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Home My WebLink AboutMiscellaneous - 55 DEER MEADOW ROAD 4/30/2018 (3) i Cr Location .F,S l No. Date MORTN TOWN OF NORTH ANDOVER 3? � SOL F A Certificate of Occupancy $ J�cNusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ - Check # �7h� ' Building Inspectprf' IJ �: . J V r- • TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 7,7 TIiSR1' rn r _ BUILDING PERMIT NUMBER. DATE ISSUED: —02_a R X SIGNATURE: (�" , Building Commissioner/1for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: -5s Dee merdow Roel 1 13 60/ m4 k Map Number Parcel Number rc�1.3 Zoning Information: 1.4 Property Dimensions: W Zoning Diirid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ _J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service: n1 (9 7?) Signature Telephone p0, N 2.2 Owner of Record: Name Print Address for Service: 0 Z rn Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address ` l� v D 97y G ?a0 Expiration Date Sgnature Telephone r■ 3.2 Registered Home Improvement Contractor / l Not Applicable ❑ // v lav P'P C44d Company Name .� /o) 4 d-:� rn �� , Registration Number r Address r .[/( Expiration Sinature 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.......❑ 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: �/�h'l� �-'7 j1�C' L✓PG � ��f✓!'P ��Pd ,y-I'y°"Y'1 e SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building a (a) Building Permit Fee p L�j C a '� Multiplier �`� 2 Electrical (b) Estimated Total Cost of /0/ — Construction 3 Plumbing Building Permit fee(e)x (b) 4 Mechanical(HVAC) 15 5 Fire Protection 6 Total 1+2+3+4+5 d Q Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUII.DING 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. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 Pri Name Si ature oOwner/Age nt Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHAINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 55 Deer Meadow Road North Andover, MA ) CL4.2 135.7G' 41,x• —Lo•T Z� q �ylce �a axa mss , S-� a Zones .. :_ C �-jeilinp7 Zon-3s .: _ C talc MORTGAGEI INSPECTION PLAN 1 l t—I�.LL I�or�CRT ��• �cR2lLYN �. A I l�, m M A 2 BUYER ' i V Q , �� THE� //,A1N ST�CT //.f�RTCid6E Go. 11.1c. � 4N DcQ AND nS TRKF DZURERL MASSACHUSETTS �� 3CD I CERTUY TNAT I HAVE EXAYPm JIM PREMISES AND THE BUMD04S 00*1 DO CONFORM TO nE=HM LAWS AND AMOMMOM L-(FRONT.SDE t REAM YARD 5E1 ONLY of NO2T1-4 AN DoV t=om- *mN CCNsTRUCTm. .iii L01= 1 FTJRTNER �Y THAT Tm PRWEM s IDGTFa tN THE 6TABU5?ED n= DEED Zoo 8!0 c� NAZAItD AREA. 104'2 COMMUNITY PANEL N0.:2��e'vv i O gDATE:June ,r -�7 `, �c,0.0a � „ • LATEST D®EXAMP"mcm OFDOES NOT WCLllDE VQJs19NC TK RAI71'M MA" � OF THETHE D®REDOMW DApESgCPTICN y • PAW PRmam TO nS DATE OF RECORD. CErr.NC. = •,1 TKOs COMPANY R NOT RespamaE PCR ANY RzOmIRFS MADE SlBS[DmT TO THE iTELONOED '��•Q3,' •y DATE OF 1KE LATEST DEED of 11EcoRDED. WHENEVER MAU*=ARE SN W IV--=THAN CNE Po01'FROM MPROPERTY UNE!T Di ADVL4D �� BK PAW 't SB8 THAT A YORE PRECLg SURVEYBE MADE 70 VERVY TlGSE YEASiJRF71EITS ply f DATED NOM- — THIS CERT4TOAIM IS DASTD ON THE LDDA CF SURVEY MARKERS OF OTHERS.AND DOES NOT RE31"?IT A PROPERTY S!RVE1 v 1 •+�� THIS CERTIFlCATION TD d1i1RTGAGE PURPOSES ONLY. 9CrLLE t'-•-10' �i 0FFSEl3r4VsHgmDARe#i0T To BE USED FOR THE:FABLISHMENT OP-PROPERTY LINES '✓ c1sa.�-•� �:< BRADFORD ENGINEERING CO. { . Y. _ l-_.��4• T`• PxLlsm 1244 tJ�.aaSLt3.L7 r �' HAyEiB11LL MA.01831 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 W 'ers'Compensation Insurance Affidavit Please Print MENEM Name: Location: City Phone QN am a homeowner performing all work myself. II�JJI am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: ifd Xf 1.2e eon ag 4 Address 9�U f�24 e!��✓ ��1/ey�'1i T ✓5 City: n/ /?a ?{,s Phone# 97Y' Insurance Co. rn,i ✓ra Pvli _. # G ComRgnv name: Address City: Phone 0. Insurance.Co. Poticv# failure to secure coverage as required under Lection 25A or MOS!152 can leed to the imposition of criminal penalties of a fine up to s1,5oo.00 and/or one years'imprisonment as wen as civil penalties in the form of a S'L'OP WORK ORDER and a fine 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 herby certify under the pains and penaAYes of perjury that the information provided above is true and correct Signatureef� 1,/ Date 0,2 Print Phone# `)t 4 r,2.15-1) Official use only do not write in this area to be completed by city or town official' I] Building Dept OCheck if immediate response is required Building Dept 0 Licensing Board E] Selectman's Office Contact person: Phone A Ej Health Department Other VORKMAN`S coMpENSATION North Andover Building Department Tel: 978-688_9.4 -688 g54 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 b c11, S150A. by MGL The debris will be disposed of in: (Location of Facility) 2AL, Signature of Permit Applicant i Date NOTE: Demolition permit from tije Town of North Andover must be this project t obtained for through the p 1 g Office of the Building' u�ldmg Inspector NORT#q ' LED � over �! Town of ~ _ .... a .. COCL dover, Mass., o a oRATED PPG�-`� 7 V F� 4 BOARD OF HEALTH PERMIT T D , Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ..?......!C ./�T..... ............................................................................................ Foundation has permission to erect...: ploceof .. buildings on ... s....d�. 'Ez 4! M'��m`� _Rqe'. Rough ..................................................... S C2 O o� �o� �� ..!��.�.�C..... V .. �......��- f P-U4 .Lf7 imney to be occupied as....................�.................................... provided that the person accepting this permit shall 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-Lawsrelat"ng to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. /� Al 03 '6 9. >S/ �6__ 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 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.