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HomeMy WebLinkAboutMiscellaneous - 46 AUTRAN AVENUE 4/30/2018 (2) 46 AUTRAN AVENUE 210/045.C-0020_-0002.0 I 4 I WJ 10 y-I� 3 15�So0 206 / �� !1 5- I9—o3 FORM U - LOT R LEASE FORM � 6 y S'C � �, INDUCTIONS: This form is used to verify that all necessary approvals/permits nm and Departments having jurisdiction have been obtained. This does not relie e applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION ` APPLICANT J/L��'C {'� w`C u/et►'� PHONEq/' _ LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) STREET- � ST. NUMBER__� USE ONLY********************�►* ******,t* ** RE MMENDATIO OF TOWN AGENTS: CONSERVATION ADMI 1STRATOR DATE APPROVED DATE REJECTED Q3 COMMENTS �tS-F F�I r�z;yah Q�� rrcor�s�rl ul,11 h0i we'v+ 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 bo O U e 6(\AA coo FORM - U - LOT RELEASE FORM E3 / 2- 10q INSTRUCTIONS: .This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ueeerrrreee a ecce■ •■r.■r■■ee■eee.■e■■e■■rreerrree■■rerrreeeeeerrrereeeeee■ APPLICANT )-54- 44 ey el PHONE � ��ffc__32 ASSESSORS MAP NUMBER LOT NUMBER a� SUBDIVISION/ �eeererre■ ■eeeeeeeerere■■eeruee/eeeeee ■■L■TOeT NUMeeBeEeR STREET IO av� 6--/ SLREET NUMBER OFFICIAL E■OY reeLeG�ee�//r,r, eeereee■ RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINIS OR DATE REJECTED Sl' ja COMMENTS A���im„� �C���i2� f+►G�E.vw y�isyDA O�i 'i'� S tzxis�ina e. v4 111' LL / ` ff�� 1� i mot-R 0 bLl, w gtrN1T NtnS is S"e�''An 444 -6,r o3oye. sa, '�44 Ras kA pal �or all NrS) DATE APPROVED TOWN PLANNER DATE REJECTED CONM4ENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING S OH:SAF O�fiefid U§C`01i1 BUILDING.PERMIT NUMBER: DATE ISSUED: rn SIGNATURE: Buflding Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage(fl) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reqwred Provided Required Provided 1.7 Water Suppty M.G.L.C.10. SJ) 1.5• Flood Zone Informatiou: 1.8 Sew"c DispoW System: Public 0 Private 0 Zone . Outside Flood Zone 0 Municipal 0 On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service � Q• `Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address Expiration Date signature Telephone 'S.2 Registered Nome Improvement Contractor Not Applicable ❑ ompany Name Registration Number Adress r Expiration Date ^� 'iQnature Telephone u/ i 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 .......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: �_. Bv✓ l�ryvhd fov L SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be `t a � £��qu S]CUI�II.S� Completed b rmit a licant � � g ;r 1. Building ' (•t ©a� (a) Building Permit Fee Al\ "7 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin 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, t S0)A. f4r'lv4as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all n ers relative to work authorized by this building permit application. Signature of Ow r 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 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DiTENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A it m Wvl$ �4-�yr-s-lv�(of�c�s. 9• �Ani 4 Sim -a �I {20PT'C-a. TUE y u�•�Ioui1-1 al-W,7 pt.A.N�-rcl� ' wT PaY-P WrnI� ZY�L-�'� �{Z,y�� LIIJL`�.�f�IVt41,`IH'u'G'S�IIJci (Ip ; ."L7 PNrI uaaT( ;S.lv vt�l n2E:�SLb•SE aP' S p� EO TaO.T 1-10 1-E./✓L-II.It'�T+2 flIV I�JIGtiI ' ` ivf I I-IZ al' s<17�Ify �,(1P oe Qpe_ ,�rwY I t 3 � v� y II-6•h I n -..00.'O'___- 8 � UJIr 7 I WTZ -4&0 ' I p L�-t%7 o 4 e+-+O-tt4--4N¢ar�re2 of 1t,E AYCHee5ei5 ,CV(RdIJ A�?IVECt+D7�.(u/xN. . Z 1 d BCAS.�r,VUIr5ol�11;s2e, .4117 ALJ-4e,- ty AE,2w�'(0 A Haacu-OW L4Ur(-,PVe4Eyh� r7xs yr!an��-co, ru-rs�tv�rL c�a.,, AU"i'17.AN AY�NUE 5 LTi PL-4M )J1j41O4=�4(4�1b,U14NJ A�E,1/1UnE!-01,V,� ,1R7MGUCLUM AWOVEC, ,V�. A04aD MCAIUlr o lam-ter"b r>� (Z� P�/yL�e 1b � ra Dec-.K- -)/7/0-2 i/7 0-2 V-/ 10 Y-1�. 3 15 R S O '^'� l // FORM U - LOT RELEASE FORM °,zed66 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits Departments having m Boards and De p g jurisdiction have been obtained. This does not retie e the applicant and/or landowner from compliance with any applicable or requirements. APPLI� gC,�ANT FILLS OUT THIS SECTION******************** * LAI APPLICANT ,cJl "1''�yI 'Tq'w`e RO u/u PHONE LOCATION: Assessor's Map Number (J PARCEL SUBDIVISION LOT(S) STREET^ n ST. NUMBER ****************** ►****** * **y'OFFICIAL USE ONLY*** ►* * ** **** **** RE MMENDATIO OF TOWN AGENTS: CONSERVATION ADMI ISTRATOR DATE APPROVED DATE REJECTED Q3 COMMENTS M�<+ f e- 01 C0-6;Q- VM+i p,, �}rootzs¢�( W,11 hof med- .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 jm 4: w Location No. Date NORTH TOWN OF NORTH ANDOVER O F a * Certificate of Occupancy $ Mus<� Building/Frame Permit Fee $ �. y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ F i Check # i r 19724 Building Inspector TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION oS-COLO 06quo to * Permit NO: `7 Date Received Date Issued: !3 ' ��SSAC HUs���y IMPORTANT:Applicant must complete all items on this ,1 page LOCATION 4(-oAa�cn ave • �J , Al1do��C 2 M/F oli` 5 not PROPERTY OWNER 4� 41 !til Newer _ Print MAP NO.:L,-1- PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑ One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: ❑Repair, replacement ❑Assessory Bldg ❑ Commercial ❑Demolition ❑Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESC IPTION OFWORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: L J5&- M, IAe_�n�i Phone: 3a- b Address: ax A-r,4y_tz CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER \ Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ _3600 FEE:$ 0 Check No.: ©20 CReceipt No.: Zr� Page lof4 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 L TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ 4 ❑ Tanning/Massage/Body Art ❑ Public Sewer Well Tobacco Sales El Food Packaging/Sales ❑ ❑ ❑ Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contra ting ith unregistered contractors do not have access to the guarantyfund t Signature of Agent/Owner Signature of contractor Plans Submitted ❑ lans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY i INTERDEPARTMENTAL SIGN OFF-U FORM I DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ I COMMENTS Q FIRE DEPARTMENT - Temp Dumpster on site yes — no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. j Total land area, sq. ft.: NOTES and DATA— (For department use) I Page 3 01'4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPEORM05 Created JMC.Jan.2006 NORTH To . of Andover 0 10 No. 3 ; (o V- I-AKE q. dover, Mass., coc ,C.E .C. 0 RATE 0 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........Laoo!............ ftwl.. . ............... .............................................. ... Foundation has permission to 9W... buildings on ...... ....... ......... .............. Rough Chimney '16+—*--*'—*-- to be occupied as...."..... .. ....... .4.9................. ............ 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 Final q? PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR . ....r- --T I'S�BU-ELDING...INSPECTOR N."=PE C�TOR Final UNLESS CONSTRU Rough ........... Service 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. a� KORT/.f TOWN OF NORTH ANDOVER 6 ti 02 OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-64 y � # �s4SS^CHU0 North Andover, Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION � Pleasc print DATE: JOB LOCATION: 4(,o Number Street Address Map/Lot HOMEOWNER �-�p ct , Ae tj A l` 3 01 1 Name Home Phone Work Phone PRESENT MAILING ADDRESS Asj_�4 e< City Town 5 State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to 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) DEFINITION OF HOMEOWNER 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 structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code a Applicable codes,b -laws rule g and other Y sand regulations. ulations. g The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNA`T'URE APPROVAL OF BUILDING OFFICI revised 10.2005 Form Holimmieis Exemption BOARD OF APPEALS 688-9541 CONSERVATION OXS-9530 )535 HEALTH GS$-9540 PLANNING 688- -1 � 1 ti 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.. i The debris will be disposed of in: Z C-5'1�ev-r Co (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOyLISH A ONE OR TWO FAMILY DWELLING .�i ..,.. ..d..,J'Y .x£ef{ BUILDING PERMIT NUMBER. DATE ISSUED: rn SIGNATURE: Building Commissioner/inspector of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 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 R 'red Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT r M 2.1 Owner of Record ��``'' j � Q0 v` ct k7 L16 Name(Print) Address for Service 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 Supeisor: Not Applicable ❑ u. (d6Jre z�0,/) LicensPonstruction Su rvisor: O r O [f�Ti u� License Number '"l a .n Address On Expiration Date C1 Signa re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v l�av,a - J Company Name/— / / m L 9' /le��ato 51'- Ami f Registration Number r Address ( V ,) // r Expiration Date /1 Si nature Telephone Y� i 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 au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Re, nnc� � 5�cYklc ��-- Y� RD o m )C0_ '#)Lt ytl s SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be '6F1"CL4 L VSE OILY Completed by permit applicant 1. Building / ©©0• CC (a) Building Permit Fee • Multiplier 2 Electrical -) /V0 0d (b) Estimated Total Cost of "C / Construction 3 Plumbing tyd Building Permit fee tel X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 0 Check Number SECTION 7a OWNER AUTHORIZATION TO A 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 (R ED AGENT DECLARATION 1, U lJ v Y k 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 bel'�4v(a Print Name Signature of Owner/Ag nt Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIvMY IS BUU DING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE z a The Commonwealth of Massachusetts u H .. ° d Department of Industrial Accidents Office of Investigations ~� Boston, Mass. 02111 ODM 6Ve c Workers'Compensation Insurance Affidavit Name Please Print Name: Location: Q City ' ` /W Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity am an employer providing workers'compensation for rry employees working on this job. Company name: Address City: Phone#7 Insurance.Co. Policv# Company name: , Address City Phone# Insurance Co. Policy# Failure to secure overage 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'in%wmorunent_as_welLas_cbd penal iesjnlhelmnW-a-STOPMRKDRDFJlarad_afine-cf-(,$1DA.w)-adaY me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification /do hereby cerW undue thepains naltres of perjury that the reformation provided above is true and correct Signature Date_M jD Print name * 40— Phone.# e ifI/5— Official use only do not write in this area to be completed by city or town official' City or Town icensing Building Dept []Check if immediate response/s required p l_icensirxl Board p Selectman's Office Contact person: Phone# E] Health Department F, Other of# //0qJ� h I certify that this plan shows unit46being conveyed and the immediately adjoining units, and that it fully and , �.� f e-Y�... accurately depicts the layout. ocation imensions, � d approximate area, main *atranc i ate common area to vhich the unit has mess, It. �Sl Y fS( L f i2S. s , 17,ytpOfM DAM ., sl ��� �f1•{ocf. 'fly-ter-r-r-�� 1 V. 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