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Home My WebLink AboutMiscellaneous - 262 BOSTON STREET 4/30/2018�a 0 0 rn dyZIL-- ,9 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT EE!A!& RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING offi"100 0' BUU,DING PERMIT NUMBER: DATE ISSUED: WON wo le SIGNATURE: Building Commissioner/inspector of Buildings Date SECTION I- SITE INFORMATION 1.1 Property C� M'' a- 1.2 Assessors Map and Parcel Number: ---� 9 Map Number Parcel Number I 1.3 Zoning Information: Zoning Dii�c—1 Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage 01) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Regaired. Provided Required Provided t- 1.7 WaW Supply M.G.L.C.40. 54) pAhc 0 Pr"w 0 1.5. Flood Zone Infornutwin: 7e- Outside Flood Zone 0 1.8 Sewerage Dispo�l Systeur Munkipal 0 ousiteDispow systeta 0 SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT I 1k1!.C';1 ;(, Ul��trlcf: \"'�3 2.1 Ownerof Record Edw-jo P —h Name (pn;v - -J� P Aqs4e4 5jyted. /V 4"M�' ) Address for Service: -� 'alAq Signature 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 Signature Telephone Not Applicable 0 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Duval Roofing, LLC PO BOX 637 Address No. Reading, MA �O 116,4 gntree�� Registration Number �119 Ir Expirati. Date - Telephone dyZIL-- ,9 4 SECTION 4 - WORKERS COMPENSATION (MG.L C 152 § 25c(6) 1 1% Workers Compensation Insurance affidavit mustbe completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildipg-permit. Signed affidavit Attached Yes ...... 91" No ....... 0 SECTION 5 Description of Proposed Work (ch�eck applicable) New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) ition 0 114W IL A ft ", CA. I I t --� I - Accessory Bldg. %(I F06tnofifiort 0 1 Other 0 Specify . "'T '-�' Brief Description of I SECTIFON 6 - RSTIMATIRD CONSTRTICTInN rnqT-. Item Estimated Cost (Dollar) to be Completed by permit applicant OMCL46L USE ONLY 1. Building (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) I 5 Fire Protection 6 Total (1+2+3+4+5) Check Nubber - ar,%-1JLW1" tVJJJM%_VMrLX1iEVWtMf4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERAUT as Owner/Authorized Agent of subject property V it I Hereby authorize to act on My,"',in all er��tive to work authorized by this building permit application.. Sign-aTtre-jt--0'4M&- --fr— —Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 'I, as Owner/Authorized Agent of subject property Hereby declare that the statements and inOMMIn III kQqpplication are Lrue and accurate, to the best of my knowledge and belief PO Box 6%33_1 No. Reading, MA 01864 Signature of Ommmr/.Agent Date NO. OF STOREES Sin BASENlENT OR SLAB SIZE OF FLOOR TIMBERS i S7 2 ND__ 3 RD SPAN DlMENSIONS OF SELLS DMENSIONS OF POSTS DINENSIONS OF GMERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE .4 6 z W P E L- IE co Z 0 cm CD cm co CD z CD CD 5 MCI 0 P-4 cf) z 0 C/) C/) fil 4E� 4.0. 4-J ,.a E ts w CIO cm CD CO) co -E ca w CD CD L- I.- = 12. — .1" CD CL) Q CL .m 0 CL CL CM< CO) Cc CL. o CD CO3 ts CL C.) CO) CL CO) w LLI U) 1% w LLI 1% w w (1) 0 z 0 or - 'zc i z x :3 cz c 2 �rl C2 �2 C/) co L-LGI to c2 —ca 0 V) 0 V) E L- IE co Z 0 cm CD cm co CD z CD CD 5 MCI 0 P-4 cf) z 0 C/) C/) fil 4E� 4.0. 4-J ,.a E ts w CIO cm CD CO) co -E ca w CD CD L- I.- = 12. — .1" CD CL) Q CL .m 0 CL CL CM< CO) Cc CL. o CD CO3 ts CL C.) CO) CL CO) w LLI U) 1% w LLI 1% w w (1) t5 CLC.3 ': CA c 2 C2 Q C4) C3 In 0 !! I CD C3 0 C CL - 0 :.CA 4D L 43 t = CL4-C3 CD an c— CO LU CE M CD *-'o A) -M co 0 CL 06= ..— :3.4- CD CS = Q LU C.3 L- Cl) E E C43 C3 CD co -0 .0 m c m CL Coo —am cm M-0 E L- IE co Z 0 cm CD cm co CD z CD CD 5 MCI 0 P-4 cf) z 0 C/) C/) fil 4E� 4.0. 4-J ,.a E ts w CIO cm CD CO) co -E ca w CD CD L- I.- = 12. — .1" CD CL) Q CL .m 0 CL CL CM< CO) Cc CL. o CD CO3 ts CL C.) CO) CL CO) w LLI U) 1% w LLI 1% w w (1) CLC.3 ': c 2 C2 Q C4) C3 In 0 !! I CD C3 0 C CL - 0 :.CA 4D L 43 t = CL4-C3 an c— CO LU M CD *-'o A) -M co Ca '— E 06= ..— :3.4- CD CS = Q LU C.3 L- Cl) Q OF cm 0-00.s C43 CL co -0 .0 m 0 064- E L- IE co Z 0 cm CD cm co CD z CD CD 5 MCI 0 P-4 cf) z 0 C/) C/) fil 4E� 4.0. 4-J ,.a E ts w CIO cm CD CO) co -E ca w CD CD L- I.- = 12. — .1" CD CL) Q CL .m 0 CL CL CM< CO) Cc CL. o CD CO3 ts CL C.) CO) CL CO) w LLI U) 1% w LLI 1% w w (1) -C\- The COMMonweakh ofmassachusam Department ofIndusbW Accidents Office offAvenigations 900 Washington S&M Bvstox6 MA 02111 www.mass.Sov1d1a Workers' Compensation Insurance AffliftVit: Buflders/Contractom�Electfidans/Plumbers N=e (Dusin�ni=tiowwivi�1): R() Rox RV Address: No. Reading, MA 01864 city/statetzip; Phone A irc;p� employer? Check thrappropriatt box: I I am a 4. 1 = a &==I costraclor and I am a employer wfth I clMlayces (fifll and/or paft4izn4* bavc hired the mb-contrar, n, -9 2. El I am a sole vroprictor or Partner- listed an ft aitacW.shta t stlip and hm uo ariployees working for me iu any capacity. [NO warkers, 3.0 fequivA.l I am a homeowner doingall wo* nryselt [No workas' coup. in5w== "nuhr&3 t 71=c sub-mtracwrs havc workere camp. hnnmM S. 0 We we a empration and its officUs bVC exercised dMir rh!ht ofoxemption Va MGL c. 152,6101 and vm bavi no MVIOYM& We wotken' conT. bsunswe requiN&I Type of project (nQuired): 6. 0 New colistalcuion 7. 0 Remodeft S. 0 Dmolition 9. 0 BuildiAga"Won. j o.0 Mecuical jep2irs or 2dditions 11.0 P1WMbh9MP*$ or MWAM i 121a-95�f - 13.0 Other ;Any applitaffl gat cbeda box 91 n0a dw (M VA Ibc actim below d0wing tb* wwk" 'CIRWO—d- FOlicy in�� liomeowava wbo VAnit dis affilavit ia&=04 Mey an deft 88 --k Md fts bke aufti& OMMuCtm mad VAMMft 0 MW da&vit Wica'"a V -1L tConvocam ftt dwck this box anuo an=hed an sd&tkm1 ohm sbvwbs Go== of&* ab-amM "d*-iT—*We-MP-V0licYi"f*rnMfi= I am an thy6yer that isptovift workers' campensadon baurancefor my empkyees Bdvw&&epvA7aivdj&bsft ipffommfim IUSUYMW COMMMY Policy # or self -ins. Job Site Addrm:t�)-4�� CiTYISOMMip: '11� - AttSCh 2 COPY of the workers' compensation policy declaration page (showing the poNcy number and expiration date). Faihm to secue coverage as mpiiftd under Sectim 25A of MGL c, 152 can kad to thi: impoison of aimillai penaities ora rbe up to $1,500-00 and/or o1ae-yeaT imprisonmen� as well as civil VmIdes in the form. of a STOP WORK ORDER and a fine of up to $250-00 a day apirAt ft violator. Be advised that a copy -of tids glUmmm my be forwarded to tht Office of Investigalions of the DiA for kswazice coverage verificatioa I do hemby ceiWf2.jw*r the paim andpenalkies ofpedury diat the informadon provided above Is &me and correwt F-1 Offidat use only. Do nof write in dds area, to be compIded by cky or to" offiCIAL City or Town- PermlYLAcense ISSWag Authority (cirde one): L Board Of HUM 2. Buliding Department 3. Cityfrmm Clerk 4. Elettrital Impecter S. Plumblog Inspector 6. Other rw 11rapasal Page No. of PI�ages N't DUVAL RGORNG < 4. A P.O. Box 637 No. Reading, MAO 1864 (781) 944-1994 a (978) 664-2557 PP,OPOSACMOBMITTED TO N I DATE Jr kll� L_`LA_ �Z__ 4� 62 C STREET JOBNAME If r� C_ ) a 01 , , I , CITY, STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS IJOBPHONE Hir proPOSr hereby to furnish material and labor complete in accordance with specifications below, for the sum of: ,rs($ W7SO Payment to be made as follows: doll 30%. Deposit Required Sdore Ordering Materials, %J Ellaiance Due Upon Day Of Completion All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from specifications be- Authorized low involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, acci- dents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be insurance. Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. We hereby submit specifications and estimates for A od oller e, XiF4 t () o NO 4eg LA) Ire j T.4,Aj YO I rou 4 P ej or (01njA7 I P P 1,9 A Cl P jf Vr 1,11ler V C, J-1 tip d 1) FTIq Po lef) 1,7_0 C) C) 700 rc)o 0., V'O Xf Pqf CA jj -1 Tom)(& Arreptattre of Proposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature i., 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 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 , It$ S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: 'r(Location ofocility) Signature of Permit Applicant Fire Department Sign o T. Dumpster Permit Date