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Home My WebLink AboutMiscellaneous - 474 WAVERLY ROAD 4/30/2018Location L//)c/ U114 Lf 9 No. Date J0 - N TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee Check # OTAL A 14 2-9 5 Buiung inspector r� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. —� DATE ISSUED. SIGNATURE: Buildin Commissioner for f Buildin Date SECTION 1- SITE INFORMATION 1.1 Property Address:,( / eR Y Pi 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Inf ati ZoningA Distzi osed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SET ACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHW/AUTHORIZED AGENT 2.1 Owner of Record In,� cM. L V r 1® L) �` poo % l/vc Cil Name Print) d rens for Service afore v Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address 4 Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone M Z O ,a 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 ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �^ SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant UFFICIAL USE ONLY;! i I . Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (8) 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 APPLIES FOR BUILDING PERMIT I, , 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 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 Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f I W ril I o O z co a w ~' a UW z E" z w A O O w a, d� U) ro � p w A.1 7 O w C U co lzL— I 00 O w % Q w w (� O r�G cn G w" C7 p w G w f� w rA o v G1 cn v Q o cn o � C H O C �... O C3 O. ev m C :Z O O 4040 E Q CD Q m �. $ o �.Em c� .� m =� �. y= E �3mm �y o y m .... C_ m J 10 N ti mED _O Em � viCD :E:5.00 C CIO o'oQ c CL. o CAM = O :�vo.� c oao S QE :2mc .o x m :ago N c= ' _ W 0 'coi00 w LL m +. C r... 0 A E 0.0 .CO O y m CL C*� Oos 1 _ (a -0`y0 O CR a4 1-� O O) I 0 O C— ._ .CO2 O O g m m CD 0 CD CD O� O O L cc O d C C caO v 'O FL 0 O C CD CD CL C.a h O C — C ev � CL GO 0 U) w W ccW 12 c/ �,vx Location No. /Y Y Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ % Foundation Permit Fee $ Other Permit Fee $ TOTAL $ =;2 nA& 4 Check # V I 1,0"q (6, 14111 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: ,e / U9SIGNATURE: Building Commissicnedlnspector.of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: )) 1.2 Assessors Map and Parcel Number: Map Number Parcel Num er A 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R 'red Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT. 2.1 Owner of Record ,,Name (Print) Address for Service i'le 6� _ 6l e A, vL)ei�T,3-- /Zz Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SEC ION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: L Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone MV SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 S 2506) 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 applicable) New Construction ❑ Existing Building 0 Repair(s) Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify BriefDescriptionof Proposed Work: 7 /' T -eax e4o- Ui /✓ e Cavi P a'� �✓,v` Ci�'[ f PUi7g r -'V UK1 W1 AJ to tS�W!—GUcAL�'1 08 S f SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY I . Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection b Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTO13 APPLIES FOR BUILDING PERMIT 1,C�hf 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 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 Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlVIBERS I 2ND 3RD SPAN DINIENSIONS OF SILLS DM ENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHHVVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover NoRpy o z,.fo , t a �'� .51� ht.•a O Building Department o 27 Charles Street North Andover, Massachusetts 01845 Z ,� (978) 688-9545 Fax (978) 688-9542 940 coc„c».wK• c"us��y DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in /at: v fW zr V --c. Facility Facility location Signature of Applicant Date orc/ Shu (VV( `P ?n fD Ss U r,-_ � NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. FORINT - U - LOT RELEASE FORM .:r INSTRUCTIONS: This form is used to verify that a11 -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. --.............:.................................... ......................... APPLICANT r� /•'!V(,L ' �'=�_CD PHONE/ ASSESSORS MAP NUMBER LOT NUMBER STREET WO ilea STREET STREET NUMBER L •........ .............. ........................................ mama. OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS ..��.imammonE .. 5 Lt -DATE APPROVED � I CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS k6 V t, (t-, j V4 k ^ TOWN PLANNER COMMENTS FOOD INSPECTOR - HEALTH SEPTIC INSPECTOR - HEALTH COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE A -41 q lZ .r i - I i f j A -41 q lZ m .fill m m 0 m V) 10 CD cl) Z CD O �r m� CL >to O CD C� c CD O .. .. CL co CD CO) CD O O CO) 0 CO) LI -J d CD O �F s CD y CD CO) 0 O CSD O CCD C W?Ic o O C•y O O• N = SO mco - y = �m n CD C') meiao m Z H. O .0 c aW �-C y � CA CL cL IS D CD -40 0 0 C y N CDCAtoZ O � N . cal) ! . 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