HomeMy WebLinkAboutMiscellaneous - 27 CONCORD STREET 4/30/2018C)
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Location C� 9 ()()/UC
N o. 1-7/ Date
TOWN OF NORTH ANDOVER
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Certificate of Occupancy $
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Building/Frame Permit Fee $
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Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVAT!� OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUELDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
. BuilTng— Commission-erflnq��ctor of Buildings Date
SECTION I- SITE INFORMATION
1. 1 Property Address:
1.2 Assessors Map and Parcel Number:
0 q's 0
Map Number Parcel Number
1.3 Zoning Information:
S&cr, t e PA.
Zoning Di Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage (ft)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required ded
Required Provided
-8-b - 4; ?.el 3 #- ge, 7
:�
1.7 ly M.G.L.C.40. § 54) 1.5. Flood Zone Infonnation:
bli. Zone Outside Flood Zone
P. Z"T" Pmve 0
1, Slerage Disposal System:
11).
Municl' On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIIP/AUTHOIMED AGENT
Historic District: Yes No
2.1 Owner of Record
Name (Print) V Address for Service
"JI a4AA. 71
Signature Teleph
2.2 Ownpr of Rec6id:-
Name Print Address for Service:
4
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Cons chon Supemsor:
LicensecKConstructijn Supervisor:
Address
Signa ,�arc Telephone
Not Applicable 0
2
License Number
E ira on Date
3.2 Ree.,tered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) I
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 ....... R No ....... [I
-SECTION5 Description of Proposed Work (check A applicable)
New Construction 11 1 Existing Building El I Repair(s) 0 Alterations(s) 0 1 Addition
Accessory Bldg. 0 Demolition 0 i Other 0 Specify
Brief Description of Prop9sed Work:
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I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building
-NO.
-BASEMENT OR SLAB
(a) Building Permit Fee
Multiplier
SIZE OF FLOOR TINIBERS I-
2 Electrical
-SPAN / !Z 0
(b) Estimated Total Cost of
Construction
-DUVENSIONS OF SI1,LS 6-
Plumbing
f�
Building Permit fee (a) x (b)
_DlWNSIONS OF GIRDERS - 1411h
-3
Mechanical (HVAC)
dlpr
-4
Fire Protection
t e , �N
-5
6 Total (1+2+3+4+5)
RIAL OF CHRVINEY
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE CONWLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BVHDING PEWMT
4-P— Z;"'ev as OxNmer/Authorized Agent of subject property
Hereby authorize -�7 , 6A' to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner oil Date
SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION
1,
,A,Zf,e,4 / 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
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Print Mgft/
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Si aiur M'�wner A ent
OF STORIES
Date Z
SIZE
-NO.
-BASEMENT OR SLAB
SIZE OF FLOOR TINIBERS I-
ND RD
1D 2 3
-SPAN / !Z 0
-DUVENSIONS OF SI1,LS 6-
_DTWNSIONS OF POSTS 11,74
_DlWNSIONS OF GIRDERS - 1411h
FOUNDATION k I
THICKNESS /0
-HEIGHTOF
-SIZE OF FOOTING 140
X
RIAL OF CHRVINEY
-MATE
-IS BUILDING ON SOLID OR FILLEIJ LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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Q0 ��.12Z FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION*********************
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APPLICANT )OC, PHONE
LOCATION: Assessoes Map Number ?Z� PARCEO,� CoeVro
SUBDIVISION LOT (S) J-_0
-VI EX 15tl K
STREET,::qo2 L170,4," e 154e elt ST. NUMBER
PUSE ONLY"************
TOWN AGONTS:
ATION ACUNINSTRkT-OR DATE APPROVED
DATE REJECTED
COM
TOWN PLANNER �4
COMMENTS
FOOD INSPECTO
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SEPTIC INSPECTOR -HEALTH
COMMENTS W/ /,�q
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
FIRE DEPARTMENT
RECEIVED BY BUILDING I
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D. Robert Nicetta,
Building Commissioner
Please print
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 0 1845
HOMEOWNER LICENSE EXEM[PTION
00S
DATE:
JOB LOCATION: n "V 0
Number
HOMEOWNER OJIII14
Street Address
Telephone (978) 688-95454
Fax (978) 688-9542
Map/Lot
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Name Home Phonev Work Phone
PRESENT MAILING ADDRESS.
City Town State Zip
The current exemption for"homeowners" was extended to include owner -occupied dwellings to two units or less
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the
owner acts as supervisor). State Building (Code Section 108.3.5. 1)
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended
to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not
be considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE AZI&all— le
APPROVAL OF BUILDING OFFICIAL
BOARD 01"APPEALS 688-9541 CONS] -TA'ATION 698-9530 HY, k1,T] I 68X-9540 PLANNING 699-9535
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(—on&nwn&veaUh of 1ija4Ad,,"Uj For Office Use Only
(Rev. I IM)
Permit Number
glow Occupancy & Fee
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMrr TO PERFORM ELECTRICAL WORK
(ALL wORK To BE PERFORhIED WrrH THE MASSACHU= UECMICAL CODE 527 0a 12:00)
PLEASE PRINTIN INK OR TYPE ALL INFORMATION Date: 7 5
- City or Town ' * - /�� 'A' &, � ---L - To the Inspectorof Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location: (Street & Number) 2 7
Owner or
Owner's
/�r— C --
Is this permit in conjunction with a Building Permit? I Yes Ar"—No 0 (Check Appropriate Box)
Purpose of Building: Z- V Utility Authorization
Existing Service: Amps Z�i-L/ z ycyolts Overhead Underground.0 of Meters
New Service:.,_. Amps Volts Overhead 0 Underground.13 # of Meters:
Number of Feeders and Ampacity:
Location and Nature of Proposed Electrical Work:
No. of Recessed Fixtures
No. of Call.-Susp. (Paddle) Fans
No. of Transformers Total KVA
No. Of Lighting Cmdets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool: Above ground 13 In Ground a
# of Emergency Ughting Battery UnIts;
No. of Receptacle Outlets
No. of 0111 Burners
Fire Alarms # of Zones
# of Detection & Initiating Devices
# of Sounding Devices:
# of Self Contained
DetactionifSounding Devices
Local t3 Municipal Connection 0 Otner 0
No. of Switches
No. of Gas Burners
No. of Ranges
No. of Air Conditioners TOTAL TONS:
No. of Waste Disposals
Heat Pump Totals:
Number TONS: KW:
Security Systemst
No. of Devices or Equivalent
No. of Dishwashers
Space /Area Heating: KW
Data Wring, No. of Devices or Equivalent
No. of Dryers
Heating Appliances KW
Telecommunications Wiring: No of Devices or
Equivalent
No. of Water Heaters KW
No. at Signs:________# of Ballasts:
OTHER;
of Hydro Massage Tubs
No. of Motors_ Total HP
INSURANCE COVEPAGE: Unless waived by the owner, no permit fo5,tD!-performance of electrical work may issue unless the licensee provides proof of liability insurance
including *completed operation' coverage or Its substantial equiv The undersigned certifies that such coverage is In force, and has exhibited proof of same to the Perm
issuing offi . ca. CHECK ONE. INSURANCE �nBOND 0 OTHER 0 Please specify:
Estimated Value of Electrical Work (When required by municipal policy)
Work to Starr. 1,7 Inspections to be requested in accorcance with MEC Rule 10, and upon corroietior
I certify, under the pains and penalties of perjury, that the Information an this application is true and complats.
Firm Name:/,-;, 42 LIC.
Lice nsee:-Al 111-f Ae S '3
LIC. # AV,9 -7 —
I Y�
Tel. #��,7 -2-16 Att. Tel. #
QVYNgR'B INGURANGra WAIVER; I am aware that the Ucensee do" not have the liability insurance roverage normally required by law. By my signature Deiow, 1 nereby
willyg Ifill mquimment, I jim the (wealit an#) Owner 0 OR Agent 0
Signature of Owner/Agent: . Telephone 0 pwdrr FEE: S