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HomeMy WebLinkAboutMiscellaneous - 327 HILLSIDE ROAD 4/30/2018 (2)I Location ,?C No. / 7 Date' Check # 'I 5 6 3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ G Foundation Permit Fee $ Other Permit Fee $ TOTAL $ G �' Buildin TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 17 DATE ISSUED: t / �J / SIGNATURE: / �' Building Comilffftoner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property %Address. 1.2 Assessors Map and Parcel Number: Map Number Parcel Number ReqWred Provided 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage (ft 1.6 BUILDING SETBACKS ft Front Yard . Side Yard Rear Yard R 'red Provide ReqWred Provided ReqWred . Provided t 1.7 water Supply M.rlLC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSBiIP/AUTHORIZED AGENT 2.1 Owner of Record e_cz Name (Print) Address for Service . .109 Signatu Telephone g � iZz z-p-rac2 ,3ad & 2.h Owner of Reco�/ Name Print Address for Service: Si ature Telephone C? 7Fr SECTION 3 - CONSTRUCTION SERVICES .3.1 Lic�ensedd Construction Supervisor: Not Applicable ❑ ` icensed Construction Supervisor. License Number Address41 f ` i '�379KI5 .--- Expiration Date Sign Lure Telephone. 3.2 Registered Home Improvement Contractor Not Applicable ❑ r t0 Company Name i/G / /—J p' Registration Number 17 T . ddre Exptratlon Date Signature Telephone 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 ail a livable New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify ti Brief Description of Proposed Work: _ 1./ SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by t applicant rt 3 (a) Building Permit Fee Multiplier 1. Building r4Z 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) �v �j Oy s 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Q Check Number SECTION 7a OWNER AUTHORMATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUR DING PERMIT 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 Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TM4BERS 1ST 2 No 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r r ,X - 1 9 Na 0 z 0 oa T a o 0 b x a 0 owU � 0 a a 0 w 0-4o~ W x v L J)) w a OU z `� r4 w W A a w N 6 z u cn o v cn 11 .. o ! C c v : o C y ' � C Cc O C3 �d'fl C C A A :2 C O C L N � EQ o o _ts CD Cl CD N i E C 5 CD fi CD O E CDL s Z 9= h C Cm p� in m Q w cc .� L oa a cmQ v �Cc �v a� .co z ts as V v� cc C — C C R — d a LCJ ci C O Q ` w+ N 07 N O -Cl-LZ '� Z ~ C3 c o 0 a CCA m C = � O o O r=r O off Li. O •df A �"� _ C •N .O :s cm V O O:C C Vi O. (aN O IDCL _ � 3 �a�m 5 CD fi CD O E CDL s Z 9= h C Cm p� in m Q w cc .� L oa a cmQ v �Cc �v a� .co z ts as V v� cc C — C C R — d a �fze �an�noozurea � o���%/�Oaac�,uarl� -Board of:Building Regulations and Standards ROME IMPROVEMENT CONTRACTOR Registration -.:1:031b8 f;xpration ,716/04 a Trypg JrSdNiduah ' FREDERICK E. 4 Y� Frederick Reid ` 104 Green St Woburn, MA 01801 Administrator I C/) x Cl) 0 m 1 Cos C � 10 O CD Z CO) CLIftr n� 0 CD p CL w CD CD o CD c CD �' agV to i S CO) co 71 O co C CD 0 X-C F 9 C1 V! O CA 3 0 O CO) Cl) m T Fn COD C rC CAO Q a.o C m S, O m CD A � CO y' Z � CL =r.0 9 d m . =r CL a � m o y 0 p r z C) � cn �Q ^ cl, CD al . :1,d ro O c o M m ~' O O LA. n CD o: COD � a co O m m 1 C d H O y N C41 CL O � CLH _ �m y N CD w N mom: X-C F 9 C1 V! O CA 3 0 O CO) Cl) m T Fn COD so o� CL,: C2. 0. cn cc m nE, ? Pj cr :31 cp ro CL so o� CL,: C2. 0. cn cc m nE, ? Pj H :31 cp ro l CA O � � nz :71 CD 0 r z C) � cn �Q ^ cl, CD al . :1,d ro O c o M z 0 y 0 a I� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Wonkers' Compensation Insurance Att<davit city L� T/ �� Phone I eSl%cl, am a hom caner performing all work myself. 01 am a.sole proprietor and have no one working in any capacity E�l am an employer providing workers' compensation for my employees working on this job. Addre ,c 1 CIN. SZ Q' f 4 7"6 ©� Roane #' �-� l�'Q CJS 1Asutan,ce-Co..C,.1 �`T �'/�/rte % fJ / c). w-.., /- - ��^ ^.4,, /_ Qh CQrxutrry name: Address C[ty: Phone #- Facture to 80Cuf6 coverage as re4WMd under Section 25A or MGL i,52 can teed to ttte i►tlpos;tton d criminal penal, of as fine up to $1;500.00 and/or one years' imprisonment as well as tical penalties in the form of a STOP WORK ORDER and aims of ($100!00) a day against me. I understand that acopy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verJAca km. I do herby certify under pains and pence of payury, UW the kAwmatim provided above is true and - correct I Print QiW1fiW,.; Official use only do not write in this area to be completed by city or town ofiiciar ❑ Building Dept , OGheak Yimrnediare response is required Building Dept p Licensing Board Contact person p selectman's ice Phone # Q Health Department 0 Ofher 7,St WORKMAN'S Cof4Paivs a TION 3u'- 7 5 1',' - / Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... ...................................................... has permission to perform ............... .............................................. wiring in the building of ...... 1-2a ...................... at ..... .....1 ... s121-0 I ....... 'North Andover, Mass. Fee.. ? .............. Lic. No. ......... .................................. ELECTRICAL INSPECTOR Check # Official Use Only Permit No. O 3 -004 ..r 4P-&- 5414 Occupancy & Fee Checked SCS3 — ark BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 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) Town of North Andover The undersigned applies fora permit to perform the Iectricall work descr Location (Street & Number / Owner or Tenant �h/1/f (;,O_ ,O_ Owner's Date / I — Cl pL To the Inspector of Wires: Is this permit in conjunction with a building permit Yes r No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters Voits Overhead 9 _ Undgmd ❑ No. of Meters Numb -*t of Feeders and Ampacity—Z—V� Location and Nature of Proposed Electrical ry i OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted 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 INSURANCE = BOND = OTHER =. (Please Specify) (Expiration Date) Estimated Value of Elpdrical W rk$ Work to Start Inspection Date Resquested Rough Final Signed under nalties pe' FIRM NAMEC LIC. NO. V Licensee Signature LIC. NO. D t(��r 745!Z-9"3,3 - 76!� Bus. Tel No. Address !/ Z, % . !i Aft Tel. No. OWNERSS INSURANCE WAIVER: I am aware that the Licenses does nof 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. PERMITfEE $ / l (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units r Nca of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No.�f Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. df Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection y dNo. No. of No. of Low Voltage Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted 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 INSURANCE = BOND = OTHER =. (Please Specify) (Expiration Date) Estimated Value of Elpdrical W rk$ Work to Start Inspection Date Resquested Rough Final Signed under nalties pe' FIRM NAMEC LIC. NO. V Licensee Signature LIC. NO. D t(��r 745!Z-9"3,3 - 76!� Bus. Tel No. Address !/ Z, % . !i Aft Tel. No. OWNERSS INSURANCE WAIVER: I am aware that the Licenses does nof 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. PERMITfEE $ / l (Signature of Owner or Agent)