HomeMy WebLinkAboutMiscellaneous - 79 KARA DRIVE 4/30/2018NORTH ANDOVER BUILDING DEPARTMENT
.1600 Osgood Street
North Andover
Tet: 978-688-9545
Fax: 978688-9542
BUSINESS FORM FOR TOWN CLERK
DATF-:�I[n�nyU�
NAM:
ADDRESS: I✓�G wV VIA
9,
ZON. NG DISTRICT:
TYPE OF BUSINESS: J �,UV ices �S v lCC �►� i n ,�iNQ f
13U7LDTNG LAYOUT PROVIDED:_ YES
AVAILABLE PARKING SP ACP -S:
ZONING BYLAW USAGE: YES
J
— C -E:
BUILDING INSPECTOR SIGNATU IE
IMINESS FORM FORTOWN CLERK
2.40 Home Occupation (1989132)
An accessorSr use conducted within a dwelling by a resident who resides in the dwelling as his principal
address, which is clearly secondary to the use. of the building. for Hiring purposes, Home occupations shall
*iiicliide, "but not 'limited to the following uses; personal services such as fl niished by an artist or instructor,
but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of
retail business, or the manufacturing of goods, which impacts the residential nature of the neighborhood,
4. For use of a dwelling in any residential district or multi f roily district for a home occupation, the
following conditions shall apply:
a, Not more than a total of three (3) people may be employed in the home occupation, one of
whom shall be the olvner of the home occupation and residing in said dwelling;
b. The use is carried on strictly within the principal building;
c. There shall be no exterior alterations, accessory buildings, or display which are not customarY
with residential buildings; •
d. Not more than twent , five (25) percent of the existing gross floor area of the dwelling unit.
so used, not to exceed one thousand (1000) square feet, is devoted to'such use. In
connection with
such use, there is to be kept no stock in trade, commodities or products which occupy space
beyond these limits;
e. There will be no display of goods or wares visible from the street;
f. The building or premises occupied shall not be rendered objectionable or detrimental to the
residential character of the neighborhood due to the exterior appearance, emissiozi of odor,
gas, smoke, dust, noise, disturbance, or in any other way become objectionable or
detrimental to any residential use within the neighborhood,
g. Any such building shall include no features of design not customary in buildings for residential
use.
TAUav- l y, 7�7/:3
Signature Date
0
Location !
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ as
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ C:R 5
Check #
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:
SIGNAI C -Q-9-
Building Commissioner/Inspector of Buildings Date
SEC 11UN 1- S11E I-NYUKMAIION
1.11 Property Address:
1.2 Assessors Map and Parcel Number:
l ` ✓�1 7D
Map Number
Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
0�GA'
3� ►
Zoning District Proposed Use
Lot Area (so
Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Required
Provided
v
1.7 water ly M.G.L.C.40. 54)
1.5. Flood Zone Information:
1.8
Sewerage Disposal System:
—A,
Public Private ❑
Zone Outside Flood Zone
Municipal
On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
N me (Print) Address for Service
��v Z
Si ture Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: V O�573y 11
1
License Number
dress
2--
�1�`
3 3 J Expiration Date
Signa re V Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Y Registration Number
rss
7 Expiration Date
Si na ure Tele hone
A. ,
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 .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check all
applica7e-�),
New Construction ❑
Existing Building ❑
Repair(s)
Alterations(s) 0
Addition 0
Accessory Bldg. 0
Demolition ❑
Other
❑ Specify
Brief Description of Proposed Work:
c r--- l
1 1 J
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
C}FICIAL7SlE ONLY
1. Building
�)
(/
(a) Building Permit Fee
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
UL%
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUII.DING PERMIT
1, C L 4-'0- ( � � ,; s as Owner/Authorized Agent of subject property
Hereby authorize to act on
y bel all ma ers
:,2=e to work autho d y this building permit application.
WJ 1-/ ZZ
!Vgnature o Owner Date
SEC ION 76 OWNER/AUTHORIZED AGENT DECLARATION
IZZZ-
I, C' V� wi 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 n -
L� l
'nt N
Si e of Owner/A ent
NO. OF STORIES
Date /
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINIBERS >( 1
2 ND 3 RD
SPAN
DEMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS _ �_-
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING ' 1�
MATERIAL OF CHIMNEY �-----
IS BUILDING ON SOLID OR FILLED LAND r'
IS BUILDING CONNECTED TO NATURAL GAS LINE
Town of forth Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax. (978) 688-9542
DEBRIS DISPOSAL FORM
No RT.
of 0004
04 4
SSAG�IUS��
In accordance with the provisions of MGL c 40 s 54, and. 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 IL sI 50a:
The debris will be disposed of in /at:
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
Name
The Commonwealth of Massachusetts
.Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02191
Workers' Comaensation Insurance Affidavit
Please Print
Location:
City We- %1\-�- V , L =. D lhlL/.i Phone #
I am a homeowner performing all work myself.
0 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: 1��.� ��, �.�, �, tS�L
Address ` gtyv S`
nnn,,y� Poliev l
## ,h'LL.,/(A.,, C- e,06q
Insurance.Co., ����.�.. �s�
Com pany.:name:
Address .
Cites Phone #:
Failureto sedure coverage w required under'Section 25A orMGL 152 earn lead to the iMposition of criminal penalfies of,a fine up to $1, *
and/or one years' iMpnsonment-as well_as_cii/il.Renattiesielha%rm-f-aSTQP.WDRK-ORDER..and_aline_o(l$IDOM)-a-day_againstme I
understand that a copy of this statement may be fotwardedto the Office of Investigations of the DIA for Coverage vetification.
l do hereb ce ify und�v'�i ains a d penalti�s^gf pe9uJbaHzinformation provided above is true and correct
Print name �,�a. � ti /� �r.{�1.., Phone.# k 60 -5-33,Y'
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
El Building Dept
OCheck if immediate response is required 0 Licensing Board
p Selectman's Office
Contact person: Phone A- ❑ Health Department
Other
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Date ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............... T.<..< ...� -- 1'�' (t, ( (c/ - J."IC
............................................................
has permission to perform .......... ....... . .....................................
wiring in the building of ........ ....... 0'..( ... t ...................................
at ..............7.7...X� ................... North Andov,!;p*,Aass
-7[
Fee .... .... Lic. No.
ELECTRICAL INSPECTOR
Check #
6
_ (fommonwea(lh o� ti'!addaclurdejjd Official Use Only
Permit No.
1Jeparintenj a�.}ire �ervicad
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/99 rl�..P ht�„t•, --
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perlbrmed in accordance with the Massachusetts GJeetricni Code (,MCC), 527 C1%lR 12.00
(PLEASE PRINT IN INK OR TYPE, -1 LL iNFOR ,1710N) Date: �Z
City or Town of: To the Ins7ector of 1•Vilres:
By this application the undersigned gives nohcc of his or her iutentiou to peIr
rm the electrical work described below.
Location (Street & Number) / 97 r.A1?A L i, j
Owner or Tenant
Owner's Address
Is this permit in conjunctionwith a 4uilding permit? Yes ❑
Purpose of Building Si L1
Existing service r\nips / Volts
Neiv Service Anips ! Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Telephone No.
No r
j (Check Appropriate Box)
Utility Authorization No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
r....._r_.-.. --�.f. _ , "
No. of dieters
No. of ZIeters
No. of Recessed Fixtures
�r u,e rououur�
No. of Ceil.-Susp. (Paddle) Faits
amte nrav be n•aived by the 1ns cctor o% (Vires.
No. of Total
Tratisforniers KVA
No. of Lighting Outlets
No. of Ifut Tubs
Generators hl'A
No. of Lighting Fixtures
(SwimmingPool Above ❑ ln- ❑
t 0.0 mergency lg itnig
2rtid• grad.
Battery Units
No. of Receptacle Outlets
INo. of Oil Burners
FIRE ALARMS INo. of Zoites
No. of Swifches
INo. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Coud. Total
Tons
No. of Alerting Devices 1
No. of Waste Disposers
Heat Pump I Number
j Tons ! K1V_
No. of Self -Contained
Totals: I
I
Detection/Alerting Devices
No. of Dishwashers
(Space/:area Heating KNV
Local ❑ Municipal El Other
Connection
No. of Drvers (Heating
AppliancesI�\;:
Security Systems:
No. of Water INo.
of* Q. of
No. of Devices or Equi valent
Heaters KVv
Si,iis Ballasts
DataNo. of Devices or Equivalent
No. Hydroriiassage Bathtubs INo.
of MotorsTotal IIP
I'clecommunications Wiring:
No. of Devices or E uivalent
OTHER:
.911aur aaditional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVERT\GE: unless waived by the OWI.ter, no permit for the performance of electrical wort: may issue unless
the licensee provides proof of liability insurance includir,_ "con;oleted operation" coverage or its substantial equivalent. The
undersiencd certifies that such coverap-e is iii force, and has exhibited proof of same to the permit issuing office.
CHECK O\E: INSUR.,INCE Z BOND ❑ 0.1-IIER ❑ (Snecify:) Cr%< ' `I -;>,r: C
Estimated Value of Electrical Work:
(Expiration Date)
(When required by municipal policy.)
Work to Start: Inspections to be requested in accordance witli iV1EC Rule I0, and upon completion.
I certlfj-, under the pair and penalties of perjun-, that the information on this application is true and complete�.1
F1101 NAME: 1 L H LIC. NO.: S
Licensee: S;/tom%. /✓�,C' ,/,? Sibnature / Zrt/— L1C. NO.:
(If applicable, eater "e.rrmp(" ur rhe license ruunb� line.) ti /
_ 7 S y L iii '!�/li�'//YG Ct�t� ��.��i��.�i�Z O/S� Bus. Tel. No. >/* L/0 "--
Address:
All. Tel. No.:
OWNER'S INSLIZ'ANCE VVAIVEIZ: I am aware tltai the Licensee does nothave the liability insurance coverage normally
required by tau. 13y :riy si,_nature below. I hereby waivc this requirement. I am the (cheek• onc) ❑owner ❑owner's aeon .
Owner/Agent
Signature 1'eleplione \o. PI'R:1fIT FEL: S