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Home My WebLink AboutMiscellaneous - Lot 1 Great Pond Road (2)mono rom "n Noma r m �� r �J' �C 1,C �'f i 1 p� ��A_�� ®� �� «� y1d 7/d � D Ef _f d- �w/ �? TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 11.1 Property Address: {� ,p 1.2 Assessors Map and Parcel Number: J /0 Map Number Parcel Number 1.3 ,Zoning Information: Zoning District Pr o se 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red I Proyided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public fij Private ❑ Zone Outside Flood Zone 9 1.8 Sewerage Disposal System: Municipal d On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT ! !wL '- JLI IC. („) 2.1 Owner of Record 6'f'q0.t� P�lU� Rolm Real+Y Trus+ 3?S ,B6XArd 59r�T4,dodA Name (Print p 9 Address for Service: G_ ' � � 6 00 -yo � o dR e. �i 'JSdoo Signator 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 T M Z O v M SECTION 4 - WORKERS COMPENSATION (11 Workers Compensation Insurance affidavit must be comb in the denial of the issuance of the building permit. r3� Signed affidavit Attached Yes ......'K No ....... 0 SECTION 5 Description of Proposed Work chat New Construction 09 Existing Building ❑ G.L. C 152 § 25c(6) -ted Aand submitted with this application. Failure to provide this affidavit will result Repair(s) ❑ I Alterations(s) ❑ I Addition ❑ Accessory Bldg. ❑ Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: ON,! I SECTION 6 - FSTTMATF.n CnNCTR7Tf T1nN VAQTc Item Estimated Cost (Dollar) to be Completed by permit applicant OIFICiAL US)�'U1vI.1t .:` 1. Building A Sc rn vi T (a) Building Permit Fee Multiplier SIZE OF FLOOR T11vIBERS 2 Electrical x 1 3 FD (b) Estimated Total Cost of Construction 3 Plumbing DR%4ENSIONS OF SILLS Building Permit fee (a) X (b) 4 Mechanical HVAC ib " 5 Fire Protection DMffiNSIONS OF GIRDERS 6 Total 1+2+3+4+5 c:`JJr" qk. 1049/ JS'p O0 Check Number .�a zz, ii 1V J3 l.UMrLtJLtV WttEr4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date 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 osEPN pelic� Print Name d - Signature f O er/wti' Agent Date NO. OF STORIES a SIZE 3 Soo f - BASEMENT OR SLAB S A Sc rn vi T SIZE OF FLOOR T11vIBERS iST-* x 1 3 FD SPAN DR%4ENSIONS OF SILLS X DUvIENSIONS OF POSTS ib " IA j 1 DMffiNSIONS OF GIRDERS HEIGHT OF FOUNDATION 9 1 THICKNESS 16 SIZE OF FOOTING A Y i nh X MATERIAL OF CHEVINEY Q r i C K CUOA lft.0Pd r IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE l 1 Ni N ;1 u L l U4/ L 1 / LUU4 14, JJ 7icooJl U77 - I'1G GIYVI1'W-Gf�11\U JVL. QUITCLAIM DIED y-1g-Qz-.0--/0 1, .Alfred Matthews, UL bf Peabody, Essex County, Massachusetts c erantoe ), for the consideration of , grant to 7obn R. Kcity as Trustee of the Great Pond►Reahy Trust, under declaration of trust dated April 18, 2002, ("Grantee"), with QUITCLAIM COVENANTS, A certain parcel of lanll on the northerly side of Great Pond Road, North Andover, Essex County, Commonwealth of Maasachusetts, being shovm as Lot #I on a plan. entitled "flan of Land Located in North Andover, Mass., Owned by Richard F. Pamialc," Scale 1"-50', dated March 1985, drawn by Membnack EugineerinB Services, Andover, Mass., filod with North District of Essex Registry of Deeds as Plan # 10041. Said Lot 01 is more particularly bounded and descn'bed as follows: NORTHERLY by land now or formcrly of Angus Realty Trust, in two lines Saving a total length of one bundred fifty and no/100 (150.00) feet; EASTERLY by other land now or fonimly of Richard F. Pardale, berg Loot #2 on said plan, three hundred and trine 97/100 (309.97) feet; SOUTHERLY by the northerly line of Great Pond Read, one hundred fifty and no/100 (150.00) feet; WESTERLY by land now or formerly of Joseph and PAricia Sartolotta, three hundred fiReen and 60/100 (315.60) feet. Containing 45,894 square feet of land aeoording to said plan Heing the stone prcrzdses co-aveyed to the GraMor herein by deed of Rita Gonsalves, dated October 19, 1993, and recorded herewith in the Esse NOrthRegistry of Deeds. Executed as a sealed instrument this ! day of 2002. COMMONWEALTH OF MASSACH.'USETT'S SUFFOLK, ss. APTJ1.Z7 -. 2002 Then pore aW� the above-VNOY aclaaowledged the foregoing instrument to be his free wt and d C ��xpiures: :/,, �'d 6GiZ8698G6i 4oFted 4dasor e8t=11 60 22 Jab Town of North Andover�s Building Department 27 Charles Street North Andover, MA. 01845 �'"►S�_'_�°. AnESd D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542. Fax Please print. DATE JOB LOCATION (0 h Number HOMEOWNER LICENSE EXEMPTION d. Ifew Street Address 3S �o p/lot "HOMEOWNER �UcSCIJ i1 % l Il(I Vo Name Home Phone Work Phone • PRESENT MAILING ADDRESS /'-'?0. U. 60 X E (f 3 City Town State Zip Code The current exemption for "homedwners" 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 one 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 SIGNATURE APPROVAL OF BUILDING OFF The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: J 0 S E /%' Location: t! i1 / 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity F1 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 vvell_as.civil.,penattiesin-the form .of-a..STOP WORKORDER.and..a.fine-of _(.$1D0.0.0)_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 hereby certify and penalties of perjury that the information provided above is true and correct. Z 0,-MDate Date 2 Print namePhone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ 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) i Signature of Permit Applicant 07 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Joseph Pelich 725 Boxford.Street North Andover, Massachusetts 01845 Phone (978) 683-3200 Fax (978) 683-3115 Date: 4/27/04 To: Mike McGuire — Local Building Inspector From: Joseph Pelich Regarding; lot 1 Great Pond Road Pages: fax only Dear Mike, Please let this fax serve as evidence that I submitted application for building a residence at lot 1 Great Pond Road. We had discussed yesterday that in order to go forward with the permit process that I submit and receive denial, to proceed to the ZBA. I submitted building plans, a 20 scale plot plan, deed as evidence of lot creation, building permit application with support, and reference for DEP file number. Q �� J Thank you. Sincerely, Joseph Pelich Sir.