Loading...
HomeMy WebLinkAboutMiscellaneous - 431 MAIN STREET 4/30/2018 431 MAIN STREET 210/057.0-0015-0000.0 i i I I I I I 1 Location 'x`31 InA // S No. 433 Date S Z MaR,M TOWN OF NORTH ANDOVER 3?0'�?�•° I.1Mo _ o + ; ; Certificate of Occupancy $ CMU t<� Building/Frame Permit Fee $ S.� S Foundation Permit Fee $ Other Permit Fee $ q TOTAL $ C/ y Check # 15 5 87 Building Inspector + TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING e rte• =, , n. r>r >_ r .ga,.' +fin• MM BUILDING PERMIT NUMBER. / 3 � DATE ISSUED. 02 O Yn=0� O o�C l X C� ic SIGNATURE: Building Co ssioner/12ELWor of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: CC 1.2 Assessors Map and Parcel Number: .7+2-C2� 2 }h •�f G c3 ,� VL Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dis1.rid Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWrcd Provided Reqllircd Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(Print) Address for Service: 9' C�--7j— 30Z O Signatule Telephone 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone M SECTION 3-CONSTRUCTION SERVICES iii 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: C $ p c1 7 / g O 1 1; t s License Number Address 0G�-.,.,C� o $-;L- Expiration Date/ Signa re Telephone rM 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name a- g M I Z i` 5 Registration Number Add s 1 `lI a 01 3 Expiration Date �1 Signat re Telephone �! i t 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.......M— No.......❑ SECTION 5 Desch tion of Proposed Work check applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) Q"' Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 00 �(( //��� A 116 XC2 0 *-/ 07 PCQ Poop- d d k( (�k) (2111111 /��✓i S v V- �� Aq Jar fa � �w� SECTI N 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed bypermit applicant 1. Building (a) Building Permit Fee 3� Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical(HVAC) �a 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 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, ��n.wa 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 �,A---e- S .A- Print Napes C Si ature&Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHININEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM E(fG\,j ft.ki d SAO'- G%a co aux INSTRUCTIONS: This form is used to verify that all necessary approvals/permits p Boards and Departments having jurisdiction have been obtained. This doenot relieve the applicant and/or landowner from compliance with any applicable or requirements. ******************APPLICANT FILLS OUT THIS SECTION APPLICANT PHONE_ LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) STREET M141 ST. NUMBER�c3/ *****************************************OFFICIAL USE . ONLY*********************************** RECO ENDATIONS OF TOWN AGENTS: CONSERVATION AD NISTRATO I DATE APPROVED 6 DATE REJECTED ------------ COMMENTS uJ rh ko 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 im MORTGAGE INSPECTION FLAN 429 - 431 MAIN STREET N0. ANDOVER , MASS . SCALE: I"a 40' JULY 15 1897 WILLIAM 6. TROY RE6/STERED LAND SURVEYOR 936 EAST STREET -TEWKSBURY, AMASS. e OQ' - 24,510 S.F. �ry 21,32 ,. . co ., _W EXISTING DWELLING }f ri N 17 8.7' �'93.. MAIN STREET I HEREBY CERTIFY TO THE TITLE INSUROR AND TO THE BANK THAT THE DWELLING JS LOCATED ON THE LOT AS SHOWN AND THAT IT DOES 'F CONFORM WITH THE TOWN OF NO. ANDOVER ZONING REGULATIONS NOF,�ta� REGARDING SETBACKS FROM STREETS AND LOT LINES. I FURTHER CERTIFY THAT THIS DWELLING IS NOT LOCATED IN THE U� WILLIA,MI ;In FEDERAL FLOOD H92A b �EA 'AS $HOWAI�N MAP DATED JUN. 15 1983 t � s; /i TROY 1 : REGISTERED LAND SURVEYOR TNIS' PLAN FOR MORTGA99 PURPQSES -NOT FOR BOUNDARY DETERMINATION. �yUSUH`a`�'tC• � 409 AN BOUNDARY INFORMATION TAKEN fROM• . bey,—_._._.- •y� N.E.R.D. PLAN �� The Commonwealth of Massachusetts DepatIment of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit �..:v.: ::: Please Print Name: YVq Location: �.31 n,. ,,a Ci I1/u z. Y'I �A V-V Phone q B 6 g a - 10 2 a (—`7 m a homeowner performing all work myself. 1E 3 : m 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: Address ch: Phone# Insua nce Co. POW ComrAM name: Address city: Phone# tnsurange-Co. Policy# Failure to secure coverage as required under-tlectlon 25A or MCL 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 penalties in the form of a STOP WORK ORDER and a fine of($100:00)a day against me. I understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. I do herby certify and pains and penefts of perjury that the iftmation provA*d above is bre and correct Signature o✓J Date �� S m Print name �'A`'`^ e S S Phone# 4?8 - a-a a Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board Contact person: Phone* ❑ Selectman's Office' ❑ Health Department ❑ Ofher VORKMAi&''S COMPENSATION i North Andover Building Department Tel: 978-6$8_95� DEBRIS DISPOSAL FORM In accordance with the provision p of MGL c 40 S 54, a condition of Build' Number rng Permit is that the debris resulting from this work shall be disposed of irl a properly licensed solid.waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of permit Applicant i l Date NOTE: Demolition permit from tl?e Town of North Andover mu this _ must be obtained project through the Office of the for Build' , tng Inspector N0RTH Town o over _ V No. ,�.., z -a ao Mo a dover, ass., WICK COG HIC � ADRATED S H � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......� — ...... ......................................... . . .............................. Foundation has permission to erect..J46."Ya.0............. buildings on ....... .....5. / / .... ... ough O2N� �� �Al 7' � �c,� Co�vnrs c.� j�'�e7FoC to be occupied as.......................cor'........... . ...i...`�.....''.-..�'Y..AS /..C34�/`�w �/I Gemma c �� Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Q� inal this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. L5-"7//6- X PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough y/.'/...1...................................r .C..................... BUILDING INSPECTOR Service Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, 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. Location No. �-3 Date A 9 / 401tTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �_ °''<�' Foundation Permit Fee $ s�C S A' Other Permit Fee $ r Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 1 3 1 8 1 06/15/99 14:37 32.00 PAID Div. Public Works _ i ;'ii' i PERMIT NO. APPLICATION FOR PERMIT TO BUILD********NORTH ANDOVER, MA MAP NO. ® LOT NO. (`j 2. RECORD OF ON'NERSIIIP DATE BOOK PAGE ZONE SIJ 13 DIV. LOT NO. LOCATION -43 i rv-� Al ev PURPOSE OF BUILDING O\VNER'S NAME --r\ �` NO.OF STORIES SIZE OWNER'S ADDRESS 4431 BASEMENT OR SLAB ARCIIITECT'S NAME SIZE OF FLOOR TIMBERS ; I ST 2ND 3RD BUILDER'S NAME 'res -s �k + SPAN - i DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM IAT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE 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 BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEINER IS BUILDING CONNECTED TO NATURAL GAS LINE 1NSTUCTIONS 3. PROPERTY INFORMATION LAND COST EST.BLDG.COST PAGE 1 FILL OUT SECTIONS I-3 EST.BLDG.COST PER SQ. FT. EST. BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMITNO. ATTA4Cl1ED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MAST BE FILED AND APPROVED BY BUILDING INSPECTOR � UILDING INSPECTOR ATE FILED OWNERS TEL# f i gl�� r CONTR.TEL i CON R SIGNATURE OF-OWNER OR AUTHORIZED AGEN {�, FEE G , a 31: PERAI►T GRANTED 19 nj w (/Y Revised 5/5/99 JNI The Commonwealth of Massachusetts Department of Industria!Accidents _ 011lcB o!/nYestlgadons ? 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit I Min name: .SWp�.QS ��5i'V,- location_ Sao 13 1� �1 S city :1—®�S \ C �Y1 iA nhane CA— b$ �k D 6 Fj I am a homeowner performing all work myself. (R I am a sole proprietor and have no one working in any capacity f—I I am an employer providing workers' compensation for my employees working on this job. comoar,v tame: � cim. phone�- in�nrance co. -.... DDII Y� Q I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comoinv name: addrea_ city: ... phone i;;- Insarancc co. policy# comnanv.name: addren: cim phone#• insurance�o. yo,ic•j Failure to secure coverage as required under Section 25A of NIG L 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. [undentind that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date G C( Print name Phone official use only do not write in this area to be completed by city or town official J, city or town: permitllicense r2 17 Buildin3�d C]Licensicheck if immediate response is required [Selectm[]Health contact person: phone N; —iOther (r—n 3/95 PIA) v e Town of North Andover NORTH OFFICE OF 3�0 .o61 �o0 COMMUNITY DEVELOPMENT AND SERVICES 0 x. 27 Charles Street WILLIAM J. SCOTT North Andover, Massachusetts Ol 845 Ssgc,Hus�11 Director (978)688-9531 Fax (978) 688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number O� 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: �r (Vxe \ko VL-A"sftm SVAA+Wv 6'eueye-t��✓ J (Location of Facility) Signature of Permit Applicant 619 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 683-9530 HEALTH 688-9540 PLANNING 688-9535 VAoRThq o L D i own of dover No. -COCHI E Q dover, Mass., 9 �eo ADRATED A �C� S 5� BOARD OF HEALTH Food/Kitchen PIER M I Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... ....../...I x................ � ...... . �® ... ....... Foundation has permission to4. 'ldin son .............. .... .. .........A i� �.............. Rough ® � Chimney to be occupied as.........�................ ...... ........ ............................................................ .. y 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-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 Pa PERM1 F EXPIKES IN 6 MONTHS Final ' = UNLESS CONSTRUCTIO S ELECTRICAL INSPECTOR 1391® Rough ............................................... PiF'SAnA 57 ......... .. ......... Service BUILDING INSPECTOR Final / 49 011- Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. Location 41o�clT ,4-131 119AIN Sf No. 3/ cR Date 0.1140 DT#1 1ti TOWN OF NORTH ANDOVER , Certificate of Occupancy $ CU i ; Building/Frame Permit Fee $ o? "U "s cMusE� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ e, Water Connection Fee $ TOTAL $ c�7 #�/ Building Inspector � 3 /- 59 Div. Public Works PERNVIIT NO. APPLICATION FOR PERMIT TO BUILD********NORTI-I ANDOVER, NIA 11IAPNO. 57 Lo'rNO. 2. RECORDOFOWNERSUIP DATE [look PAGE ZONE SUR DIV. 1.0'I'NO. / LOCA I'ION `, � J1 ai l 5-�- PURPOSE OFF BUILDING ' � X f l0 S f'® rteg � �hecQ OWNER'S NAME T� 1 NO.OF STORIES i� pE�� SIZE OWNER'S ADDRESS �. Dq- YSl tn/�1Jy \ _ C [3ASFNIEN'rORSL:\Il ARCHITECT'S NAME I '"' ll l ll/l[U �J SIZE OF FLOOR TIMBERS t si, 2ND 3RD RU ILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DINIENSIONSOFGIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION "IIIICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL.OF CHININEV IS BUILDIN ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIRE NIENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SE\\'ER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTUC IONS 3. PROPERTY INFORNI.ATION LAND COST EST. BLDG. COST O PAGE I Fn.L Olrr SEc noNs 1-3 EST.BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. Al-I'ACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS d. APPROVED BY: l PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR _ DATE FILED 99-7� aQ%O\VN ERSTL'I.H J� � `� - CC CCV CONTR.TEL# ' SIGNATURE_01' OWNER OR AUl'110RI"LED AGENT CONTRAAC9 OZ6 II.I.C./E 1'ERN11T GRANTED _ 19 Rcvised -S/5/99 JN1 - FORM U - LOT RELEASE FORM 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**'��********** -7 APPLICANT PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET Aq I/y !:,1,4 ST. NUMBER 410-)7 * *** * * * * * * OF1=1C1AL USE ONLY*************** JRECOMMENDATIONS OF TOWN AGENTS: SERVATI N ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTSCT1 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 i RECEIVED BY BUILDENG INSPECTOR DATE= Revised 9197 jm NORTFI own of o L ®ver No. 31a T Z � h o - ��Q h dover, Mass., 7JITq co .1 E ADRATED P'P�\�t5 S IS BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT..........�....:. 0 BUILDING INSPECTOR ................ ...........................z. .................. .................................... Foundation D ��t � has permission to erect...�...............A&......... buildings on ... 0� 3 I.... /4.t.N �'I Rough to be occupied as.... 0.... y .....t /N /�'C a r rd p r ~ Chimney .......... ................................................................... ........................................ provided that the person accepting this permit shall in every respect conform to the terms o the application on file in Final this office, and to the provisions 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 rl�l Jr r) PERMIT EXPIRES IN 6 MONTHS Final l UNLESS CONSTRUCTION TAR ELECTRICAL INSPECTOR • Rough 3 IZec# 1 oZS � . .... .. ... ... .... . .. ............ ...... . ............... .......................... Service BUILD INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. 1 MORTGAGE INSPECTION PLAN 429 - 431 MAIN STREET N0. ANDOVER , MASS . SCALE: I°s 40' J LILY 15 1997 WILLIAM 6. TROY 47E9/STEREO LAND SURVEYOR 936 EAST STREET -TEWKSBURY, MASS. oQ 2 4 510 S.F. � 21.3 2 rc 30 k, QXISTIN EXISTING DWELLING M N 178. 7' MAIN - STREET I HEREBY CERTIFY TO THE TITLE INSUROR AND TO THE BANK THAT THE DWELLING I$ LOCATED ON THE LOT AS SHOWN AND THAT IT DOES _ A y �11 0F�CONFORMWITH THE TOWN OF NO. ANDOVER ZONING REGULATgNS REGARDING SETBACKS FROM STREETS AND LOT LINES. I FURTHER CERTIFY THAT THIS DWELLING ISNOT LOCATED IN THE FEDERAL FLOOD HA-ZARD REA AS $HOWN�QN MAP GATED JUN. IS X983 . REGISTERED LAND SURVEYOR iy a �. . THI S I PLAN FOR MORTGAGE IpURrQSES -NOT FOR BOUNDARY DETERMINATION. -4.4 �Ro�A� BOUNDARY INFORMATION TAKEN FROM N.E.R.O. PLAN 409 . 1440 Location Y31 No. �`�� Date NaRT� TOWN OF NORTH ANDOVER O�•„ c •,ti0 + + � ; , Certificate of Occupancy $ Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ?� Check # f Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: rn SIGNATURE: € Building Commissio r/I for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: X13 05- 7 I � Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Area-(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record -7—k "I (, ft CA 31 mA4 VJ S Name(Print) Address for Service: IN -a 's ® 1 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O 7. M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Z S 'rQ S" Licensed Construction Supervisor: C S O 5 y 7 1 O License Number Add s "1 _ 6 / $ /a-.Doa t CIT5 7 ® 3 Expiration Date Signa a Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name 1 -.)L 0 a fo Sao 3 Registration Number l���t s-t Address 0 cL,� ��- 3033 lI� � � Expiration Date ^ §7ignaturi Telephone w 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.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ocRepair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: -�v.rS� ,q �( 1�, �, � LL 'F n/�e•v � . ..� d�w S SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be F CI iL USE"ON . Completed by permit applicant 1. Building y (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 14 SO O Check Number 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 Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 'S -e- s �e s Print N e �� c /,6/ o O Signature of wner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1Fr2ND 3KDi 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: 'ZT A S A--A Location: C'{ S�- city tv e rt tti A"jZAIL Phone 0 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: Address City Phone#: Insurance Co Policy# Company name: Address City Phone#: Insurance Co Policy# 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 penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify andpains and penalties of perjury that the information provided above is due and correct. Signature 0L --A Date 6! 00 Print name f ekNf--S Me S+A Phone# 61N 4 21-0 -� Official use only do not write in this area to be completed by city or town official' ❑ Building Dept []Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: phone#. ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION a Town of North Andover RTH 0 4t Leo 1 1''•6 to Building Department o 27 Charles Street � North Andover, Massachusetts 01845 m 978 688-9545 Fax 978 688-9542 ( ) ( ) �9SSAc►+u'��t�� DEBRIS DISPOSAL FORM In accordance with therovisions of MGL GL c 40 s 54 and a condition of Building Permit# the debris resulting from the 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/at: Facility location Gid Sign ure of Applicant �6(® 0 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I i 1 t NONE IBPROVEHENT CONTRACTOR I Registration 120296 Expiration; 111W2001 Type: 08A TESTA BUILDING & RENOOELIN 3ANES TESTA 7? � , 120E HILL ST AaMINSTRATIOR TOPSfIElO NA 01983 =.��'"` �, ✓1r�o�rvm+yn�uea� o�✓��,rr�aac�r�del�t BOARD OF BUILDING REGULATIONS .. ., License: CONSTRUCTION SUPERVISOR Number. CS 054718 Birthdate: 06/08/1965 Expires:06/08/2002 Tr.no: 26195 Restricted To: 00 JAMES M TESTA _ 1208 HILL ST ..«�, TOPSFIELD, MA 01983 Administrator WORTH Town of Andover No. 311 CON dower, Mass. O COCIIIC MEWICK �t ' ' A0RAT E O P? BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT...��M!�...............G...... ........................................................................... Foundation has permission to erect �� I... � ..... � p ....... ....... buildings on ...... .... ....... ... ............................... Rough to be occupied as..... ; �P f� ...� 1>0 9iv ......................................... Chimney �V............. 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-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. P) n to ��� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIO SELECTRICAL INSPECTOR T 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. Locationl�; .u .�" � ,No. c Date f NORT1y TOWN OF NORTH ANDOVER Certificate of Occupancy $ { �SsACNusEtA Building/Frame Permit Fee $ Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ v Check # 7 r 1360 Building lApector I i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 5-. -r f.A.. r•.....a.-- ^ham,Lna,..r's:er.e .,A,. BUILDING PERMIT NUMBER: Qe o DATE ISSUED: SIGNATURE: I Commissione for of Buildings Date SECTION 1-PTE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: / J�7 0d �© Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: i v Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Public ❑ private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Oc�� N � � �.ec�ooa� Q Name(Print) Address for Service Signature Telephone a 2.2 Owner of Record: Name-Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 LicenTd Construction upervisor: Not Applicable ❑ non Licensed Construction Supe/rvis r: b-5-P Z3 3 I W� LOWt/ �Fiv�ih License Number Addre 1 V(,a �, s �-jS-aoo1 7 'rJ U� Expiration Date a re Telephone 3.2R ' teredHome I provement Contractor Not Applicable ❑ Company Name - 96 M S-by Registration Number Address W L� - < Expir ion D# ^ i na re Telephone Y 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.......❑ No.......❑ SECTION 5 Description of Proposed Work check ev applicable) ❑ Alterations(s)New Construction ❑ Existing Bkulding ❑ Repair(s) ❑ Addition ❑ ,k tldI � f Accessory Bldg. ❑ Demolition ❑ Other LVs Specify. '&- rP GcP Ml z Brief Description of Proposed Work: 1 / k1 / i r Z25 t r SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be (f 'ICIA.ti US]C{31vLY Completed bypermit applicant 1. Building (a)(a) Building Permit Fee coo 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 pc>p Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN u OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property a « Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. a Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION d 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 e_4�, (Sc f Print Z1 _ -7/zt�/0 v Si tore of Owner/A Da RNMOSEEWAMN WE NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1ST2ND 3 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 Town of North Andover o� NORTH 6x aL Building Department o 27 Charles Street ` North Andover, Massachusetts 01845 4 ?o oy*V (978) 688-9545 Fax (978) 688-9542If f �9SSAc►+us���y DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location ` M t L ignature of Applicant 07 () U Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: zo w ell !tv Ci 9A'J'AAM . V44 o e Phone 9,� F-1 am a homeowner rforming all work myself. F-o 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: Address City Phone#: Insurance Co Policy# Company name: Address City Phone#: Insurance Co. Policy# e 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 andlor one years'.imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under t pains and penalti s of perjury that the information provided above is true and correct Signature Date -71101()n Print name r 0'CY— Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept []Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION vkpRTFt olm ' o 4Andover lot dover, Mass., 7- /V O V O COCMICMEWICK ' A0'QA T E D APS��� . `r BOARD OF HEALTH IT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT ..... ..... ................................. . .............................. ........................................................ Foundation • has permission to erec .......I... ..... ... ........ b dings on . .. ............. .................. Rough �i�e to be occupied aS ........:.. ... .. .......... Chimney . . . .. . . .. . . . .. . .provided that the perso cepting this permit shall in every respect conform to the teion on file in Final this office, and to the p 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough ...................................... Service G 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 (Nall To Be Done EIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. R f . :_. .. _. . ✓fie �am�nwmurea/,ll o��aaoczcfiuoelta � BOARD OF BUILDING REGULATIONS + License: CONSTRUCTION SUPERVISOR Number: CS 058238 Birthdate. 09/15/1964 a Expires:00/15/2001 Tr.ho 4827 '-- Restricted to: 00 GLENN M GARY 507 WEST LOWELL AVE HAVERHILL, MA 01832 Administrator r3 1._. ......-.._,....�.,..._._._. ... .. .I-�--•- ��_ .. _....._.__..,.,� ...-. .,,...r- �. I HOME IMPROVEMENT CONTRACTOR a Registration: 105965 Expiration: 7121102 Type: Individual GLENN GARY GENERAL CONTRAC Glenn Gary 507 Nest Lowell Ave ADMINISTRATOR Haverhill NA 01830 I s 1 {