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HomeMy WebLinkAboutMiscellaneous - 53 MONTEIRO WAY 4/30/2018 53 MONTEIRO WAY V01060.0-0147-0000-0 Location S3 1)�or"4 <- + r a wA Y No. s Date MORTq TOWN OF NORTH ANDOVER f A Certificate of Occupancy $ Building/Frame Permit Fee $ s�t14US� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 5 'i 6 3 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TW}O FAMILY DWELLING F,; �.,y£Rk<{ i,"gYvik it li BUILDING PERMIT NUMBER: DATE ISSUED: — SIGNATURE: .� Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors d Parcel Number: �,61L q2$4 P, (55 O 53 O lav Map Number Parcel Number 1.3 Zoning Information: 1.4 Propdaty Dimensions: 1(Q 2. Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Rapired Provided R red Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record - Name W-' Address for Service: C T 7_U 3- 7ai3 \ Signature Telephone 2.2 Owner of Record: W Name rint Address for Service: §igAture Telephone go SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ s Licensed Construction Supervisor: O License Number mn Address ~ Expiration Date i 1 Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable �' v `—!)�>I-'Ct(fs D01-kC Company Name m .2,Z 5 U,,n t� d �, � J ress J n _ I _v^/ /h� Registration Number r Add (T[1�'d(J G� l r ?4�Jk— 1 `Q'f t �l - [ O b Expiration Date � Si natur Telephone Q f � 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 Ar Repair(s) ❑ Alterations(s) ❑ TAddition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �oAoue- 5 j c Y)el r RewtOJe S�J e-A4-h ep)✓q�E (P Z1f� �l e end w�U S�d.3 �P1�Iz�' s��e�ltiiy dry ue!c !�j�-Gv�d-s SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building (a) Building Permit Fee 7Multiplier 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 ?jp6 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 6;—[/I— ---I J `wL as Owner/Authorized Agent of subject property Hereby authorize ©D U(r 42A_t_X � to act on �My be < m< 1 matters r ive to rk authorized by this building permit application. ,� � � G�-ter ���3A-3 Si nature of Owner Date SECTION 7b OWNER/AUTHORIZEDD AGENT DECLARATION I, ��L '� /" �� S 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 Nam 2 Si ature o Owner/Age t Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVIBERS 1 2ND 3RD SPAN DMIENSIONS 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 NORT#j d Ss,ED I6�ti s O6�•r h 6 #- 71 Town of North Andover Building Department '` '�.•�_w 27 Charles Street SSACHUSEt� North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. / DATE /c/ O) A 3 JOB LOCATION v-.3 Number Street Address Section of Town "HOMEOWNER 63 7,1' 6,y3- 7,;L/3 9?F -173 6d6e Number Home Phone Work Phone PRESENT MAILING ADDRESS 14NOtme& Rl+. al City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six 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 109.1.1) 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 to six family dwelling,attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 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 requi reme . HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. Driver's License 05-2067 05-20-05 M 5'09" 0 S26181017 f Date of Birth Expires Sex Neigh Class Number DALKE u DOUGI.AS E cc _ -22 SUMMIT ST N ANDOVER, MA 01845-1721 P-0 f 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: ' Oul i� 411 Wc� reL MOnte190 V9-352 -21520 r �,(i54._ oAft"A S (Location of Facility) e Signature of Permit Applicant 23 k 3 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector 't'40RTH Town of Andover 0 0 No. 0 t�-OC L dover, Mass., C CHIA9 f'A'rr:D H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System P.d 40/ 0 CO OW / AP&W 100%,S BUILDING INSPECTOR THISCERTIFIES THAT............................................................................................................................................................... Foundation has permission to vvd...OR A0.*.;4' ......... buildings on ..S.3....I&AAND-IrP.....PW......... Rough to be occupied as.Ch!P#*.& / Chimney g(ist!A provided that the person acceptin hall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-ly s relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. A 40 1 /y5 *70 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ............................... Service ...... ........................................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTO.R 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. _ _ r c. r� �vssayaar��,•• l� 1 _ y 1 t i tit " ( i_� 't...;„ti'•1*'"t� .� ,� wr Al - �y � f•. l3 Date.. . l.:: !...... .. 1 � WORTH TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION 9 . 9 SACHUSE�A This certifies that . .... . . . . . . . . . . . . has permission for gas installation,.'-:.�f?:)- . -�* 11:� . . . . . . . in the buildings off. /�f!f�//,.� . . ./1 �?`:Q-r. . . . . . . . . . . . . att�.j(:, . . ., North Andover, Mass. Fee.. -q Lic. No..,3./.7/.h_ �. . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR r Check# '15622 MASS APPROVAL # MASSACHUSETTS UNIFORM APPLICATION FOR PERM GASFMING (Print or Type) q' t bOk knrAIQU`tfL . Mass. Date Feb. i Permit Building Location 53 j�orrheiro 1.1l.Ly� 's Name �LUIa pOIAJf1�5 �— ' of Occupancy ._ New ❑ Renovation & R placement Pians Submitted: Yes❑ No WL n s N p Y 9 in H a: H 6 2 Ut = t- W W F ri 07 V 1- < �' z = O F 6 z o u o: ¢ O O - r A m a I.- y r 0 a. c Ic Z W C Q > ti H V J Ip+ W tl �- i > e w Z. < t < O O ra O y sua�-BSMT. BASIMENT 1sT FLOOR >( 2ND FLOOR I DRD FLOOR 4TH FLOOR STH FLOOR GTN FLOOR TTH FLOOR `TH FLOOR Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET Q Corporation 103C MIDDLETON, MA 01949 [. Partnership Business Telephone 9 7 8-7 7 4-2 7 6 0 C Firm/Co. Name of Ucensed Plumber or Gas Fitter WILLIAM R. -HARRIS INSURANCE COVERAGE: I have a current liability insurance polity or its substantial equivalent which me--+s the requirements of MGL Ch. 142. t Yes IR No ❑ If you have.checked yes, please Indicate the type coverage by checking the appropriate box ( A liability Insurance policy 0 Other type of indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does nct have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent 0wrW110- Agent C1 I hereby certify that all of the details and information I have submitted(or entered)in above appkation are and accurate the best of my knowledge and that all plumbing work and installations performed under the perm!(' or this I be in ante with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the r 8Y T of License: Plumber gnature o mber or Kter Title Gasfitter Baster license Number 3785 Crty/Town Journeyman NL p