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HomeMy WebLinkAboutMiscellaneous - 697 WAVERLY ROAD 4/30/2018Location 9 WAy £ � � Y No. 0/4 Date NaRTh TOWN OF NORTH ANDOVER Certificate Occupancy $ of �'� s",•'°' t<� +cNus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # C 17438 /P/M`61-- 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: /a SIGNATURE: Building Commissioner/12sMtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: G9 -7 U-MvE tzce y 90,40 1.2 Assessors Map and Parcel 27 Map Number Number: Parcel Number Nb9TV �4Av0o1r&-2 , /�l.4 0/9¢9 Signature Telephone 1.3 Zoning Information: 1z f Zoning District Proposed Use 1.4 Property Dimensions: 7e+( Lot Areas Frontage (ft 1.6 BUILDING SETBACKS ft SECTION 3 - CONSTRUCTION SERVICES Front Yard Side Yard Rear Yard Required Provide Required Provided RegWred Provided 3.2 Registered Home Improvement Contractor Not Applicable 1.7 Water �S� GL.C.40. 54) Public LI' Ptiva[e ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: On Site Disposal System ❑ SECTION 2- PROPERTY OWNERSHIPIAUTHORIZED AGENT I! I J iU i i U u iZ� U i UL. r U 5 a V U 2.1 Owner of Record tL!P C 'PAiZS0r 9 Nam PWzal�v� idwv C�j7 W,4vc72/.fy R0,1D Address for Service 60 3 - 27S-- 065-/ -- Ceez- Signature Telephone 2.2 Owner of Record: MA1?y P PAP-90A.)s ,Name Prfnt c y Si nor Telephone C97 w4ve;.cey Address for Service: 6a 3 - Z75- OCC/ /ZpAo SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ©/ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable i, .ompany Name Registration Number idress Expiration Date Signature Telephone r SECTION 4 - WORKERS COMPENSATION (1VLG.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 buildinppennit. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ 1 Existing Building Repair(s) W-' I Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: YL S/,O/yG 1 SECTION 6 - F.STIMATFD C0NCTRTTCTu1N CncTc I Item Estimated Cost (Dollar) to be OFFICIAL USE ONLY Completed by permit applicant 1. Building 0 4do 0, Oo (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 LlD 5 Fire Protection / 6 Total 1+2+3+4+5 Goth. 00 Check Number aZ%_11V11 /a VW11r,KAU1riVK1GA11V1V 1V UL UUMYLELED WHE1N OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT t, , as OxNmer/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 . I, ?H I L 19 C 7�q 12S L tus 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 l -t l_l.l P C PA 2SOA)S Prin=�4A o la, wool Signature of Owner/Agent Date' NO. OF STORIES SIZE 3 BASEMENT OR SLABlqSe,0916_xL T SIZE OF FLOOR TINMERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY k / C 4 IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE YA. S 0 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: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Town of North Andover .. NaRTM ?ON�,.o ,•1�c Office of the Planning Department 3 ° s Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 �'Ss�CHtl`+��y h!W://www.townoftiorthandover.com Bob Nicetta P (978) 688-9545 Building Commissioner F (978) 688-9542 INFORMATION REQUEST BUILDING DEPARTMENT Please use this form if the Building Department is unavailable to provide immediate assistance. The building applications are available on the labeled hanging bins to the right on the partition. The forms are also available on the Town of North Andover Web Site www.townofnorthandover.com listed under the Building Department. Please fill out the attached form in its entirety to ensure an accurate and prompt response. All requests for information will be handled as soon as possible. CONTACT INFORMATION Dater /2 , ooi Name: PI -1 / L / P C 174 .GS" otiS Phone number: 9 03 - 13 7 - 1644d1-;0"-- A09 -,2 73"- 065/ (Cc--Gc it) Fax number: /YD n/C Address: 6 y 7 Ly lEiLC'� mA oldr INQUIRY Property in question: (Please include as much information as possible, e.g.: address; tax map and parcel number. 697 1aA11L-3?LEZ %240. Wff- 972, 11¢ -- WHine C'q!'e Inquiry: 4V0V1-D S,-Zz7f 7-0 wvyL <',o it /- /y& House, ,' i,)s'T1fe4 4 4C4'c y �i=f=r c;� r cvcA."'06&.s ( lel) Thank you for your interest and inquiry. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 �;'°•^•° rr"<�` D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE J Q Ly 12, 2 0©!f JOB LOCATION 691 VIA tJC►U-6 Ro/40 27 /+ Number Street Address Map / lot 0 "HOMEOWNER 'PH LL(P 0 'PA,RSoNS 6o,3-2 75-b6 5! Name Hotre Phone Work Phone PRESENT MAILING ADDRESS 697 WALK-&Ey R0A0 No(z n ANooVt---K M14 6 ( 845 City Town State Zip Code \J The current exemption for "homedwners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFF The Commonwealth of Massachusetts F Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: t-1 1 L (1� C ?A R 50 U -S Location: G 9 7 WA tl acy RoA p city NbQTId ANOOVERA MA 018+5 Phone # 603 275- 0651 I 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- Insurance. hone Insurance. Co. Policy # Company name: Address Citi 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 and/or one years' imprisonment.as.weD_as.civil.penaltiesin-the formof-a_STOP WORK ORDFRand_afine cf.($140-00)-a AWagainst.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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 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