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Home My WebLink AboutMiscellaneous - 66 BRADSTREET ROAD 4/30/2018 66 BRADSTREET ROAD - - 210/057.0-0018-0000.0 Location No. / Date �— i �oRTM TOWN OF NORTH ANDOVER O��t� o ,•'�q.O ' Certificate of Occupancy $ �ss�►cMusEt� Building/Frame Permit Fee $ — { Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # J 3 / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ."AN BUILDING PERMIT NUMBER ( DATE ISSUED: SIGNATURE: A ic Building Commissioner/In for of Buildings Date I SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide gegfired Provided Regildred Provided v 1.7 Water Supply M.G.L.C.40. 54)• 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zona Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone m SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ 9. icein�sed Construction Supervisor: O License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improv t Co Not Applicable ❑ Company Name / Registration Number Address z p.c-, � Z Expiration Date 5t nature Telephone � S 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 IV Repair(s) ❑ Alterations(s) ❑ . Addition ❑ 1 . Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: VA SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be 0MdAtUSE'UhILY Completed by permit applicant n. . 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 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OW S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on M e alf in all mattlative 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 v, F VVL 4: mt • Si ature of Owner/A ent Date NO. OF STORIES SIZE N. BASEMENT OR SLAB SIZE OF FLOOR T HERS 1 2 3 SPAN DMIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 TOWN Off,NORT.R A1NDOV R of Noarr�.� Office f the.Building Department �r Community Development and Services 27 Charles Street 41 1 Nortb Andmer Massaebuset#s 01845TED D. Robert Nieeita, Telephone(978)638-9545 Building Commissioner FAX(97 8)688-9542 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and as a condition of building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by'MGL c 11, s 150a. The debris will be disposed of at/in: (Site location) z4lop Signature of permit applicant Date Michael McGuire,Local Building Inspector JamesDecola,Electrical Inspector JamesDiozzi,Gaslplumbing Inspector M E ✓!� v'a��vazagz a�-�l�aaicrcluaplta BOARD OF BUILDING REGULATIONS $ }License: CONSTRUCTION SUPERVISOR + t Number: CS 022476 B i rthdate: 11/11/1955 { Expires: 11/11/2003 Tr.no: 9642 Restricted: 00 ROBERT R TIMMONS _ 2 HAMPSHIRE LN/PO BOX 416 LONDONDERRY, NH 03053 Administrator �fc'�Jomzoizonrue�l(� a��Q��»� Board of Ruilding Rcgu;ations end Standard: . HOME I161PROVEMENT CONTRACTOR Regis"gyration: 117426, Eic`p#}anon: 10/03/2'002 Type: DBA TIMMONS CONT ROBERT TIMMONS 2 HAMSHIRE LN LONDONDERRY,NH 03053 Adminittraor i The Commonwealth of Massachusetts Depalfinent of Industrial Accidents Office of investigations Boston, Mass. 42111 j workers'Compensation Insurance Affidavit Emil t - , { Please Print Name: Location: City A/� `��1 rIG ✓l°_r/ Phone am a homeowner performing all work myself. 01 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 nam Addres2,Q /n/*1 City I'JG D & a Phone Insurance Co. /�' ;�/ys/. oli . # Company name: Address City: Phone# lns�urance.Co. Policy# 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 well as civil penalties in ttte form of a STOP WORK ORDER and a fine of($1 oa.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 u r the pains a allies of perjury that the information provided above is true and confect Signature Date_ Print name � Phone# Official use only do not write in this area to be completed by city or town official' Building Dept _ Check if immedr ❑ p ❑ ate response it required Building Dept p Licensing Board Contact person: ElSelectman's ice Phone# ❑ Health Department 0(he'r RM WORKMAN'S COMPENSATION NORTH Town of 1 4 Andover 0 o A o lover, Mass., 8 •d .'Z I� COCMICMEWICK �t 7,9 A�RATEo PPa,`-`� S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System � V r /q* ?p . BUILDING INSPECTOR THISCERTIFIES THAT............. ................... ............................. ..................................... ............. ...................... .......... Foundation has permission to erect..` �R.�..,..... . ... buildings on ....&.&......amo........................................................a4g .. Rou h v►ao IZ�S�aP to be occupied as �� ' 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. t7/1? S�/ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIONS S 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.