HomeMy WebLinkAboutMiscellaneous - 7 HEATH ROAD 4/30/2018 (2) 7 HEATH ROAD `
210/060.A-0005-0000.0
� `1
'F Location
a No. Date
MOATM TOWN OF NORTH ANDOVER
3? � .SOL
Certificate of Occupancy $
�'�s'••°''t�' Building/Frame Permit Fee $
S4CMUSE
Foundation Permit Fee $
Other Permit Fee $
' TOTAL $ O
Check # ��
�l
17299
f �' -Building Insp ctor
L/
1 TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED: _ - W
SIGNATURE:
Buildin Commissioner/I or of Buildings Date z
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
o
Map Number Parcel Number
1.3 Zoning Information: V(J , v"V 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 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 OWNERSHIP/AUTHORIZED AGENT "oLuriC IS r1Ct: eS No M
2.1 Owner of Record
An,-, Avvpa p9-7y✓1,�}- `1 7-x`39-�1,4 21 N, dWf--,M01
Name(Print) Address for Service
3
Signature Telephon
2.2 Owner of Record:
Name Print Address for Service:
z
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES 90
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address � ()
NCV Expiration Date
S4gna-tirff Telephone
3.2 Regnistered Home Improvement Contractor Not Applicable ❑
Company Name so CZ M
CNt Registration Number
rMrt
Address ^-� yXSEM
c, / ExpirationDae T ^
Signature Telephone Y
SECTION 4-WORKERS COMPENSATION(XG.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:
2i z4-� ( '-c w,1A0 o VJ S
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be (} C ;,;[jSE
Completed by permit applicant ,
1. Building j) (a) Building Permit Fee
I .dD 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
OWNERS AGENT ORCONTRACTORAPPLIES FOR BUILDING PERMIT
ER
I, I \ I' C LTOC,� fJLJ�� as Owner/Authorized Agent of subject property
Hereby authorize C C UC;_7 C-0 to act on +
My b m matts relativ to work authorized by this building permit application
_Signature of 6wner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, R ( C W�z4p 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
R, v
Pri ame
G `
Si a ure of Own"
nt Date
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIlVIBERS iST 2ND 3RD
SPAN
DIMENSIONS 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
NORtil
TO" of
-W .
No. i
V- Z^ _x= M% v �D
1` 0 LAKE _O over, l� ass.'
COCMIC KE WICK I.
ATED PP5
V BOARD OF HEALTH
PERM . Food/Kitchen
I
Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT.......................`......................... ......... ................... '. ....:.....'.................:.....:..... ..�............................ Foundation.
has permission to erect..............:.........#.............. buildings on .... .. ................�....................... Rough
7
tobe 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. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMU EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION S T Rough
............................... ... ....... .................... Service
B DING-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.
1
1
BOARD OF,SUILDIHG REGULATIONS`
.� License "CONSTRUCTIQN SUOR
PERVIS
aw►; 1 t
Number.'CS 050710
f
B i rt h da te:,.04/22/1956
t
,. t
Expires: 04/22!2005 Tr:no: 9641
Restricted::00
RICHARD A FLUET r `A
102 BRIDLEPATH LN `, r
METHUEN, MA 01844
Administrator '
371. �� �✓ll ,
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration 106620
Expiration 7%24/2004
Type Pnvate Corporation
'RICHARD FLU ET;CONTRACTING
Alchard Fluet
102Bridle Path Lane �
""Methuen,MA 01844 y
Administrator
r
Z u The Commonwealth of Massachusetts
" Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
Name Please Print
Name:
Location:
Cit rL Phone #
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.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 penalties of,a fine up to$1,500.OD
and/or one years'imprisonment-as xvell,as_civil..penaltiesin-theJormnf-a_STOP WORK_ORDFR_and..a.fine_of-(.$1.00.0D)_a day.againstme. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
l do hereby certify ins ando6na re perjury that the information provided above is true and correct.
Signature Date--Z4
�7
Print name U 1 �� A-, P.hone.#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
Building Dept
❑Check if immediate response is required E] Licensing Board
Selectman's Office
Contact person: Phone#: E3 Health Department
Other