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Home My WebLink AboutMiscellaneous - 41 Woodbridge Street � lt � � aob �3 (Zl � C9E sT \� Location W,14 wodb�J v No. 1`7 Date 9-3 -01 Ma�TM TOWN OF NORTH ANDOVER i » + ; . Certificate of Occupancy $ '',Ss•^°'E<� Building/Frame Permit Fee $ {p o +c MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r 17525 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI&RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING rill " t rn BUILDING PERMIT NUMBER: DATE ISSUED. _ L t C / z SIGNATURE: Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION O j1j.1 �P�roop-er�ty Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Proposed Use Lot Area(sf) Frontage fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.GL.C.40.§54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal C On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT ti 5 rn 2.1 Owner of Record Name(Print Address for Service �QA4 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Tele hone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: O License Number Address Expiration Date Signature Telephone r .2 Registered Home Improvement Contractor Not Applicable v Company Name rn Registration Number r Address r Z _ Expiration Date G) Signature Telephone N� • r SECTION 4-WORKERS COMPENSATION(M G.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 it. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: - back d�k �l/L " s f rb(�- dup_ re weed LVL"C lluivfa' (W(- P)AAM& aiim lv6o�pd — +l°.+vip,� t�rau l�b�l�n a be�r�►s burr-� �a der SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building 3C0 (a) Building Permit Fee J Multiplier 2 Electrical 1 500 (b) Estimated Total Cost of Construction 3 Plumbing 16DO Building Permit fee t.l Y(e) 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 t 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 Signature of Owner/Agent Date NO.OF STORIES SIZE SEMS R SLAB SIZE OF FLOOR TIMBERS 2ND 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 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 or requirements. ********APPLICANT FILLS OUT THIS SECTION************—********* APPLICANT��IDl1�1 �� /T�L1 � PHONE LOCATION: Assessor's Map Number PARCEL 17 SUBDIVISION LOT(S) �) STREET W e- W �4I_ ST. NUMBER **********OFFICIAL USE REC MENDATIONS OF TOWN AGENTS: CONSERVATION ADMINIST OR DATE APPROVED B DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm II lvavn a aaV%-Jr-a=v a 1v914 rL r%1v LOT 10 L O-r 3 A= IZ,4IT4S.K-t s �� t� p Is, LOT 4 PART of _ raARAGELOT 3 oo *141 0 left t+ M 1 , II 108.00' WEST WOODSRIDGE ROAD THIS PIAN IS BASED ON ATAPE SURVEY(NOTAN INSTRUMENT SURVEY)AND IS TC BE USED PDR MORTGAGE PURPOSES ONLY. THEREFORE,THE OFFSETS AS SHOWN 9 4WW NOT BE USED TO ESTABLISH PROPERTY ONES. MIDDLESEX COUNTY DEED REFERENCE: PLAN REFERENCE: PLAN OF LAND PL NO. 1780 IN BK. 4M PG. 937 PL.BK PL. CERT.NO. BIZ. PG. ATl1DPPU A ATT1/1IMD �tLUR7ht� Town of North Andover Building Department , A 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta SRChtttS� Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION �N`ulImbbeAAr��11 q Street Address J� Map/lot "HOMEOWNER l9 W�6VN W• ��TtiVU � —((J � �(O'17 �' 7U760 Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code 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) e 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 onehome 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 req irements and that he/she will comply with said procedures and requiremenS. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL N The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02191 Workers'Compensation Insurance Affidavit Name66 pp Please Print Name: �"!�N N W , A� kb Location: l uy % �I �� i ciNU tvLhWU , Phone, # 12 7'J I am a homeowner perforniling alf 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. Polio____ 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$1,500.00 and/or one years'imprisonment-as_well_as_civil.Renaltiesin.theform nfa_STOP WORKORDER..and.a fine.of_(.$100.00)a-dayagainst.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify un r the a a d pen Ifies of perjury that the information provided above is true and correct. Signature Date i7 Print name V':�WA) W, ka,j, a Phone# q1F-n/'dU Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required E] licensing Board p Selectman's Office Contact person: Phone A- F-1 Health Department 7 Other • I 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 c 11, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Pbrmit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i STRUCTURAL ENGINEERING CONSULTANT KEVIN M. FINNEGAN, P.E. 122 HERITAGE DRIVE, TEWSKBURY, MA 01876 (978) 771-6259 July 16,2004 Acciard Real Estate Development Mr. Glenn Acciard 109 Millpond Road N. Andover,MA 01845 RE: Engineered Floor Beams Dear Mr. Acciard: This letter comes to you as a summary to the engineering of the beams that you have requested at the first floor wall framing. The proposed beams have been sized based on the design criteria set forth by the Massachusetts State Building Code, 780 CMR sixth edition. Beam No. 1 (2) 1.75"x 11.875"Microlam—Trus Joist-MacMillan(or equal), Spike member's together w/(2)nails at 12"o.c. The newly proposed beam at the kitchen spans 11'-0"+/-and is recommended to be installed under the existing perimeter beam that currently supports the second floor joist framing(shim tight to underside). The existing perimeter beam should not be removed due to the arrangement of the existing framing and the current condition of the existing beam. Locate double 2x4 or 4x4 bearing posts adjacent to the existing outer most door openings,as to not interrupt the diagonal braces within this wall. Bear new posts onto the top of the existing foundation wall and block for a tight fit,nail in place. Beam No. 2 (1) 1.75"x 7.25"Microlam—Trus Joist-MacMillan(or equal), Shim w/plywood to meet existing interior wall depth. (Note: for consistency it may be easier to provide a 1.75"x 11.875"having all new beams the same,coordinate this with the supplier) The newly proposed beam at the kitchen/parlor spans not more than 5'-0"and is recommended to be installed under the existing beam that currently supports the second floor joist framing. The existing second floor beam should not be removed due to the arrangement of the existing framing. Provide double 2x4 or 4x4 bearing posts for new beam support. Page 2 of 2 Beam No. 3 (1) 1.75"x 11.875"Microlam—Trus Joist-MacMillan(or equal), Shim w/plywood to meet existing interior wall depth. The newly proposed beam at the Dinning room/entry hallway spans•not more than 8'-0"and is recommended to be installed under the existing beam that currently supports the second floor joist framing. The existing beam should not be removed due to the arrangement of the existing framing.Provide double 2x4 or 4x4 bearing posts for new beam support. This concludes the structural design of the requested beams for this project. Please provide temporary bracing for the installation of these beams and maintain standard carpentry practices for all framing. If you have any questions regarding this matter,please contact me by telephone at(978)771-6259. Very truly yours, Kevin M. egan,PR • �ytN OF a�! KEVIN M. FINNEGAN STRUCTURAL N No*41289 O O,c Viers A4��' �SS1ONAl I Enclosures JOB TOD1-T IFILAOT i orQFLA� SHEET NO. 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NORTH own of _ 4Andover * o dower, Mass., I� COCKICMEWICK V 7�A0RATE0 pCl S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT......a.,.....0....N.......................... C C, . .�....��........W.... dO� 6n.t..d..... .............� BUILD ING INSPECTOR ...................... . Foundation has permission to erect..IfY..1. ....PT K buildings on�..�......� . ................................. Rough to be occupied as.R.mI..... AATII.S,..R ..#�r...1v1 �. ...�r. 4w� R�v .4...Ch!w4w� himney P I................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Lpws relating to the Inspection, Alteration and Co truction of Buildings in the Town of North Andover.3.1''� &0—' IZ!�O V i a W A 11 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. F14- l Qom 1O# RN` ''i INSOM Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU O ST T Rough .. . .. . .. . ............................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Omtpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done . FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner •- Street No. SEE REVERSE SIDE Smoke Det. CERTIFICATE OF USE &. 00CUPANCY Building Permit Number Date // as o THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUHA CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO a C i Cq j^ J Building Impector NORTvf o of R over r- - to No. = o 97 dover, Mass., 46 If �A0RA 7E D A4�\ �C2 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......6.1"'00 L.C . h ..................................................................... Foundation has permission to erect.A.)'J. .....v.TOtbuildings on`4..)......W�s`'�'.... k! 41h41 1*....Rd Rou�h pp I A S p�rpa�r �� 4 �* V h�NAN� him, tobe occupied as.1�.IMI ................/..�..............�...!1... ..............�.................�..............:�............�............�...... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes By- ws relating to the Inspection, Alteration and C truction of Buildings in the Town of North Andover.32jind 1114 f1 &0.+ It`�O V i a W% I PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. F14- 10#16100 RV" Doi 1D&&*W4PERMIT EXPIRES IN 6 MONTHS UNLESS CONST UC-DO sT Ts ELECTRICAL INSPECTOR Rough `.................................................... Service l �� BUILDING INSPECTOR Finan 7/� f i occupang_N7 Permit Required t0. OCat� - Building GAS INSPECTOR Rough �'vy Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. J SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts -� ` _rteS�b Department of Fire Services Office of the State Fire Marshal ° P. O. Box 1025 State Road Stow, , MA 01775 CERTIFICATE OF COMPLIANCE M.G.L. CHAPTER 148, SECTION 26F ORI own Date Certifies that the property located aa✓ has been equiped with approved smoke detectors Has found to be in compliance with Massachusetts General Law, apt r 148 ction 26F. :ct on T esting completed on: / —/d'G� By. Inspector �a;d 2i Head of Fire Deparunentwoej -- -- )Tit,: This Certificate expires sixty (60) days after date of issue SELLER'S COPY 'FLCeoiricaleofcomp Rev 05/19/03 NORTH . Town of 4Andover No. w. dover, Mass., -01 'd o y COCWCME-fcK �A0RATEo FIf0 �C') BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 6/C�� C C, 2^1 BUILDING INSPECTOR THIS CERTIFIES THAT................................................ t:... ... d r h.. ....*.... PJ Foundation has permission to erect........ ..J. ................Kbuiidings on ..).......W.........+5.......... s Rou h .............................�..... ... .... . ,��-.tit to be occupied as.rt �-Vlf A1'�Is �p�1r` A 1 A� %!N*� himnmJ!..... .15..... . .,..... . M..... ............. .........�. ............... provided that the person accepting tis permit.shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Lpws relating to the Insppection, Alteration and C ruction of Buildings in the Town of North Andover.3-211� 0 i`~helit .: W A 1 P' PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. FI a. 1 G 1ailO Rr^ to dt�bo�l f�- ►' '��' PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIO ST TS ELECTRICAL INSPECTOR � C � Rough ..... ..............AAA........................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Roagh No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. b e Date. . / 7 .... NORTH TOWN OF NORTH ANDOVER O p PERMIT FOR GAS INSTALLATION SACHUS ') _ �' ' This certifies that .:.. . 1� has permission for gas installation ...,, in the��buildings of . x . . —4 . .!. . . //- : -�. . . . . . . . . . . . at �/.l�.�'l .�. . . . !��G�. . !.I . . . . . . , North Andover, Mass. Fee. .&�C?�Lic. No. . . . . GASINSPECTOR Check# 7,0 4646 C- MASSACHUSETTS"UNIFORM APPUCATIGWfOFf- MaT TO 00 GASFFTTINCs (Print ofType). • _ _ ox r Mass. Oates IS Q' 2Q__ Permit 4~ r Bulding Location 0 Owner's Name- AilameLs1i _ Type Of Occupancy t New p Renovation.0 Replacemer*{/ Plans Submitted: Yap No(j Gia 1< Z. CC.- 0_ re. c a o �' on: _: F. W J . 0 W. N' t Z =• C• }- Z. Z o- z O W. �, a. n 0, o p Z W W t J a v W W a Z �. O O W ; 19 Z 1� r� W O O Z Z t W t C r 30. M O: IF T C 301 SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STN FLOOR 6TH FLOOR 7TH FLOOR" 6TH FLOOR. Installing Company Nam- A Mc.[LCn 121 o cv. ,nc . Chedk-one:: Certificate: Address_ 5 t (2P,,,eyLt 4-. O Corporation- L 04 cu rn A . n;:11<1 O Partnership Business Telephone i- - css A Firm/Ca. Name of Ucensed Plumba or Gas Fitter. t7L.,—evi -::i Aac6 ei;5 c? , 1 INSUP.A! a! cavri1'.r.m.. I I have a ifablity•ir>:elranoe•pd lcy or Its stbstarttial eq"artwhich.meets the requirements of.MGLCh,..142.• Yes JR No O If you have chedced1a2&_ essa*WIc fire C a 3ype coverage-by checking the zppwprlatei box. A liability insurance_polley Other 11. Bond O OWNER'S INSURANCE WAfVER:1 am aware that the licensee does rnot-have the mance.coverage required by Chapter. 142 of the.Mas&Generd-Laws, and lthat.my signature on•thls•permj-applica*m waives this requirement. Check one: Signature at.OWW-Or-O~r S Agent:, OwnwO Agent.0 I hereby certify that all of the details and information l have submitted(or enterer)in above application am true and accurate to.the treat of my knowledge and that all plumbing work and installationtperformed under the permit issued far this application will be in compliance with al. pertinent provisions of the Massachusetts State Cas Code and Chapter 142 of the General By TAP of License: .. Plumber Signsturt,01 Uceni"Umberor Gas ROV-1 Title Gasfitier City/Town master License Number 31aC0. BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO OASFITTINO NAME A TYPE OF BUILDING LOCATION OF BUILDINQ • r r PLUMBER OR OASFIfTER PE�IMIt QlutNfiEo DATE - 20 - i OAS INSPECTOR r Date. f NORTp, ?o,,� •� ;goo TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SACNUS This certifies that Y.• f. . . has permission to perform plumbing in the buil i gs o `. ... . . . . . . at .1.�' . �.. /�--. ., North Andover, Mass. Fee. . . .L>c. No.. ./— (i'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR �/ '> Check !t �` e s 59U9 � s � 1 fp WATER CLOSETS KITCHEN SINKS �4 C — LAVATORIES Z BATHTUB 0 a O SHOWER STALLS �) a i 0I1SHWA8HER8 r°""'s ic = S g DISPOSERS, ; $ LAUNDRY TRAYS.,,, ` .., WA8H. MACH.CONN. ' 9' °� HOT WATER TANKS TANKLESS a $ 'q SLOP SINKS 0 } (� Z FLOOR DRAINS t O Inn r0 , � GASTRAPS o -p,, O O URINALS m DRINKING FOUNTAIN I Z AREA DRAIN 9 ; D WATER ER PIPING � QCI p i3 ROOF DRAINS to O. O BACKFLOW PREV. OTHER FIXTURES: �. BOILER MATE c rte.. GREASE TRAP '< SCULLERY SINK SHOWER VALVE ZLa 17 , 1 �v oo� BELOW FOR OFFICE USE ONLY �l FINAL INSPECTIONS SKETCHES FEE PROGRESS INSPECTIONS NO. APPLICATION FOR PERMIT TO 00 PLUMBING UNDERGROUND ROUGH COMPLETE ROUGH FINAL INSPECTION PERMIT GRANTED DATE PLUMBING INSPECTOR Location r No. `, Date //C MORTM TOWN OF NORTH ANDOVER Of�"a' ,•'�yC h 9 Certificate of Occupancy $ '•••°''< Building/Frame Permit Fee $ s�CHUS Foundation Permit Fee $ Other Permit Fee $ a v*� TOTAL Check # 51� 55 Building Insp +or i I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT ` i APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: aKAµ �I SIGNATURE: IU&f A1174--4� Building Commissioner/In for of BUHTR Date SECTION I-SITE INFORMATION LI Property Address: 1.2 Assessors Map and Parcel Number: 4-1 O-X�I lwaoiltd* Pd- V 23 Z, / lV / ,0U(k / J/K sJ • o 1 U- h .q Map Number Parcel Number 1.3 Zoning Infmmation 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided R red Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record 09 Z d1rld 0 4-1 (def l wpA�)� Name(Print) Address for Service: Al—� �/q 0 Sig a Telephone 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number on Address ' Expiration Date ic Signature Telephone P 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name M Registration Number Address Expiration Date ^ Signature Telephone !�) c SECTION 4-WORKERS COMPENSATION(M.G.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.......11 No.......❑ SECTION 5 Description of Proposed Work check all a Hcable New Construction ❑ sting Building+'] Res) ❑ Alterations) 0_ Addition ❑ 00 Accessory Bldg. ❑ Demolition ❑ Specify Brief Description of Proposed Work: kevla�eMp �,v�n�owS SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFPfCUL USE ONLY Completed by pennit applicant 1. Building 0 (a) Building Permit Fee Ti OQ 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 S Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT � l 1, �� Sw�, .� Anrfo I ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in n ers ativ a orized by this building permit application. 1 :x 4--- vAhn,I f f, 2002 Signof 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 Signature of Owner/Agent Date a " _ NO.OF STORIES SIZE ' BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3Ew SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I[BIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE vAORTH ® ®f over -_-- y Zoo T �O y-- LA , lover, Mass., LA ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... .. HAT.... .. ................................................................................................................�....... Foundation �u has permission to erect........................................ buildings on...11V®.. ... � .... ..... ough to be occupied a Chimney . . . . .. . ............... ..... ... .. .............................................................................. provided that the person cepting this permit shall in every respect conform to the terms of the application on file in Final Visthis office, and to the pr isions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION S � ELECTRICAL INSPECTOR ff Rough ��, •` .............................................................................................................:... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. gl 17 Ot NOATp ..' Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Sr►n,s=t ,Building Commissioner (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE A0rt /9, Z ao JOB LOCATION 4- R ' . Number stree Address Map/lot '•HOMEOWNER RV04 0' nhlob M 1�/FJ--/I,-k 2 N e Home Phone Work Phone PRESENT MAILING ADDRESS 6 0 j �4i.1'I� lt'S�• 0194-S City Town State Tip Code The current exemption for"homeowners"was Qxtended to include owner-oocu 'ed: � dwelr►rigs of two units or less and to allow such homeowners to engage an indMdual•for hire who-does. not possess a license,.provided that the owner acts as supervisor (State Budding 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 ordetached �ac- Gesso y to such vise and/or farm sbiKtures. A person who more than one horne 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, byL4aws, 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 wilt comply with said procedures and requirements. . HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL JUN-12-2008 10.;16 PMP, 1 �.. Department of PublicIi�ellltll&Department of Labor ' �. ( C `t �i F* NOTIFICATION 1[,�, �'C NOTIFICATION OF DELEADING WORD pa s iI %Ao All sectio"of thio form must 6e completed ht order to comply with a r 0 the notification requirements of M.G.L.C.111$197, 454 CNIR 22.00 and 105 CA4R 460.000,as most recently amended Contractor performing{project � �License tOCr)0.�10 _Fxp. Lead Paint Inspector Z`! Date of In "I IK.16S spection d la Licen®e#i �osp.Datr. - -__ �_„� ADD KWQZRO Street Address4— Y V v ` Apt.Number_ Cite'--�,r Property Owner Y1 CAddress 1 __� w a�l C. yt i Vag 0l a Telephone Deleadfng,%4.th6d:0 Wet/Dry Ccraping j]heat Gun Q liquid Encapsulant Demolition D Catgsties MRoplaeement RCovering ❑Other If-other-selected,please emplain _ �--- Check one' I)wcliing ismulti-family Single-fMil_y� Olhat �— Stant Date^ � p. Completinn Dat"S17--9L(T When will Rork be done: AAI- PM (Specify times on site) Weekends? ProjectSuper%4NrName 1 _ l ” [leense# pnonla Esp,T)ate 5 o Wcrlccr's Comptnsation Policy Number � A _ Carrier In case of emergency contact rte,v `: 1 S - Td. (Contractor's Representative) nt r rnnrN cONTRACI-QU lite o adersig ned hereby states,under the pains and penalties of perjury,that he/she has road and understood the Commonwealth of lVassachosetts Deleading Regulations,454 CMR 22.00,and the Lead Poisoning Prevention and Control Regulations,105 CNIR 460.000,and ths.t the information contained in thi9 notification is true and eorrect to the best of hislher knowledge and belief. Dete_ �l►� 4� _ � T - Coin pang N ante n "— . Address ��" 'telephone Number OVER4 I JUN-12-2008 1016 PM P. 2 Paw 2 of 2 `y In Accordance with Massachusetts Cenral Laws C.111§197,454 CMIt 22.00 and 105 CMR 464.ODti,notice of the daft and methods)of Kremovat or covering of paint,plaster or other d Visible mto aterials beginning f containing dangerous levels of lead is to be provided and must be received by the lb,lowing agencies,at least M(10) a3 prior NOTIFICATIONS MAYBE FAXED I Department of Labor,Lead Program,Division of Occupational Safety 399 Washipgton Street,5"Floor.Roston,hlA 02108 FxX.617-927-7568 2. tlirertor,Childhood Lead Poisoning Prevention Program Department of Public Health,Donovan Realtb Building,5 Randolph Street,Canton,MA 02021 FAX:761-774-6900 3, Occupants of dwelling unit 4, :Ul other occupants of the residential premises,If any S. Local Hoard of RealthlCode Enforcement Agency 6, Massachusetts Ilistorflcal Commission (if preraiies are listed on the State Register of Hstoric places this notification must be made upon receipt of an 220 Morrissey Blvd. Hooton,NLA 02202 Order to Correct Vtolatina or at!cast 30 days prior to F.kX(617)72'1-:1128 inldlnting preventive deleading) NOTIFICATIONS SHALT.BE COMPLETED IN THEIR EN"171RETY,DATED AND SIGNED-INCOMPLETE NOTIFICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED HY IRE DEPARTMENT OF LABOR&WORKFORCE DEVELOPMENT. PROPERT1i OWNE$(If owner or utzliccnsed owner's agent will be performing low ask detcadiug wotir complete the following) Property Telephone Number (—_) _—--.--- -- I certify that I have complied with the training requirements of the Comalonw,alth of Maswollusetta Lead Poisoning Pmvtntion and Comrol Regulations,103 CMP-460.175,for owncrlegent low-risk abatement and containment. I further certify that I or my agent will be performing the following lUw-risk activities a have ciroled till that apPM: capping baseboards removing doors,cabinet doo , applying liquid encapanlsrst ■hatters rs applying esterlor rvtyl siding covering;surfaces I certify that all the information conminnd in this notifcetion is true and correct to the best of my knowledge and belief. Date 0 O Slpted Revised 01:2007