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Home My WebLink AboutMiscellaneous - 67 KARA DRIVE 4/30/2018 / 67 KARA DRIVE / 210/098.A-0087-0000.0 Location & r,� �A�.� L /2- No. 2No. Y L o Date 0N0RTr4 TOWN OF NORTH ANDOVER 3? �,,`•o I•,hOOL " Certificate of Occupancy $ cNus ttBuilding/Frame Permit Fee $ a S s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ S Check # -, G I ! 51 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 77777-7 =.." "n a`.,`x, `•" '_ ? �W ,+>'_''",�'y' ,x be BUILDING PERMIT NUMBER: DATE-ISSUED- SIGNATURE: ATEISSUED:SIGNATURE: Building Commissioner/I motor of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Map Number kPLINumber -Q% 1.3 Zoning Information: 1.4 Property Dimensions: I Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide R 'red Provided Required Provided 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 ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT rn 2.1 Owner of Record "1z R �6 7 )�'l ,')Q I VL" r Nnerint) Address for Service L 9q ,gignathre 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 11Licensed Construction Supervisor: O oD cr)cll Aver Hr 13 License Number mn Address Expiration Date ic Si n tore Telephone icr 3.2 kegisfired home I provement Con for Not Applicable ❑ 0 Company Name M Registration Number r Address _r Expiration Date �^ Signature Telephone V 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.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑Tddition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �`b `?.�1"1 c�/Lf. L�tr Tl�✓� j�I�-i( /�`.'p �LE'�'��C%' 7Z71 /L-�-`� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building ry,r (a) Building Permit Fee Multiplier 2 Electrical f (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 OWNER AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Own Authorized A 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 I, 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 Print Name Signature of Owner/Agent Date r NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS iST2ND 3 RD SPAN DIMENSIONS 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 �-INFSh i�Aa��►.--�f / `7rcCC. VZ.�P��ac��l- ��_��_ �� FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the a applicant and or landowner from compliance with any applicable requirements. APPLICANT U " T �Zty PHONE 7 ASSESSORS MAP NUMBER G LOT NUMBER ' SUBDIVISION LOT NUMBER STREET STREET NUMBER d OFFICIAL USE ONLY RECONM ENDATIONS OF TOWN AGENTS ..IFG...—.....................................................`...c............ 16 I -^ S DATE APPROVED I CONSERVATION ADMNISTRATOR ( DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED CONUVIENTS DATE APPROVED FOOD INSPECTOR—HEALTH DATE REJECTED SEPTIC INSPECTOR—HEALTH DATE APPROVED _ DATE REJECTED COMMENTS PUBLIC WORKS—SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED l FIRE DEPARTMENT DATE-REJECTED ' COMMENTS RECEIVED BY BUILDING INSPECTOR DATE !O/ � r . • �` �3 `SF r O � 0 O �J C� OW �_G/=G 6S,7 �,.• �__.-- � 1 it �zs,oa _ -- I CCA-7XIr 7b 7',lre T/T46/NS�/.t��t rWp o r Rz 4AI 7"A�P BGsa/r77Ysvr T.varor.-ezc% iJ �a�c.+r�r-o ov �air�or.e�,.saen�-.v.P.vo r,4ciT�rocvcs cavr=oe,N �N. dA'/Tr4/ TiN�f"7'�w r. d.�'��;,,�.••, :• _ :� TO.�//vR .r�'At�.�rbvS A'�' OiC�/tile JP7"B/fC�t:4" 1�4r!.M! S A/10./.t!�' l.fafJ. ' ; ,9044M-W AV 4 ,., / /7 t f MAO /.4/f�.►RriI- E.�.t'O�40 � .4;-VW 1N,r6V .. ..,.,.ss ..r-,. - /�•ri/®AY�� i19•d'.f..5.dC,f/6�3�"7"J'S �/�/e? ' • j 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations , Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: I Location: NT r n7 City jN`� �� Phone 9 f am a homeowner performing all work myself. r �I am a sole proprietor and have no one working in any capacity aI am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: Insurance Co. Policy# Company name: I 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 penalties of a fine up to$1,500.00 andlor 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 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 p naltfes of perjury that the information provided above is true and correct. Signature Date �� 313-161,11 ' Print name 7 S(/ / Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A ❑ Health Department j ❑ Other FORM WORKMAN'S COMPENSATION tl NORTH 01" . o _ over 0 CHIC o dower Mass. COC MIC HE WICK v 'AA ORATED P .(5 S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THATBUILDING INSPECTOR �.I.... �....... ............ .V. .. ........................................................ Foundation has permission to erect..../0....AFAY. ... buildings on ......4...... 0.4.�� ................. Rough to be occupied as .164 N 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION T ELECTRICAL INSPECTOR Rough ................ .. .................................. .. . . ............ Service ... . ....... ........................ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. Location No. Date S- J S to HpRTM TOWN OF NORTH ANDOVER F 4` Certificate of Occupancy ' � • � $ � s^CNUs<� Building/Frame Permit Fee $ S ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ o i Check # / r ebuilding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING asM« BUILDING PERMIT NUMBER DATE ISSUED. �� SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O U / Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red t Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomution: 1.8 Sewerage Disposal System: Public ❑ Private ❑ ZOIIe Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record ill �0&)\ Naqle(Print) Address for Service: t� Sifnature el Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone rn SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ (5r4 X T Licensed Construction Supervisor: O �=nse Number Addres D Lk't-4 t E iration Date S" na re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name rn Registration Number r Address r Expiration Date Z Signature Telephone Y♦ 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.......0 No.......0 SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: gvi(-D 3 rvON-- S i„ i ny P�L/^ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multi lier 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILD G PERMIT (JGtl- ,as OwnY/Authorized subject property Hereby authorize T ��My behalf,in all matters relative to work authorized by this building permit application Sigrikure of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Print Name Si ature of Owner/Agent Date E NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS 1 ST 2ND 3 RD SPAN DIMENSIONS OF SILLS DINIENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of Andover p �....,.., 1. No. qqj C, = A o dover, Mass., COCKICMEWICK V ADRATED PPS\ 5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT...../....... .... . ...r ...... .` .. ............................................. ......... Foundation has permission to erect....1:100 ....3...... buildings on ,......K..... ...... Rough .... ..... . .......... to be occupied as...W ... :. su .... lir M ... ..$�� r..+-. 'R�. ....a trs Chimne y 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. at SA P g 001 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STTS 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. r r i k :%�Q ��ntr�taxuxral�t o��.. l�tr:�+rc�tufet�i 4: BOARD OF BUILDING REGULATIONS Jam- License: CONSTRUCTION SUPERVISOR Number: CS 045094 -� Birthdate: 08/26/1956 � - Expires:08/26/2002 Tr.no: 195 Restricted To: 00 GARY F STANDLEY 33 WOODCOCK AVE#13 HAVERHILL, MA 01832 Administrator NbME I�p�OVEl1ENI C4NTRACIOR Registratien 117967 I Type _ li1pIV1DUAL Expiratl G1�p5/Ol GAR t F, 51 And, 7g9 4iASNiNfi1a41932 ' �o MILL MA ; ADMMISU t CELLA 2 ' w,NDow Z b ct2tA2 r Fou wD A-T/oN W A LLL-T-- �. C--ItZ j12►[ goy GAS GP's yor { go 149 wA%t ► t D �o U N � 0 �a�k LSA LL la �g-r�nJFr t p 0 W 36Joe A oo iL OD rA L 32 L 00I oo Z'b'WAE� .y+\j/ALL00 4 01 wait D eF F►�� s:s''wac� WATETL 9�WpLL ' 3 wA S P6 D khl. a(ke C Z,L A R WALL i DOWL 22 -+O (z -- A ro 3vjLA 3 tNWR IAO tLS dj 2� -5+ 9'IoQ— � G � � c cyG 3�" S � � Q To Reorder Catl I-SM225.&W PRODUCT 218 Page No. of Pages GARY STANDLEY QUALITY HOMES P.O. Box 296 HAVERHILL, MASSACHUSETTS 01831 License & Insured Phone (978) 373-1641 PROPOSAL SUBMITTED TO PHONE DATE M4 99f?- 17Ys-32ft STREET 7 KAQ/� 'A i+ 5' JOB NAME (� 'EK t45'"� i AJ5-V r t .4 A)j0 iQ��i�ifLS CITY,STATE and ZIP CODE JOB LOCATION WR 1-14 14/1/p 0c/44 IBJ•"�) 0/,F$5 SA M6 ARCHITECT DATE OF PLANS JOB PHONE We propOR hereby to furnish material and labor—complete in accordance with specifications below,for the sum of: 5a- *- IVDZ-S '9&1149 W Payment to be made as follows: dollars($ All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from specifications be Authorized - -low involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, acci44 - dents or delays beyond our control. Owner to carry fire, tornado and other necessary Note:This proposal may be 7 insurance. Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. We hereby submit specifications and estimates for: ....� i�. . . w' 3u�_ D 1 .. r�.i ......... ........ Imo' �L. .._Z .. ...` Z...7f ...►'i rt7�.....- 1i 'i�15.�.. .5 .. �}-t i. .... p u .. .... 1 ...... La ?�Z.... .. . .. . . �� ( �saDS� 1 Z Z ...f Cv .. tq Tr -.._3%..._�•�; 2 .16 __�.p... .12«�) �._ �. _.... .�y.i .1..- - -�, ..eJ 10"'17"r 1�"k;� 'iV .J�n 1)AjLi�,S .!'4r;nc_ u)®,2x_........L�.. 7 ....��i......:j-�.�k '.... ......_..._... Date.. ti NORTH o? O� TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION SACHUSEsty This certifies that . . T%'.! �. . . :�. . . f. .�'.�.� . J/ . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .' . . f . . . . . . . . . . . .. North Andover, Mass. Fee. �. . . . . . . Lic. No./.l. :-. .'. . . . . . . . . . GAS INSPECTOR Check# f 4 3 4 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) ateY�1�' r� lo 2 NORTH ANDOVER,MASS ,ACHUSETTS Building Locations _ C 7 4 /1 / tz)ue Permit# _ Z 7 Al, )�PJ)—/2)V - P41& • Owner's NameAmount$ New❑ Renovation ❑ Replacement �� Plans Submitted ❑ � W a U x � F c w a o c w Q CO m F W r� zW� O ,.,, O F CW7 F Z � d a O A > W z0 0 a SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD . FLOOR 4TH . FLOOR 5TH. FLOOR 6TH . FLOOR 7TH. FLOOR STH . FLOOR (Print or type) (�j L �s�� heck one: Certificate Installing Company Name11 Corp. Address 3 �'f,7�� (�7Y2 ❑ Partner. Business Telephone / L❑—F'i'rm/Co. 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.General Laws,and that my signature on this permit application waives this requirement. Check one: ❑ Signature of Owner 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 under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S Cod Cha r 142 of the General Laws. By. Signature of Licensed Plumber Or Gas Fitter Title p Plumber /Y-016 City/Town ❑ Gas FittericenL'-se Num er ❑ Master APPROVED(OFFICE USE ONLY) ��rneyman