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HomeMy WebLinkAboutMiscellaneous - 369 SALEM STREET 4/30/2018 (3)2 ff nf+,^rel s',.a!I be filed ().0) ejjys after the, U L%;. cf �i.:�; of tl.ia I�ctice in the Office of the To,.. n Clerk. 1: MEN:' 1D JOYCE BRAG::itAW TOWN CLERK NORTH ANDOVER TOWN 20 OF NORTH ANDOVER OCt MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION .369 Salem St. 53 aM'31 NAME: John Duda DATE: 10/16/97 ADDRESS: 369 Salem St. PETITION: 031-97 North Andover, MA 01845 HEARING: 10/14/97 The Board of Appeals held a regular meeting on Tuesday evening, October 14, 1997 upon the application of John Duda, requesting a Variance from the requirements of Section 4.136: of the Watershed Protection District, paragraph 3C: of the Non -Disturbance Buffer Zone, and (2) construction of any septic system, to allow installation of septic system within 100 feet of a wetland in the watershed district, of the Zoning Bylaws which is in R-3 Zoning District. The following members were present: William J. Sullivan, Walter F. Soule, Raymond Vivenzio, John Pallone, Ellen McIntyre. The hearing was advertised in the Lawrence Tribune on 9/30/97 & 10/6/97 and all abutters were notified by regular mail. Upon a motion made by Walter Soule, and seconded by John Pallone, the Board of Appeals unanimously voted to GRANT relief requested in the applicants petition, section 4.136 of the Watershed Protection District, Para. 3C: of the Non -Disturbance Buffer Zone and (2); construction of any septic system, to allow installation of septic system within 100 feet of a wetland in the watershed district of the Zoning Bylaws, and on the grounds that the Board of Health approve the system. Voting in favor: William J. Sullivan, Walter F. Soule, Raymond Vivenzio, John Pallone, Ellen McIntyre. The petitioner has satisfied the provision of Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw, Note: The granting of the Variance and/or Special Permit as requested by the applicant does not necessarily ensure the granting of a Building permit as the applicant must abide by all applicable local, state and federal and building codes and regulations, prior to the issuance of a building permit as requested by the Building Commission. BOARD OF APPEALS ' /decoct William J.Sullivan, Chairman oll HO orM 11,0 it 0 I' 1 o ,SSA HUSES TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS ` Notice is hereby given that the Board of Appeals will hold a public hearing at the Department of Public Works, 384 Osgood St, North Andover, MA. on Tuesday the 14th of October 1997 at 7:30 P.M. to all parties interested in the appeal of John Duda, 369 Salem Street, North Andover, MA. requesting a Variance from the requirements of Section 4.136: of the Watershed Protection District, paragraph 3C: of the Non - Disturbance Buffer Zone, and (2): construction of any septic system, to allow installation of septic system within 100 feet of a wetland in the watershed district, of the Zoning Bylaws. Said premises is land and building with frontage on the West side of 369 Salem St. which is in the R-3 Zoning District. Plans are available for review at the office of the Building Dept., Town Hall Annex, 146 Main Street. Published in the E.T. Sept. 30 & Oct. 6. By order of the Board of Appeals, William J. Sullivan, Chairman LEGAL NOTICELEGAL NOTICE .. >Nrw� TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing al, the Department of Public Works, 384 Osgood St:, North Andover, MA on Tues- day the 14th of October 1997 at 7:30 P.M. to all parties interested in the appeal of John Duda, 369 Salem Street, North Andover, MA requesting a Variance from the requirements of Section 4.136: of the Watershed Protection District, paragraph 3C; of the Non -Distur- bance Butter Zone. and (2): construction of any septic system, to allow installation of septic system within 100 feet of a wetland in the watershed district, of the Zoning Bylaws. Said premises is land and building with frontage on the West side of 969 Salem St. which is in the R-3 Zon- ing District. Plans are available for review at the office of the Building Dept., Town Hall Annex, 146 Main Street. By order of the Board of Appeals William J. Sullivan, Chairman E -T — September 30: October 6, 1997 -NORTI TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Department of Public Works, 384 Osgood St, North Andover, MA. on Tuesday the 14th of"October 1997 at 7:30 P.M. to all parties interested in the appeal of John Duda, 369 Salem Street, North Andover, MA. requesting a Variance from the requirements of Section 4.136: of the Watershed Protection District, paragraph 3C: of the Non - Disturbance Buffer Zone, and (2): construction of any septic system, to allow installation of septic system within 100 feet of a wetland in the watershed district, of the Zoning Bylaws. Said premises is land and building with frontage on the West side of 369 Salem St. which is in the R-3 Zoning District. Plans are available for review at the office of the Building Dept., Town Hall Annex, 146 Main Street. Published in the E.T. Sept. 30 & Oct. 6. By order of the Board of Appeals, William J. Sullivan, Chairman LEGAL NOTICE LEGAL NOTICE of y ATM .yTssu"� •'h TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD,OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Department of Public Works, 384 Osgood St., North Andover, MA on Tues- day the 14th of October 1997 at 7:30 P.M. to all parties interested in the appeal of John Duda, 369 Salem Street, North Andover, MA requesting a Variance from the requirements of Section 4.136: of the Watershed Protection -District. paragraph 3C: of the Non -Distur- bance Buffer Zone. and (2): construction of any septic system, to allow installation of septic system within 100 feet of a wetland in the watershed district, of the Zoning Bylaws. Said premises is land and building with frontage on the West side of 369 Salem St. which is in the R-3 Zon- ing District. Plans are available for review at the office of the Building Dept., Town Hall Annex, 146 Main Street. .By order of the Board of Appeals William J. Sullivan. Chairman E -T — Seotember 30; Octobe,r_6, 1997 TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Date: -3 /, 9 �p Dear - 4, As you know, the Board of Appeals /has granted a variance and/or a special permit for land located at As the 20 day appeal period has passed, please pick up your signed mylar at the Board of Appeals office located at the North Andover Town Hall, 120 Main Street, North Andover, MA. The certified copy of the decision must be obtained from the Town Clerk's office located at Town Hall. The mylar, along with a certified copy of the Board's decision must be recorded at the North Essex Registry of Deeds located at 381 Common St', Lawrence, MA., as soon as possible. Once this is completed please bring a copy of the certified'decision and submit it to the Building Department along with the receipt/recording information. My business hours are Monday, Wednesday, Thursday: 9:OOAM - 2:00 PM, and Tuesday: 9:OOAM through 1:00PM. If you have any questions, I can be reached at the Zoning Board of Appeals office (978) 688-9541, or 688-9545. Sincerely, Mary teary-Ippolito, Z�R��tw, 120 Main St., North Andover; MA cc: Joyce Bradshaw/Town Clerk .~ ml/mylar Received by Town Clerk:: R 'EIVED joyCE oft=At CL NORTH AND ' R 3LP 49 as TOWN OF NORTH ANDOVER, MASSACHUSETTS BOARD OF APPEALS APPLICATION FOR RELIEF FROM THE ZONING ORDINANCE Applicant John Duda Address 369 Salem Street North Andover, MA Tel. No. 508 687 1806 1. Application is hereby made: a) For a variance from the requirements of Section 4.136 Paragraph -3C iii_.(2) and Table of the Zoning By-laws. b) For a special Permit under Section Paragraph of the ZoningiBylaws. i c) As a Party Aggrieved, for review of a decision made by the Building Inspector or other authority. 2. a) Premises affected are land XX and building(s) ,,,, numbered 369 Salem Street, North Andover, MA —Street. b) Premises affected are property with frontage on the North ( ) South ( ) East ( ) West side of Sal6 S treet Street. Street, and known as No. 369 Salem Street Street. c) Premises affected are in Zoning District, and the premises affected have an area of 50,094 square feet and frontage of 0 feet. 5 of 8 Rev. 06 . U3 . 96 ---- - ----- _ ._.. 3. Ownership: a) Name and address of owner (if joint ownership, give all names) : IRE John and Bogusha Duda Date of Purchase 1983 Previous Owner 1. If applicant is not owner, check his/her interest in,the premises: Prospective Purchaser Lessee Other 2. Letter of authorization for Variance/Special Permit required. 4. Size of proposed building: front; feet deep; Height stories; feet. a) Approximate date of erection: b) Occupancy or use of each floor: c) Type of construction: jI S. Has there been'a previous appeal, under zoning, on these premises? no If so, when? 2 6. Description of relief sought on this petition Allow the installation of a spptic system within 100 feet of a wetland in the 7. Deed recorded in the Registry of Deeds in Book 1680 Page 78 watershed Land Court Certificate No. Book Page district The principal points upon which I base my application are as follows: (must be stated in detail) There is no other location for the proposed system. House exists and there is no sewer that is close enough to tie into. I agree to pay the filing fee, advertising in newspaper, and incidental expenses* , A ignature of Petitioner(s) Rev 06.03.96 DESCRIPTION OF VARIANCE REQUESTED ZONING DISTRICT: R 2 / Watershed Required Setback Existing Setback Relief or Area or Area Requested Septic to wetlands 100' approx 70' to 62' Lot Dimension Area ! i Street Frontage Front Setback Side Setback (s) Rear Setback Special Permit Request: 7 of 8 Rev 06.03.36 Map Parcel 37D 37D .37D 37D 37D �37D 37D 137D 37D 37D 37D 37D +37D 38 38 38 37B 37B 37B 37B 37B 37B 37B 6 42 7 5 14 13 29 12 10 9 35 18 8 134 135 136 55 39 35 67 49 38,37 50 Abutters List for 369 Salem St. !Yl a P 4137 D P H R4 E L"� 3 p Owner William and Bernadette Doherty Robert and Dianne Braga Patriot Realty Trust John and Caroline McLoughlin Alfred and Dolores McKee Jean Smith and Helen Gorman Steven and Grazia Lush David Warwick Earl and Vera Warwick Estate Thomas and Margaret Geraghty William and Sylvia Whittaker Ridgewood Cemetery Ass. John and Rosemary Draper i Patricia Rennicke James and Justine Oates Robert and Cheryl Kettinger Charles and Jean Camasso Mildred Mae, Gayle and Randall Buturlia David Sideri Steven Sideri Steven and Karen Kneupfer Andrew and Belinda Tompkins; John and Dolores Hayes Address 343 Salem St. North Andover, MA 01845 P.O. Box 69 North Andover, MA 01845 373 Salem St. North Andover, MA 01845 327 Salem St. North Andover, MA 01845 260 Marbleridge Rd. North Andover, MA 01845 270 Marbleridge Rd. North Andover, MA 01845 280 Marbleridge Rd. North Andover, MA 01845 43 Woodbridge Rd. North Andover, MA 01845 43 Woodbridge Rd. North Andover, MA 01845 330 Marbleridge Rd. North Andover, MA 01845 342 Marbleridge Rd. North Andover, MA 01845 2 Johnson St. North Andover, MA 01845 393 Salem St. North Andover, MA 01845 6 Woodberry Ln. North Andover, MA 01845 16 Woodberry Ln. North Andover, MA 01845 26 Woodberry Ln. North Andover, MA 01845 338 Salem St. North Andover, MA 01845 346 Salem St. North Andover, MA 01845 30 Anne Rd. North Andover, MA 01845 29 Anne Rd. North Andover, MA 01845 P.O. Box 411 West Boxford, MA 01885 378 Salem St. North Andover, MA 01845 404 Salem St. North Andover, NIA 01845 k e o -I- f�L. Gt-" n A. t4 FORM U - LOT RELEASE FORM 4� 0, d r 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*********************** APPLICANTA&/e?0 7-/4E62rW 5 1 PHONE ?-,79, O7% LOCATION: Assessor's Map Number ' PARCEL SUBDIVISION LOT (S) o STREET 59�gyp` ST. NUMBER **********OFFICIAL USE ONLY*********************************** RECO ENDATIONS OF -TOWN AGENTS: CONSERVATION ADMINIS TOR DTE -A'#' D DATE REJECTED COMMENTS i ca �ere�►ce -aHa- D887— �e9u iv�s Film, �o� ��e,HJ xclo�1r .5 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPEC R- EALTH DATE APPROVED DATE REJECTED SE Id IN`SP.EC R -HEA DATE APPROVED Z DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm 3N\ r." of I SECTION 1- SITE INFORMATION I Date 1.1 Property Address: sGgf' s/gEm Sf 1.2 Assessors Map and Parcel Map Number Number: Parcel Number /�R(� �m/ cl ER W 01, f I 1�..3���Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Reqwrcd Provided Not Applicable ❑ L.5 Qtlt6% Company Name 1.7 Water Supply M.G L.C.40. 54) 1.5. Flood Zone Information: Public ❑ private ❑ Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System .❑ SECTION 2- PROPERTY OW NERSIIIP/AUTHORIZED AGENT ' 1' J i U' IL; u 1 Zjtr 1 U t: T@ 5 N O 2.1 Owner of Record A0 Name (Print) Address for Service : Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Signature Telephone Not Applicable ❑ 12-0 / q License Number 3 (2 �!© 5 Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ L.5 Qtlt6% Company Name Registration Number // /(v q0ES Expiration Date Address Signature Telephone ou 0 J SECTION 4 - WORKERS COMPENSATION (KG.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) 0 Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Coinpleted by permit applicant z h d3FFIC ' FUSE ONLY I . Building©Q` O D (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SE TION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OJVNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ` 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 TINIBERS 1 2 ND 3 SPAN DEMENSIONS OF SILLS DINIENSIONS OF POSTS DINIENSIONS 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 # of Proposal Submitted To: Job Name Job # r Address Job Location SR F Date Dat of Plans i I Fax # Architect We hereby submit specifications and estimates for: ..... ......... ..... .................. ............. .__............ .._................ ............ __ .... vJ67 .......... .... �C. F�,/r,rr�?© ,f fr J� ,�ps� �,c-_f�'� ,, ....... 9�ail� �w _ D GSC'-I.PAOX __ 521 . l X . �� � ....._ . ..� ....... . c . ' S .4 s, ' S _ _ / rW 7-;6',4X ,< I- Ir- i l/// __oo oo .. _ .... ........................ ........... _....................... We propose hereby to furnish material and labor — complete in accordance wiJ the above specifications for the sum of: $ 4 ` J Dollars -with payments to be made as follows: %v 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 withdrawn by , if not acc pted within days. 2cceptance of Vropofsal The above prices, specifications and conditions are satisfactory and are Signature hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance -4Z 2 �� 2 .t,.. L"1 Signature .2 -W. ZY0 U- irE # , a: w a Lu M 5; MiE CO Coc ui Ao .2 Ao ca z N 0) a) > d lu > —0 c c 0 0 Z \ \� ■ 2 k.:b cn LU a x 0 LL, F: G co cn Z z — 0 UJ . } UJ I DR UJ a - I U- 2: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity aI am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #: Insurance. Co. Policy # Company name: Address City: Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties cf.afine up to $1,500:00 and/or one years' imprisonment -as _well_as.civil.,penatties _inlheform nfa..STOP WORKORDER..W.d_a .fine of.(.$1 DO..OD)-aday against me. 1 understand that a copy at this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ce under th ins and penalties of perjury that the information provided above is true and correct. h 0 Signatur � � Date Print nameaeUe�/�i4��l�ivt%C�S' \ P.hone.# Oficial use only do not write in this area to be completed by city or town official' City or Town Permit/Licensinq Building Dept ❑Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person. Phone A Health Department Other J�DM CERTIFICATE OF LIABILITY INSURANCE 06/21/2004' PRODUCER FAX DeAngelis Insurance Agency, Inc. 283 Merrimack Street Methuen, MA 01844 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Fielding Construction Inc. DBA: David Fielding Pres. 548 Merrimack Street Methuen, MA 01844 INSURERA: National Grange Mutual Ins Co 42 INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN( ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRDD' LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIV(MM1DDfYJE POLICY EXPIRATION LIMITS GENERAL LIABILITY MPB 29652 12/31/2003 12/3DATEIm1/2004 EACH OCCURRENCE $ 500,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 PREMISES (Fa ncrairence) CLAIMS MADE OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 500,000 A GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F] CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate is issued in the interest of the named insured and Certificate holder listed below. Certificate is subject to company conditions and exclusions. Amit Bnaji 369 Salem St No Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE David Segal /1MG ACORD 25 (2001/08) ©ACORD GORPURAI IUN 196d 4 r t 'x^.+. �,d .r'.. �.�.kw'.•yn,,... �+...-w,w ... �.` .a..`.1.�.,.. ..... �.. w- -` ..... � _ � +.+. - -.- �+'-t�F� �,w-a-. �_. „ .- y Location�� �/ 4 No. a % Date MORTN TOWN OF NORTH ANDOVER Certificate of Occupancy $ s'••E<�' Building/Frame Permit Fee $ 1 3 MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 130 -- Check 3© — Check # 7 ` - 17566 AN 6� �� Building inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPA94 RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: / JDATE ISSUED: j SIGNATURE: A/WC Building Com;;7id'Phe_rA2EeEtor of Buildings Date C1C /T1A1T CiT1T i1TTA11�� ♦.n.�a.T 1.1 Property Address: `3G,1 r/K s 1.2 Assessors Map and Parcel 1� 1 D_. Map Number Number: 5z) Parc el Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Recpfired Provide Rrcpired Provided R red" Provided 1.7 Water Supply M.G.t:G; W:' 34) 1.3. .... T`.... Public ❑ Private ❑' " ZO°e Flood Zone Information: Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ on Site Disposal System ❑ ..�. �.aava.� aa�va a,a�a.a v��a�aJianaa111 aAValaV� n.L t11171Cm\1 `""" �"""'��• t -��> 1•cV 2.1 Owner of Record �CO / I /q ryr/t `7Z 3�°/ s C�C/yt S/ Name (Print) Address for Service ,/(-A4/, , 'f7G-SS7 Signature U Telephone 2.2 Owner of Record: Name Print Address for Service: V SECTION 3 - CONSTRUCTION SERVI 3.1 Licensed Construction Supervisor: .10R v I D )c " 4- Z_ D/ Licensed Construction Supervisor: S'1 '0z, /y7cx L ria c Ic S 7 Address Signature 1.2 Registered Home Improvement Contractor ,,,Company Name Address Not Applicable ❑ License Number E"iration Date Telephone Not Applicable ❑ Registration Number Expiration Date y SECTION 4 - WORKERS COMPENSATION (KG -L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Fails in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 11 SECTION 5 Description of Proposed Work check all a ble New Construction ❑, Existing Building ❑ Repair(s) 1� Alterations(s) ❑ • A Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: terbVz�-r s-/ �-: '3 5 b r %C . I QWrT1nN 6 _ B.CTIMATF.fl MNCTRUCTInN CnSTS I I to provide this affidavit will result Addition ❑ Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building 2t eti (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (t,) 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 1, 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 1, 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/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3Ku 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 Page # of pages L Proposal Submitted To: Job Name Job # Address(Oct Job Location O Date Date y& PI Phone # Fax # Architect We hereby submit specifications and 9st , imates for: kWe propose hereby to furnish material and labor complete in accordance with the above specifications for the sum of: $ Dollars with payments to be -made as follows: Any alteration or deviation from above specifications. involving extra costs will beRespe �Ctf6lfyr- executed only upon written order, and' will become an extra charge over and -su . bmitted above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. Note this prbposal�m drawn by us if not accepted, within days. pay beIvith 2rceptance of5P, ropo a The above prices, specifications and conditions are satisfactory and are Signature A �,6 hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature NC3819. MADE IN USA q 41 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: LL w4rsrivru0 (Location of Facility) Signature o0ermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector W v E o w A ID CC2 a w G4 RC1 a a U it C W pp 0 0 c+ A S c C3v U w 000 O C E �• z o -� ''row m �, w c o C� oa W ID CC2 RC1 it C W 0 0 c+ S c C3v o, c 000 O C E �• z o s ''row AA Z Y r { Iu0 2 E C CD O V AVO o � m IS �m y v J h ; BRAS • = C � � MMS--+�ii1l m zip 4:�y o 0 Co sgacs > amc ym •wommoo. -00 c cmo< 0 J aCz a o g� m CID qill 2 `o C=o c c c � o o CO) o LAJ .� C re LA w ui c Z W �E ca .= y O 40 C y a S z �_��-SCD s aim L O CL CA C O CO3 O LA CL r ccC O a� v y O v .CL CO3 C C..3 C c y 0 M LLI YI co Im 19 W