HomeMy WebLinkAboutMiscellaneous - 39 HAROLD STREET 4/30/2018K)
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TOWN OF NORTH ANDOVER
�4-� PERMIT FOR GAS INSTALLATION
,15
This certifies that ..................... .................
has permission for gas installation,.-”,
in the buildings of .
at
.......... North Andover, Mass.
.? - 0�d
Fee-71�� ..... Lic. Noz--�/v .. . .................
GASINSPECTOR
Check#
6656
MASSACHUSETrS UNIFORM APPLICAroN FOR pERMrr To Do GAs ffnJNG
(Type or print)
NORTH ANDOVER, MASSACHUSETTS Date
u Uing Loqations
..ownerls Name
New Renovation Replacement 10
SU B-BASEM _ENT
WASEM EKT. —
I S T -
F L 0 0 R
2NE1.
FLOOR
3 R D
F L 0 0 R
�TH
F TLO 6 ���
;TH-T—LO�ORR
g
i T H
TL 0 'oR
FL OR.
I T H
F L 0 0 R
(Print or type)(
Address
Permit 4
Amount S
Plans Submitted
5
Name ofLicensed Piumber'or Gas Fitter
�b, /1, Check one: Certificate installing
I., -P_/11/1 Corp. Company
nPartner.
777
—
F INSURANCE COVERAGE
ha e a en In ura Check o e:
v h �d 4 pleast
c eck
I v cu
have a current liability Insurance, policy or it's substantial equivalent
f u Yes NoO
If you have checked Ms, please ' dicate the type coverage by checking the appropriate bo,
Liabil
ity insurance policy Other type of indemnity ED Bond 13
Owner's Insurance Waiver l.am aware that the licensee does not have the Insuran
Mass. General Laws, and that my signature on ce coverage required by Chapter 142 of the
this Permit appfication waives this requirement.
Signature of Owner or Owner's Agent Check one:
y that all 7 tet�ls and inf- Owne Agent
I hereby dertif r
ormation I have submitted (or entered) in above 13
application are true and accurate to the
best of my knowledge and that all Plumbing work and installations Perfo ed under Permit Issu for this application will -be in
compliance - with all pertinent provisions of the Massachusetts State de and Ch r 142 f the General Laws.
P�'To ed under Permit 'S'u fo
e C
ead and Zr , 42 f therGel
'44_ h
[IB3 y: of Ji,
,n re
T Signature of Licensed Plumber Or Gas Fitte
Title _r
City/ToWM r_3 Plumber
[D Gas Fitter License
1%3P Master
LAM
A.PPR6V ED (OFFICE USE ONLY) Journeyman
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Name ofLicensed Piumber'or Gas Fitter
�b, /1, Check one: Certificate installing
I., -P_/11/1 Corp. Company
nPartner.
777
—
F INSURANCE COVERAGE
ha e a en In ura Check o e:
v h �d 4 pleast
c eck
I v cu
have a current liability Insurance, policy or it's substantial equivalent
f u Yes NoO
If you have checked Ms, please ' dicate the type coverage by checking the appropriate bo,
Liabil
ity insurance policy Other type of indemnity ED Bond 13
Owner's Insurance Waiver l.am aware that the licensee does not have the Insuran
Mass. General Laws, and that my signature on ce coverage required by Chapter 142 of the
this Permit appfication waives this requirement.
Signature of Owner or Owner's Agent Check one:
y that all 7 tet�ls and inf- Owne Agent
I hereby dertif r
ormation I have submitted (or entered) in above 13
application are true and accurate to the
best of my knowledge and that all Plumbing work and installations Perfo ed under Permit Issu for this application will -be in
compliance - with all pertinent provisions of the Massachusetts State de and Ch r 142 f the General Laws.
P�'To ed under Permit 'S'u fo
e C
ead and Zr , 42 f therGel
'44_ h
[IB3 y: of Ji,
,n re
T Signature of Licensed Plumber Or Gas Fitte
Title _r
City/ToWM r_3 Plumber
[D Gas Fitter License
1%3P Master
LAM
A.PPR6V ED (OFFICE USE ONLY) Journeyman
0
a
Location
No.
Date
TOWN OF NORTH ANDOVER
6 Check # ("4 � / /
L
6 U Ti , Building Inspector
Certificate Occupancy $
of
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
6 Check # ("4 � / /
L
6 U Ti , Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI&
RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PEFMT NUMBER: DATE ISSUED:
3,
SIGNATURE:
Building Commissioner/Inspe-ctor of Buildings Date
SECTION I- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information:
Zoning Di�—u �ct Proposed Use
1.4 Property Dimensions:
A oo
Lot Area (sf) Frontage (ft)
1.6 BUIIDING SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Required Provided
1
1.7 Water Supply M.G.L.C.40. 54)
Public 0 Private 0 Zone
1.5. Flood Zone Information:
Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHWAUTHORIZED AGENT
Historic District: Yes _No
2.1 =er'of Record
Ln Y7
Na e
Address for Qrvice
7
Filq(ature
Telephone
2.2 Owner of Record:
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature
Telephone
Not Applicable LD,'*'
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature
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1 SECTION 4 - WORKERS COMPENSATION (AG.L C 152 6 25c(6) I
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 ....... 0
SECTION 5 Description o Proposed Work (check applicable)
New Construction 0
Existing Building 0
Repair(s) 11
Alterations(s) 0
0
Accessory Bldg. 0
Demolition 0
Other 11 Specify
Brief Description of Proposed Work:
& - CoW 5�� / 54-
"OY-
'
3 6 fee,,-Avy-a
mat& W'S�'�
U
-ESTIMATED
SECTION 6 CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit 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 T
1, , as Owner/Authorized Agent of subject property
Hereby au i to act on
if matt :ed by this buil
f�.' - ding permit application.
M glf
gnaArj(/ Owner""" Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
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
Signature of Owner/A ent Date
I 1 —11 1"' 111111
NO. OF STORIES SIZE
BASENENT OR SLAB
SIZE OF FLOOR TIMBERS OT 2�D 3RD
SPAN
DIIVIENSIONS OF SU_LS
DMENSIONS OF POSTS
DRVIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING x
MATERIAL OF CHIIANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
FORM U* -LOT RELEASE FORM
INSTRUCTIONS: This form is used to Ve* rify thatall necessary approvals/permits f . r0M
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******qk****************
APPLICANT -&,--A— PHON
E 9/ OT9007
LOGATION: Assessor's map Number PIW PARCEL__!5��b
4"�o
tA
SUBDIVISION. %_V6_k)e_(tx LOT (S)
STREET_" A-
ST. NUMBER_3?-
_q
ATION
COMMENTS
TOWN PLANNER
-OFFICIAL USE ONLY--******************�
TOWN AGENTS:
DATE APPR-OVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
FOO ) INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
Revis I ed 9197 im DATE
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 properly
licensed solid waste disposal facility as defined by MGL Chapter I 11, S 150 A.
The debris will be disposed of in:
ion of Facility)
2,
o e Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project
through the Office of the Building Inspector
Tel: 978-688-9545
Town of North Andover
Building Department
27 Charles Street CHUS
North Andover MA 01845
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE
JOB LOCATION
Number Street Address Section
"HOMEOWNER 3 lWf Ve q
Number Home Phone Work
PRESENT MAILING ADDRESS
City Tow6 State Zip _C4
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of six 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 109. 1. 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 to six family dwelling, attached or detached structures ac-
cessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such "homeowner* shall submit to the Building Official,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
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 e/she understands the Town of No. Andover
Building Department minimum inspection edures and requirements and that he/she will
r
comply with said procedures and req7uii/h t
'�r n s.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
CIMIRIVX]FUM" IPXj4Dp]r IPXdALIW
Noting Existing and Proposed Porch
Of Property Located At
3 9-41 Harold Street, North Andover, IIA 0 1845
Prepared For Kevin and Kristine McLellan
Date: October 27, 2003 Scale V=30'
R&B Survey Service
219 Salem Street
Andover, NU 01810
978475-8232
Exiging porch to be
raLsed and new porch
to be consUucted in
the same footpda.
V)
V)
A" OF
DANTE I hereby cer* that the structures shown on this
E. plan are located as shown and that they conformed
BARTOLOMEO
3; No. 1.530 to the Zoning By -Laws of the town of North Andover
01 when cons
14, 0/sm�
L -IANri
Reh N. E.R.D. — Deed Book 4791 page 70 & Plan #0247
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