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HomeMy WebLinkAboutMiscellaneous - 380 BEAR HILL ROAD 4/30/2018 (2)w No uj CYI) Q P M Location No. 8 Date 7 - 3 D -d Y TOWN OF NORTH ANDOVER i 1 - • OL S Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # .3a9 Q, e U i 7 17 ,V S , 7 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 04 SWUM %r ami VIM BUILDING PERMIT NUMBER: 0�_, DATE ISSUED: SIGNATURE: Building Commissionerff or of BuildingsDate -- AL' l 1 a'a aV111 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Num Map Parcel 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Fronto 1t 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard RegWred Provide red Provided R red Provided 1.5. Flood Zone Information: 1.7 Water Simply M.G.L.C.40. 54) 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑On Site Disposal system ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Signature Telephone Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ L , n <�STe Company Name Registration Number Address S`f Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (MG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all a cable to provide this affidavit will result New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building Q Q (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Pern it 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 BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorizer--- -- ��t//�/I/� My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION to act on 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 of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 11 as, t t Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR — Registration: 134830 Expiration: 1129/2006 Type: Individual MPA LAROCHELLE MIChALi LAROCHELLE 2 NIGIiTWGALE CT. y LAWRENCE, MA.018441w.. _ Administrator 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 ® I am an employer providing workers' compensation for my employees working on this job. Company name: ^l' �'� '`,6�' Address �e-- C) . Z'° t'`' ' 11,�4' Phone * I%s S/'c-1o�%.^� 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 of,a fine up to $1,70o and/or one years' imprisonment.as.ve ll_as_civil.pienaltiesin The farm dA_sTOP.WORK_ORDER..and..a fine of (.$140.00) allay against.me. I understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification. ! do hereby certify under the pains endpenal ' s of perju that t i rmatlor► provided above is true and correct. Signatur �A / > Date > �� z Print name 1 "1 • GA.e d CA f Ile— y Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensin []Check !f immediate response is required 11 Building Dept ❑ Licensing Board ❑ Selectman's Oft/ce Contact person: Phone #: ❑ Health Department ❑ Other Page of cl/ A 3 L CONS f U CTION, ONC. Mike Fax 978-975-9874 978-258-1131 PROPOSAL SUBMITTED TO f PHONE -DATE S7T Ori %3e,4 C , JOB NAME S e ,��,G -,-- f � J A/ CITY, STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit estimates for: S � ��' �--• _,er✓S,rl�>'-✓6/� ��,,,��" C1'� R.cr>f' av-e,� �'r/� rpt/ ���'y5� .f��w c IT A, �✓ .�► fry -rc e -r S �t � S � C1��Z C `�"� ���'-___._ �l�-�'' ^,'r- �'oe �-r � �'.SJ . _.c"•_cP-t- G,i�i � ��, .le��l S- , �, :�v6 w � i � � � c.� C e�_✓a IL .s . �, :,. G . ,f' e�-,;,d , R.. S � �� 1v� SF. l �i . `*30-0,e�s ��� pnt.y e¢ S w, >9c--,-/�r l.,�Y w ori � . � -c .,p.�,r� � /_�.a �1.� S iJ/ � ��,c , � ,�/c d,v j �• �c �C '3a 'us Propose hereby to furnish material and labor — complete In accordance with above specifications, for the sum of: Payment to be made as dollars ($ follows: ) Cl All material is guarantoW workmanlike manner according to be as spectfled. All work to be completed In a to standard practices. Any alteration or Authorized deviation from above specifications only upon written orders, and Involving extra costa will be executed Signature will become an extra charge over and above the estimate. All agreements contingent our control. Owner to carry upon strikes, accidents or delays beyond fire, tornado and other necessary Insurance. NOTE: This proposal may be Our workers are fully covorod by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. AcceyUmce ofa— specifics Iona The above prices, i—j'/mA5� and conditlona accepted. You are authorized are satisfactory and are hereby to do the work as specified. Payment Signature will be made as outlined above. Date of Acceptance: Slgnatur �' I-larleysvdle Worcester Insurance companY ---� 120 Front Street, Suite 500 Worcester, NIA 01608-1408 www harleysvillegroup com Harleysville. 3ML CONSTRUCTION CONTRACTORS' BUSINESS OWNERS F CB 834069 Policy Term Issue Date 04102104 tc 1201 AM S' 04108104 j Agent Code 75-5580 SCHEDULE OF LOCATIONS Loc No Location Description Lawrence MA 01841 001 2 Nightingale Ct I SCHEDULE OF COVERAGES Deductible: $500 I: Property Coverages Section I l Section Deductible Exceptions: Contractors' Equipment Endorsement Other Coverages Deductible and Endorsements Refer to the Schedule of for applicable deductible. Limit Of InSurnee Location 001 Building 001 80% Coinsurance: Construction: Frame Terr: 001 Protection: 03 $2,000 Business Personal Property $10,000$10,000 Accounts Receivable Inside the premises $10,000 Money and Securities Outside the premises other coverages ReplacementeCost s� Applies to Business Personal Property Only Section II: Comprehensive Business Liability $500,00 Business Liability and Medical Expenses Each Occurrence $1,000,00 General Aggregate (Other Than Products -Completed Operations) $1,000,00 Products Completed Operations Aggregate $5,00 Medical Expenses $100,000 I Fire Legal Liability SCHEDULE FOR COMPREHENSIVE BUSINESS LIABILITY CLASSIFICATION Class Loci State- Code Bldg Terr Description 17512 001/001 20-001 Carpentry - All Other $28,600 Payroll Premium Basis SCHEDULE OF OTHER COVERAGES AND ENDORSEMENTS Contractors' Equipment Endorsement i m m s o � U I o r m c' c rn r p Cv ,ems+or 01 01 DB V Page 2 Continued Tkici iaFn s COPY 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) Signa ure of Permit Applicant Da e NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector CA m m m m m CO) m v. y � d 10 CO CD az t=/� CL �• O CL y aCc o m CD O p CD O CL c� d CD CD o CD co ao —3. C• CD y CLD y -• o to CD I C �?�aom = _00�crl Else a y C 1 Z � m . C =F-0 g �= °:m w T sa„�a o m �o o m o y N w -4 b m '� a 0 .�.v n 1 � � W � o • r a om �_ ... to C.L C!)m � n� ; 'Wb : r1 c CL _ ` J ��...��yy O1 P'r O N :� C d G1 cr c N � Cn a . Cn ? H OV w p A p t �is- M W: n C2 4 3 C c D oma. (ncn9 O 9� 9 z � w O :71�.�° ro O C�7 0 ? C w n n S p\cn z O omi 0 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax Please print. DATE JOB LOCATION Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Number Street Address Map / lot "HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State The current exemption for "homedwners" was extended to include owner -occupied dwellings of 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 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 or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. 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. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Zip Code Location S60 No. 3103 Date it 3 C, TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ � A Other Permit oa' $Z— Sewer Connection Fee $ g Water Connection Fee $ TOTAL $ Building Inspector — Div. Public Works m PERMIT NO. *J 6 3 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. e PAGE 1 MAP i-40. l � LOT NO. / dI PAGE 1 FILL OUT SECTIONS 1 - 3 2 RECORD OF OWNERSHIP DATE BOOK iPAGE — ZONE SUB DIV. LOT NO. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR � LOCATION PURPOSE OF BUILDING j1g OWNER'S NAME '�/� lI�O/a ©�f, (�8'ooge )ro� NO. OF STORIES SIZE 7f/L OWNER'S ADDRESS c7 6 (o �,ee — /�jl /�f� BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ;Wlly ZLS 411:p O IA , - /V ` SPAN DISTANCE TO NEAREST BUILDING o�0 ' DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET I O` 9 S / DISTANCE FROM LOT LINES - SIDES O?0 1 REAR �G "' GIRDERS AREA OF LOT FRONTAGE / ;7X / HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER YIS BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER Us IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES G �YYY X111 .5 PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATnED '7 - 3J ► �S SIGNA3/URE OF OWNER OR AUTFTORIZED AGENT FEE 772^ PERMIT G3R- 19 q 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY AL_ �� �1,irr OWNER TEL. # I/.i s - Zoo CONTR. TEL. # 6H -?-307 CONTR. LIC. # o 03 3o H.I.C.# Ilk --)o4 �(o Lt a v-* (sf BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY FAMILY E-ORIESMULTI. [�-F`FC S APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE PINE B 1 2 I3 CONCRETE BL'K. BRICK OR STONE HARDD _ _ i _ PIERS PLASTER DRY WALL — _ _ JNFIN UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/1 1/2 314 FIN. ATTIC AREA NO BMT HEAD ROOM FIRE PLACES MODERN KITCHEN _ _ 4 WALLS ' 9 FLOORS CLAPBOARDS B 1 22 J 3 _ DROP SIDING CONCRETE EARTH WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING HARD"J'D COMtACN ASPH. TILE VERT. SIDING STUCCO ON MASONRY _ STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STIRS. & FLOOR I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE GAMBRELMANSARD I HIP BATH 13 FIX.) TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ to 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. cn m D m T Z r C') C) z m D 0 Z T Z C •C S O CO)CD n Z yCD R Q r CoCD � C. = y 'fir O 0 0 C. cr CD O �o Co CD Cos .o CD a - CD 7 �rt CD CDa y CD CO) O CD0 0 dc CD 0 O to o v' . oem a0�m .0 N! n m n �na� mO ,,,. c -Z a� --� 00 cor ct m o .-.'o ; N COgy: m = m .1 O y , So m Z so' fl- ,Cc +� CL CD m H m cm m aO CD y C CD 7 cgo y H � CD CD � r .�+ Ncm Y O m Y N � D CO P i =m. v 0 � Qv V '< CDNN h �► �m d� RM: o C o Opt y 0 0 c O gC '1 pmC mO T(T Oa:r �% • cn 7C y rAIt x y 0 0 c Jul. 21. 1995 11: 32AM LCo7 7 /A FA""IL 7 BANI. ENGAGE LUl /4� it I JOFiPI S, iAURETANI A PROFESSIONAL LAND SUAYEYOR, �• -� DO HEREBY CERTIFY THAT THE ABOVE MORTGAGE INSPECTION PLAN WAS PREPARED FOR FAMILY R�, NY_ IN No.6y26 F' 1!I NC�RTa Scale: l L 0 AMERICAN SURVEYING COMPANY 77 Rumford Avenue, Waltham, MA 02154 (617) 893-6477 CONNECTION NOT INTENM OR Mortgage Inspection Plan AND 13 NOT INTENDED OR REPRE- SENTED TO SE A LAND OR PROPERTY --- UNE SURVEY. NO CORNERS WERE THE LC,CATION OF 1HE ORIGINAL RECORDED AT = A COUNTY RE013TAYOFDEEDS SET. IT CMyQj BE USED FOR ES- DWELLING SHOWN HEREON EITHER 800K 4096 PAG -EIA VL- LC. Con / TABLISHING FENCE. HEDGE OR WAS IN ;CKIRLJANCE WITH THE LCCI.L PUN REFERENCE: &&KK BUILDINGUNES.THE LANDASSHOWN XPPUC, bLE ZONING 6YLAW5 IN EF. DRAWN PER TOWN OF ASSESSORS HEREON IS BASED ON CLIENT FUR. FELT Y, +�N CONS1TILc%IED wrrH RE. WP / PARCE /—DATED_ NISHED INFORMATION AND MAY M SPECT' D HORIZONTAL, DIMENSIONAL ADDRESS: i F0 Ie - p SUBJECT TO FURTHER OUT -SALES, REOVAR MEhTSONLY), OR IS EXEMPT TAI9NGS,EASEILtNTSANDRIGHTSOf FROM \IOUTION ENK HCEMENT AC. BORROWER: Y WAY. HQ RESPONSIBILITY 15 EX. TION UNDER YASS.G.L'I rLE VII. CHAP. TENDED HEREIN TOTHE LANDOWNER 40A. StC. 7, UNL `55 OTHERWISE SUBJECT DWELLING UES IN FLOOD ZONE OR OCCUPANT, IT IS NOT INTENDED NOTED -,H SItO'NN ✓,EAEON. A CON- AS SHOWN ON NATIONAL FLOOD JN6VRANCE PROGRAM FLOOD TO Be RECORDED F1HMA1 RY I,vSTllvti rNT suRdEY INSURANCE RATE MAP DATED SIL _4L` ` y 1 S'3 L 30 5 15 A.DVI GJ WHEN STT-CTURES ARE COMMUNITY PANEL / -Z ooiLJ 3� DATE SHOKf. :D eE Y U,. LESS FfIOM pFi�LD�EQJORAFTEQCUENT T-anI Y '�An1Y PROP£'+7( OR RE OU ftEU ZONINGBY CHECKCUENT REF.# SET BAC < Lir1E5.J.O./ ino DATE '95 �'�O-'1 7.11 "i FA. 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Z m -i Cf) Mpmz n) cpc:-sC N _mn �00�<� \ n -M4 (M- °zmc-mn>,m-\- O zmG)���z� m cvm m=�0= a) { �zm- n c p 3mzCp - 7J J\ �O=�x<y < mop Dc,mU o m ------- �- Z0---1 Z U: '-Z ZO�G)U) �D 7)_ \ A a mzKz0>: 0 O0 Irrc 2 �-.1— w p �cmcmm m o^z �mnco D _\ i C>) C)ZC;- U;' r-�CDjzzm -I-- p C/)- �ZI?-o DCn c--{0pm m �C--{0 m zr ) mpmnC) O nm�mm u z.=r O� OC n-1v3�00'_if� �� �Om�o co �--a-- m zz m�m S m �Fn zcn w • 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: _rOM F (TAI L VASO A) Phone / ft'- x'(D03 LOCATION: Assessor's Map Number Parcel Subdivision Lot (s) Street �F1�2 `u, K� . St. Number �y 3 an RECO D O SAGENTS: Conservation Administrator Comments &Itl6k�SIltk/ 'Z_6 Town Planner Comments Use Only************************ Na Food Inspector -Health AUL -t6ZUV) &)/hAka- ) IU wG-b-k 't- eptic Inspector -Health �` Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved �DJate Rejected ` Date Approved Date Rejected Date Approved Date Rejected Date ApprovedI �% 5 Date Rejected Received by Building Inspector Date