HomeMy WebLinkAboutMiscellaneous - 6 Woodberry (2) / 6 WOODBERRY
210/038.0-0134-0000.0 `
l
Location
v _
j
No. Date
I
TOWN OF NORTH ANDOVER
O: • GR
Certificate of Occupancy $
E<� Building/Frame Permit Fee $ ���'• '�
.1 CHUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
P S^
Check # .� x
i
1 5340
3 4 0 � Building Inspec(oe
"Y v 4
t
TOWN OF NORTH ANDOVER
BUILDING ]DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
MUM
BUILDING PERMIT NUMBER: DATE ISSUED:
Z.-6
SIGNATURE:
Building Commissioner/I tor-of Buildin Date
SECTION 1-SITE INFORMATION
1.1 Property Address: 1:2 Assessors Map and Parcel Number.
Ze
Map Number Parcel Number
At Vy�L-7'!�l � 1� 01/ L'�L
1.3 Zoning Information: 1.4 Property Dimaisions
Zonin District Use Lot Aria Fronto ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Reqdred Provided Rapj&W Provided
1.7water SupplyUGLCAO. s4) I.S. FloodZonoIufom mow IS SawerWDisp ASystem
Public ❑ Private 0 zone Outside od FloZone 0 Mrnicipal 0 On Sine.Drsp J System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2:1 Owncr of Record
Nam (Print) Address for Service:
Si tore Telephone
.2-2 6wner of Record:
Name Print Address for Service:
Sifaature Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed
+wConstruction Supervisor: / Not Applicable. 0
�
Licensed Construction Supervisor: 6/
License Number
7 "35 Z- 26','/ Expiration Date
afore Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Pte`16 of i Ia. G t'9 K C 7`O w y A(4 ,
�r(4 t l V�U Registration Number
Ad ress �V� (j
J,.6 �60 Z
Expiration Date
Si ature Telephone
i
SECTION 4-WORKERS COMPENSATION(AILG.L C 152 § 25c(6)
! j 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.......V No.......0
i SECTION 5 Description of Proposed Work(check an applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify., ,, ,
Brief Description of Proposed Work:
-7'z, 10Ccieli C 4b ,`Aur -15 , I/ Zig
O1-( "14 �?eTif 15 ej, 40 1- 40
7. CK, 4/cou e. r1p -S/ggg- �s it &-e� t-4
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be
Completed by applicant
1. Building (a) Building Permit Fee
-4/1, Oavv0 Multiplier
2 Electrical (b) 'Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a)x(b)
4 Mechanical AC
5 Fire Protection do
6 TotalJ1+2+3+4+5)1+2+3+4+5. /./1. 0o 0-0 U Check Nuinber
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
He y authorize to act on
My half,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, aster/Authorized Agent of subject
pro
Here declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
c) i
Print ame
M/f CL 02
Si a of Owner/Agent Date
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TRABERS 1 Sr 2ND 3
SPAN
DRVMNSIONS OF SILLS
DD.4ENSIONS OF POSTS
DRvIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
i BOARD OFR ✓tl�ua� a
License: BUILDING REGULATIONS `
CONSTRUCTION SUPE
i Number: CS SUPERVISOR j
Birthdate:
11/02/1942 08147
i
EXPlres: 11/0212
003 Tr-no: 8931 t i
JOHNRestricted: 00 t
10 TTI
MOULTONRST _
GEORGETOWN MA 01833 �Ad
nistrator i t
Board of Building Rte{ bona Standards
HOME tMFROVEtNENT CON T FUlC?OR
�.. Registration: 108505
Expiration. 8119/C2
Type:--PRIVATE CCRFFORATiON
MORE-,`T!&SOr4,INC.,
john Moretti
10 Moulton SVPO Eox 119 _
Georgetown,PAA 01833 "
Administrator
iThe Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
{
i
Please Print
i
Name: t<i
Location: PQ:910k UU Li L '70-'U ,i,er 4c-
city `�u y . /�� 01P.33 Phone 3.x z---Zaq(
am a homeowner performing all work myself.
�i 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:
Address
City: Phone 4P
Insurance Co. Policy#
Company name:
Address
City: Phone#•
Insurance Co. Policy#
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penallies.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 fine of($100.00)a day against rne. 1
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 ndepr the pains and penalties of perjury Chet the information provided above is true and correct
Signature "� l�G Date_ 6'14 i
Print name Svc �i A. /�'�a .�: �� Phone* l�
Official use only do not write in this area to be completed by city or town official' E] Building Dept
❑Check if immediate response is required Building Dept E] licensing Board
p Selectman's Office
Contact person: Phone A. r-� Health Department
n Other
FORM WORKMAN'S COMPENSATION
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:
l Q } 4
(Location o acility)
Signat re of Permit Applicant
��0
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
NU rc 1 ry
Town of over
No. _ _ -
� / oZ
�O LA o dower, Mass., '
COCHICKEWICK
S RA 7 E D
H BOARD OF HEALTH
PE IT T Food/Kitchen
Septic System
AJ. BUILDING INSPECTOR
THISCERTIFIES THAT. ... ................................................................................................. .........................
•• +••••••••••• Foundation
ftv
has permission to erec buildings on.. .... ............................... ...... ........... Rough
to be occupied as.... ................................................................ .......I.............................
Chimney
.. . ........... . . . . .. . .
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-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 CONSTRUCTION &WS
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.
I
Location �o G-'ao�i3c�Yz
No. SS3 Date
I
paRTH TOWN OF NORTH ANDOVER
,t`,o I•i+W.
� F
Certificate of Occupancy $
Building/Frame Permit Fee $
,ss'ACMUSEt� Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
ru 12/23/93 09;46 15.00 RAIL'
v- 6 8 21 Div. Public Works
Location
No. Date
„oRTly TOWN OF NORTH ANDOVER
+i p Certificate of Occupancy $
Building/Frame Permit Fee $
CMU sEth Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ !I
Building Inspector
12123:c 05;47 15.0: i AID
Div. Public Works
Pr9RAIIT NO. 3 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1
MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE
ZONE I SUB DIV. LOT NO.
LOCATION , e PURPOSE OF BUILDIN f
�.®� ��y L,ofiwoCd �1
OWNER'S NAME wle U,q AA/ NO. OF STORIES SIZE
OWNER'S ADDRESS / AE .� s BASEMENT OR SLAB --
ARCHITECT'S NAME (n ��9 SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME )y// ,v,��0 N G�yi f� SPAN
DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES
EST. BLDG. C08442//5-C,-j:>
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COOT PER*Q. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
.� PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE ILED
BOARD OF NEALTN
SIGNATURE 6FOWNER OR AUTHORIZED AGENT
FEE !S
OWNER TEL.k 6 -26�y PLANNING BOARD
PERMIT GRANTED G2 j4-
CONTR.TEL.k
3 19 CONTR. L!C.## D�CoG Ys-
BOARD OF ORLECTMEN
���' BUILDING INSPZCTOR
s
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE 3 1 2 13
CONCRETE BLK. PINE
BRICK OR STONE HARDWD
PIERS PLASTER
_ DRY WALL _
UNFIN.
3 BASEMENT 11
I
AREA FULL FIN. B'M'TAREA _
v, FIN. ATTIC AREA _
NO 8 M'T FIRE PLACES
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS 8 1 2 3
DROP SIDING CONCRETE
WOOD SHINGLES EARTH
ASPHALT SIDING HARDVl'D
ASBESTOS SIDING COMMOM/dCN
VERT. SIDING ASPH.TILE _
STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER ELK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR POOR
ADEQUATE
ADEQUATE NONE
5 ROOF 10 PLUMBING i
GABLE HIP BATH (3 FIX.) `41
GAMBREL MANSARD TOILET RM. (2 FIX.)
AT
SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES
TILE FLOOR14 -
TILE DADO
16 FRAMING 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. 3 COLS. STEAM
STEEL BMS. & COLS. HOT W'T'R OR VAPOR
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING
r r NORTly
Town ofZ` �
L
1
93
o ort over, Mass.,
Cz, 3 X953
IASCOCMICMEWICK
ORATED
/ t
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT............ ! I ! !!.� M!1..... ...:.....................................................
Foundation
has permission to ems.... .......... buildings on ... ...... .hftme. ..... . i Rough
to be occupied asA.& ....A ( � f
� ..... �....dAft......9.o0 .. Chimney
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-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 t
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCTITS ELECTRICAL INSPECTOR
Rough
..... .....&........... INEService
.
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
la in a Cons icuous Place on the Premises — Do Not Remove Rough
Display Y � P Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
\�I ,, � °T.l��oomneo�unevld o�✓6laawdu I� i
HOME IMPROVEMENT CONTRACTOR
Registration 102658
Type - DBA ,
Expiration 07/02/94
Mike Antoon Construction
Michael J. Antoon
14 Bearse Ave
ADMINISTRATOR Methuen MA 01844
e,
COMMONWEALTH -
OF I DEPARTMENT OF PUBLIC SAFETY
MASSACHUSETTS ONE ASHBORTON PLACE
BOSTON,MA 02108
04219 L I C E N S E
EXPIRATION DATE C
CONSTR. SUPERVISOR o r:
RESTR C?ONS 9 4 EFFECTIVE DATE
NONE LIC-N0. ;
06/30/1993 026645
j o MTCHAEL J ANTOCN
SS q 023-38-4086 14 3EiRSS AVS o
m METHUEN MA 01844
PHOTO(BLASTING OPR ONLY) Z
FE
00.00 m
NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
HEIGHT: - STAMPED-OR-SIGNATURE OF THE COMMISSIONER
DOB: -,
11/25/1957
'- THIS DOCUMENT MUST BE l�
CARRIED ON THE PERSONOF
_ THE HOLDER WHEN EN" F NSEE
OTHER MB`PRINT GAGED IN THIS
OCCUPATION.
COMMISSIONER
a
I,