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Home My WebLink AboutMiscellaneous - 493 MASSACHUSETTS AVENUE 4/30/2018 (2) 493 MASSACHUSETTS=AVENUE A 210/045.G-0003-0000.0 Location L4`'1 3 M A SS Ay �— No. 330 Date d Z O1 ,4ORTh TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ ;� '••a�E<� Building/Frame Permit Fee $ ACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 O Check # 16078 Building Inspector r t TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �y BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: / 'l cep_ Building Comnlissioner/InTmtor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number r�J W 1.3 Zoning Information: 1.4 Property Dimensions: 0 Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide ReqWred Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane 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 1 Owner of Record n Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ 1 r6vrn;er, fob l S� icensed Construction Supervisor. O „1A �� ( R J j, n A License Numbermn Address / rj/1 / r A/W✓✓ V l � 5 T 7 _ Expiration Date � Signature Telephone r 3.2 Registered Home Imppr�rrJovem((ee�nt Contractor Not Applicable ❑ v Company Name / rn C 16 , ,( ( Registration Number r e /r ' / /F'll�r �� - _r Address d o COPP •Aj4A- `ted J �l P— Expiration Date /1 Signature Telephone Y) 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 allapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 7 fly l�P(a4--P SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beOFI+ICIAL USE ONLY Completed by permit applicant <_ 1. Building (a) Building Permit Fee C> Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(8)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 U tin e as O r/Authorized Agent f subject property Hereby authorize to act on My i lt�all matters relative to work authorized by this building permit application. nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Herebv 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 A." NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS 1 s 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS D`NIENSIONS 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 u The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 °��,M 5�•"'o Workers'Compensation Insurance Affidavit Name Please Print Name: r M;/ o Location: City /V° / t/!J Phone -5 57 7 I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity ls�r I am an employer providing workers' compensation for my employees working on this job. Company name: Address ale, City: 1�elyrl _ Phone#: Insurance.Co. �r�h r^7 S�� Policv# f.✓�'8�'��r�'7 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$1,500.00 and/or one years'imprisonment_as_wetLas_civil.aenattiesin-theimm nfa STOP WORK_ORDER.and_a fine_of.-(.$lDO.DA)-ajday.against-m,e. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I I do hereby certify under Me pains and penalties of perjury that the information provided above is true and correct. Signature X�.61�V7 ?� Date Print name /y,� 4/✓4 Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept E]Check if immediate response is required a Licensing Board E] Selectman's Office Contact person: Phone#: Health Department Ei 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 resultingfrom this work shall hall 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 Permit Applicant lc�2 —/'g —�D� - Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector FamilyRoofers & Painters �L FOURNIER .MOBILE EXTERIOR PAINTING - CARPENTRY- ROOFING 508-341-1583 168 MAPLE ST. METHUE.N, MA 01844 FREE ESTIMATES TEL. 683-5127 / 3 54ve-vi L.ke. 0 e / p x ( ;�� ro� o� cf�n �ha��,, ; y e-1c�1 P 1'(! V&,e7f TOTAL W G� ON ACCEPTANCE WHEN STARTED Q� HALF COMPLETE BALANCE WHEN COMPLETE ALL CHECKS TO ALBERT FOURNIER Date. ./....�—J ?'.... .. NORTH 3� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 9v `. h ,SSA,oUSE�S I . This certifies that ./,�.? . . . !: . . . . . . . . . . . . . . . . . . . l has permission for gas installation in the buildings of . . . .. .'a- Z. `. . . . . . . . . . . . . . . . . . . . . . . . . . . . . at .. .. . . . . . ... .. ... . C. . . . . . . . . . ., North Andover, Mass. Fee. .�� . �. . Lic. NoP'.�/u. . . . L�-�:——! !. . . . . . . . . . . l . .%GAS INS ECTOR Check# 3753 RM APPLICATON FOR PERNIlT TO DO GAS FITTING MASSACHUSETTS iJNIl�,O (Type or print) Date /a/23/61 NORTH ANDOVER,MASSACHUSETTS Building Locations °g�s Permit# u g Amount$ Owner's Name New❑ Renovation ❑ Replacement Plans Submitted ❑ U z p w O w d A Gal U 09z SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR 8TH. FLOOR (Print or type) / one: Certificate Installing Company Name '► !�l✓'!C,4C Corp. Address E] Partner •e Business Telephone /„p21- Finn/Co. r Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one• I have a current liability Insurance policy or it's substantial equivalent. Yes No[] Ifyou have checked M,please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass-Gene s d my signature on this permit application waives this requirement. Check one: ❑ Signature ofOwner"or Owner's Agent Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed un#r,Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State GALC d hapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber A /Q City/Town ❑ Gas Fitter License Number I 2' r master APPROVED(OFFICE USE ONLY) [3 Journeyman `aZ Date/.� . �. . f NO oTM 4 cjo�< tioo� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACNUS� This certifies that ! /. . . . . . !' �'` . . . . . . .�. . . . . . . . . . . has permission to perform—"/-,,-,--/- . . . . . . . . . . �. . . . . . . . . . . . plumbing in the buildings of . ./ . . . . . . . . . . . . . . . . . . . . . . . . at. �� .' ?�:t�� ?. . . . . . . . .. . . . . . . . .. North Andover, Mass. Fee. . . . . . . . .Lic. No.-142 . . . . . . � . . . . . . . . . . . . . . . . Plf�UveING INSPECTOR Check # 4997 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS QQ Date Building Location ?J SS A e— Owners Name Permit#—Y!P / Amount Type of Occupancy J New Renovation Replacement Plans Submitted Yes No ❑ FIXTURES Cn x � z z w W U x a C7 1 Q O H OA x a Cn z W 0 U 3 x A A a 3 0 F0.4w C�7 A d a ;tp S�H4VVIC &VSEVENr in MOM M Hfm MIL" 4II3 Hi" 5M HACM 6M HAOM 7IH HIM 9M HAOCR (Print or type) Check one: Certificate Installing Company Na:!et Corp. Address Partner. 1-44 D�G7 �usinyss Te ep one Ch2 Q 2(o��- Firm/Co. Name of Licensed Plumber: • Insurtince Coverage: Indicatffthe tpe of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed und.e-,Aamit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Pl in e d Chapter 142 of the General Laws. By: Signature oT Licensuariumot" Type of Plumbing License Title /0q o / City/Town i1 se lNumfier Master Journeyman ❑ APPROVED(OFFICE USE ONLY