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Home My WebLink AboutMiscellaneous - 45 INNIS STREET 4/30/2018 (4) 45INNIS STREET / 210J098.C-0050-0000.0 t Location No. �� Date NORTIy TOWN OF NORTH ANDOVER 3? OL ' Certificate of Occupancy $ *'�s "•'''�� Building/Frame Permit Fee $ sk,wsE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t m Check # 64 , 9 f Building InspIc,Yor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING T;1"his #pT SIC# IpC L lt1� M BUILDING PERMIT NUMBER. DATE ISSUED: ic SIGNATURE: �- Buildin Commissioner/I or of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ,4 e_s 3 As� .;7- ;5 YO�--r-k- rL?o?,3 2- Zoning District Proposed Use Lot.Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required I Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private I< Zone Outside Flood Zone Municipal ❑ On Site Disposal System SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record r� 11.9n4A 7' r✓iS STS N§me(Print) Address for Service 2�C_17 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: O License Number T Y -■ Address Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name m Registration Number r Address r Z Expiration Date ^ Signature Telephone Y SECTION 4-WORKERS COMPENSATION(XG.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......V SECTION 5 Description of Proposed Work(check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition 'lam Other ❑ Specify &(0urh Brief Description of Proposed Work: /04 Zg SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee l�l� 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 I, as Owner/Authorized Agent of subject property f Hereby authorize to act on ; My behalf,in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, Br-il -,— A&17c:"h las Own uthorized Agent of subject property ' Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief u c-/Z 14.4 .y .y,3 Print Name 4weLoz Signature of Owner/Agent ent Date Y NO. OF STORIES SIZE BASEMENT OR SLAB $' SIZE OF FLOOR TIMBERS 1 s 2 3 SPAN P DIMENSIONS OF SILLS a x DIMENSIONS OF POSTS c .,L DIMENSIONS OF GIRDERS FIFIGHT OF FOUNDATION X,5 iri THICKNESS S17-E OF FOOTING .( �h v X MATERIAL OF CHIMNEY a IS BUU DING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �/ 12Ie iMPy LD e v �t2_�(A FORM U LOT RELEASE FORM :5, 13 -a 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. *****************************A&nI7 PPLICANT FILLS OUT THIS SECTION******`***************** APPLICANT )Or ucl. PHONE LOCATION: Assessor's Map Number PARCEL `CLQ SUBDIVISION A! 7f LOT(S) STREET /2i � ST. NUMBERCc? AD ************************************OFFICIAL USE ONLY*********************************** REC MENDATIONS WN AGENTS: /_ _CONSERVATION ADMINIST TOR DATE APPROVED Q010 DATE REJECTED COMMENTS c. Ae ►MyZf b2 r-e.a(czc,?A ADO � W1II is exfonl Slab :> so 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 9\97 im N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: _ )C�j N AA,)IIV /9 � Location: S- _%.�>,� S S"7- city lyv rz r-tj ,vo v r/ 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: Address City: Phone# Insurance.Co. Policy# Company name: Address Citi 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.penaltiesin.2helorm-d aSTOP WORK ORDER.md_a.fine_af_($1DDM)-ajday.against.me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ti I do hereby certify under the pains and penalties of pedury that the information provided above is true and correct. Signature Print name _ D d1 0 C-9 A u� Phflne.# 9P?- 6 9---X 9Sr S 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 0 Licensing Board E] Selectman's Office Contact person: Phone A- E] Health Department ❑ Other 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: (Locatio of Facility) Signature of Permit licant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project-through the Office of the Building Inspector NORTH E AndoverTown of � �, Q � VIA No. 67i T,o L Ao dower, Mass., 'a D - o?OD 3 C0CHICH WICK V ORATED PPS\ t J 7 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System :Be # BUILDING INSPECTOR THIS CERTIFIES THAT ........................ ....... w .N. d..... ...................................................... Foundation has permission to erect.��`Nx. �4 buildi son ......q. S. ....................... Rough fora s to be ocCUpled as... .................� e�lAt r r»��V'T' s a ti'1`t �0.... Chimney ....................................... ......... ..... .. ............................................................................ 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 In pection, Alteration and Construction of Buildings in the Town of North Andover. 9P ec/ 6-0 `-0 doom PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. �7 Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 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. MORTGAGE INSPEC' FION PLOT PLAN NORTHERN .ASSOCIATES, -INC. 11 SALLARD WAY, LAWRENCE, MA 01843 , Tel. 617.975.7117 3220 MAIN ST., RTE. 6A, P.O. BOX 253, BARNSTABLE, MA 02630 • TEL. 617,362.8639 Ya9MAQONT BRUCE 6 PAULA HV"Y DEED REF. BK BB PD 245 LOCATIA t 45 INNES STREET PIAN REF. 3263 B ITY, STATE: N. AMOVER. NA SCALE !- 30' DA TiE APR/6/88 JOB Of.' 881 877 ADMAN STIREET Bp Op. ry LOT 206 \` LM !A9 117 zoo a 804 - 2atr eft LOT !97 ' S STALOT 20! RTY MOOD i -* r rVIES STREET , vf}�r CERMFIm Ta' ANDOVQR SA VINES SANK 6 HAhM Y MTH MOAT AN INSTFEME?(T S M% T gE . aE ��{�r �<<w�►i�cy TING M% NON , A S IC�IITY S. TATE THAT N NY PROF(ESS N �N�CI�-- S A ' ~ S ► INE VM MITH aA'l EI MAYTrHERtE 1 ��LII�NES EXCEP AS�ip1N. I T SON NAp:S PROPERTY IS Wo_Y)_ LOCCATED IN FLOOD HAZARD ZONE I ) (,�h I S OL A GAN