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HomeMy WebLinkAboutMiscellaneous - 72 PATRIOT STREET 4/30/2018Location % AA T,2 o r No. 3 F(p Date D �aRT� TOWN OF NORTH ANDOVER 10. • .. 9 ; Certificate Occupancy $ ; of ;+ s'•^°' Eta' ACkUs Building/Frame Permit Fee $ Foundation Permit Fee $ Check # Other Permit Fee $ 7,0.6)0 — TOTAL $ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOV.A/yTTE,,� OR DEMOMLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 2 DATE ISSUED: SIGNATURE: 2VZ Building Coissioner/Insvector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 0 1 �- Map Number Parcel Number P" h l ©-- Cot`Net` ®� 3 el mon�t 1.3 Zoning Information:. Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 19 7r 1.7 Water Supply M.G.L.C.40. 54)° ­ 1.5. Flood Zone Information: Public ❑ Private ❑ ?one Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT i.1 Owner of Reco d /1� LL � vam R w op sor,% 7a O�-44a--r 5.7 N, A nV Ao ve4—' A'A--OIYW N me(P 'n Address for Service r ct rgnature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone 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 Company Name Registration Number Address Expiration Date Signature Telephone 9 O Z M 90 O Mn ic e r v M r r Z ^ Q SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 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 ....... 13 No ....... ❑ SECTION 5 Descri tion of Proposed Work check all licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 60-f -X6 t.,,4 U S ZX ro r"*r- 5/t 5-ic-& zX g �F, r>~ c� (� v G 1 I+ 3P ani SU c r+'t rar> t4C *-ff rW-1e-VLv4-1 c, SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant 4FFICIALU;;ENLy r 1. Building(a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) —704 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 t✓ 6 p S&pJ as Owner/Authorized Agent of subject property Hereby authorize 6' p i ow t cfot� to act on My beha all atter a ' e t wor authorized by this building permit application. is ier Date 11/1/03 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 Signature of Owner/A Ient Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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: Yi 1d60,0 5C,--An5 •To /" aJ W 'M 13 vCZ�N (Location of Facility) 1'i2 S &AtW4rW*0 n -n, &A.pWS,W", iv 0- 03 Z,zs' P� &-&-y a7w� pe -601 czZ=y ignat re of Permit Applicant 11/%3 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Tel: 978-688-9545 Please print. DATE JOB LOCATION Town of North Andover Building Department 27 Charles Street North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Ay,,4 o -r -5-r, /U ry Number Street Address "HOMEOWNER �/ cfn 479 Ono Number Home Phone PRESENT MAILING ADDRESS City Town State Pwa Section of Tc Work Pho Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of 1 or 2 units 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 of two there is, or is intended to be, a one family dwelling, attached or detached structures accessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the .building permit. (Section 108.3.5.1) 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 an that he/she will comply with said procedures and requireme OMEOWNER'S SIGNAT%lf€_ APPROVAL OF BUILDING OFFICI Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. Revised 4.30.03 Home owner Exemptions Form DEC -01-2003 07:05 PM N.H. INSIGNIA I WoNSO/� 603+396+4971 P.01 ��� I)o t3tjotl> se kl; )5 ^ �sl Le 5 "�f R -le E- -,� m m X m C m ,,m VI mm CD O 1 -w -w -M .. CO) .p CD 0 CA d O CO) C7 O CO) d CD 0 CD CD CO) CD CO) C cc ? S O C. cr w n0Sa y OCL yma� C2 Z =� y �_ 0, .-r C " d► d 0. T -4O m 0 p y N O m O : n 030 O m o y. C , G No", a o o ti C =r CA j co CL O O y : C d O : 0 OIIL O r+. d N ►� a �cCL y E;7 :6 . .. :6m C H �;Q0 a m� �D `~ to ti O 3 0 m O9 `� IL4 O 0 cc O1%a q . z y . JsCDCD �0 oCD:,��� 0 h ?V a C",� V] : H ' 1 0n p °' O ' � O a r �' O ►d 7+ w p OSo. °QQ a OI, Cd y O a tz omi 0 T Location X7 / v / r �t� No.F A76 Date —3a- 96 TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ ssACHUSE Foundation Permit Fee $ Other Permit Fee $�` Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector )2/% 09:59 25.40 PAID qQ w j,, 1 410 D' 15 bli W k PERMIT NO. 4 7e `/ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 L. - MAP d40. r % LOT NO. C>4C> 115. 2 RECORD OF OWNERSHIP IDATE BOOK '.PAGE Z N.E SUB DIV. LOT NO.I L/O/CATION PURPOSE OF iIG dd1rAl)6��� �D �` 'F�/'�' V Al WNER'S NAME NO. OF STORIES SIZE trW-NER'S ADDRlkSS ll BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND . WftC-BUILDING CONFORM TO REQUIREMENTS OF CODE 66- IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS , SEE BOTH SIDES '✓ I�Jt� �� ��/ N CY1Ls� 4 A3 % L o L - PAGE 1 FILL OUT SECTIONS 1 - 3 PVE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR PERMIT GRANTED r7''1.3019 9w 3 PROPERTY INFORMATION LAND COST -•EST. BLDG. COST r ` EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY 14 SUILDING INSPKCTOR O�EL. # CONTR. TEL. # CONTR. LIC. # H.I.C. # G� x`3/5 lo4lo-- BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY APARTMENTS _OFFICES _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH d 1 2 I3 PINE CONCRETE CONCRETE BL'K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA _ 1/1 1/2 �/� FIN. ATTIC AREA NO B M'T FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE B _ 1 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES EARTH HARDW 0 COMMCN ASPH. TILE ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY _ ATTIC STRS. 8 FLOOR BRICK ON FRAME I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR EQUATE NONE AD _ 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD A TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 22d . _ 1.1 13rd I ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. ...: . . .-.,; . . . . , T1 I . . l C� — y . 0 Q -.N . = s - Lj ,1 4. x 8 _ Q m �± `v - O ,4. MIA,. -.7 �Z O?. y.. ""'f �a tit �� t' ,.O O Cis w y,. •� { w . E Rtrrri`TM" '" - Y s - f�F � m � '�' ,' t4. O' rn ' � � } .. P-4. CD 4 ! , CD '�O O- TT� y Ys` I. 1 t .: ,- A ,4 .�'� �, + 5 dpi... V d a �t > . 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I m . - . ..- j' I- - . . -.%,T� , -1� I. t F O ,IL 110 PERMIT NO. o? -4 3 t APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE -1 MAP NO. LOT NO. I 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE SUB DIV. LOT NO. 7; LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE fT ! �7� OWNER'S ADDRESS / Q-. p �� BASEMENT OR SLAB r�� r-"` -t ,' �/�.�'°!.v{C�j-�lw,-.L �1�', - .. A ARCHITECT'S, NAME SIZE OF FLOOR TIMBERS IST 2ND `1 D BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING ^'r DIMENSIONS OF SILLS DISTANCE FROM STREET ,{ POSTS DISTANCE FROM LOT LINES — SIDE REAR /Q " GIRDERS - AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY 7 IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE t IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER - IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR PERMIT GRANTED 19 3 PROPERTY INFORMATION LAND COST .-ter EST. BLDG. COST wnw �l EST. BLDG. COST PER SQ. FT. V EST. BLDG. COST PER ROOM .SiWPIC'PERMIT NO. 136 4 APPROVED BY O BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR 0NIIV3H ONP'E 1Sl JI211J319 -I P"L llo SVO SWOOt 40 _ Sd31V3H 11N11 0.1,H 1NVIOV21 _ ONINOIIIONOJ tIV SN313Vd DOOM _ 210dVA 21(D d.1.M IOH •S10J '8 'SW9 13315 WV31S _ 'S10J 7 'SW9 d39W11 'Ntni NIV IOH 03JtO 3JVN21n3 SS313dld Is1of OOOM ONIMH ll II ONIWVti 9 OOVO 3111 21Oo13 3111 S321n1X13 Ni1300W ON1300f 1101 d3MOHS 11V1S 13AVdo 8 21Vi JN19wnld ON 31V1S NNIS N3HJ11N S30NIHS DOOM ,kNO1VAV1 S310NIHS ilVHdSV 13SOIJ 831VM 03HS 1V13 I'Xid Z) 'wit 131101 O2VSNVW 13HMO 'X13 £I H1V9 d1H I I 319VO ONlownld OL loot 5 3 aOOd �I i10ld3dns 3WVt3 NO 3NOIS ONIHIM ANNOSVW NO 3NO1S N19 d30N0 210 'JNOJ _I 3WV213 NO NJIdU 210013 8 'Sills JI11V kdNOSVW NO NJIii9 — � — WVdJNO OJJn1S A2I -- NOSVWOSVw NOoDDnis 3111 'HdSV `ONIGIOIS '1213 NOWWOJ ONIOIS SO1S39SV OJA021VH ONIOIS 1lVHdSV H18V3 S310NIHS DOOM E l 9 313dJNOJ ONIGIS SO21 UVlJ Mold 66 I6 sllVM v N3HJ11N N?13OOW WOON OV3H S3JVld 3211 1.W.9 ON V3dV JIIIV 'Nld N IA 71 V3dV .1.W.9 'NIA lln3 V321V 1N3W3SV9 E N13Nn IlVtA AK — — d31SVld S431d O.MCldVH 3NO1S 210 NJIa9 3Nld 'N.19 3138DNOD £ L 9 31383NOJ HSINId tO1t31N1 9 NOI1VONnoi Z N0uonHISN00 'Md1d 101d S30V-ld3U SIHl 'c33SOdwim3dns '013 'S3ov?j S1N3WidVdV -VV 'S3H:)UOd H11M 'SONICIlin9 d0 SNOISN3W14 lO`dX3 aNV S3N11 101 — S3JI330 Al1wv3 111nw WOMA 37NV.LSIa C3NV 10-1 d0SNOISN3Wla 10`dX3 MOHS1Sf1W NO1103S SIHl S31ao!s AIIwV3 319NIS Z I AONvd f1000 l aa033b ONiaiins