HomeMy WebLinkAboutMiscellaneous - 250 HILLSIDE ROAD 4/30/20184114
. O
Town of North Andover
HEALTH DEPARTMENT
�SswcHus°t
CHECK #: of W DATE:
LOCATION:
H/O NAME:
CONTRACTOR NAME:441t-,i
Type of Permit or Dense: (Check box)
❑
Animal
$
❑
Body Art Establishment
$
❑
Body Art Practitioner
$
❑
Dumpster
$
❑
Food Service - Type:
$
❑
Funeral Directors
$
❑
Massage Establishment
$
❑
Massage Practice
$
❑
Offal (Septic) Hauler
$
❑
Recreational Camp
$
❑
Sun tanning
$
❑
Swimming Pool
$
❑
Tobacco
$
❑
Trash/Solid Waste Hauler
$
❑
Well Construction
$
SEPTIC Systems:
❑
Septic - Soil Testing
$
❑ Septic - Design Approval $
❑ Septic Disposal Works Construction (DWC) $
❑ Septic Disposal Works Installers (DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
Other (Indicate) $ �D ClC/
r �
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
kms, Locationz--�v �--a-•-
No. 7-4z Date 46� 0<S—
TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
Building/Frame Permit Fee $
4CMU5
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ �r/r•
Check #
�/ Building Inspe55r'
TOWN OF NORTH ANDOVER
` BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT RE! RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
&��dings Date
Buildin o /Ipft
SECTION 1- SITE INFO TKW--- _
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
L
0 a- S . 0
CSG 44
Map Number
Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning Dii-r d Proposed Use
Lot Area
Fronts 8
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Rapired Provided
Recmired Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. blood Zone Information: 1.8 SewenV Disposal System:
Zone Outside blood Zone ❑ Municipal ❑ On Site Disposal System ❑
Public ❑ Private ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
M49t
Name (Print) Address for Service
lv (2oti GU's ;y -(�
Signature Telephone
Q.2 Owner of Record:
Bun Chhouy
4 Coburn Road
Name Print Tynlaboro, MA 01879 for Service:
�7 � /Address
!/-- (9 % 'li-:;-%C/o iv
Si a re Tele hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
A'
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Home Depot
f 2 G ?9,3
Company Name 345 Greenwood Strut
Registration Number
Worcester, MA 01607
Address
Expiration Date
Signature Telephone
a
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 ag analicable )
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
SZ4 1-
I SECTION 6 - RSTIMATRD CnNCTRrtf Tina rrncTc
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1.
Building
o U v
(a) Building Permit Fee
'Multiplier
2
Electrical
`
(b) Estimated Total Cost of
Construction
3
Plumbing
Building Permit fee (a) x (b)
4 Mechanical HVAC
5 Fire Protection
6
GTT 11T1A1T
Total 1+2+3+4+5
A. Ati11T�}T
Check Number
11V1\ av yl, a %-1LV r'JU JLZ.0 YY NMA
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/AUTHOR17.F.D AC.F.NT nr.rr.ARATrniv
I ,%�4r% A/ A/041 (0as �twne
property /Author ed Agent of subject
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
Sianature of Owner/Ae t
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 b7, 24D 3
RD
SPAN
DIMENSIONS OF SILLS
DINIENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS . s :.; 'si eta -j:. , ; r_ri
SIZE OF FOOTING X
MA'T'ERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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7urs 15 05 07:30a Michael Bedard
.J
1-401-246-2868 p.4
HOME MUROVEMEIN7 COMRACT
• y Sold, Fu shed aad'.ns!alled hy:
Branch Namc: !�1�— Dnte: I 10THD At =Monne Setvi, es, laic.
�
bb/a The Herr:e Depot At -Horne Ser is^s
! 145A Greenwood Street, Worreste:, _.La )MC7
Branch Number: . _ •liar �� Sf Tot; Free !860) 557-5 t 62; Fax: 50S.756Q859
Fc1.nl I:Ns 75.201 460 ME Lot A C 07439 R? Cont Lira 164:'
Licp,SG3fj
a52'.hA Hlunro lmpmvort,am Cnntrrctor Peg. Ht;AR03
Llstallntion hddress: 5d lri 1 �d ti d
g`� t ^'.NtdC�
-- City State Zip
RIA(ti _ (5V_1t55 1AyM I H7V b'6_7175 141 i
0
&Lome Address! r _ h4—
(if different fr,m instal;.: ion Address) City State Zip
Pra eel tinTrtrmauun: Ywe!YDu ("?l:rchaser"), the nwwers of ire property lowed at the above ills:allanian sc.dte;s, Direr to
contract Wit"I Ho1•iome Depat U•S•A •, Tnc. ("N of to iluris1. deLlc'er and arrange for -he inshilaUon of all materials as
lescnbed on the attached Spec Sleet #: j y incorporated hettdn by reference and made a pant hereof.
t513a)9
Home Depot reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determines that it
cannot perform its obligalious due to a structural problem with the home or becaume work required to complete the job
was ant include(! is the cuntract
CONTRACT AMOUM 5
*LESS DILPOSTr S zCf
BALAN'CX DQE
ON rOMPLIFTiON 3 -
*Nlininium 75'Y e Centract.Amotmt due upott oxmtuon
or kttfs cmtlrac[.
Indicant Paytncnt I\Iethod For -- -
HALAIN'CE DUL ON COMTUCTION:
DE'POLSU PAYMENT OPTIONS
{Sub, txt to Ned veriduawa and+or credit epptwal)
I. tt;irxk. Caeh.rsa t;7eec of US Pes!cl 5en'ieu Monry Ud--
yMo& sayable :a The Home D,;.1),
Z. Credit Card• enNoc at;tcr pnyngnt n;,;iuns Clrtic Onc Sdow
Vi« btlttt:Cutd Dicuvcr A=iran
rat Hattie:)(* Home IrAFrovetnent Loau I'It Home Dspot Cmdit Cula
Avtllabie Credit: S�_{ HIL & FJDCC ONLY -
'U01; ---- -"------ Exp. D5t""'-------
Natm Usti: aPq.ura o0
-By mylour tignalmo below, 1/ to agrw fo 6ow• Homo Dutra to charge the above
rnibrnncad annul ",d iurttw &,po,,i 1r.dlat+d.
- ML ar HDC Autorzatkt-oots
Deposit fr
Fustueat
i'srchast:T agrees t.11% l:nmedfatcly upon sa�sf=cry completion of rim work, Purchaser Kill eneoute a Completion Certificate
and pay any ba:ince due. Purchaser also agrees to be jointly end severally obligated and liable :hereunder.
Entire A,•reemcnit 'fids agreement and its avachmctts, includir.e any Unseeing avrrement, W:x'un :he complete agrcir.ent
etwtrn rue panes and call not be amended or modillLd unless m writing in a septl-ate 3greetrpnt signori by both parties.
NOTYCI:'fO PC1RCnA$TI2
t)u not sten 1111s colltrod before vnu react it. Yue ars mttitlod To n earnplelvly Glied-ta 6 py ofti ha contract ut tht u— you sign. Atop
eer,
t to protect vrighls. Do not sign Ay Completkn Ccrliveate nr awromirmt statin Kt •eu are stttisllcd 'Aith Cie eollrn p. SJmct
bcfare this project N complaie. Law pro home repair contruclnrx from requost4ng ora ceptWg n Completion cerGfente ylaned
w
by iho Oner',u•ior u, the uelua, comptetlon u! the .vork to he purTormud under the contract.
You may ducal this transaction at any Unte erinr t.9 tnidni¢ht o! -the third busin<as dry ancr tha date of this contract. Sec lNoiice of
Cancallition for an rRpldnatton or this rtgbt. Ih-t -in L- a mrviec ehurgu .:qua( to 35/ or the :ontraa anmuut tt th, jun is
euneu!lod by Purchcv r .RAFTER the third buaincsx day.
B'r M.YIptIR SICiWATU2!_ L33L0'N, :rW E AGRLL -t'0 f3F 9±�UND 9Y 2'NL'tRRMS QF THC3 CvI•dTR.hCT. ;1tVl; ,tCk:NOtWLt.DG?
R EEC E1l'I' OF A COPY OF TH9 5 CONT:,ACT AND TWO CON;?LETED COl'Ji5 orn% NOTICE Oi-- 1 JON.
AY MY OUR S:GNA7li r,, BLWw, jM E UND RSiANI% TT{,e,T THE .4CREL'MTiN7 TS S;JWEC_7 70 2LVIPAv G"
CRLDIT RYIS701Y AND bWL" ALITNORIZE UOMT DGP07 AUTIICRi7.F.D CONTRAC70R, TC
CkSMIT rCCORD W�%.''kN rNT)F,PSNDE:NT CREDIT REPORTING At3ENC,Y AJ�D 2L.LEA5; TH E'vr FRONt ALL U&SILILY
INCUUBA)�.RO."! INAD ERTENT Oh11F. tONF OK ERROR$. ISO NOTSJGN'TRISCOiNTIUC' 1P'rnE1;WARL- ANYBL.'kNK
SUBMITTD By:
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At--CEPTZ
Homec un -r +
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14711CL: AJDDI-MUNAL't'L1015. CONDMC)Nh ANO WAIUZA ,7+:VAkL.sTATk7D ON TUX TR9'1'X1,%:a;WZ AND ATR rART OF'rti75 CCINTiLICI•
4lbita-0—h Fac Yo¢cw-G�„onxr Pi*H->al:r Can.u; au:
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Location Z �;b
No. S I S' Date 1�
TOWN OF NORTH ANDOVER
Water Connection Fee $
TOTAL $
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J(� S)". Building Inspector
14/24/ 1,6:14 25.00 PAID
8892 Div. Public Works
Certificate of Occupancy
$
#
Building/Frame Permit Fee
$
�'�s'•'t�
Foundation Permit Fee
$
ACMUSE
ACMU
&;?
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee $
TOTAL $
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J(� S)". Building Inspector
14/24/ 1,6:14 25.00 PAID
8892 Div. Public Works
PER311T NO. 9-15- APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
PAGE 1
MAP +40.
LOT NO.
CONTR. TEL. #
2 RECORD OF OWNERSHIP (DATE BOOK '.PAGE
ZONE
SUB DIV. LOT NO.
I
LOCATION > �, �` S. `Q c
D• IG••_��
PURPOSE OF BUILDING
OWNER'S NAME
1
,J
NO. OF STORIES SIZE IL�
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME ---------
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME 10
417
SPAN
DISTANCE TO NEAREST bUILdING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES
REAR
" GIRDERS
AREA OF LOT
FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INS UCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
SIGNATURE OF OWNER OR AUTHOR
F E E
3
PERMIT GRANTED rr
19�J
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BUILDING
OWNER TEL. #
CONTR. TEL. #
/ / �(
6 �L//2 u,
CONTR. LIC. #
ol
/(, !? O
H.I.C. #
88ctZ Cbd �� Ibc-25
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY I
STORIES
MULTI. FAMILY
OFFICES �_
APARTMENTS
CONSTRUCTION
2 FOUNDATION
—I
8 INTERIOR FINISH
CONCRETE
PINEHAR
B
1
2 13
CONCRETE BL'K.
BRICK OR STONE
---III
D
PIERS
PLASTER
DRY W
DRY VlAll
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. 8'M'T' AREA
_
'/ 1/7 1/
FIN. ATTIC AREA
N_O 8 M T
FIRE PLACES
_
_
HEAD ROOM
MODERN KITCHEN
4 WALLS 9 FLOORS
CLAPBOARDS
B
1
2
3
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
CONCRETE
EARTH
HARDIVD
COMMC:N
ASPH. TILE
VERT. SIDING
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. & FLOOR I_
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
_
STONE ON FRAME
SUPERIOR I� POOR
ADEQUATE NONE
10 PLUMBING
5 ROOF
GABLE
HIP
BATH 13 FIX.)
_
GAMBREL
MANSARD
TOILET RM. 12 FIX.)
FIAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR & GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
_
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. 6 COLS.
STEAM
STEEL BMS. d COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T 2nd _
to 13rd
ELECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT, AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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OFFICES OF: ��r _. __. Town of
OFFICES.._ L ►Zo mains reef
-_ APPEALS. �, . �. NORTH ANDOVER - . -.North masAndover. o 1 84sBUILDING t�-�;e
CONSERVATION DIVISION OF
HE.-kLTH
PLANNING PLANNING & COMMUNITY DEVELOPMENT
_ KARENH.P. NELSO\, DIRECTOR
In accordance with the prcvisic ns of NICT_ c =0, S 54, a condition of Building Permit
Number 13 15 is that the dctris resulting from this work shall be
disposed of in a solid -ante ' ^cs-i :ac;iir: as u'c :cd by ,MGL c 111, S
The debris will be disposed of in:
Sicnat:.� of Pcrmic Applicant
Date
NOTE: Demolition permit from the Torn of :forth Andover must be obtained for
this project through the Office of the Building Inspector.
N; 1 J7J
Date .&.../7- �F.....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that...........................................................................................
has permission to perform .......`....................................................
$wiring in the building of .. - ✓! r�-� a-r�---�--�
............................................................
mat ....' ti,}..... ,.....& ................................................. ......... , North Andover, Mass.
°7Fee— �:1.............. Lic.Nd&!. ..�-�-
...:........... .....
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Office Use Only
of 4e (lommonwealt of leassttchusetts Permit No. 11,3-3 _
Reparttntnt of Public bufetg U 1iOccupancy b Fee CheckeOZ_
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 heave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 5/11/99
City or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 250 HILLSIDE ROAD
Owner or Tenant MARK BRISSENDEN
Owner's Address (978) 687-8161
Is this permit in conjunction with it building permit: Yes ❑ No ® (Check Appropriate Boz)
Purpose of Building Utility Authorization No.
Existing Service Amps I Volts Overhead ❑ * Undgrnd ❑ No. of Meters
New CA #cAmps __ I Volts Overhead ❑ Undgma ❑ No. of Meters
Number of Feeders and Ampacity
I Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Bibs
No. of ltansformers Tout
KVA
No. of Lighting Fixtures
Above In -
Swimming Pool gmd. ❑ grad. ❑
GeneratorsKVA
No. of Receptacle Outlets
No. of Oil Sumen;
No. of Emergency Lighting
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
Nnitiatingo. oftection Devices�
No. of sounding Devices
No. of Self Contained
DetectkXVSoundtng Devices
Local municipal❑ Connection ❑ Other
No. of Ranges
No. of Air Cond. tons
No. of Disposals
Total
No•of pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KIN
No. of Water Heaters KIN
No. of No. of
Sign Ballasts
Low Voltage
"ring-
No. Hydro Massage llrbs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy Including Completed Operations Coverage or Its substantial equivalent. YES G NO O 1
have submitted valid proof of same to the Office. YES O NO O If you have checked YES. please indicate the type of coverage by
checking the appropriate box.
INSURANCE Q BOND. O OTHER O (Please Specify) (Expiration Date)
Estimated Value of Electrical Work i 678.00
Work to Start 4/30/99 Inspection Date Requested: Rough Final 5/3/99
Signed under the Penalties of perjury: LIC. NO. %fit. --
FIRM NAME ADT Spr-ttriry SP-rv!Lr-ej%- Trite,
Licensee nnnal d A_ BrnnksSignature LIC. NO.. 1231r-
00F J- Bus. Til. No. (Y61) 741-4008
Address 111 Morse Street, Norwood. MA __ All. Tel. No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the, Insurance coverage or Its substantial equivalent as re-
quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent
(Please chock ons) 1.
... Telephone No... PERMIT FEE S . 35.00
(Signature of Owns( or Agont) IArfiy
