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HomeMy WebLinkAboutMiscellaneous - 484 SHARPNERS POND ROAD 4/30/2018 484 SHARPNERS POND ROAD 210/105.D-0123-0000.0 � �aasarH q 3 st.• �.,,6 oc a t - s Telephone(978)688-9545 ( ) cwusE FAX 978 688-9542 TOWN OF NORTH ANDOVER OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street COMPLAINT FOR INVESTIGATION DATE : IL-+ ZOO t FROM• ADDRESS: 54~1 L<—'�j � Tel#: t0 6A ' 8 3(P. Complaint Against: ncrs �d R d ELECTRICAL: PLUMBING: GAS: BUILDING CONTRACTOR: PROPERTY OWNER: r. F s ke O fke,rrwh A o, ®t Same •(•a rr N of OTHER: excWvmb�M f-Sana std}in •� homc . Or► �,O&t (5)1-L) , he �\ h�S trvcks rY,� nfi�e �P�,�. 5 hautr�• Signed: Location �`7� NoDate �.A 'U . � NpRT� TOWN OF NORTH ANDOVER F R a y Certificate of Occupancy $ cM tBuilding/Frame Permit Fee $ s� us Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 7088 6'---Building Inspector J TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONES OR TWO FAMILY DWELLING �xut �,, ''`«..; ',R1';'. i, :ice �'" '`•.�, • "- "iJ :..: .z �n a< BUILDING PERMIT NUMBER --Vd DA'T'E ISSUED. �_c / X w lo SIGNATURE: a44W Building Commissioner/I for of Buildings Date �� SECTION 1-SITE INFORMATION , 1.1 Property Address: Q �Q 1.2 Assessors Map and Parcel Number: Yb l 1 /12�/�71�rI ��nG �c� �� �= l Map Parcel Numb 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water SupplyM.GLC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record IT11A e S 'V (/ l z fl Name(Print) Q Address for eivice i Sign re Telephone 2.2 Owner of Record: Mime Print Address for Service: 188 Signature Telephone go SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicabl Licensed Construction Supervisor: License Number am Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number Address rM Expiration Date �1 Signature Telephone �1/ 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: r�rDD SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit a licant S 1. 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 6 Total 1+2+3+4+5 D D, Check Number SECTION 7a OWNER AUTHOR ZA ION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behaA in all matters r ativL"o work authorized by this building permit application. giknatuiV of Owner DatXl 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 TIlVIBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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 s 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 Permit Applicant Y fl Y Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. // Type of Work: r�n4 Est. Cost /10®,0 90 U Address of Work rZQ-r�/16"il, °hCk Owner Name: Fit, Date of Permit Application: a — I A Y I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under$1,000 Date Building not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: ' OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: A.V /0 Y Dae Owner Name �.1ORTH TONM of Omr,••...n•, l,v..4.•. Irl":'.."�. T 0 — LAKE �. -10lover, Mass., COC NICK_".C. SRATED PP�,��(y U BOARD OF HEALTH PERMI D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT............. .. ........ ........ ..... . ....,.......................... ... .................................... . .... .. ��//y Foundation has permission to erect...... ................................ buildings on ....T.P. .... ...... Rough to be occupied aS ................................................ Chimney .................... ................ ............... ..................................... provided that the person accepti this permit shall in every respect conform to the terms of the application on file in Final this office,,and to the provisions f the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO��u,1T0►r Rough .............................................I.............................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDEJ1 Smoke Det. r Location NO. Date Or HORTM TOWN OF NORTH ANDOVER O • O;r-qL Certificate of Occupancy $ Building/Frame Permit Fee $ CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17712 "--building pector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING &r BUILDING PERMIT'NUMBER. 01 DATE ISSUED: r ic SIGNATURE: dalj Date -4 Buildingm Comissioner/I for of Buildings /�- j3-- SECTION I-SITE INFORMATION 1 O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RegWred Provided Re red Provided 1.7 Water Supply M.G.L.C.4�. 54r... .- 1.5. Flood Zone Infomution: 1.8 Sewerage Disposal System: Pnblic ❑ Private ❑ t 2%', Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY'OWNERSHIP/AUTHORIZED AGENT i iStriCt; 2.1 Owner of Record Name(Print) Address for Service: T Signature ` Telephone �— $4— ©y&L 2.2 Own of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number q Address iRC t_ Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number row AddressRoom z 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.......0 SECTION 5 Description of Proposed Work check applicable) New Construction ❑ Existing Building P— Repair(s) Or Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: L s iR �v nq SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL.USE ONLY Completed by pem-iit applicant 1. Building r 0© (a) Building Permit Fee i7 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) v 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS 'GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _ I, L as Ownerilhorized Agent of subject property Hereby authorize_ gip' �_. �y to act on My behalf,in all ma rs relative to work authorized by this building permit application. L Signature of Owner Date SECTION 7b OW AUTH RIZED C1tNT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are L*ue 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 TRVIBERS I' 2' 3RD SPAN DIMENSIONS OF SQ,LS DIMENSIONS OF POSTS DRvIENSIONS OF GMDERS _ HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of _ _ 4 Andover No. t! as� _ - dover, Mass. v' COCMICKEWICK y ' ' ' 7,ps RA7ED 1 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT......... ., :.........: .......... .............................V........................ ... ..................................... ...... ...... Foundation has permission to erect ..... buildings on Rough �. ............................. .. .... to be occupied as ........................................... Chimney . ... JCodes ....................................................................................... provided that the person acceptipermit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR /� /'�, Rough ..............................................................a4&f /J'/`' .. .... Service ........... ............. BUILDING 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. a µoNrk q Town of North Andover oa ` Building Department 27 Charles Street North Andover, MA. 01845 'p.," .��` y �ss�c►+use� D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATES1 D Y 42 JOB LOCATION l �' `Q d'F"s I/ Number i� Street Address Map/lot "HOMEOWNER V t� r`e' `'�t� P7 11,/7 L C ( S 78,- Name Home Phone Work Phone PRESENT MAILING ADDRESS ( l �Fi1D ale, /V_ &lX QVCI". 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 horse 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 p The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations C Boston, Mass. 02111 'w ,�•"� Workers'Compensation Insurance Affidavit 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 aI am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone#: Insurance Co. Policv# 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.weU.as_civil.penaltiesinTheformnfa.STOP WORK_ORDER..anda.fine.of.(..Sloo..OD)._ajday.against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. L I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' I City or Town Permit/Licensina Building Dept ❑Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person: Phone#: Health Department Other 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: C // -dc���Yon (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