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HomeMy WebLinkAboutMiscellaneous - 7 COURT STREET 4/30/2018 G C Location 2 �.7 f No. Date ,4ORTM TOWN OF NORTH ANDOVER i Certificate of Occupancy $ Building/Frame Permit Fee $ s�cNusE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ti + Check # i ; O / Building Inspe for • TOWN OF NORW ANDOVER BUDDING DEPARTMENT' ►PPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A_O1VE OR TWO FAMIIsY.DWELLING w_... )UR DING PERMIT NUMBER: 7D7A ,ISSUED: • -off; IGNATURE: Building Commissioner rofBuildings Date r ECTION 1-SITE INFORMATION 1.1 Property Address: 1•.2 Assessors Map and Parcel Number: O -7 CWI�T 5 i M Number Parcel Number 1.3 Zoning Information; 1.4.. Property Dnneasions: . nm DistricttJse Lot Area FraRa & , 5 BUILDING SETBACKS ft Front Yazd Side Yrdf f Rear Yard Rzqu• Provide provided Provided Water supplyALGLr-4o. ser) ls. Flood zowhdonnsem: sawmge"Mal bysicn,. clic [7 Private ❑ Zone Ootd&Flood zoee ❑ Municipal ❑ — - Oat Sne 13rsposal Systeoa (I ;CTION 2 IpROPERTY OWN19RSHIP/AU HORIZED A� i— �I Owner of Record :. ...� .•.; a:=•. m JYC F RLP N °-'7 (r rry►-T S i Ivor ?rtjt)f V 6 me(Print) Address for Service: `" t 6 nature 75 3 Telephone � Owner of Record: i ame Print Address for Service: O z nature Telephone m `TION 3-CONSTRUCTION SERVICES �p Licensed Construction Supervisor. Not Applicable 0 nstzl•Construction Supervisor GIA.. License Number Fess -7'7,? 07 es UCS afore Expiration Aate Telephone ,�. Zegistered a Improvement Contras Not Applicable ❑ pany Name Registration Num lber ess - �-l/ 0.3 lure Tele hone Exp�ratron Date 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.......0 SECTION 5 Descrition of Pro .. ed Pork checkaRapplicable) New Construction 0 Existing Building 0 Repair(s) . 0 Alterations(s) 0 Ado O' _ Accessory Bldg, ❑ took—ti on vOther ❑ Specify Brief Description of Proposed Work: � d lilODE G � —�,� vim,►-r-Y 'm/J-g TION 6 ESTIMATED CONSTRUCTION COSTS Estimated Cost(Dollar)to be Completed by permit Applicant Building (a)` Building Permit Fee Multi tier 2 Electrical (b) Estitna#ed'Total Cost of Construction 3 PlumbingBuilding Permit fee(i.)_x(b) 4 Mechanical gffAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED"WHEN OWNERS GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property authorize to act on half, 1 ptters relative to work authorized by d&building permit application. T �i vZ% ot9 Z S' 'e f Owner Date t f SEOIfTON 7b OWNER/AUTHORIZED AGENT DECLARATION ; property as Owner/Authorized Agent of subject 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 afore of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T VIBERS iST 2 ND 3RD SPAN DRAENSIONS OF SILLS DR%4ENSIONS OF POSTS DIIv1ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIvIIdEY IS BUU DING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents t Office of Investigations, Boston, Mass. 02191 f Workers'Compensation Insurance Affidavit Please Print Name: SRT �.�t- �' U / /\J Location: ���� .S'� �J©- PrtJJ70VF_ City d-)O Phone T-? 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 Co. _ Policv# Company name: Address City: . Phone# Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penal es.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 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 er t ins and penal of perjury that the information provided above is true and correc t Signature Date Print name_ v A i L. �. �I/✓ Phone# 27 t����'6 a ` Official use only do not write in this area to be completed by city or town official' Ei Building Dept []Check if immediate response is required Building DeptEl Ucensing Board p Selectman's Office Contact person: Phone#: n Wealth Department 0 Other RM WORKMAN'S COMPENSATtO)v (ZErAobi-- 3 1 C 5. C)o ;X, . TOWN OF NORTH ANDOVER of NoeTr�� Office of the.Building Department Community Development and Ser<<ices 27 Charles Street. North Andoi7er,Massachusetts 01845 39SS�CHO t D. Robert Nficetta, Telephone(978)688-9545 Buffifing Commissioner FAX(9;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) MAP- L Signature of permit applicafit Date Michael McGuire,Local Building Inspector James Decola,Electrical Inspector James Diozzi,Gas/Plumbing Inspector BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR r Number. CS 002685 1 Birthdate: 02/24/1947 Expires: 02/24/2004 Tr.no: 17862 Restricted: 00 ROBERT M LANGEVIN 795 DALE ST N ANDOVER, MA 01845 Administrator fee �!'ani�na�iuwa�l�e a�. Aoard of Building Regulations and Standards License or registration valid for individul use only =f �i before the expiration date. if found return to: HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards One Ashburton Place Rm 1301 •:� Registration: 111990 Expiration: 2111103 Boston, la.02108 Type: DBA / ROBERT LANGEVIN BLDG&REMRbr �/ I GEVIN q�4 795 DAL LAN ���pw, / 795 DALE ST Not valid without signature N ANDOVER,MA 01845 Administrator TOMM . 0 4Andover No. q �q _ o,� COC L MEWIC0K dover, Mass., ADRATED P? C:) S H E BOARD OF HEALTH Food/Kitchen T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT 1111..... .�..........PERM !j .... 1111. ................... Foundation buildings on ..... ...... g has permission to erect.............................. ................. ....................... Rough t0be occupied as....1111.. .............woo............. ......•�! ................................................................................ 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 CONSTRUCTIONS TS 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. L___SEE REVERSE SIDE smoke Det.