HomeMy WebLinkAboutMiscellaneous - 895 FOREST STREET 4/30/2018I ocation -
No.
Date
NORT►,
TOWN OF NORTH ANDOVER
Certificate Occupancy $
+ ; ,
of
S., CNUSES
Building/Frame Permit Fee $
•.
Foundation Permit Fee $
Other Permit Fee $
'
TOTAL
Check #
Building Inspect
SIGNATURE: x A116"Ow ,
Building Commissionerfl for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
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)
Public ❑ Private ❑
1.5. Flood Zone Information:
Zone Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
pe'te'r 4 wenn if ^ 51 mmsm 9qIS Roy- est Styect
a (Print) Address for Service :
�<<5
signatu a 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:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Tele hone
{ SECTION 4 - WORKERS COMPENSATION (X 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 .......0 No ....... 0
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ mt.erations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
d c% c)�i
n 2w nj�P�C1c-��G o� ex�S�c+'la 2C�
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL ItSEbNLY'.: ...
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
8®4
3 Plumbing
Building Pem it 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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , as Owner/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, ,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
Sienature of Owner/.
Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2 No 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
TOWN OF NORTHANDOVER
• Office of theBuilding Department
Community Development and. Services
27 Charles Street
North Andover, Massachusetts 01845
D. Robert. Nicelta,
Builrlirrg Commissioner
DEBRIS DISPOSAL FORM
Telethon (978) 688-9545
l /1X (978) 688-9542
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:
l �-u Vl S. �t j 6 r` Vl VA\1t/�
r (Sit, location)
• Signature of permit applicant
e --6— /�-, /,'s -
Date
Michael McGuire, Local Building Inspector James Decola, Electrical Inspector James Diom, Gas/Plumbing Inspector
N eCw a n�j� 1�a o P�►.� c ��
f``eSut�tAC� ekt5�' 1%`��� PP'plV
FORM - U - LOT RELEASE FORM � �K
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from
Boards and Departments having jurisdiction have been obtained_ This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
noun ammumAPPLICANT PHONE
ASSESSORS MAP NUMBER ) 0 LOTNUMBER I c3 1
SUBDIVISION LOT NUMBER
STREET `s'_2 S 1' STREET NUMBER
OFFICIAL USE ONLY
loommom RECOMMV� DATIMN Q...
.WN AGENTS...............Samoan
/mum Mason ......
4�7 70,07W.10o DATE APPROVED '! 1apd Z,
CONSERV N ADMH-HS TOR
DATE REJECTED
DATE APPROVED
TOWN PLANNER
DATE REJECTED
CONRVHNTS
DATE APPROVED
FOO INSPECTOR - HEALTH DATE REJECTED
h" \,- 1, ( �,& DATE APPROVED (o Z
SEPTIC INSPECTOR - HEALTH
DATE REJECTED
coNrrrlE m az-> e
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMIIV'r
DATE REJECTED
CON VffNTS
RECEIVED BY BUILDING INSPECTOR DATE
S
Ksi
D. Robert Nicetta
Building Commissioner
(978) 688-9545
. •'(978) 688=9542 Fax
Please print
DATE
Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 01845
HOMEOWNER UC -NSE EXEMPTION
JOB LOCATIONA K. "/ 1"7%Y `ice - -17
dumber Street Address Map / lot
"HOMEOWNER
Name Home Phone Work P
PRESENT MAILING ADDRESS
City Town State _Tip Code
The current exemption for "homeowners" 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 on 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 SIGNATU
APPROVAL OF BUILDING OFFIC
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^� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING 1
(Print or Type)
;�11146 vel. M'�, amass. Date 19 Permit #
U1Buil141
ding Location !, O{ �e�% Owner's Name
Y , l / / Type of Occupancy R r-_5 i oF_Kl-r A,
1 New Renovation ❑ Replacement ❑ Pians SuVZtted: Yes❑ No,fa
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installing Company Name CLAY 5TATF C.AS CD (PKoPANF) Check one: Certificate
Address55 M A RS i Diel ® Corporation CSA C,
!_A VU R EtJ C p HA 01841 ❑ Partnership
Business Telephone_ 5 O R - t', 8 7- I ( n S '-�—� ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter J -
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ❑ No ❑
if you have checked yes. please Indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ . Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner[] Agent ❑
hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene ws.
By T e of License: - .._._._ r._.._... .._
Plumber Signature of Licensed Plumber or Gas Fiter
Title Gastitter
Master License Number i� — A-2 q
APPROVED (O IC[Yf-- Journeyman
installing Company Name CLAY 5TATF C.AS CD (PKoPANF) Check one: Certificate
Address55 M A RS i Diel ® Corporation CSA C,
!_A VU R EtJ C p HA 01841 ❑ Partnership
Business Telephone_ 5 O R - t', 8 7- I ( n S '-�—� ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter J -
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ❑ No ❑
if you have checked yes. please Indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ . Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner[] Agent ❑
hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene ws.
By T e of License: - .._._._ r._.._... .._
Plumber Signature of Licensed Plumber or Gas Fiter
Title Gastitter
Master License Number i� — A-2 q
APPROVED (O IC[Yf-- Journeyman
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SL P �Y IE Date .
f NORTH 1
AP►� TOWN OF NORTH ANDOVER
O t,.Eo ,etiO
rGAS INSTALLATION
No A
This certifies that ......... .... . ,
has permission for gas installation ............................
in the buildings of ..........................................
at ... , ............. .... . ............ . North Andover, Mass.
Fee.......... Lic. NO........... ..........................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
z� L 1 Date .... -Ala.
.
NORTH
,4,
O 9
sAcmU
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... On ....... (.............�................................. U....
has permission to perform ........ ''
wiring in the building of.�.:...:!.......
............ ...................................................
......,,/,North Andover .M
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Fee..,% .5...i�. Lic.No./.%���.....� �......... .::�.-n..:,.".. ....... .............
ELECTRICAL INS 4C R
Check # D 6,
14
(� Oltice Use Onh �%%
The Commonwealth of Massachusetts - P—a N. 7 o V
Oampanty d& Aw Ctw&ed
Department of Public Safety 3/90 (lows bunk)
BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12M
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be paionned In accordance with the Massachusetts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL IK'rOMSMON) Date
City or Toga of /J h/YDdyC''Jp- To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical Work described below.
Location (Street b dumber) F•9f
Outer or Tenant P€ 7-62 'S / M 4 N S 0 IJ
Owner's Address
Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box)
Purpose of -Building D60 c- t CI Nh Utility Authorization N0.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Serzice Amps / Volts Overhead ❑ Undgrd ❑ No. of Y.eters
Number of Feeders and Ampacity
4cation and Nature of Proposed Electrical Work W / /Z'l� /�i QT T` B
No. of Lighting Outlets
u
z No, of Lighting Fixtures
i
No. of Receptacle Outlets
•
No. of Switch Outlets
uNo. of Ranges
x
No. of Disposals
n ✓ No. of Dishwashers
=� No. of Dryers
z
W No. of Water Heaters
s
4 No. Hydro Massage Tubs
OTHER:
Yo. of Hoc Tubs
Swimming ?ool A8rr
No. of Oil Burners
No. of Gas Burners
No. of air Cond.
No. of Heat Tot;
Ponos Toi
Space/Area Heating
,Heating Devices
No. of Transformers 0.
In-. grnd❑ ICVA
Generators
�No. of Emergency Lighting
Battery Units
(FIRE ALARMS No. of Zones
tons
Total
no, 11L
KW Sens Ballasts
0
IM
No. of Motors Total HP.,
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local ❑ Municipal❑ Other
Connection
Low Voltage
INSURANCE COVERAGE: . Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES ❑ NO ❑ I have submitted valid proof 'of same to this office. YES ❑ NO ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE 0. BOND Q OTHER p (Please Specify)
Expiration Dace)
Estimated Value of Electrical Work S
Work to Start ����f r} Inspection Date Requested: Rough Final "��/�Q�
Signed under the penalties of perjury:
FIRM NAME ` /1JF� ELf� JC RI Ca /N C LIC. Mn. Al 0(S9
Licensee DAy ID 1)'ENr/?CM a -7— Signature jV J LIC. N0. 61 % lo.V4
Address g !3ARPOSt DF RD13 OA PORI) PIA Bus. Tel. No. Q7¢^ 8 8 7 -,(/.A PA
11 Alt_ Tel. No. 47?P- tt %^ AXk Fitt\
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
application Waives this requirement. Owner Agent (Please check one) �0^ 0