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HomeMy WebLinkAboutMiscellaneous - 1 Berekley RoadLocation I Pd No. C�20 Date 401tTN TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ZQ -2� 15074 Buildi ng 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 Rs'l s Section for Official Use Onl ax _ e� t, BUELDING PERK 1T NUMBER: / DATE ISSUED: SIGNATURE: Buildin Commissioner/I or dBuildings Date 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1. 1 Property/A_ddress: g / 6e & Tte-le, CC et 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Fronts ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Re red Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System. Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ ;e 33 2 n r .f c 2.1 Ownerof Record , ,e � �`�:LIZ 6' ani arT py l� ,5 i9' Name (Print) Address for Service: Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ Address License Number Licensed Construction S sor: Eviration Date SignatureTelephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name„ Registration Number Ad rens ,. = •1 _%��J//�! //y/ ��� � gr" J��� r�6 Expiration Date Signature Telephone 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 Owner/Agent Date Item Estimated Cost (Dollars) to be Completed by applicant permit 1. Building qn / (a) Building Permit Fee 0 l ' Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) f/ — 4 Mechanical (HVAC) f 5 Fire Protection 6 Total (1+2+3+4+5) Check Number � t :5 7 I:.yf �r".:.'1 ?%iz ,�}P h �.;a-�.$ � S 5yi �. i"h � i (�'f�Ti. f?'>S�i. t •! i ��ti}'4.: � �, I�,. � % fA5.:J7�"s. ��'��hys � i4i �)��i 9 % { �t ,� S � by i (5 k � . iso. f� Ip�te � �',-(,�"Yf 3 t 4 `Sj Cfh I�„Ey)7Rji i k �': t� 9� �Yi.��1'k. S't.. �'J:.�'�'Pub�..>,�*.T F'(>ti',. U.f P11.4 i...-Y-1a,•�i 1t;: ir y! u`,...,. ?> 1t�5 {..:.7 � fit i ! : 1„ 'J.(y �y � ' Y /'Ety�•`F� i �2 �-. Q:.s AF, /..,., !': `,�yC 2 y sY� t i,; y- k 0i4 f L Y Ifi yWjfjD.uiu Tj'Sd�;`,J�.dTY+ ). r 4 ,' L ".*.iitin:ny 5,kd2-.tt i� '^r`s� S'_SJ�S ! ty � y� . t� o ) k. tF �.. i1tf.N, ✓ IIi.� W .•Y �yrF.�y^�f�k � y` � t�. �"�n 3!"��t`��5 ��.i+`4 h �Sf'�,thi x�7�j^Y'1h� AM1T "\il3 _1%iF'ek }�•�'��..1 �r k� /Y��il j93bi y F,�y 4�,f iYty3 �l if'� �'��5.3,.'s� �. Zit`, v.:i:1 �:n.4�ir 1. NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHININEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. ❑ ❑ A-1 ❑ A4 ❑ Demolition ❑ Other 0 Specify , Brief Description of Proposed Work: U Aj q ( Sl C& V Co �,:e nn -� 2q 11 c. 1,- lj�o. ti A V �{ (� -C[C aS�6crS M4W 'Ni lr. is S B Business ❑ Independent Structural Engineering Structural Peer Review R Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date . USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 0 A-3 0 ❑ ]A IB ❑ ❑ B Business ❑ 2A 2B 2C 0 0 ❑ C Educational 0 F Factory ❑• F -I 0 F-2 0 H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ 1-1 0 I-2 ❑ I-3 ❑ M Mercantile ❑ 4 0 . R residential ❑ R-1 0 R-2 ❑ R-3 ❑ 5A 5B 0 ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Utility M Mixed Use S Special Use 0 ❑ ❑ Specify: Specify: Specify COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE -A- Existing Use Group: ExistingHazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: Independent Structural Engineering Structural Peer Review R Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date . 5! ,1 Registered Architect 111 e: Name: L +�It dre; Address Signatur Name Name: Responsible in Charge of Construction Telephone Area of Responsibility Registration Number Expiration Date Total Not applicable ❑ Registration Number Telephone Expiration Date Area of Responsibility Registration Number Telephone Expiration Date Area of Responsibility Registration Number Telephone IExpiration Date Not Applicable ❑ REGISTRY: =-SS �-7C� ►� o fi TITLE REFERENCE: LL 3 PLAN REFERENCE: P 1, No, `� . A -O 25.og /I s� I STo RY LOT A 2,5SS S,� -4- co Z3S_'7o' BE R K CL_E_Y C'Q This plan was not prepared from an instrument survey. Offsets and distances shown should not be used to establish property lines. This plan is intended for mortgage purposes only. I certify that the structure shown on this Plan in conformance with zoning setbacks in effect at the time of construction. I certify that the parcel shown is�l_located within a flood hazard area as depicted on HUD Flood Insurance Rate Maps for Community No: 2 SO O `) g CAMERON BROTHERS INC. Job No. 11 Touro Ave. Medford, MA (781) 324-9566 MORTGAGE INSPECTION PLAN LOCATION tB ER K E EY RD, SCALE: =©� DATE: 9 — 27-9 8 CERTIFIED TO: H o m e 'Ft 'n Q'A C 2. a Cl) M Cf) CD0 m C d CO) C13 10 CD CD O Z y CD o CL r �� � � O y O o p CD CD C9 �CL C m CCD CD O CD C CCD P. a O CD CO2 Ca CD CD CO) O 1 Z O O O CD O CD tom•}• 0 m cn O Q• y _ aO :5.m y m o m C°! Z col C2 m C'ja = 3• '� =-= y �_ K ED H TI ? d .•s C- O CD -4 O m CA O y N o i � m' o a > > H :� ® —1 10 .O.w'O 0 1 .0. O O O HBO �� V m s CD U2 i CL" ,.*: U2 O =r ^ s CD O CA t0CD CD l p H C. C�• C EL - CL y % co: co H` N Oj _ m CO w ' O . 1Y CD CD CD Q cn E Cn 0 d Cn ro ?? ib r-ww a- COD '�f C/) w O w C 00 n •d p CL - O CDo / c� -2 : r.: �oCD m CL C. : „cc'•F C's i� E Cn 0 d Cn ro ?? ib r-ww a- COD '�f C/) w O w C 00 n •d p CL - O E 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) ( 1 (/-�,C�0 e___ - - Signature of Permit Applicant /Z-YZO / Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector k . - - J✓ze �rrnz.�,xa�u��eall%a- a�� ��i�asi.�c�,us�.s; §moi BOARD OF BUILDING REGULATIONS License. CONSTRUCTION SUPERVISOR Number: CS 074027 cf ; -Birthdate: 06/26/1952 Expires: 06/2512002 Tr. no: 74027 .=.g� Restricted To. OQ l RICHARD.A LEBLANC 0 HIDEAWAY. LANE METHUEN, fi,� 01844 I �o j Administrator ` Location: / �e e rL - 7P. City P • /�N d V f � � ° Phone aam a homeowner performing all Work myself. I am a sole proprietor and have no one working in any capacity ,,1;0.20zm� - I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone #: Insurance Co Policcv # Company name: Address City Phone #:_ Insurance Co Policy # r•:- 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 u er the ppain and penalties of perjury that the information provided above is true and correct. Signature �C O [date A� � ® / Print name / r C��9 b`<'� Phone # Official use only do not write in this area to be completed by city or town official' Building Dept F1 Check /f immediate response is required Building Dept p Licensing Board E] Selectman's Office Contact person: Phone #: F, Health Department 0 Other FORM WORKMAN'S COMPENSATION ta <TOWN...MAP TOWN LOTS_' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT T O DO GASFITTING Yg� (Print or Type) j Mass. Date µ L 4- le 19 Permit # �`�) -3 �d ? Building Location 4yeV L*�� Name_l Type of Occupancy, New 5 j� Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Name of Ucensed Plumber or Gas Fitter Check one: ❑ Corporation ❑ Partnership ❑ Firm/Co. Certificate # INSURANCE COVE E: I have a current myin u a ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No 0 If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity ❑ gond ❑ OWNER'S INSURANCE WAIVER: I 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 ❑ I 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 f pertinent r- 9 provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene app 11 be in compliance with all of license: Plumber Title Gasfitter Stg a of cen umber �or^Gas atter Master License Number 7 �7 i City/Town -5Journeyman C Ij ' Y • ENE No' 0 N ME No NNE ! ■���o������EMEME "IMMEMME NOME MENOMONEE NOMEMINERE ME .. ■MEMEM IMMIN NEON MENEM ENS! INNIMMINIMENIMME NNE .. �0 ■ENEM MItNIMMEtMMINIMEN Name of Ucensed Plumber or Gas Fitter Check one: ❑ Corporation ❑ Partnership ❑ Firm/Co. Certificate # INSURANCE COVE E: I have a current myin u a ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No 0 If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity ❑ gond ❑ OWNER'S INSURANCE WAIVER: I 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 ❑ I 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 f pertinent r- 9 provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene app 11 be in compliance with all of license: Plumber Title Gasfitter Stg a of cen umber �or^Gas atter Master License Number 7 �7 i City/Town -5Journeyman C Date...................... �OWWO F NORTH ANDOVER 1ppw L-4, p-,��IJPIEFMT FOR GAS INSTALLATION SSACH This certifies that7i-1-17 .................. has permission for g�a"s installation ...... in the buildings of ... ....... at . / -:�C- � /'�r & , kd - ........ ....... ........ North Andover, Mass. Fee.-�P.,vt:7Lic. No ... ...... ..................... ",'- — /" /V GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File 4211 L -S EO Date..J/- .. ......... i ................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ....................................... .................................................... has permission to perform ........ F-e.p A t.v-� ..... ....... .................................................. wiring in the building of ....... A .... I ......... ............... I ........... at ..... / ..... - !�� /!� -Y ........ ................ . North Andover, Mass. Fee ..... 3. ��.... Lic. No. IV (�—� ELEcrRICAL i�S' 0- R - Check# THECOMMONWEALTHOFMASSACHUSEM Office Use only DEPAKTMENTOFPUX1CS4FETY BOARDOFFIREPREV1MlONRE4WA770NS527Cfi�12.� Permit No. Occupancy & Fees Checked —� APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 6 Gll-,-) / 4 t Owner or Tenant s1-7 Z LL .r,4 . Owner's Address Is this permit in conjunction with a building permit: Yes M No Purpose of Building Existing Service m Amps / olts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges No. of Disposals No. of Dishwashers No. of Dryers No. of Water Heaters KW No. Hydro Massage Tubs --,TIER, No. of Hot Tubs Swimming Pool Above No. of Oil Burners To the Inspector of Wires: (Check Appropriate Box) I/ Utility Authorization No. Overhead nderground No. of Meters Overhead Underground No. of Meters No. of Transformers Total KVA Below Generators KVA around M No. of Emergency Lighting Battery Units No. of Gas Burners No. of Air Cond. Total FIRE ALARMS Tons No. of Heat Total Total No. of Detection and Pum s Tons KW Initiating Devices Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Heating Devices KW Local Municipal No. of No. of Connections Signs Bailasis No. of Motors Total HP a.yup.u.u,uinlvIm,�M=llef)ei'cllLaWS ` t y PbkyOmPkte ComngeoritsgksWtialegmvalatt y --wnroofOfsum tothe, Office YES01Ifyurrhaw M/0 hecl6t._ ?ebox NSURANi+,- 6 _] BOND r7 y) No. of Zones — ......� V NO a the gpeofcowrageby Expftatim ate Rough Eswrgmd Value dnac tical Wo& $ Final Other Lice wNo. rf, f7 Sigrtattrte LkmseNo `� BusirmTel No. d s dr_hPcc i WI S NSURANCE W Ah Tel No. id WAIVER, lam � thatmysignahueonthispumitappl fiS�t.rie t 'lease check one) Owner Agent M Telephone No. Ignaure owner or PENT FEE