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HomeMy WebLinkAboutMiscellaneous - 9-11 Merrimac Street` �- ' ' Location ,/ 'No. Date MORTII TOWN OF NORTH ANDOVER 4g Certificate of Occupancy $ 4u Building/Frame Permit Fee $ E r ` JACMUS Foundation Permit Fee $ Other Permit Fee $ a TOTAL $ f Check # /2 (/ Building Inspector t/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING YLBUILDING PERMIT NUMBER: DATE ISSUED: 17-3--to0 SIGNATURE: AAC60&� Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: Ok +M�Q(zx,:.•• ACS c 54n-Ck 1.2 Assessors Map and Parcel Number: Map Number Parcel Number O R'rk" y J.N, 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Franta e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 1)0tv917 6)1,y }- rte,-eaa: n,AL% Name (Print) Address for Service : Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: ��r.-•eS �e 5� �A Licensed Construction Supervisor: Address /mow `li Yj S%-7 — 203 3 Signa re Telephone Not Applicable ❑ S 6 C S 7) License Number Expiration Date 3.2 Registered Home Improvement Contractor Tes�ha i.rVR (� 12-ew•0fle Not Applicable ❑ Company Name Registration Number 1� 9� dd( 1J 4:11�-� R-7% - S8- - 3033 Expiration Date Signa. re Tele hone T M Z O O Z M 90 0 mn r M r _r z 0 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 aff 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( s7Alterations(s) ❑ 775iti on ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 'CxSisi-' 'Frza-J SC2-e�q.v "TN2 CNfS I SECTION 6 - F.CTTMATF.-n VnNCTR1TrT1nN rncTQ 1 will result Item Estimated Cost (Dollar) to be Com leted b permitapplicant _ (}ICA, 1. Building Oo d (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 Check Number OM-11LUA ra VW1NhKAU1riVK1L,A1lU.N -lU 1JE C:UMYLE'l'ED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize My behalf; in all matters relative to work authorized by this building permit application. Signature of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date to act on 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 of Owner/ Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3 RD SPAN DHAENSIONS OF SILLS DIN ENSIONS 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 k W III 0I k W MORTGAGE INSPECTION PLAN. AT 9- /l MERRIMA.CK S TREE NORTH ANDOVER, MA. NO. ESSEX REGISTRY OF DEEDS.' BK. 3948 PG. 290 PLAN NO. 270 CERTIFIED 70.'ANDOVER BANK SCALE.' I 30, DATE: SEPTEMBER 20, 1998 /00' 2� STORY�\E PARCEL 2 WOOD�FR,PARCEL l p p DWELL/NG \ t h \ WO GAR.\ /00, 70!1 NOTES. I) THIS IS NOT A PROPER Y SURVEY, DO NOT USE THIS PLAN TO ESTABLISH PROPERTY LMES OR TO ERECT ANY STRUCTURE. 2) PROPERTY LINES ARE DETERMINED FROM COMPILED INFORMATION TO BE USED FOR MORTGAGE PURPOSES ONLY. CERTIFICATIONS.' """'' BASED ON MY KNOWLEDGE, INFORMATION AND BELIEF I HEREBY CERTIFY THAT THE PERMANENT STRUCTURES INDICATED ARE LOCATED ON THE GRCUND APPROXIMATELY AS SHOWN AND ARE CONFORMING TO THE ZONING SETBACK REOUIREMENTS OF THE APPLICABLE MUNICIPALITY WHEN CONSTRUCTED OR MAY BE EXEMPT PER MASSACHUSETTS GENERAL LAW CHAPTER 40A, SECTION 7, AND THAT THE STRUCTURE SHOWN IS NOT LOCATED INA FLOOD HAZARD ZONE PERFEDERAL EMER6ENCYMANAGE/S9NTAQ5WYMAP' COMMUNITY N0. 250098 EFFEC 77 VE DATE.' 06- 02- 93 ZOINE,' X JOHN ABAGIS B ASSOCIATES, PROFESSIONAL LAND SURVEYORS 137 CHANDLER ROAD, ANDOVER, MA. (978) 688-4899. APPLiG'ANT.' CANNELLA 8 ELLIOT N0. 3681 Town of North Andover �f NORTH tt,4so .6, ao Building Department o 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 Ao� `°`�"~' �• V 7a X44 9th PIPp DEBRIS DISPOSAL FORM 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 c11, s150a. The debris will be disposed of in /at. - Facility location Sign ture of Applicant C/a5 doe Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: T iNn,'2 Location:i City Siz. \A Phone r7am a homeowner performing all work myself. 01 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. Policy # Company name: Address City: Phone #: 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' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct to a c v Print name 73-esn.e_s 1 c S I w Phone # 4 - %7` 3 03-3 Official use only do not write in this area to be completed by city or town official' [] Building Dept 13 Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone A Health Department Other FORM WORKMAN'S COMPENSATION N �'/!e tran�nzanu�a�(� 0�4 lfazsricfuselta BOARD OF BUILDING REGULATIONS f License: CONSTRUCTION SUPERVISOR Number: CS 054718 Birthdate: 06/08/1965 z _ - Expires: 06/08/2002 Tr. no: 26195 Restricted To: 00 JAMES M TESTA _ 1208 HILL ST ( w«. F �i 1 '` TOPSFIELD, MA 01983 Administrator NONE INPROVENEN60NTRACTOR RagistratiW 12E246 Expiration: 11fI4/2001 s _ Type: D80 TESTA HILOIN6 I REWELIN 3RNES TESTA 1206 HILL 51 G� ,� WSHELD HR 01483 ADbtr,aSrFlT0R i i LSI 1 w Q cAv O v C4 o w rij z z a . c O xDo p -C ro C w p. an O C ce. O u a Ucz W °° O 0 ct C x O U ow, z C7 to O 1:4 ii z A w a Gzr c rA cn o cn V 0 0 6 O fm ca W .7 co L CLO C O CD V CL CO) O v .7 w C O U O •C 0. COD rmaw Lij _0 U) ui CCW W IrW Lli U) 1 -R c o � S c� 0 Nbc c) �• o y r+ oc U .Q :Ajo: bi C CML v M ! =co ,sem CO)to E¢ o_ E.S oz f •� (7 0 a: cn CD c o.:.. 3 `—� E : m D o 3 N m L y... N y A C O CO3 Eco �. m o 0 cm �• CLU .: •: y m m m C 0= �Z Q' 0 o c c Y: c ¢ _ m : h 0 � Z 0 R7 E. o CL C> c m c �C = 0 ds 0 r 0~ N 0 y lJ.l N m !d t m O 0,ca w W N at�c �E o N Z co V m m C CO) a m F. H' w d � m V 0 0 6 O fm ca W .7 co L CLO C O CD V CL CO) O v .7 w C O U O •C 0. COD rmaw Lij _0 U) ui CCW W IrW Lli U) 77- wil 11111,1111111 ri%i/ FIBILL q T r 7 Location No. 3 Date 4* /� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $S Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ well TOTAL Building Inspector 21/ t��1 Oa:3i 25.00 PAIL} — Div. Public Works Location No. J a T Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $� r Building inspector 03/17/99 99.31 K',. Co "AID Div. Public Works n I Q N b w u Z N Llr) N x C G 0 z 3 v`. C .7 z 3c } w w = V u ~ z Z = Y1 Z w w z z N77 z /-� `-• W N W N V7 Lr) ii Z Z C,JJLu W `i Z u; J w = N < L r N oz r Z U Q <W W < N Z Z © Lu W W _ N } z Lu uj w w t z u FW- �z< N N y W u F. N z ? c z: G c. 1<1 y1 cr Z Z ^ Z - - w W W Z Z - _ C C © C ON r. w O A C� O co C v L" ) ` �coa� a cn a 0 z z o o u. o C2 U co w 1w O c7 o a c x ilz O u w � o w chi G P. O U a o 0� c w F� W w a w v 7 m z cn v E CY) 4- uj 7 CL z 0 W w a ., N co O co 0 0 0 O y � C CO Q� I O 'O O— M m m i 0 co = O .0 O Lft Cl) O D O !C O d a oM a C,* C 4– C C Cc FL oCD co Z: V CO) C C CO) O T ti o yon kc ` O H O go ' v�: Q• c a cc v S r o �0 ,i E 0 0 L O.: o. .0 ♦+ N C D :o~ : v 0 Li r E a +• mm a O N : m 3 H y •- �' `t = m O > � m %ft:: CD 3 CD m =o cm J Q,CL O O m V — Z O l ^� v ? O a cn C m 3o = (D o n � N CD ti h m N �. °c 'E CLC 0 , y Z o CW.3 m p O C VD a O� O� h •O 2 _0 =s a.-m> z 0 W w a ., N co O co 0 0 0 O y � C CO Q� I O 'O O— M m m i 0 co = O .0 O Lft Cl) O D O !C O d a oM a C,* C 4– C C Cc FL oCD co Z: V CO) C C CO) O T ti 67 (N(cy provisions: WC 00 00 00 (NM ONLY) , WC 00 00 Uu w 29 VM Wz INFORMATION PAGE - WCIP WORKERS COMPENSATION AND EMPLOYERS LIAIILITY POLICY ITT HARTFORD INSURER: HARTFORL') UNDERWRITERS INSURANCE COMPANY HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115 NCCI Company Number i n Company Code: 6 SUM LARS RENEWAL POLICY NUMBER: E � Previous Policy Number. 1. Named Insured and Molltng Address: NORMAN GAY DBA ALL UNDER ONE (No., Street, Town, State, Zlp Code) ROOF/PEST IN PEACE 70 JEFFERSON STREET FEIN Number. 028349269 NORTH ANDOVER, MA 01849 8W* IdentHicaiion Numbet(s): The Named Insured is: INDIVIDUAL Business of Named Insured: ROOFING Other workplaces not shown above: 70 JEFFERSON ST . , NORTH ANDOVER, b% 01845 2 policy period: From 11/09/9-7 To 11/09/98 12:01 a.m., Standard time at the insureds mailing address. Producer's Name: MASS WORK COMP A R DIRECT LENNOX INSURANCE AGENCY 515 LOWELL STREET PEABODY. MA 01960 Producer's Cods: 083477 Issuing Of We: ITT HARTFORD 4801 NORTH WEST LOOP 410, SUITE 200 SAN ANTONIO T% 78229 {8001 852 79 1 Total Estimated Annual Premium: Deposit Premium: Policy Minimum Premium• MA Audtt Period: ANNUAL Utstaltment Term: The policy is not binding unless countersigned by our authorized representative. rz77� dn-4� ktitorized Representative Form WC 00 00 01 A Printed in U.S.A. Process Oate: 10/29/97 ORIGINAL page 1 (Continued on next page) Policy Expiration Date: 11 / 0 9 / 9 8