HomeMy WebLinkAboutMiscellaneous - 45 WOODSTOCK STREET 4/30/2018Location 1S- Wv01S 4,x i v-�
No.
1311 Date
�ORTM TOWN OF NORTH ANDOVER
C? O4
� 9
+ Certificate of Occupancy $
Building/Frame Permit Fee $
s�cMuS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 60—
Check
0
Check # /-/C� f0
16 u 51 -.1 u /a ( &,-,,
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: f� DATE ISSUED:
i a ` 3 _ p �Z
SIGNATURE:—
Building Commissioner/Inspector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
�) (JO J clp PMI"
1-D— S
Map Number Parcel Number
r1.3
Zoning Information:
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. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public ❑ Private 0 Zone Outside Flood Zone ❑
Municipal 0 On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSE11P/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Address for Service :
Signature Telephone
2.2 O;wwner of Record:
` -
1/ �:w�'L �PivS�tcocc �[ i ��,� Li c� c�TarL S 1
Name Print Address for Service:
J// a,__ -7
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable 0
Licensed Construction Supervisor:
License Number
Addres
r
1
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
1
/ /6) 6 7
Company Name
IC) I, R �4� Jecli ' �y
1
Registration Number
Address
"-
�� � �rt' �) �,
Q of 7 -- ? — T
o:Da
Expiration Date
Si nature Telephone
Ma
M
X
Z
O
O
Z
M
90
O
Mn
r
v
r
_r
Z
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 ....... r No ....... ❑
SECTION 5 Descri tion of Proposed Work check allapplicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other 4U Specify .P -
Brief Description of Proposed Work:
S V,oeJ
�
w Arr S�T.r)I
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
T
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL U,SE ONLY,
1. Building
/""�n 1 0"0
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee tel X (b)
�J
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 iiAPPLIES FOR BUILDING PERMIT
I, 6 lM a w L �� �.r �,... 1 \ t as Owner/Authorized Agent of subject property
Hereby authorize 36i0 15 (crw�.t_ �4r.� Vyv�� c�"i to act on
My b If in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, ocrV"%t moi. c �� w S o .l � 1 l 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
f'
out w1 c Perseus I 1
Print Nme
SignaTure of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TMERS 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 CHFVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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)
Signature of Permit Applicant
��- ;,._0Z
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through.the Office of the Building Inspector
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print
e
I am a ho owner performing all work myself.
I am a sole proprietor and have no one working in any capacity
?71-/672-
F-1 I
71 /67.2-
I am an employer providing workers' compensation for my employees working on this job.
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-we0.as_chALpenaltiesin-theinrm d -a STOP.W. _ORK ORDER..and..a.fine,oF_(.$1.AO.flD)-arlay.against.me.
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Print name /fir t�Ci P_hone.#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
Building Dept
[]Check if immediate response is required r] Licensing Board
E] Selectman's Office
Contact person: Phone #. ❑ Health Department
El Other
C Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration -119567
Expiration 07/27/2003
! T ' TYpe DBA t
BOB'S HOME IMRROUEMENTS
{
ROBERT GEIST
10 Bay State Road_�.�
Reading, MA 01867
f Administrator
!n
x
w
A
u
>
o
z
°z
a
Or.
C
m
w
0
z
w
a
W
z
V
w
ao'
cn
w
o
v
w w
z
C7
o
w
w
N
W
a
a
w
w
a
CO
co
v
0
cn
•: C O
m c
O
O
16 -
ca H
O C
"~ O
v V
•a'o : c
cc C13
N 1 E a
C
✓ Y y
tow
yr
42 u Of t
m c
4-D, m
L
o$Az3M=
N m ++
ccm
C * m J1%%� �
4 �
_ N
N C
coo O
r E m
OIL
m ID
o
d a
a== •o
:mom m
C� O L
CIM Z O
.-: cro c
� a
Q y ; m
0 C O
S m �: m 3
O
r+ N
COD
O
2%
F- CL=
CZO C Z
S O `r m •N O
C.3.3 m C2 m C Q
CO3 a 4Dto M
o v J
t- t C -L m i
Z
0
v
CO2
co
43
L
CL
co
C
O
a�
w
ev
CL
h
0
.C3
y
0
C-3
L
0
V
co
CO)CL
C
CD CM
C
CD
0 �
m m
1— Z
3�
L
o �-
a.
�4
C
C
cc
J 'C
CO
Z C3
C.
H
C
_0
U)
w
w
crw