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HomeMy WebLinkAboutMiscellaneous - 474 STEVENS STREET 4/30/2018 474 STEVENS STREET 210/096.0-0009-0000.0 b- Location No. Date �? 16 -6,. ,.ORTq TOWN OF NORTH ANDOVER + ZSC Certificate of Occupancy $ E��' Building/Frame Permit Fee $ Mus a Foundation Permit Fee $ > Other Permit Fee $ TOTAL $ Check # 17557 Building Inst ctor s TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1 BUILDING PERMIT NUMBER: DATE ISSUED: I D lz9 rn Y X SIGNATURE: /" (ca___ Building Commissioner/I for of Buildings Date aaaq SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O 0 — 7 Map Number Parcel Number .1.3 Zoning Information: 1.4 Property Dimensions: zoning District Proposed Use Lot Area Fronto ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.5. Flood Zone Information: System v 1.7 Water Supply M.G.L.C.40. 34) 1.8 Sewerage Disposal S tem: Public 0 Private ❑ zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT IOLU 1 I U LJ Is't 1• • t.s -!',10rn 2.1 Owner of Record V e4 (�� S z•_, Name(Print) Address for Service -Iai� R� Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES Qo 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervi 6� 3 O License Number Address a"a- d f/ Expiration Date 3 Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number r Address r Expiration Date Z Signature Tel hone 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.......0 No.......0 SECTION 5 Description of Propos edWork check en applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: g o o SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multi lien 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(:) 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 r 1, as Owner/Authorized Agent of subject property 1 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, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are tnie and accurate,to the best of my knowledge and belief s Y Print Name ` . t Si ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE pcqA ►^ , FORM U - LOT RELEASE FORM 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*********************** APPLICANT R,L `JCr � PHONE LOCATION: Assessor's Map Number G PARCEL_ SUBDIVISION LOT (S) STREET S (, n/ 3 ST. NUMBER **********OFFICIAL USE RE MMENDATIONS O TOWN AGENTS: l/ CONSERVATION ADM INI RATOR DATE APPROVED D DATE REJECTED COMMENTS 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 1aN6 \.. W The Commonwealth of Massachusetts Department of Industridl Accidents Office of Investigations Boston, Mass. 02111 W '�, yy•y Workers'Compensation Insurance Affidavit Name iNs Please Print r Name: Location: curl 3 4c— AJO• Aiy�lCi vlf� �IyI City Phone # 0 I am a homeowner performing all work myself. U I am a sole proprietor and have no one working in any capacity 0 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. Policv# 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_welLas_cimi.penalties in the fWn da-STOP WORKORDER..and..a fie.of(.$100.00)-clay 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 hereby certify under th mins and penalties of perjury that the information provided above is true and correct. Signature Date a / Print name Phone# 7,- A .tFrF,Ft�S Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensinq Building Dept []Check if immediate response is required Licensing Board p Selectman's Office Contact person: Phone#: Health Department Ei Other &ORTH Town of North Andover Building Department 49 27 Charles Street 0 North Andover, MA. 01845 �SSACHU`'�< D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax E HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map!lot "HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for'homedwners was extended to include owner-occupied dwellings of 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 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 or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. 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 Proposal Licensed Over 20 Years Experience Sand S Building & Remodeling Kitchen • Baths • Custom Woodwork BOB STEPHENSON Complete Interior/Exterior Carpentry 11 Bixby Ave. (978)688-8097 No.Andover, MA 01845 NAME OF OWNER 9 ADDRESS OF JOB TEL. C'i+ ;' (,., 7�; I DATE: i We hereby submit estimates for: i r" I :r /.;)c u We Propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: dollars($ �IJ Payment to be made as follows: (�tJ Li- 1 U ,/-��`.'r' - % : ; ��L.� �' )J t! All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or devia- Authorized tion from above specification involving extra cost will be executed only upon Signature 1 written orders,and will becorh¢an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,weather or delays beyond NOTE:This proposal may be our control. Owner to carry t @b, tornado and other necessary insurance. Our workers are fully covered by,� orkmen's Compensation Insurance. withdrawn by us if not accepted within days. Acceptance of Proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. ' Signature Date of Acceptance: Signature t. P 1 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 Perm-it Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector C� 0 N � I N 3 0 00 0 r -sF 0 L✓f� 1. MS1 �'y L N-SF CAR.L O f? 7-Z-R t w L 07- 00 - r ^SF PORTER c co �Aotl 9 ToTIiL APIA` 23,400 �• C[D 1 Q © SMlC Q A'-f." B f1 R Tc1 O MEG a for A •� M , ` NSF VAN /1FUhfF1eM � o /lo $fes "'JF M/oG1.FY Trio/tisON w t. N �♦ DWFLLI NG . I O / }f •' �y4W 1^o i Y Z 'o N � O ��61 N _ F� `kD 91.15 _ ./ •oo-• .P14. �yWaxy �,s 99. 8 S•oo - 32= 2c SnNr RsrA/N/N� y Ca°�'41� 01 S TE VC N 5 S 7- R .EFT /sT/NG PRoPgRTY of HENRY qNo Do,q/s V CONVEYED To , ,q ND V-s D CONT/GUousJY W/7N HENRY /SND /7o/i/s V. VRNI-/EUK£I..OM, NORTH '9 ONM Of _� Andover 0 No. dover, Mass., O COC MICME WICKo 'k* V ADRATED PPS` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT....... r ...�j�. ..........I/ . C...1 BUILDING INSPECTOR ���.I. it�. .............................................................. Foundation 4 has permission to erect...RO.O....................... buildings on .......y........ . . ...`�-+.u�.A+ s &4........................................................ trough to be occupied as...O r a r S a 1 N S CP wi IZ M b 1 CA to Ai C r.. 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-La s relating to the nspection, Alteration and Construction of Buildings in the Town of North Andover. 4 ` PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. trough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T TS Rough ........................... ...................................... Service .. . .. . BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove . Fnah 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.