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HomeMy WebLinkAboutMiscellaneous - 274 WAVERLY ROAD 4/30/2018 (2)vs Location 17 No. "---j Date A- TOWN OF NORTH ANDOVER 7 - Certificate of Occupancy $ MU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 16 5 31 '-�-Building inspCcior TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: - 7T1 AM A A Map Number Parcel Number 1.3 Zoning Information: 1.4 Dimensions: Ries I /Property ft Zoning District Proposed k4e Lot Af6a�s Fr 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.7 Water Su76 pply M.G.L.C.40. 44) 1.5. Flood Zone lnfon tion: 1.8 Sewerage Disposal System: Public -J4 Private ❑ Zone Outside RoM Zone Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record - nva- !st Name (Print) Address for Service ,_ _ Sign re Telephone 4.2 Owner of Record: Y � s Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ _t Company Name Registration Number Address Expiration Date Signature Telephone SO 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 all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: CJ �i Co t# b Lv CJ I of X Q CL (�' _, ne •� n� re >r �` SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be e : OMCIAL_`USE ONLY Completed by permit applicant I . Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction l 3 Plumbing Building Permit fee (a) x (b) �D 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATI TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,NIA as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1,�� N � C�Nl i�f�'{ 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 Signature of Owner ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2 TC 3RO SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DiMENSlONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING JC' / X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND Q IS BUILDING CONNECTED TO NATURAL GAS LINE �, �� �1 '� �4 �) ^ Registry of Deeds Northern District Cl, Essex ty Co Lawrence i MIA 01040 06/26/03 DR # 12 Land Court Doc#83068 Fee 5O.00 [. P. 20.00 D. 5.00 ��NK YOU! Thomas J. Burke 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******'***************** APPLICANT-�JN N A (;R(J/s1�— PHONE �J!S – 7 % 2 7 LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET—,(Lam` FO Atm ST. NUMBER�41 ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF—TOWN AGENTS: CONS ATION AD INIS COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS TOR DATE APPROVED _ DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm LCP 88138 M 7S 2, NNi,t: �49 °�l11110641 r�eo � PROPOSED DRIVEWAY W m I 0 co U) 11.3' N� J6 t 18 ASSESSORS MAP 15 LOT 51 10.1' 5,458 SQ FT 0.125 AC 0) I 0 00 z I DGE OF PAVEMENT W A V jE R1L jY ROAD (PUBLIC N 60' WIDE) SITE PLAN 274 WAVERLY ROAD NORTH ANDOVER, MA ASSESSORS MAP 15, LOT 51 SCALE: 1" = 20' DATE: MAR 6, 20C NEW ENGLAND ENGINEERING SERVICES 60 BEECHWOOD DRIVE NORTH ANDOVER, MA IA(978) 686-1768 10' 0 10' 20' 30' PIAN#: 659 Btt: 5GC3 CHECKED R.C.t, & 13,80, p-. 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: (Location of Facility) 4ite of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Tel: 978-688-9545 Please print. DA JOI "HOMEOWNER N Town of North Andover Building Department �,�• �'` .9 DAAitD �PP�.�: 27 Charles Street SSACHUSE North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION —I kel —� Home Phone PRESENT MAILING ADDRESS s4e221,c City Town State Wor! k Ph ne The current exemption for "homeowners" was extended to include owner -occupied dwellings of six 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 109.1.1) Zip Code DEFINITION OF HOMEWOWNER: 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 to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance 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 No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. _ , 1f _ HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. ICU _o ku Con �r Cn o - w w s um 4 �1 t*#46. r w3 Q O �: (L) l u-6 ai �0 ♦� ® N e Qp 4q CL We Q' ; LU z (06 io ® o .3 a - Ow N o a V3, cc O ; u t° ac"aoo aQ >® o -' u 0) E 0 '44;-'s a, , Lim a c 0 0f�ear W c Vol V Q 0` .y Ua�15 0.03N ti CU a r a5�. a?L a h H ` ,� � m t .0►s- G� 0 z aJ u � 0 lox:2U o Ao i m a 0O z 6 1 s. w ° O w v cn z .o O w O c�' X U CISQ. C w °�° p a cz C w" 0 W °�°cz p C2 cx C u: a " °�° p r� �, C w ` r «� o cn Q o cn co O C L O CD z o. O y o C 4 im r o L �: Q1 C CM L O C,) a c 2 d CPQ t M H CL, -3 ~ t�:ino o` /� U co q� CM L O C,) a c 2 m M H CL, -3 ~ "1* m N 0.coo2 O J C a w MDr.+ W (4 EQ CLM rn o1*6ca co q� 2 L O •� C CL _0 U) Ir w cc w' U) e I� S ORTi{ - • Q�,�S4Co •d��n u ��SACNilS@^S A, Zoning Bylaw Review Form Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone ,978-688-9545Fax 978-688-9542 Request: Date: Please be advise DENIED -foe thb Zoning no. ♦ i kWIV Esc �! fo '8. Fa 1• m a+'- - __ t x &,01 `Dm* s cls. aQ,; 6 vy J i that after review of.your Application and Plans that your Application is PoUowing Zoning Bylaw*"'easons: Remedy for the above is checked below. Item # Special Permits Planning Board Site Plan Review Special Permit Access other than Frontane Rnarini D. - rrontage Exception Lot Special Permit Common Driveway Special Permit Congregate Housing Special Permit Continuing Care Retirement Special Permit Independent Elderly Housing Special Permit Large Estate Condo Special Permit Planned Development District Special Permit Planned Residential Special Permit R-6 Density Special Permit Watershed Special Permit Item # Variance C-a+S Setback Variance Parkinq Variance, Lot Area Variance Hei ht Variance Variance for Sim Special Permits Zoning Board ermit Non-Conformin Use ZBA moval S ecial Permit ZBA ermit Use not Listed but Similar iS!E ermit for Si n Special permit for preexisting nonconforming The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled" Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all,plans and docutnegtation for the above file. You must file a new permit application form and begin the permitting process. iIng epart Official Signai.ure Application Received Application Denied r Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient_ 1Frontage'Insufficient- - - 2 Lot Area Preexisting e s 2 Frontage Complies , 3 Lot Area Complies 3'- Preexisting frontage • ,A-.. Insufficient Information 4 Insufficient Information B :Use '. `� ":' 5 'No access`ovet Frontage 1 Allowed G Contiguous Building. Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required yeg 3 Preexisting CBA ,meg 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 1 Front Insufficient 2 Complies 3 1 Left Side Insufficient aaw q- 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient Ga.-a'a.. I Building Coverage NIP. Preexisting setback(s) n., �. 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies p Watershed 3 Coverage Preexisting 1 Not in Watershed �(e S 4 Insufficient Information 2 In Watershed Sign 3 Lot prior to 10%24/94iQ 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information -E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district r S 2 Parking Complies ,e s 3 Insufficient Information 3 Insufficient Information 4 Pre-existing Parking Remedy for the above is checked below. Item # Special Permits Planning Board Site Plan Review Special Permit Access other than Frontane Rnarini D. - rrontage Exception Lot Special Permit Common Driveway Special Permit Congregate Housing Special Permit Continuing Care Retirement Special Permit Independent Elderly Housing Special Permit Large Estate Condo Special Permit Planned Development District Special Permit Planned Residential Special Permit R-6 Density Special Permit Watershed Special Permit Item # Variance C-a+S Setback Variance Parkinq Variance, Lot Area Variance Hei ht Variance Variance for Sim Special Permits Zoning Board ermit Non-Conformin Use ZBA moval S ecial Permit ZBA ermit Use not Listed but Similar iS!E ermit for Si n Special permit for preexisting nonconforming The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled" Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all,plans and docutnegtation for the above file. You must file a new permit application form and begin the permitting process. iIng epart Official Signai.ure Application Received Application Denied r Plan Review Narrative The following narrative is provided to further explain the;reasons for DENIAL for the APPLICATION for the property indicated on the reverse side: ` Referred To: Fire Police Conservation Plannina Health 909 Zoning Board De artment of Public Historical Commission ti Building Department, 0 V M z e O � � ?3 C� o� w W ao w� a U) rn Qw � J z in a=w Uo t-�jt Kill w - HUH l.r Er w ' w Z w U O = Q -of- z v O a� OW Z W f�m OR N J O R' a � U O wo O p w tow L,0 w O a� n w Z a oZ A O Z0- C! W N N Imo- VI O ~ �i w > �+ 1 a '- to Zo H w OE O� n' wa Z w as v�"a z � o o w z [� O a in ON w wn velli Q W WL U lwi 0O0 0 �O Q:U O O 0U- ZZ www z 1. 0, Ir c oc-an. i zvio 0 V M z e O � � ?3 C� o� w W ao w� a U) rn Qw � J z in a=w Uo t-�jt Kill w - HUH l.r Er w ' w Z w U O = Q -of- z v O a� OW Z W f�m OR N J Tovylld C, Th 1003 IIA y 2g O qo 4r N o A. V � z a4 AC� 2 a o.sb o W) M "1 °w rrww 0 c 8 N ox or tQ A M C7 p� O N •ts `0 .n N .° 0 0 > ��' � `�fal P-qFQ � a ¢, o � a o V* v V a4 AC� 2 a o.sb o W) M "1 °w 0 c 8 N ox or 4 o ° J. M C7 p� O N •ts `0 .n N .° 0 0 > ��' � `�fal ,o 0 on 'o !Q�00 C t� Nod ° c� oo,aA�c 0.9 ° a l0 -. ° t! .95 00 CO C* 3$ '"0rofix v W c �.C� ' s ! ^O M It N'R �iwZ"p'�' O , � '.cf h7 M co c0 a cqv q b -• �.:a N a•?'4o"��a �� or, 'o�°��e eNa°aoa� q48 CO 4) 110) 44 Qac � � �: y �' 3 � `` � .�' �° •�' .� � � � .,,.a � •� ; •t, CA cn ►, .. 4ra 3C3 A pp 04 $04 04 ccs .. ... o aa. •• MD 4) th BIC N aosi �� L�+ a a t NYf� .O''-' -`QTy, ;U `� N Z Q G' Fs �j to 0 ° �. C s ° q �Ct,' y '0 _0 O Op `ti to Qt 'N ° •�I o Go O la 0 0 °�°° •Z 9 b 4.4 ti b q 79 T ° ycn.0 TT77 cd 0 .1 S Dcc 44��,,� � l � q U4 0 M 0 0 N O A N 0 a o, 00 00 00 OD a 1 00 4) x 0 In In o, 00 00 r 0 7 h T 00 00 119 00 to b 7 19 00 rn y O 3 • O na O, 00 b 0 a x O h a 00 0 b 0�q rn . o 0 7 h rn 00 00 C- rn m w 7 h a 00 00 e n a y d 0 W) M y �; o � U 000 T 00 P-qFQ � a ¢, o � a o V* N 0 a o, 00 00 00 OD a 1 00 4) x 0 In In o, 00 00 r 0 7 h T 00 00 119 00 to b 7 19 00 rn y O 3 • O na O, 00 b 0 a x O h a 00 0 b 0�q rn . o 0 7 h rn 00 00 C- rn m w 7 h a 00 00 e n a y d 0 w J N Date. S - e�. :� ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... e� e/ ........................ has permission for gas installation 9c, �% P�< �-? (!q. — � ........ in the buildings of .... SX.:q..,e . Zj4 . I ........................ at ... ......... /,North Andover, Mass. Fee ... rq. Lic. No.. Y.� .. .... (I". D. —tt-4�� ........ 4SINSPECTOR Check # Ll / )'J 4422 3n5°� MASSACHUSETTS UNWORM APPUCATON FOR PERMIT S' TO DU GAS ANG b (Type or print) Date 8 g c) 3 NORTH ANDOVER, MA.SSACHTJSETTS Building Locations �0 Owner's Name New ❑ Renovation Replacement Permit #7 Amount $� COL r Plans Submitted ❑ 14✓1 (Pram or type) �` ,,�/ / one: Certificate Installing Company Name ' �� /C'Cl'i Gr �!/ Ac ` l/%C Corp. Z Z -y i C Address' 80 o x °aP Q Partner. Business. Telephone' Jp 65192 .� / ! 9 7 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �`j/` s `j A AO P r INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. yes No Ifyou have checked Yes, please indlfate the type coverage by checking the appropriate box. Liability insurance policy Ol her type. of indemnity LJ ,� gond ❑ Owner's Insurance Waiver: F am aware that The licensee does not have the l&urance coverage required by Chapter P42 ofthe Mass. General Laws, and that my signature on this permit application waives this requirement. Check arae: Signature of Owner or Owner's Agent Owner. ❑ Agent ❑ t hereby certify that all of the details and information I have submitted (or entered) in above application are true acid accurate teethe best of my knowledge and that all plumbing work and installations performed under permit Issued for this application will a in compliance with all pertinent provisions of the Massachusetts State Gas a and Cha 142 o e th eral Laws. By: Title (OFFICE USE ONLY) SSI'gnatlure'of Licensed Plumber Or GasTitter Plumber � Z y Gas Fitter ;cense Number �i aster ❑ Journeyman TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... has permission for gas installation .... �1 9'.-n ............. in the buildings of ... SA. - ' 0-e Z"14 at I � �— No�h Andover, Mass. ...... .... '3P ...L) Fee. .-7.. Lic. NoPA�V�: . ..... �'AS'INSPECTOR Check# 4fl') 4421 ;A' S0 11 y; k ? MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUM] (Type or print) NORTIi ANDOVER, MASSACHUSETTS Building Location 2- 7 q f,(Ja V Ptf i k New Renovation 1 r Date � -1 u 3 rs Name /�. t�.h,� r©, �l�C' a i Permit # L4' -L2- Z Amount cS,� %_ cupattcy pw.1 f, 2� S Replacement FIXTURES Plans Submitted Yes Q No (Pryor type)// Check one: Certificate Installing Company frame S K /y'ecA ct e)/Cal A C 19 Corp. _ Z Z t� � C Partner. Firm/CO. Name of Licensed Plumber: ��� ins �o� e r- S''? � Ak Insurance Coverage: indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity u Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the ab( three insurance Signature Owner Agent I hereby certify that all of the details and information I have -submitted (or entered) in above application are true and accurate to tl best of my knowledge and that all plumbing work and install 'ons performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MassachuseVState P mbin ode.. hapter 142 of the General Laws. c By sgna e of Mcensecier Type of Plumbing License Title City/Town Zinense lNuum'EerMaster Journeyman APPROVED (OFFICE- USE ONLY IJ M76 S< '0 iso i`l oZC% r (iU L°'l� ( l 3.5±' 5.8± 6 S�'�� „� I 7 6 L �g z LCP 88138 3.6±' w o0r) N � of 00 (n 11.6±' 11.4±' NEW GARAGE /NEW-/ DDITION 10.3±' 0 10.1±' w 1 50.00' S.B. N08° -31'E WAV E R LY ROAD This plan is the result of a survey performed on 10/21/02, based upon the Land Court Plan No.8813B, recorded in the Registry of Deeds, and an as—built construction survey performed on 9/30/03. This plan is for the use of the Building Inspector of the Town of North Andover, for determination of zoning compliance. This plan may not be used for conveyance purposes. M16 L52 AS—BUILT Addition & Garage Location Plan for land at 274 Waverly, Rd., No. Andover, Mo. Scale:1 "=20' — 10/03/03 GRAPHIC SCALE: 1 "=20' NEW ENGLAND ENGINEERING SERVICES, INC. 60 BEECHWOOD DRIVE NORTH ANDOVER, MASSACHUSETTS "� Je1=�Ls �' E0 (978) 686-1768 4219 Date.............................. 0" TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . .... .......... ................................... ............ / . ...................... has permission to perform . . .............. -42-/ 6,1 - wiring in the building of ........ ....................................................... I/ at ....... 4 . . ........... . North Andover, Mass. Fee....... Lic. No ...................... .... .... .... ........ —ELEcrRICAL INspEcrOR Check # 0 -/jy TBEC0AM0ArffEALTH0FMSS4CHUSE'TIS Office Use only DEPARrMiSA 0FPUX1CSAFEIY iia/ 4 BOARDOFFIREPREVEN170NRWPermit No. ONS527 M12M Occupancy & Fees Checked APPUCA77ONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Spector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street Owner or Tenant Owner's Address Is this permit in ct _, Purpose of Building `-�--- ••-»• " .,......1'1S F1111111• ICS L--, IN _ (Check Appropriate Box) Existing Service ,/U` Amps � / Volts Utility Authorization No. �Il Overhead ® Underground a�ED No. of Meters New Service Amps�Volts OverheadUnder 'round g � No. of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures Swimming Pool Above Below KVA Generators No. of Receptacle Outlets No. of Oil Burners KVA round round No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS No. of Zones No. of Disposals No. of Heat Tons Total Total No. of Detection and No. of Dishwashers Pum s Space Area Heating Tons KW Initiating Devices KW No. of Sounding Devices No. of Self Contained No. of Dryers Heating Devices Detection/Sounding Devices KW No. Local Municipal E3 Other Connections of Water Heaters KW No. of No. of No. Hydro Massage Tubs Si ns No. of Motors Bailasis Total HP OTHER: fiwanoeCovgage, Putsuu�tothetecgu�rlaysofMas r}a>�ttsGataalLaws [haveaaanentLiabt7itylrntuariovpblicymkxlugConPlete Co�orits�tbalequivalart YES NO havesubtr>�d�alidproofofsametotheOlfio~ YES ED YyouhavedWod YES pleegdbox ��x)caethetypeofmaageby NCBOND MIER py i�odcto Slat Fst nwdvak eofEl�cal Wotk $ lrWectiml)aleRegtlesled Rough Final gnedundertTie IRMNAME LicenseNo. �� J ioffW_- Signature Loa>SeNo J,� Bt>messTel.No. ddt a2-1 �� �-�- WNERSINS[ JRANCE W Alt Tel. No. AIVER,Iam that theIlemsedoes.9havethenestuulc oevaageor'itssttl6wtialegtuvalerltasrequired bylMassxhusettsCkietalLam dthatmysigmWoonthispmntapp) thisragtuterrtent 'lease check one) Owner Agent Telephone No. PERMIT FEE $ `j rgna ure o caner or gen ) Cf Location No. Date 6-2-03 14ORT" TOWN OF NORTH ANDOVER Certificate Occupancy $ of Building/Frame Permit Fee 3 c') $ Foundation Permit Fee $ Otber Permit Fee $ TOTAL s 3 0— Check # CA 16422 It1w Building inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING � -n BUILDING PERMIT NUMBER: DATE ISSUED: ASI A ( rho A Of I SECTION 1- SITE INFORMATION 1 Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 2711 Ua 9 ^� " v -25-6- 001/n Number �� 7 Signtv V V Telephone Parcel Number 1.3 Zoning Information: Address for Service: 1.4 Property Dimensions: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES Zoning District Proposed Use Lot Area Fronta e ft 1.6 BUILDING SETBACKS 00 Not Applicable Front Yard Side Yard Expiration Date Rear Yard Required Provide R red Provided Required Provided Company Name Registration Number 1.7 Water;ply M.G.L.C.40. 54) 1.5. Flood Zone Information: I's ew a SDisposal System: Public Private ❑ Zone Outside Flood Zone �% Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record L Name (Print) I nh/-� I I OF ^� " v -25-6- Address for Se- rvice + Signtv V V Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Co struction Supervisor: Address 'Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone 00 M X z O O z M 90 O mn ic M r YI .- , 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. affidavit Attached Yes .......❑ No ....... ❑ –Signed 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: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant 4FF'ICIAL ISE, 0 'Y 1. Building (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 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BURDING PERMIT /A—I, 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/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 Name Signature 'O r ent Date .. ups .. .. . rM . ::..h. NO OF S'110RIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvlBERS 1 ST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS Di1vMNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover Building Department 27 Charles Street North Andover MA 01845 Tel: 978-688-9545 Please print. DATE JOBLOCA HOMEOWNER LICENSE EXEMPTION 40 z z� Number "HOMEOWNERzoCzl W Number &Ab Street Address r Home Phone Section of Town Work Phone PRESENT MAILING ADDRESS ' ��h+ �'L f✓ City Town State The current exemption for "homeowners" was extended to include owner -occupied dwellings of six 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 109.1.1) Zip Code DEFINITION OF HOMEWOWNER: 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 to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance 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 No. Andover Building Department minimum inspection procedures an¢ requirements and that he/she will comply with said procedures and requirements. 7 HOMEOWNER'S SIGNA APPROVAL OF BUILDING OFFI Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. 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: C) (Location of F re of Date 2 (VOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector W co �I OG 16 $ a a O z A .d r.c o .0 o C :c u a x ® U w Q. o w w O w U W o w V cn G w O a o a c w W A w W G 00 ° 2 cn Q co !- .6 rU P4 N _o U) U) ccW W Cc U) C o c cl o O_ C r O cj V CL. W W c 1 C :t O !►m . O L CAN C V 90: Jy,,, a y C.� m o �. cm m C E 0 `3 C. CO y tH y c c O J y C C cc ca 7► • : E c cm :�pm0 cm On- C C CID v y Ob. � cc O •� •moo cn CL-c o CD ca W � y o .co r r �.�. LU .`m aCD t .c Z O r o y _O ch v m F - h Z a A o-5 0= y'- O =cla�m� !- .6 rU P4 N _o U) U) ccW W Cc U) I i Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ........ -,has permission to perfo .... ........ .......................................... "Cring in the building of ......... �77�� ...................................... at.5��7�1 ....... ............. . North Andover, Mass. Fee;?/� ..... ........ Lic. No . ............. ... .. ........................................................ ELEcTRicAL INSPECTOR Check# �-5 5U46 7,?,£ (,mmmZaugw?w eig Dy -15--t 4;Do#& S44 BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO All work to be performed in accordance with the (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number Owner or Official Use Only Permit No. Occupancy & Fee Checked 9a 12:00 ELECTRICAL WORK Electrical Code 527J, MR 12,00 Date 3 0 T TO the 1164ector of'A loves: Owner's Address S�p%1SL. Is this permit in conjunction with a�� //building permit /� ��n /Yes � No 0 (Check Appropriate Box) Purpose of Building /llT1/Ah 12ac L� Clir'" C/Vu%, Utility Authorization No. Existing Service Amps Voits New Service Amps Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Overhead 0 Undgmd a No. of Meters Overhead 0 Undgmd 0 No. of Meters VSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 11have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent 6? = NO have valid proof of same to the Office YES = NO If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANC BOND OTHER (Please Specify) (Expiration Date) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under th P natties 9�jjperjury:� FIRM NAME L04- msu I.1Lirl o,(if �/ �fiP� �1�I C i[� _c LIC. NO. E2 NO. yJ � Bus. Tel No. Address�/1' Sraaam Gt S� �U�rL�/�Jt�D�/ � �j Alt Tel. No. OWNER'S INSURANCE WAIVERA am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ U (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA i Above a In 0 No. of Lighting Fixtures /3 Swimming Pool gmd 0 gmd 0 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 Diposal No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices a Municipal 0 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP VSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 11have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent 6? = NO have valid proof of same to the Office YES = NO If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANC BOND OTHER (Please Specify) (Expiration Date) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under th P natties 9�jjperjury:� FIRM NAME L04- msu I.1Lirl o,(if �/ �fiP� �1�I C i[� _c LIC. NO. E2 NO. yJ � Bus. Tel No. Address�/1' Sraaam Gt S� �U�rL�/�Jt�D�/ � �j Alt Tel. No. OWNER'S INSURANCE WAIVERA am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ U (Signature of Owner or Agent) Name: Location: City Phone am a homeowner performing all work myself. F -1I am a sole proprietor and have no one working in any capacity F-1 I am an employer providing, workers' compensation for my employees working on this job. COmpanv name: Address City Phone #: Insurance Co. Policy # Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 andfor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' E] Building Dept ❑Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone #. Health Department Other FORM WORKMAN'S COMPENSATION M