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HomeMy WebLinkAboutMiscellaneous - 9 HODGES STREET 4/30/2018 (2)WN 1-NoLocation �" +e S S1- No. . a Date Check # 3 a -/b -()a TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ $ K 16076 ,'1, /M, %�-�-- Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Section for Official Use OnI s BUILDING PERMIT NUMBER: DATE ISSUED: � 16 0 C— SIGNATURE: Builft Commissioner/ ddor dBuildings Date NOUN' 0 P -MIN, N 1.1 Property Address: 1.2 Assessors Map and Parcel Number: A Map Number Parcel Nurr*, 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage (R) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Reqwed Provided ReTund Provided 1.7 Water Supply M.G.L.C.40. §754)- 1.5. Flood Zone Information: 1.9 Sewerage Disposal System: Public 0 Private 0 Zone - Outside Flood Zone 0 municipal On Site Disposal System 0 2.1 Owner of Record 14ame (Print) Address for Service: Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable 0 Address License Number j C S� 0 -3 Licensed Construction Su so Construction "on , - 9 n K Signature 7 Xelephone 13 - U 3.2 Registered Home Improvement.Contractdr Not Applicable 0 Company Name_ t Registration Number Address /-�— Expiration Date Signature Telephone T M 0 YV 13 M 0 i X M Z 0 Z M 90 0 -n M r* r - Z 0i sErcrrorr ,� t�''QRK�Rs G�J�ENSA�l1Qx (���. � � f f, Workers Compensation Insurance affidavit roust 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 Yea .......❑ No ....... ❑ SEC')C)EOPi 5 ;PitOi1�SSIQNA�. I'�ESIQ� G`�3�TS�L�CiIE�N R'�tvl+:S �`{,����� SLU�:"iS Si3i�'�T+t3 CONSTRUCT IQl.12©LST 7f C► tail! �r 1♦ICC At?S,t GFt QF ECflS%15#'Ai 5.1 Registered Architect: Name: Address Signature Telephone , Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address j Expiration Date Signature Telephone Area of Responsibility Name Registration Number Address Expiration Date Signature Telephone Area of Responsibility NameC Registration Number Address 6 Expiration Date Signature Telephone Company Name: Not Applicable ❑ ; Responsible in Charge of Construction i New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s 1 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ZrA• ' a 4' 0 A-3 ❑ Independent Structural EngLneenng Structural Peer Review Requred Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Hereby authorize Owner of the subject property My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date to act on USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 0 A-3 ❑ ❑ IA 1B ❑ ❑ B Business 0 2A 2B 2C ❑ ❑ ❑ C Educational ❑ F Factory 0 F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ I-1 0 I-2 ❑ I-3 ❑ M Mercantile ❑ 4 0 R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage 0 S-1 ❑ S-2 ❑ U Utility ❑ Specify: M Mixed Use 0 Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: Independent Structural EngLneenng Structural Peer Review Requred Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Hereby authorize Owner of the subject property My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date to act on I, as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Own /Agent Date Item Estimated Cost (Dollars) to be Completed b t applicant P YP�i PP 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) , 3 Plumbing Building Permit fee (a), X (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number F+�2 'B t 7. ,.:`�ytf ) t• y., �' •,2 +'.:, t v »a i r' 'fie .t. nib.. c V iT�lx?r r {. �E• .2 e3hA ..,4 i it%� �r: S : Xi'h.�.� .i 1, J:,! Yt'.SaSi'�✓`4yY �_ ''6 i 4 > � x�t JFk f� ' 3 ^T�'KSY 43e 4 t •' s i 5 3d }1;dtiL,:P.i' �f > �.Sg4yNEE a 31 �y(��r .� t ✓J �... :.i '�I F 1:... Flt �+ / :F. �. y : Yl�Ft t,^5 F !(� �+ i P•+�a1- e k� '%-' �' � ?i`F'2- S 3 ��,_ M�k. ( Y�?' H k S �,;,y{' � ..'; .z'�� . „/%i, rssEn�d� u� x aw � 1 �' o- } � d � i F!_'�'•'., i. , f ..�,F.� � �Y YY . �.� � ��. .� a y'i\ P. xzN ix � NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TI1v1BERS I sr 2ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS 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 GASB LINE .F r,{ U. (r 42 3"r'�,4"£+R„+-{' n4 - .Y Y- ZY �fY Z Anr" ye`•Sv�..-Vd4.-w' 1KE y „tel SY �'Y'.,F - t �g`,a� 'r's,,.ax v ,-Z",y.. ,g } �k}= 2'i�',t Yl a� x k' t�, hiFt;t 5 ,Y4. iiifCx k t The Commonwealth of Massachusetts. Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print 0 Name: f?n % Dea 1C.= L.,Y Location: /N oma( — > City 0" + _ _ _ Phone # 97i 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 S- 2 e Company name: A/ z Address x City: Phone # i /L &-Z / r Insurance Co. Policy _# 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 $1,500.00 and/or one years' imprisonmentas_r+tell_as_cb iI.penaftiesinshe-fam-ofa STOP WORK.ORDFR.Anda.fine._of_(.$1IlO.OD)-atlay.against.me. 1 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 under the pains and penalties Signatu V provided above is true and correct. Print name s e—:� A CT- 4, Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina. E] Building Dept ❑Check if immediate response is required .0 Licensing Board p Selectman's Office Contact person: Phone #: E] Health Department o Other 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: Location of Facility) Signature of Permit A licant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Cb z M W Co oij da v 0 w°:2 O � coo= a m .03 cto w° PO4 v U Coo w OO± a Cd a2 w O w nr chi Co w H �r t:4 w W w G Co' ° z V) o cn z 0 w a 1 rz z O U C40l C* H .E CLL L C O Co V CL CO2 O V CA C O C.7 111-i d CO r�l HCo L .0 Co L oa a � 4 � C cc J .fl O O Z CD CL CO) C LLJ C) U) LLJ U) Ir W CrW LLJ U) o O � coo= ' m c co C H r: O C rte• .'0 O nr C �t CO A l0 N S z 0 w a 1 rz z O U C40l C* H .E CLL L C O Co V CL CO2 O V CA C O C.7 111-i d CO r�l HCo L .0 Co L oa a � 4 � C cc J .fl O O Z CD CL CO) C LLJ C) U) LLJ U) Ir W CrW LLJ U) O � coo= Ea • o nr N S S w� U S ; ' m C N A :mm Ca Qf mo: go m J N C y C s O D O �: mo am . y m m � a: C = O Q! Co., o m C. Ca Z I O r C O C "E mpyd m� o fV H yoL.oF- 0 CO LU ze=zt •H y... C O C LU .E dL �.+ m •N w cv O Cm y a m� C- 2 A y'O z 0 w a 1 rz z O U C40l C* H .E CLL L C O Co V CL CO2 O V CA C O C.7 111-i d CO r�l HCo L .0 Co L oa a � 4 � C cc J .fl O O Z CD CL CO) C LLJ C) U) LLJ U) Ir W CrW LLJ U) U4p l-llam IIInwgal h at EiUBar4us, a j'Mrt1M %A111611111 l E partmrnt of public *ufctt! C — t'i ccs+pt�rx.Y: Fee pftsalJteo BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 yso 0611111" W APPLICATION TO PERFORM ELECTRICAL WORK performed (PERMIT accordance. All work to be with the Massacnusetts Electrical Code. 527 CJWA 12.Oa (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) 3 Q* at Town of NORTH ANQOVFR Date To the Inspector of Wife&: The udersiflned applies for a permit to rperform the electrical work described Location below, (Street iS Numoer) Owner or Tenant Owner's Address la this permit in conjunction with a building permit: Yes No C Purpose of Building Or�tc'-- (Check Appropriate Box) Utility Authorization No, Existing Service Amps _J VOits Overhead _i Unagrind No. of molars New Service Amps —J Vous Overhead Undgrna [ No. of Meters Numoer of Feeders ano Ampacny Location and Nature of Proposed Electrical WorK N0. of Lighting Outlets I No. of Hat -_cs No. of TranllOffhefe Total I, KVA No. of Lighting Mature!i Swimming P_o, aoc%,a — ,n. r I Srro — Sr^o — Generators KVA No. of Receotacte Outlets Z� I No. of O,I turners I No. of Emergency Lighting Battery units , No. of Swflen Outlets I No. of Gas=_rrers FIRE •►LRAMs No. Of Zonee No. of Ranges I No. of A,r Ccr.c. ;diet Nig. of Ostection and chs , Initialing Devices No. at Oisoosils I No.ol Heat o:a, 70 (a aur. =s No. of Sounaing Devices No. at Oiahwasnera INo. SoacerArea �eauca K`.v of Soil Cantalnsa OeteetionlSounaing Devices No. of Dryers I Hsaung Cev.cesKW Local '— Munrcio u Connection '- Other No. of Water Heaters KW Signs 3a-ias:s Low Voltage Wiring No. Hyara Massage iuos I No. of Malcrs alai HP OTHER: LoG9_1e `7` / 0 INSURANCE COVERAGE. Pursuant :o Ins reouiremenis --t .Iassac%sars ;enefai Laws 1 have a Current Liaoility In urance Policy mciuotng C„n=.stet Cceraiions Coverage or iia suoatamta1 equivalent. YE3 NO _ have suomihea valla of of same to the attics. YES '4O It you nave cnecxsa YES, pipe" inawAte We type of I Cnecxing the app nate cox. �e►ye oy , INSURANCE aONO = OTHER = (Please Scec.•.I i Eahmateo Value of E!ectncai Warx S �f7U (ExtWauon Oatet Wont to Start Inaascaon Jats %+ac�as:ec: Rough frfrai Sighed under the Penalties of penury: FIRM NAME .�'�� �' "r �?.z? CP7,c� UC. NO. 1 Liceneso S S-a:_rs /fir//i> �7�4GG/f.E' Ac. NO./.F6 4,�,� �S SJ— Bus. Tel. No. 6.r 2-62E 2_ AgoreaeL�- /,L� ��O r(� All. TeI. -10. 7Y' 7c— t OWNER'S INSUAANCE WAIVER: 1 am aware inat Ine licensee :ces �m nave ins insurance coverage or its suostanusi equlveierrt as rig, quriso by Massacnusetts General Laws. ano Inat my S,rnafure an ^.,s _em" a00itc2tion waives this 1`e0uuernem. Owner (Please checri OM1' Agent eteonone No. PERMIT FEE S . .. ($.g1latYle 01 QMN1N Of A9M11 N° 1 475 Date.��>�Q......C5� i f NORTH q , ".- '6."-0 TOWN OF NORTH ANDOVER PERMIT FOR WIRINGQ. r - This certifies that � Ili has permission to perform ............... ................. wiring in the building of .. ij t-��' at....,/...................................................................... . North Andover, Masi 1 Fee.25—.- Lic. No. 1.0 .a3f90 ...................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer H al_ . Y 0 0 m W F < w N L X N L M W W Z 3 Q 0 Z 0 J J W ac 0 La p 0 p O F Z W N W m g 0 f W O N i z m m 0 H N W s � 2 Z �C 0 a z �CIo. z o O 1- m �> J N y V �J\ N I o z < o z < 0 0 . N r WK K o L z u i i N 0 O o M Y W 9:;L z 0 F 0 L Z W IL L L n N z 0 u D L H z F O u O z < J 1 8 a W 9Z H 13 � o e N cx: dl01 1 z z t O O 1 t W W N IA t ~ ~ 1 N W O O 1Lw f k L t O N 0 W W W L% 1 W < < N L L 1 7 z �. W 9Z H 13 � o e cx: f 1Lw f L . z z �. J J LU LU V W 4 U 3 0 o O U u Z W 9Z H 13 � o e 9 HODGES St., NORTH ANDOVER RenovGtion Plan Scali- 3,/16" = 1)—Oil 11m q represents all new walls 3�� r � ! DEPARTMENT OF PUBLIC SAFETY i CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Birthdate: CS 658241 61/68/2666 61/68/1955 Restricted To: 86 r1 � RONALD S HEBERT l �162 ADAMS AVE N ANDOVER, MA 61845 a ... _ .� .� _ ...� ... ..r•m .� ,...... w..� <. v .. r ,r `...-rw- atirn ra-x�, W. _ . �� � � ,� ✓/I6 7009)NI10lN//00l(R O�✓dE�d. {. ' + HOME IMPROVEMENT CONTRACTOR j Registration 108450 type, - DBA Expiration 08/18/98 J-, ! R.S. HEBERT BUILDING & REMODE I !; Ronald S. Hebert I ' 4dams Ave, ADMINISTRATOR Andover MA 01845 Ad}.. lux t� ..,.--......... ..} ... _. • dls: �i� FORM tj - LOQ' RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and ^apartments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. PLICANT FILLS OUT HIS SECTION �. C�k ��c. r APPLICANT PHONE '17S 3Y2 --220S LOCATION: Assessor's Map Number 01 O(21 SUBDIVISION STREETZ�i�° **********OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED PARCEL0/' 10 / LOT (S) I ST. NUMBER °C'S COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT Z ---PM DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE s s� s., AC7 c c 'm a U c a PW c v o � a w c H a 7W a Cl V V �2 w H u)v a chi M•1 O 0 w 0 r� U G u: ac cc ev 0°4 —cow w a°' �o w a°G w cn U) F-; C/) z O z O U O v Q., co O ai ■ G3 Z a O CO) � C O rm CO) O ■O O— A02 O O 'i m to 03 co LM CL _- L O� 3� 0 o Cc O d a.ca cac ev a■ Oca Z , CL C � V H c C ■ C c CL 0 c c 'm c c v o � c H r Cl V V `�- ac cc ev c :t O A N it v� o 5 CD A- N 0 40 C2 C.2� . = t; cm O c E H�v o o ` � O N N N 3 ... Co v O N ca O Cc c H H c C N E O ;aC� N O C1 c c O Q � N d,Ct m O O v N O cc Z C ' C O d cm c Q : ►N. O C Q _ _ p A COL. O O F- W N 'E at C CX d 'oO y O 'O ��4-a�m> F-; C/) z O z O U O v Q., co O ai ■ G3 Z a O CO) � C O rm CO) O ■O O— A02 O O 'i m to 03 co LM CL _- L O� 3� 0 o Cc O d a.ca cac ev a■ Oca Z , CL C � V H c C ■ C c CL 0