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Home My WebLink AboutMiscellaneous - 476 JOHNSON STREET 4/30/2018 476 JOHNSON STREET 210/038.0-0061-0000.0 Location y -1 �/A,;Sy Aa S/- r No. 5ae� Date `3//- Olt NoRTh TOWN OF NORTH ANDOVER • ; , Certificate of Occupancy $ CN � Building/Frame Permit Fee $ Foundation Permit Fee $ z� Other Permit Fee $ TOTAL $ 3y " Check # CAS 7113 wilding Inspector f TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING K BUILDING PERMIT NUMBER. DATE ISSUED: ic SIGNATURE: Buil3n—g Commissioner/Inspector of Buildings Date z SECTION 1-SITE INFORMATION o 1.1 Pr y A dress: 1.2 Assessors Map and Parcel Number: 7� A e 38 Cr 44 /� Map Number Parcel Number 1.3 Zoning Information:' 1.4 Property Dimensions: Zoning Diiiic—t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.Ol't Record ,p �� Z/ �j &14, W� N me(Print) Address for Servi Signatur eleph n 2.2 Owner of Record: (� a,,v- Mi` 0,f d;, Name Print Address for ervtce: �y t°tl-Del rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: �,,,5 0(D 16(7 License Number '70 n,n � , �pig; �,.n� �q, Address Atl ILI 6 9 7 9——359_ on Date ASignaTelephone rM 3.11 Registered Home Improvement Contractor Not Applicable ❑ Cewipany Name rn Registration Number r Address r Expiration Date ^ Signature Telephone Y) • -i SECTION 4-WORKERS COMPENSATION(NLG.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: P0 uiA Q4 E)L a'i,, Ia. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed beZkalicant 1. Building t n 000f o (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(n) 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 4 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 1 and belief Print Name Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3RD SPAN DRVIENSIONS OF SILLS DIMENSIONS OF POSTS T DIN ENSIONS 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 a FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used.to verify that all-necessary approval/permits from Boards and Departments havingjurisdiction have been obtained This does not relieve the applicant and or landowner from compliance with any applicable requirements. �..sssses.ssss.s.rr...s. s.rss. ■.......s.Eno owns s..r..Ross Nona..sEmus Nos asoa APPLICANT ONE ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET STREET NUMBER�� .....r.■■ .......seer....■ . •..s.ss.■ s.s.s.......s.s.ss.s.s..s. ■.ss.s■ OFFICIAL US ONLY ..............................gas..............■sss.s..s..NONE.smono e..MEN soa RECOMMENDATIONS OF TOWN AGENTS a.ess.eees..■sees...s.•.■s.■ee• .eeeeeee■■ee■..ss.s..r.eemono SOS sman sEmu sss■ DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COh4N1ENTS l f DATE APPROVED TOWN PLANNER DATE REJECTED CON MEN,CS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED CONWIENTS PUBLIC WORDS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT n DATE APPROVED 'I ©V FIRE DEPARTWNT. DATE REJECTED COMMENT'S RECEIVED BY BUILDING INSPECTOR DATE 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: ES 000 f P-PLIV(r,/V 11 (Location of Facility) Signa ure of P rmit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 03/09/2004 10:08 FAX 6036353815 INS OFFICES001 AC-ORD. CERTIFICATE OF LIABILITY INSURANCE 3/DATE9/20041 FF�5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Leo Rush Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 25 Old Lawrence Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pelham, NE 03076 NAICS 7i.978-352-6210 635-2539 INSURERS AFFORDING COVERAGE p une O 1 Ori INSURER A. n 8 Dna corn ssell, Marilyn INSURER B: _' y ua Tenney Street INSURER C C nsLlranCB orgetown, MA 01833 INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY RECOIREMENT,TERM OR MAY PERTAIN,THE INSURANCE AFF ICATE MAY BE ISSUED OR CONDITION RDED BY AN CONTRACT pOLI TR3 TDE3CRR DESCRIBED HEROTHER DS ECT TO ALL THE TERMS,EXCLUSIONS T WITH RESPECT TO WHICH THIS SAND CONDITIONS OF SUCH pOUC1Eg,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L IX RAT POLICY NUMBER DA7 Mill LTR N I Wv I GENERAL LIABILITY EACH OCCURRENCE i -UOZS' Y PREMISES EIoccurence S r COMMERCIAL GENERAL LIABILITY CLAIMSMADE OCCUR MEDEXP(Alyompawn i A 7172310 4/14/20D3 4/Z412D04 PERSONALBADVINJURY s I r GENERAL AGGREGATE f r pROOLOCTS.COMP/OP AGG OEML AGGREGATE LMT APPLIES PER POLK:Y LOC AUTOMOBILNUAB'JJTY COMBINEDBideM) GLE�Lfu1IT S (Ea eocid�nl) ANYAUTO ALLOWNED AUTOS P�D�PDraon) Y S SCHEDULED AUTOS HREDAUTOS BODILY INJURY f (Puaccldonq NON-OWNED ALTOS PROPERTY DAMAGE f (Pexuciem9 • A UTO ONLY- 3 GARAGE LIABILITY I �ACC f ANY AUTO AGG $ CE i EXCESWUMBRELLA LIABILITY OCCUR LJ CUUM4 MADE S S S CEDUCTiBLE 3 RETENTION S 0.WORKERSCOMPENSATION AND lac,00 EMPLOYERS LIABILITY C531S343055023 09/ob/loos 09/OS/soon EL EACH ACCIDENT s AW Nl0PItWr0MARTNiF/PXi4UnNE EL DISEASE•GA EMPLOYE S 100,0 B OFFlCFJLt,IWW EXCLUDED? OIS beudUWer E.L.E. FASE-POIK Y LIMIT !I cPiiROVISIONS b910W OTHER :08/10/2003 . 06/10/2004 $39,000 C Equipment Floater 606DM408679 WSCRPTION OF OP(3LITKNJS iLOCATIONS/VEHICLES/EXCLUSIONS ADOEO BY ENOORSEMENTI SPFGAI.PROVISIONS DEMOLITION CONTRACTOR 476 JOHNSON STREET NORTH ANDOVER, D4A CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCAIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO CARMINE CALZETTA DATE THEREOF,THE I6SYIING INSURER WILL ENDEAVOR TO MNL10 DAYS NAITTEN 476 JOHNSON STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LETT,BUT FAILURE TO DO SQ SHALL NORTH'ANDOVER, MA IMPOSE NO OBLIGATION OR UUIB OF ANY KHD UPON INGURER,ITS AGENTS OR 9783522446 REPRESENTATIVES. AUTHORIZED REPRE / CACORD CORPORATION 1988 ACORD2S(2081/D8) ORTH Town of Andover Z ~ - .� � 3-11 -dno�f o S=r LAK Q '� dover, Mass., CO C MICKEWICK BOARD OF HEALTH AZ PERMIT TOR . E Food/Kitchen Septic System C� r , ! C Z&�A BUILDING INSPECTOR TRIS CERTIFIES THAT..... . �. ...........0 .. ...........�.............�......... Foundation has permission to 9........RAZ... ........ buildings on '7 Rough '................... n..............s AW to be occupied as.........A..0 C C 5 5d n �.V.�'.�7N Chimney .................................... . .............. .............. . provided that the person accepting this permit sha m every respect conform to t e terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws r- lati g to the Inspection Iteration and Construction of Buildings in the Town of North Andover. S 7 ` � PLUMBING INSPECTOR 3 � VIOLATION of the Zoning or Building Regulations Voids this Permit.- Rough PER. T EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR ..1*10 ......... ........... ........ Rough .».. Service BUILDING INSPECTOR Final Occupancy Permit Required t® Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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.