... 'r ✓,nq BUELDING PERMIT NUMBER: / / / DATE ISSUED: SIGNATURE: Building Commissioneffl for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Pq 1Q 0 14 6 Q, �/ �N �BVC � �� • Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronta ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard ReqWred Provide ReqWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Punic ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2- PROPERTY OWNERSHIP/AUTHORIZEDAGENT District: YDS �.jp 2.1 Owner of Record bEmmS `�-' o �� �;�nl s Name (Print) Address for Service over Signature Telephone 2.2 Owner of Record: Niame Print Address for Service: 4 Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone V 3.2 Registered Home Improvement Contractor Not Applicable ❑ M ,Go P Na��.�iyl Registration Number � S�' /Iwir ce _ Addr s Expiration Date Signatur _ Tele hone T M M z M z M 90 0 am M rMz 0 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 .......0 No ....... 0 SECTION 5 Description of Proposed Work check su applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: MEAL S�WG�Fs Mf I RECTION 6 - F.CTlMATFn rnNCTR1TrTTnN rncTQ I Item Estimated Cost (Dollar) to be Com leted b permitapplicant CIAL USE:ONLY 1. Building ©� (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x tb> rf /0 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number 5El:1lVP1 /a V WPIEK AU lliVK1LA11VI4 l V BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize My behalf, in all matters relative to work authorized by this builduig permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION to act on 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 of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 15 2NU 3RD SPAN DII TENSIONS OF SILLS DINIENSIONS OF POSTS DIlvIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND _ IS BUILDING CONNECTED TO NATURAL GAS LINE M N t PROPOSAL PROPOSALNO. SHEET NO. 1'• .1 _� DATE , PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME ADDRESS ` , PHONE NO. ADDRESS DATE OF PLANS ARCHITECT We hereby propose to furnish the materials and performthe labor necessary for the completion of AJ Mfr 6 yl� P r t,A ,4 ±'A AP n Ukl %y f 1 1 ia'f A J , 12 Fe /;r ifs"; " 0 yell r, iiuil `F; .A 0 J 5 ._e e -NJ r: C 't ,? t j - qn��Nr sP! ' r, 3 ,, .tP- 41A f # tl "T r _ /) . a ,rte Ice f All material is guaranteed, to be as specified, and the above work to be performed in accordance with the drawings and specifi- cations submitted for above work,and completed in a substantial workmanlike manner for the sum of c -r _ Dollars ($ (I, Z, with payments to be made as follows. Respectfully submitted d 2 J,) Any alteration or deviation from above specifications involving extra costs will be executed \only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents, or delays beyond our control. Note—This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature Date Signature GAdams NC 3818-50 MADE IN USA PROPOSAL 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 c11,S150A. The debris will be disposed of in: L fl � i (Location of Facility) Signature of Permit App scant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector License or registration valid for indivdul use only before the expiration date. If found return to: Board of Building Regulations and Standards One As burton Place Rm 1301 Boston, Ma. 02108 P Not valid without signature B�rd o�uin�g2eg 'dns and . tandar HOME IMPROVEMENT CONTRACTOR Registration: 134035 Expiration: 9/13/2005 Type: Individual DENNIS MARR DENNIS MARR 277 A MERRIMACK ST. LAWRENCE, MA 01843 Administrator I n - ui z c o c is o ` C y O C 3 C3 � a o a :w O � a 1 : O O w+ d%b: a TO xa p x U G x a p -i q w a w o C Cora m a ` � ; ; E O z o ui z T IS z E Z cm w C. CO) c 0 CD 3� L� Ci oLM L d o a coa c c �i cis o � Z C. H c cl U) U) 19 W W ce LLIW U) c o c is o ` C y O C 3 C3 O. C A A :w O � 1 : O O w+ d%b: �o m w o Cr '� CD c E C Cora m ` o GO CO ; ; E O s f" y y co O E CD mo cm C = ccO o co a cm c Q o O C3 : o •Q = � $ o vim IV CIO w c +- w y cc E c C= o Z O w a m-0: 5 CIO w m9=� s CL, in T IS z E Z cm w C. CO) c 0 CD 3� L� Ci oLM L d o a coa c c �i cis o � Z C. H c cl U) U) 19 W W ce LLIW U) 0 N2 2262 Date ..... X/ R TOWN OF NORTH ANDOVER OZ. PERMIT FOR WIRiNG 4L This certifies that ....... k-:.:.. �. (- C. 1. ............... 2 t4t,�adlj.,,� has permission to perform .... Pf..vv.,A�.J ........... .............................. wiring in the building of ..... 70!�.fft ......... H. ................................. at ....... �. ...... d , North Andover.,Mass-.�7 Fee..L"" 0 3.. Lic. No.� 0� ....... . .... ...... �—*.*" ELEcrRicAL INSPECMR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office Use only TW COMWONWE4LTHOFM. ASSACHUSETIS ' DEPARTA&WOFPUBLICS4FM Permit No. 0� BOARD 0FFIREPREVEM0NRWUI.47I0N.SV7CW 12.00 Occupancy & Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 ' OQ (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 work described below. Location (Street & Number) �2 / Z /),/l zgles � Owner or Tenant 7U2>4-Aj Owner's Address ne94Y . _ Is this permit in conjunction with a building permit: Yes M No M (Check Appropriate Box) Purpose of Building " ILV Utility Authorization No. Existing Service C 00 Amps/ Volts Overhead nderground No. of Meters New Service Amps /� Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Liighting Outlets/ O No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA and round No. otrReceptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Other No. of Dryers Heating Devices KW Connections Ni.. of Water Heaters KW No. of No. of I Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER Itnt r&=Ca=gt Laws Iha%eaa=tLiabillybur& oePcbcymdu&gCanplate Covaageorils&ksbr>tdeWhdat YES NO IlmeahnadvalidpmofofsamelotheOffix YES rJ NO a FjwtmedvdWYES,pkm dc*theiyWcfoomagebydrkirgttte INSURANCE ©-BOND o OTI-ER a ftwe) EViatimDaw EstmtatedVakXCfE cbw Wak $ WakIDSW =� hq)ecfimD eRequ�d Ragt1 .. �%,/� Final FIRMNAME Lioa>SeNa�` Lir�amae %1'Y�l�`7 7. my7tl� Signm= L'toamilb AILTd % Z OWNWSNSLRANICEWAIVER;Iamm=tAthelmmdpes not theitau=wmWonisst>iAvidegtrivdettastegtmWbyNtmmdmsmGairALaws and8�mys�taernth'spami<watwslltisteguagna>t (Please check one) Owner Q Agent Telephone No. PERMIT FEE 90 v -0 ..�Lqcation No. 9 Date &ORTol TOWN OF NORTH ANDOVER 0. Certificate of Occupancy $ Building/Frame Permit Fee $ CH Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 136,03 Building Ins ,64ctor ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING su t BUILDING PERMIT NUMBER: DATE ISSUED: ®� no /00 V SIGNATURE: Buil ng rv--i—r/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: S 7— 1.2 Assessors Map and Parcel Number: -L Map Number Parcel Numba 1.3 Zoning Information: Zoningbistrict Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Re red Provided rC 7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: `Public 0 Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT iw 2. I Owner of Record Name (Print) Address for gervice cogs—�a�o Signature Telephone 2.2 Owmepe€Reoord:t7l-a�v r', 0 �, t t- � U / T Print { Address forService: Z �7" -7 oC o / ,Sijn'a-6r-e-7 L Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Constructi Supervisor: r") e La c tA) -0., /, Licensed Construction Supervisor: tJ — oL — �Q �S re Telephone Not Applicable ❑ 6Z �p License Number ���� Expiration , e 3.2 Registered Home I vement Contractor Not Applicable ❑ 6 ny Name / �/ v , / �� J A / �(,% Registration Number /0 Expiratio Da w ddr s/a �� i tur Tele hone 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 .......0 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: /ub vale Bet.f k a n Q, �12e c, Lo /A 'p- L -o SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant Uk'FICGIA USS (NLY 1. Building 06 (a) Building Permit Fee Multiplier 2 Electrical / 0 o (b) Estimated Total Cost of Construction 7 t7O o 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 (j 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 authorized � W l to act on My behal , u all matters relative to work authorized by this building permit application. Si is e of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Nam$o ��Vj 1177 ` Si attire o Own r/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T \IBERS OT 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS S17 -C j1X OOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 0 T 4o ,9 -20 CV LLJ C, Ui a.LU D lz: CO o z Z 0 OD ZZ 0 ca gr LL Cl 0 0 Z o C.) Cl O D) m LO Z 4o ,9 -20 CV C, Ui a.LU D lz: CO o z Z 0 OD ZZ 0 ca gr LL (14 0 Z o C.) L) m E m LO Z he Commonwealth of Massachusetts Department of lndustrral.Acc;dents Office of Investigations Boston, Mass. 02111 workers' Compensation Insurance ,Afdavit L.ccaticn:1e�C l44L1-i� St-- �1 I am a'hcmecwner pererming all work myself. Eam a sole proprietor and have no one )N(Drkino in any capac:P/ CI am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address Phcne T Insurance Co. Pelici T 1 Comoanv name: Address CItV Phcne_ r' Insurance Co. Polio T Failure to secure c :verace as recuirea under Section 25A or MGL 152 can lead to the impcsidcri of c imirai penalties cr a fine up to 51,900.00 and/or one years' imorscnr:ent as'Neil as c:vii penalties in the f.crm cr a STCP'NCRK ORCE:R and a rine cf (S100.00) a day against me. I understand that a cd -..y or ;tris statement may be forNar to the Office cr Invescgaticns cf :he OIA fcr coverage verification. I do hereby c . ny car e ns and It s of p lh t .'he information provided accve is :7ue and correct. s Signature Date 1?rint name Phone Ofsic:al use only de not wrrte in this area to be completed by c::y crown c^:caf C'ty or Tcvn Permit/Ucensirc ❑ Building Dept ❑cre`k ,f immediate resperse s required C] Lic-ensing Board p Selectman's Office Caniac: person Phcne . health Department Other In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properiy licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility /§igg:ture of Permi-t'AA� 'cant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 2'-10" X 3'-0" 4 O w O Cl) m m Cl) Cl) O C2 A10 d — M o n Z y CD Co�• r � � o CL _• y too o v CD CL Q .0 CM CD ww C• CDCD o) � t CD S v CO) O � Z CD o 0 o CD 0 CD 0 Ki p C � C r� CA a c� damn m ycan, n anEr-3, Py n • � o o oGC ]- m aid = CD OCc a•' ti to = <a a CL Iz C17 rim ZS d 0 y a O C7 .0 _ � o CD CDH CL CA AM: ,omd CL CL CO \ / d N CS m C'. d W CS rn Cn C!) 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