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Home My WebLink AboutMiscellaneous - 68 SURREY DRIVE 4/30/2018 / 68 SURREY DRIVE � 210/074.0000.0 �� D Location 6 8 s" /, r Yy l';> No. o;�,S Date — NORTH TOWN OF NORTH ANDOVER 3? °c Y - s • ; , Certificate of Occupancy $ cNuEBuilding/Frame Permit Fee $ sws Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # L 16047 Building Inspector Location /� ' '1'1 r No. 1�1/` Date NORTH TOWN OF NORTH ANDOVER 3: •• O F � s Certificate of Occupancy $ tHuBuilding/Frame Permit Fee $ s� sE Foundation Permit Fee $ / `` • 0 Other Permit Fee $ TOTAL $ Check # 15939 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. !� DATE ISSUED. -1 SIGNATURE: — Building Commissioner/12EQector of Buildings Date Z SECTION 1-SITE INFORMATION O 1. Property Address: 1.2 Assessors Map and Parcel Number: KOl w Map N Parcel Number 1) 1 �/ f l 111AVVVJ 1.3 Zoning Information: 1.4 Property Dimensions: Two 11-V �.�1 >r a�C',te r Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided v 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 ner o ecord I--- a rint) Address for Service r �A St T lephone V 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: o x License Number Address i z Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name M Registration Number r Address r Expiration Date z^ Signature Telephone A SECTION 4-WORKERS COMPENSATION(NLG.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: �- �t/� QG�hj✓ oJtJ �G77-)&1 C, ��,i?v� ow F-4 V CtF 6Vys4-1z IX. �ng� �4'rJr.. % r-D '� !7'!'7 6vti ��rcTnF.�.% a GL O�✓ �ti� �C&Q-0A a,r� Cs •it c,�r - f wi r� ` S 4n0:�1770 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL,'USE ONLY Completed by permit applicant I. Building (a) Building Permit Fee Multiplier A/O P /J04 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 BUILDING 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 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 P/Fint Name Signature of Owner/Agent \ Date I NO. OF STORIES SIZE r BASEMENT OR SLAB �1 SIZE OF FLOOR TIMBERS 1 ST2ND 3RD SPAN DIMENSIONS OF SILLS DINENSIONS OF POSTS 1 DIMENSIONS OF GIRDERS \HEIGHT OF FOUNDATION THICKNESS �IZE OF FOOTING X TERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ******************* ********/*APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT L.D fi/ PHONEO,� d77,k�? LOCATION: Assessor's Map Number PARCEL_ SUBDIVISION LOT(S) STREET o �,QT� /U ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECO MEN DATIONS OF TOWN-AGENTS: ONSERVATION ADMINIST TOR DATE APPROVED V DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm ORTFy Town o ..- ,o Andover O -11-�.'----'-��--'--'' .y TO No. c:;Z�5- rl ndover, Mass., 0 LAKE COC H':H'E I WICK Arl C O'c'?4 TE ss, c 'Ac P IT FOR EXCAVATION AND FOUNDATION THISCERTIFIES THAT .........16 ......... .................................................................... has permission to excavate and our foundation at ......G.8.........S..Q.n..r..I - �r 2) R/ U'C'- ................................. for the purpose of.....S;�6 Y-31 ...................................................................................................... The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. ? -. ' 41- a C� .VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. Al ...............................,/......... ........................... BUILDING INSPECTOR NORTF, 0VV`nAndover o� "-coc L <� dover, Mass., , Hlc2 �` ADRATED P'P�,C`� S BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......P .��..��...........�® �`�� Z- ......................................................................................................... � Foundation I hasp l......... buildings on ...... �S v �^ r•e �j U� permission to erect..a. ?�...........� . ..................................��.//........................................ Rough to be occupied as... 00%1)•! ad //iV�>l�r...../ T1 �r�....�c•d Z �t1 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 anF�� aws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 0/ / /) g PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. / Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C. Rough J ........ ............ ....c............................... 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner • Street No. SEE REVERSE SIDE Smoke Det. Location �� S v ° r q ' No. j Date 11 U NORTH TOWN OF NORTH ANDOVER • - s • . Certificate of Occupancy $ s,��N�S tBuilding/Frame Permit Fee $ a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ d Check # 1 13378 OJ18 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: ^ DATE ISSUED: 3` 7 SIGNATURE: .� C Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION e 1.1 Property Address: 1.2 Assessors Map and Parcel Number: `6 S .1 Z 2�Pi7 � ►Z 01 4 C?v3y 2 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin Dist rid-rictPrODosed Use Lot Area Fronts fl 1.6 BUILDING SETBACKS ft Front Yard - Side Yard Rear Yard R red Provide Required Provided Provided 1.5. Flood Zone Information: 1.7 water Supply M.GLC.4o. 54) 1.8 sewerage Disposal system: i Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT e n 2.1 Owner of Record P,-4--e 2 L u 2-e .J i (o y, S 2.may 1� rZ Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: C 2 Signature Telephone n' SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ to Licensed struction Supervisor: S (� 5 l License Number err MT Address 'Te"— 9ls Expi noxa Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ j-e 5y v4 3 v� \ oI-,% t KLA --oje k� 5, Company Name l 1 -.�- C3 ,- C' I 3 (41. (( S Registration Number r Address , ( I l r 7 -Z t5 U - / o .3 Expiration Date Si natur Telephone i 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.......6Y No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building Q Repair(s) 0- Alterations(s) Addition ❑ i i Accessory Bldg. 0 Demolition 0 Other 0 Specify I Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit applicant 1. Building (a) Building Permit Fee 3 d 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 et b'C) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUR DING PERMIT I, �=ti--� �Tas Owner/Authorized Agent of subject property Hereby authorize 3 A�-. S 'Z S}✓� to act on My behalf 1 11 matters relative work authorized by this building permit application. Signature oVOwner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 0 C'_ 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 + �1 Print N Si ae of Owner/A gen Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TDvIBERS 1 2ND 3 SPAN DRx4ENSIONS 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 The Commonwealth of Massachusetts J Department of Industrial Accidents ' Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit r Please Print Name: A,,o--S S Location: c- ---- City To P5 F i r t c) (V-\ A . Phone <6 }.a a �. am a homeowner performing all work myself. 2Ttram 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. Com )any name: Address City: Phone# I Surance C oli .. Company name- Address City: Phone# Insurance Co. P0 int# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the i and/or one years'imprisonment as well as civil mposition of criminal penalties.of a fine up to$1,500.00 understand that c Penalties m the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I copy of this statement m be forwarded to the office of Investigations of the DIA for coverage verification. I do herby certiry under the pains and pena#ies of perjury that the information provided above is true and correct: Signatures Date_ 2Zj /aa Print name Phone# c1'+% W3-— Official use only do not write in this area to be completed by city or town official' ❑Check if immediate response is required [] Building Dept Building Dept ❑ Licensing Board Contact person: Phone#: ❑ Selectman's office ❑ Health Department ❑ Other 4 WORKMAN'S COMPENSATION TOWN OF NORTH ANDOVER of NoaTt�q Office of the.Building Department Community Development and Services � p 27 Charles Street. * ; North Awdover,Massadiusetts 01845 �RSs•�cKus t� D. Robert Nicetta, Telephone(978)688-9545 Building Commissioner FAX(978)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: v D-(e S O S A 1 V'�c3 Z r7 Q J �✓v�� (Site location) SignatXe of permit applicant Date Michael McGuire,Local Building Inspector James Decola,Electrical Inspector James Diozzi,Gas/Plumbing Inspector NORTiy Town of And No. q y q * _ a dover, Mass. c3 D O COC MIC KE WICK ' ' �oR .P5 ATED P �`�� 7v BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ROW4.0% ��oBUILDING INSPECTOR THISCERTIFIES THAT.......................... .............. ..r..�..................... .............................................................................. Foundation has permission to erect................ .............:......... buildings on ......... .............#%V.6t........ Rough ,3 ". .............. 3 v r rrr.... C% to be occupied as....... .`Ar'.�... !� ~ ......w...... .�................... .. ........... .. ........................ 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. n q / 3 4 '112 re.-OWW PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARELECTRICAL INSPECTOR L Rough OU0 ............ . . ......R........&................................................ 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. FEE REVERSE SIDE SIDE Smoke Det. Date. .�. .l`... ..?... .. Of a40RTN o� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,SSACHU$ This certifies that . .� . . . . . . .'. !.�... . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . .'.. . . . . . . . . . . . . in the buildings of . . .Z: . !? . ... . . . Z . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . .i, North Andover, Mass. Fee. .lti.?. . . . Lic. No.. . .�. . . . . �. �.,. . . . ! . . . .. `. . . . . . GAS INSPECTOR Check# 4281 l MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS F rr]NG (Type or print) Date..--) 17 -3 NORTH ANDOVER,MASSACHUSETTS ' Building Locations i, K S U /Re C/ Permit i Amount$ Owner's NameL v to -e New Renovation ❑ Replacement ❑ Plans Submitted ❑ rA w d C O w C N w z a a c SUB-BA SEM ENT BASEMENT i 1ST. FLOOR 1 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR ! 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 0 STH . FLOOR (Print or type) ` / n ec one: Certificate Installing Company Name ,� 'l„v�� /'v�— Li Corp. Address 51 n6 .V2* 5 ❑ Partner. -14 ,f ✓t/ A c/ J t g -2L� _ Business Telephone (� [I Ly 13.-Firni/Co. Name of Licensed Plumber or Gas Fitter 13 4) INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑/ No❑ Ifyou have checked yes,please indi to the type coverage by checking the appropriate box. Liability insurance policy Other type ofindemnity ❑ 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 Massachu S Gas ode an Chapter 2 of th eneral Laws. v By: Signature of Licens Plumber Or Gas Fitter Title Plumber f `� City/Town ❑ Gas Fitter Licens um er Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Date./.-.,!. : . .�: . ' 4c TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �SS CHU r� This certifies that . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . .' . .l t.t . . . �:�. .e�. F. ''. �.'. . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . ... . . . . . . . . at. . . . . .. . . . . . . . . . . . . .... North Andover, Mass. Fee.( . .' .' . .Lic. No.N ., . '.t. . t. . . . . :. �. . . . . . . PLUMBING INSPECTOR Check # 554 MASSACHUSETTS UNIFORM AP LI LION FOR PERMIT TO DO PLUMING (Type or print) NORTH ANDOVER,MASSACHUSETTS / Date Building Location (/ SJ g ►n`-C 4 Owners Name L tj (2 Permit# Amount T Type of Occupancy NewEur [3 Renovation Replacement Plans Submitted Yes No FIXTURES 1l. - (Printor type) Check one: Certificate Installing Company NamCorp. Y Ne �C ,`t- l �/� �E'(,?i✓�� -z_ / r- �� Address c 445 % D Partner. Business Telephone 1/1_ Q K- LO D-FrrmlCo. Name of Licensed Plumber: �- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond D Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance ..,Signature Owner D 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 installation performed under Permit Issued,for this application will be in compliance with all pertinent provisions of the Massachusetts State Pl bin Code n d Chapt 142 of the neral Laws_By: Signature oi T-icenseurjumoer / Type of Plumbing License Title KV 3 L, City/Town icL erase um er Master, Journeyman APPROVED(OFFICE USE ONLY