Loading...
HomeMy WebLinkAboutMiscellaneous - 35 SAWYER ROAD 4/30/2018N J N�' g� w m V � O � o v 0 Location.v�--� No. —?3 Date U` ' NORTq TOWN OF NORTH ANDOVER O F 9 Certificate of Occupancy $ ;� s'•"° E<� wcHus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ w Check # 18728 / Building Inspector TOWN OF NORTH ANDOVER x BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: O rDA"TEISSUED: f / D - SIGNATURE: nBuldn Co Ssioner/I for of BuildingsDate /v iTI? - _ G TNVnDuAmrnwr 1.12Property - — 1.2 Assessors Map and ParcelNumber: v32 ©d3/ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Repired Provide red Provided R red -I Provided 1.7 Water Supply M.G L.C.40. S 54)Z 1.5. Flood Zone Information: — 1.8 Sewerage Disposal System: Public ❑ Private ❑ one Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes _ No _ 2.1 Owner of Record 9 Name (P t Address for Service: 4� -6d-f --6 7,37 vwner or Kmora: Name Print Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Constructio u rvisor: License Number Addras n �l 7 v J/6+�f,ff 2 7 (0 a Signature Telephone xpirationDate 3.2 Rem' teed Home provem Imt Contractor01(t/��91 4 11111 iwz Not Applicable o Registration Number 6L9(©� Expiation Date SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 & 2506) 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: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 00 3 Plumbing Building Permit fee (a) Y (b) 0 4 Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 Check Number tri SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING 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 IV )i Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Mae iVICSIV Pri am Signature of Owner ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 CO) m m /mw YI m CO) F, y d C � � d TJ O CD aZy CD 0 06 � � O CL y a� :► 0 CDCL 0 CD co C� CDCD y CL Cl O CO) CD I � v CO) O 'D CD Z O � • CD O tD c 0 es�� m �. y C Q O O CL o DCL m 0100-, Co CL o _L O �OOy n r O O0 O n .► "O" O O d 0 ro ZS O H l) OCD �m CL ,,. ,.. O ?. O m y :� ,om CL -1 m3 VJ "Z• d y • CL. Q dm: CL C -) C2 0 o CD . ate: CO) C9 m m CO) z ci omi 0 0 omh w.. R 5 4 ro o o o tz �? n ;� z7 cn C/) 'rl 0 ro 7d Z1 I� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesdgadons Boston, Mass. 02111 Workers' Compensation Insurance AAtidavit Name Please Print Name: S� Location: 436 S e Citr Ale) 91)10 0(� Ie Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: � 4VxZ6Y1- 9/ SO/lis' Company name: Address City: Phone �k 0 /tad Failure to secure coverage m required under Sedan 25A or IYIGL 152 can lend to the impo@lVan Of aiming penatlea d,a Ane up to 11,500.00 wWaroneyeem'Imprisonrnant_as.rmdi.as_chAl.pmakiesJnlhOhMX(ASTOPYVDRKORDERpod-a.Aaad.(,f9A0.CM.az*aprht-ms I understand that a copy of this statement may be forwarded to the Was of Investigodar e of the DIA for coverepe verification. I db hereby Cerny uprsr the pains and penalties Print name W2 A`cam. 1' the inlbrmadon provided above is bue and correct. Z� �7 official use only do not write In this area to be completed by city or town Adel* City or Town P anal []Check M immediate response is required ❑ Bum 1 ng Dept ❑ 119 Board Contact person: ❑ Selectman's Office Ph" ❑ Health Department ❑ Other We propose hereby to furnish material and labor — complete in accordance with the above specific dons for the sum of: o V- �' $ k Sa .Si-ov WDCS V Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, or delays submitted beyond our control. Note — this proposal may be withdra+Gvfi by us if not accep"fe`d within _ days. 2cceptance of i3lropo ill The above prices, specifications and conditions are satisfactoryand are herebyaccepted. Y Signature p You are authorized to do the work as specified. t Payments will be made as outlined above. Date of Acceptance Signature &> NC3819 MAOE IN USA 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: 5 i��4is that the debris resulting from this work shall be disposed of in a p perly licensed solid waste disposal facility as defined by NIGL 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: (Location of Facility) a44—ya-4& Signature of Permit Applicant Fire Department Sign off: Dumpster Permit %�- -7 _a Date P �6f �- Date.... ..., .......... TOWN OF NORTH ANDOVER O + 9 : PERMIT FOR GAS INSTALLATION -�SSACMUSE This certifies that has permission for gas installation . in the buildings of at Fee... ...... Lic. No..-? 74�. Check # ri 1 ?��Oj/:............. North Andover, Mass.. GAS INSPECTOR MASSACHUSETTS UNIFORM APPLICATION (Print or Type) C!� SINTIOR N -. Mass. Date Building I DW New ❑ Renovation ❑ PERMIT TO DO GASFITTING Permit #�� a Owner's Name_PETEI? � CJS) Type of Occupancy t� Plans Submitted: Yes[] No ❑ -- oil I III Y11 • - = MEMO on .. ■��������������r����nrf'N OUN. •• ■������������������t�■ son M MEMO Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone .687-1105 Check one: �O Corporation ❑ Partnership ❑ Firm/Co. Certificate # 1862 Name of Licensed Plumber or Gas Fitter Francis X. Corkery ,. INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indemnity Bond ❑ ®WNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) In abo plication are true and accu a to the best of my knowledge and that all plumbing work and Installations performed under the permit i f r this appiicaiion will n pliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the S. i Tof license: Plumber Signature o cense Plum r or Gas TitleGasfitter Master License Number Qty/Town . Journeyman At'PIiOVE6Z0 IC O L r z 0 U W a N _Z N N W K 0 O c[ IL NI w z - U w W .. X N' a z H 1- H I U W 0. LL N a z J Cal 2 O . O Q O N O � H H U Occ LL z a C7 z cc C W z W O h 0 0 K. U. Z aO ., w t' a m 0 Off. CL a L cl n a o w ~ '� Z z `c . t m u. o O �. a O 1 F ~ U. a rs ¢ o. m m = a1 O Y j a w a NI w z - U w W .. X N'