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HomeMy WebLinkAboutMiscellaneous - 47 SUTTON HILL ROAD 4/30/2018 (2) 47 SUTTON HILL ROAD 210/097.0-0031-0000.0 r Z Location No. Date " NORTq TOWN OF NORTH ANDOVER 16. ` Certificate of Occupancy $ s i US tt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 355 Building Inspector U TO" OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION Td6NSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING T went r ,r102 WB, 171 BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: /fal&f Z�� Building Commissioner/I or of Buildings Date 4r., ♦ Z SECTION 1-SITE INFORMATION 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 Dislrid Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided C 1.7 Water Supply M.G.L.C.40. 54) 1.5. blood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ -Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT R 2.1 Owner of Record Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: C 2 rT Signature Tele one SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ N c,S J �- Licensed Construction Supervisor. C License Number Qs P Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name n Registration Number r Address r t Expiration Date G Signature Telephone 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 ❑ Exi g B,uiliting ❑ Repair(s) is Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ " Demolition ❑ Other ❑ Specify Brief Description of Propos Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be F ' CIIL DISI+;pn �� 4 Completed b permit a licant dTo ` 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tat x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHOkPLATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUELDING PERMIT 7V ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, i a matte rel t* to w k authorized by this building permit application. S, 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 Print Name Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS 1 2ND 3 SPAN DMNSIONS OF SILLS DM ENSIONS OF POSTS DMNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUll DING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 140K UN ownED of Andover s".,.s.r�r,. •tip. ' No. ZJ COCHICy dover, Mass., ORA 7E0 S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...............(1......,............................ ...................................... ........................... • Foundation has permission to erect.... ............................... buildings on .... .. .. ... .. Rough to be occupied as.... ... ................................................................................................................... Chimney Ch' provided that the . rson accepting this rmit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the odes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPEC'T'OR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ..................................... ...................... ... Service BUMING 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 Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT Street No. SEE REVERSE SIDE - - Smoke Det. X The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers'Compensation Insurance Affidavit �7M She Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity F-1 I am an employer providing workers'compensation for my employees working on this job. Company name: Address (, City ta - M, Phone* 3 b U 3 Insurance.Co. Policv# 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'imprisonrrient_as weU_as_chili-penaltiesiashelam..of-a-S?OP WORKORDERand..a.fine-f.($1120M)-ajiay.against me I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. y I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature �` l . Date Print name Phone# 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 p Selectman's Office Contact person: Phone A- n Health Department Ei Other I North Andover Building Department I 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: 7_5 (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 0 OAS S ?- ®' .f PRp OF gVUG,1ON SUP�R� © G(MA I a�2g92 ��en5e t umber 1 N 61iAI:.,( Tt e 11 R? 6�0daY`r �p9124i20,��NG\S �oN 21 PNpOVER: • NORTFj • Qf St IED 16�� O M Town of North Andover Building Department �'. �-M-�• �'' 27 Charles Street SSACHUSEt�� North Andover MA 01845 Tel: 978-6889545 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Section of Town "HOMEOWNER Number Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six 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 109.1.1) 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 to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 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 requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control.