HomeMy WebLinkAboutMiscellaneous - 34 MARBLEHEAD STREET 4/30/2018Location,
No. 3 G %
Date A4
NORTM
TOWN OF NORTH ANDOVER
AL0
F 9
Certificate Occupancy
$
. • ,
°+
of
ss�C '••E<�'
Mus
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$ �5
Check #
18773 <'�----
"`Building Inspector
1.1Proopp Address: i
1.2 Assessors Map and Parcel
��
t,- 6 v
Map Number
Number:
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area
Fronts ft
1.6 BUILDING SETBACKS fit
Front Yard
Side Yard
Rear Yard
Regaired Provide ReqWred
Provided
RegWred
Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5.
Public 0 Private 'p — Zone
Flood Zone Information:
Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No
2.1 Owner of Record
I C 6 a r �
Name (Print) Address for Service
97$-e �
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
s
Signakure . Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address af
07 0 (JiCi
Expiration Date
Signa Telephone
3.2 RegisteredNome Improvement Contractor Not Applicable 0
Company Name
Registration Number
c� r bq� �,� L-1-1. �,,�,)1�--
Addre
�1C�Nlp�
Expiration Date
Si a re Telephone
00
M
X
z
O
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z
M
90
O
an
MENEM
M
r"
^Z
V/
SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 2546)
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 it.
Signed affidavit Attached Yes .......❑ No ....... 0
SECTION 5 Description of Proposed Work check au applicable)
New Construction (
ctsting Builyding ❑
Repair(s)
❑
Alterations(s)� 0.'
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other *-,Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
1. Building
Estimated Cost (Dollar) to be
Completed by permit a licant
'Sv
�?FFICIA)(1
s _ �.
(a) Building Permit Fee
Multiplier
USE Q,y
" I� ,
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
f
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 BUILDING PERMIT
I,
Hereby authorize - �--""`— ---
My behalf, in all matters relative to work authorized by this
Signature of Owner -
, as Owner/Authorized Agent of subject property
to act on
permit application.
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 e -
Si ature of wner/A ent
NO. OF STORIES
/ 1 iy o .5,
Date I1
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TEVMERS iST
2 ND3RD
SPAN
;
DRVIENSIONS OF SILLS
DEVIENSIONS OF POSTS
DUVIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING
X
MATERIAL OF CHIMNEY
-
IS BUILDING ON. SOLIDOR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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MA Construction Supervisor # 082056 Home Improvement Contractor # 135385
ROB FARRELL
ROOFING, SIDING & REPLACEMENT WINDOWS
FREE FULLY
ESTIMATES 978-682-9449 No. Andover 603-378-0515 Hampstead 603-247-4668 Cell INSURED
29 Cortland Rd, E. Hampstead, NH 03826
Uwe, the owner(s) of the below mentioned premises, hereby contract with and authorize you as a contractor to supply all materials,
labor, and perform all workmanship in accordance with the following specifications, terms, and conditions on premises below.
Owner's Name �kclkrlg) ane 1, to Phone C
Job Address A 1 t 2 I� •`s' T City AJ)tlt, State (P7fl
11 f q cur-) SPECIFICATIONS
aNAJ 1}1q�yti.As!=t• ()A.! 1'4r41n:t,APn- r> 4w
r
Materials and labor to cost $ 'S Payments to be made as follows OiyN'�p�r.t U,J
Options: . I f., Additional cost $,
Additional cost $
The above costs, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as
specified. Owner has 3 days from date signed to withdraw without anycons uences
Re pectfully Submitted: Signature x- ;, Date
', ` Aer
lP /-o�
6 proposal may be withdrawn by us if `
not accepted within days.
Signature Date.
Owner
Gerald A. Brown
Inspector of Buildings
Please print
DATE: OT
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
Telephone (978) 688-9545
Fax (978)688-9542
JOB LOCATION: 3q M ll+2 N oid -�
Number StreetAddress Map/Lot
HOMEOWNER ?(e X1.4 r -d 07� 11110 97Y 2 g -L 603)'-166 5_— 2 Z Z�
Name Home Phone Work Phone
PRESENT MAILING ADDRESS '3f Y-0 t9i213 %. ti f C✓
City Town
Zip Code
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. If
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Form Homeowners Exemption
WARD OF APPEALS 688-9541 CONS6IZ VATION 688-9530 iff.—A ; I H 688-9540 PL ANA NC; 688-9535
Board of Building Regulations and Standards
�I HOME IMPROVEMENTONTRACTOR
p
Registration: 135385
Expiration: P 3/29/2006
Type: DBA
ROBERT FARRELL ROOFING + SIDING
ROBERT FARRELL
29 CORTLAND RD.
HAMPSTEAD, NH 03826
Administrator
$ f�''-:sC � ✓lieF�a�mnaaatr��eix�U ��./G7.a�cu�.et6e�
a
BOARb OF.BUIGbING REGULATIONS,,
Wcerise: CONSTRUCTION SUPERVISOR .
:Number• CS ro
082056
j ! Birthdate: 07/08/1966
i
Expires: 07/08/2006 Tr. no: 82056
Restricted: 00
ROBERT J FARRELL
29 CORTLAND RD
HAMPSTEAD, NH 03841 Administrator
x
A
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: 109 --s,- is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
11,S 150 A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
I OA.
The debris will be disposed of in:
Fire Department Sign off:
Dumpster Permit
Y� AJ4
(Location of Facility)
ZLP
Signature of Permit Applicant
Date