The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 477 WAVERLY ROAD 4/30/2018 (2)�} N_ O N N O Q m b�j � o � o c J � J Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17802 Building Insp 6r 4 APPLICATION TO CONSTRUCT RE 4 ' BUILDING PERMIT NUMBER: - r SIGNATURE: TOWN OF NORTH ANDOVER BUILDING DEPARTMENT [R, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY I SECTION 1- SITE INFORMATION �- 1.1 Property Address: -A0, 1.3 Zoning Information: Zoning Distrid Proposed Use 1.6 BUILDING SETBACKS (ft) Front Yard _ — Required — I Provide DATE ISSUED: //.,/Q d Date 1.2 Assessors Map and Parcel Number: amY 1 Z? 0 ber Parcel Number 1.4 Property Lot Area (sf ) Side Yard Provided 1.7 Water Supply M.G.L.C.40. !j 34) 1.5• HInformation: Flood Zone Infoation: 1.8 Sewerage Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Rear Yard Provided On Site Disposal System ❑ Name (Print) M Address for Service Vr/4� Signature Telephone 2.2 Owner of Record: Name Print Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Lirensed Construction Supervisor: Not Applicable ❑ Licensd Construction Supervisor: Addrels Signature Telephone 3.2 Registered Home Improvement Contractor -DAV tD CASTR) z.oA)P-R -� Vc Company Name Address License Number Expiration Date Not Applicable ❑ '� !�G 2 N Registration umber 1. �.6 G Expiration Date M M X ic Z O rn 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 ....... 0 SECTION 5 Description of Proposed Work(check- aD applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ • i er` Addition ❑ Accessory Bldg. ❑ �' Derttolition ❑ Other ❑ Specify Brief Description of Proposed Work: (` &/Ad r0 o'c SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE (3NLY _. I . Building I 5R l0 D • 0 O (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) LL_ V �' 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) (p Q . D D Check Number SECTION 7a OWNER AUTHORIZATION TO BE 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. Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, Di V 1 7? CA S T X.L CD/y E 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 VAV1,QQ s Print.r).'L49 C A=, Signature of Owner/A ent Date NMI. % 11=11941N NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3RD 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 y 4a o' �: a y O C O C L N a W OOr a C V C3 v� � 01 aj• o� P `NG *** aCc 10� m� • O � CF m 0 d �• E e w w c3i ca w rx u co 4a o' �: d y O C O C L N W OOr �. C V C3 v� � 01 aj• o� P `NG *** 0 O z n o' �: m C_ NJ y O C O C L N OOr �. C V C3 J �a� aCc 10� m� • O � CF m 0 d �• E e n o' �: m C_ NJ y O O � .m y W ym mo o. CD LZ�mm TO OQ N C f_ 0 am44 •=- 0 ~ w ymoH' W x=..12 LUc «- H CL .y C.3 ��oc caI:LW � MS a s m E _y t IS 0 y C cm ID ac CD C a CD O CD c C s CD 0 Z O g 0 T IMI '(y 6 O CD E �i Z aL CL O h — CM I � C O■_ COD Q� mm �3 'O O Q O cc o a ca o c cc .5.v as C Z C V y O C cc C CA Q N N C9 W W 19 W N APPLICANT rNFORMATION Name: I r clad �o The Commonwealth of Wassachusetts Oe partinent of Induaiiaf,4ccidents Of, ze of Investigations 600 `Washington Street Boston, WA 02111 Workers' Compensation Insurance Affidavit Location: 7 q WCA, 0 ti -1(A IC d City: 0 d0 t/. r Telephone #: Ot I g O I am a homeowner performing all work myself. O I am sole proprietor and have no one working in my capacity Please PRINT Legibly ❑ I am an employer providing workers' compensation for my employees working on this job fi e � n n (� _ Company Name: DA V i D UST 21Co li) E R 0 O `1 /) 6 i' S 'It ! AI .4—1 y C. Address: 0rE ��•• ti.0 City: _ V /`QP)D O UeiK Telephone M 9 0 tD a 3 r 3 T IZ Q Insurance Company: Rim Policy #: VW G 0 O Q T ff 0 0/ A 10 Q Al ❑ I am (circle one) sole proprietor, general contractor or homeowner and have hired the contractors listed below who have the following workers' compensation policies: Company Name: Address: Insurance Company: Company Name: Address: City: Telephone #: Policy #: Telephone #: Insurance Company: Policy #: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fmc of $100.00 a day 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 ce i under he pains and penalties of perjury that the information above is true and correct Signature: / / / rr II Date; Print Name:_ l GLV LU �a 54-ri Con Phone# q-16 (� Official Use ONLY -,Do not write in this area City or Town: o Check if Immediate response is required Permit/License #: ❑ Building Department o Licensing Board D Selectmen's Office D Health Department E) Other 1. DAVID CASTWONE ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET, SUITE 226, NO. ANDOVER, MA 01845 7 HILLSIDE ROAD, BOXFORD, MA 01921 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 Uwe the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to famish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the followin specifications, terms and conditions, on premises below described: Owner's Name...l Job Address. .T.!...1...-`f''...Waver i.i. . .............................I................. .... Telephone #.. ................................. State ... ��. �. .......city...:.1hrvr................ ....1�l................ Specifications: .................... :.................... ,............. .�c.(.1... debjf�;s....................................................... It jie ..mde.A...!v/.... ..1... ............................... : x o rL..N: 6 Town of North Andover f tAORTH O �tLeo � .1, 3�et ,6 s 6 Q Building Department o .1 27 Charles Street North Andover, Massachusetts 01845 * 2 ti (978) 688-9545 Fax (978) 688-9542 °9Q ca mc�• �` 9SSACHUS�� 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, s150a. The debris will be disposed of in /at: Facility location rl Signature of Applicant I/A5 % 5z Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector.