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HomeMy WebLinkAboutMiscellaneous - Waverly RoadLocation No. Date qDg &ORT" TOWN OF NORTH ANDOVER i • OOL R 9 Certificate of Occupancy $ '7s '•••o Et'� Building/Frame Permit Fee $ sACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ / Check #� 13 7 0 1 Bwldin4-Inspector ~ ',- TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUELDING PERMIT NUMBER: DATE ISSUED: /*)007 1U0A6A440"-% SIGNATURE: Building Cordfussioner/Inspector of Buildings Date SECTION I- SITE MORMATION 1. 1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning DiArict Proposed Use Lot Area (so Frontage (ft) 1.6 BU]ILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provi&d red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone U Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 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: Not Applicable 0 Licensed Construction Supervisor: License Number Address �Z;--2 714 ao Signalu� Telephone Exp6ation Date '�-rRegistered Home Improvement Contractor Not Applicable 0 3 Ila 76 Company Name Registration Number Address Expiration Date Signature V Telephone 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 affidavit will result 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 i�� Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit a licant OFFICIAL bSE bNLY 1. Building (a) Building Permit Fee Multiplier / b 2 Electrical (b) Estimated Total Cost of Construction /3 a 6) 3 Plumbing ---- Building Permit fee (a) X (b) 8Y. 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 BUH.DING 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 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 Si ature o Owner/Agent d Date T OMANMIR "M NO. OF STORIES O'Ile SIZE pi4 x BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIN ENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION ' w gur THICKNESS ' SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED L /D IS BUILDING CONNECTED TO NATURAL GAS LINE �� .�..... r -- _ ^-uuea� a�✓��aay�uiucae%t4 -7 i BOARD SUPER SOROF BUILDING S i License. CONSTRUCTION Number: CS 000505 Birthdate: 0912711935 r, Expires: 0912712001 Tr. no: 4337 II , - Restricted To: 00 EDWARD E VIEL�r 55 PORTLAND ST Administrator LAWRENCE, MA 01843 DEPARTMENT OF PUBLIC SAFETY License: HOISTING ENGINEER LICENSE . jaNumber. HE 004011 Birthdate: 09/2711935 Expires: 09/2712001 Tr. no: 3763 Restricted To: 2A EDWARD E VIEL oa ph 55 PORTLAND ST LAWRENCE, MA 01843 Acting Commissioner The Commonwealth of Massachusetts' Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Location: City �/�� Phone�����`� 62� F7 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity F7I am an employer providing workers' compensation for my employees working on this job. r:mmnnnv name-/" , ,/ 'x j /,—": , z Address City: �%��,ci�� � Phone #:��G Go2� ✓� 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 O ice of Investigations of the DIA for coverage verification. I do herby certify under pa' . and penalti s of pery' that t i m►a on provided above is true and correct Signature Date Print name`'°�x ' G Phone #�� Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #.— ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION J � ~ ~I J �� II _. \I FORM - U - LOT RELEASE FORM 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. APPLICANT PHONE ASSESSORS MAP NUMBER -2-2).2-3 LOT NUMBER %/__>_ SUBDIVISION LOT NUMBER STREET IVA U i R L l/ ��'l STREET NUMBER ........................................................................... OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED Z Ott /X CONSERVATION ADMINISTRATOR I l ( DATE REJECTED CONDAENTS �1 U `'V t <'1 (Dv/ DATE APPROVED TOWN PLANNER DATE REJECTED COMN ENCS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED &TE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE m M m C/) 0 m _) CA d C .0 03 CACD n CC Z CA CL o �, r _ ? O d �• y D� O cm o p CD CD O �M CrCL CD CCD o CSD C CD y� CD O y Cc CD I F v CO) O -o Z co o o CD 0 CD CDw_ •z O -N O C N dS. mmo 0 y =0n m C') CAec� Z m O Nm�c 3 =.CD N T b CL o CD ��mm y CO) O ''o ; O � m m > > O C a2>4 .-r msm p N n K OD ' m CD m C*l N m tom c ag d CO) N d d Q 0 G W C d CO) CD c N N �� CD At O m t N co E * * To CD o C CA Om:% F i T NCD ' II �cc, Z =° d ►-3 y C QQ M �.l CL y C OC m � M w G OQ Z C) � 00 y =r- G A C7� c? y �o b `� n p a o p rD Z =° d ►-3 y C QQ � y C OC m � M w G OQ Z C) � 00 y =r- G A C7� c? y �o b `� n p a o 1 Q 0 21 I� Location 0 �� l✓��2 L �/ �? Cl No. 2 Date s,, ,,) x 76 a x:71 TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 13 L 07/22/99 13:13 25.00 PAID Div. Public Works IJ, a Y — YLnJ .., • — — — Y Y Y Lr — — y / y � � ' ✓ A C vii :'' `\ O �`^ � v.� �Z — V" �\ D F Z O O z o L I I � M. _0 z rn — T "/ — p L IN r r r^ ti v> ^- rl V Ln T_ Ln R R =_ = s Ln °, v � r ,J Ln e U z V, i w a Y 7 I IJ, a Y u 0 � ' A o it, E r'1 (/ i i Aa I , I r FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** � ,o ,c Pe r, NoL14 APPLICANT �Rc�%�loa� �""S e p�4� jj PHONE fLOCATION: Assessors Map Number PARCEL SUBDIVISION LOT (S) �— STREET W A -CA -e t Lc/ 1 d- ST. NUMBER ***********************************O F F I C IAL USE ONLY**`***'`* RECOMMENDATIONS OF TOWN AGENTS: Rdts,-- w1V 51ol-^.y-O ATION ADMINISTRATOR COMMENTS W U 191i— � TOWN PLANNER COMMENTS FOOD. INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS A DATE APPROVED DATE REJECTED_ . DATE APPROVED DATE REJECTED DATE APPROVED w DATE REJECTED `a ' r -- DATE APPROVED DATE REJECTED N PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm TE 0 0 CV tolV- U) m m m VJ 0 CO) .0 CD 0 z CD CZ r— Co CM � O ®v CD cr CD Q us -.-m W- d O �= CD CA CD -e O CA M c. CO) L-� D� c� CD 0 rM CD CD a y. CD C40 Z CD O CCD V J C) O cn C ' c EO CA c d O - O y �-{ O =t c® co 0 dO m Z co) =r= cm Q O d "+ a T CD -4O ®W C/9 y 0 =r m a O OCD O CO'! OIV . O •-► O O H n R c . Oca CL mom' �. CD C=c, H C) � c d m CD H O w H n m : a C — c O W :� O. H CD CACDm H H mH .� 3 gym: A O O mo 1 CD CD o o -, .T N CD m C m n� C.) c' 0 CM a cn d 0 in ..� o 'F�� tb C to /v p'7 �1 J 'r1 cn � r ro n Ito M O rrj C r O � M l / n :� CD 1r Z�.� 0 a"' 0 0- = 0 pC�y l z O � rD ,< CA n (i to O � 9 y I F�� /- "-?y 0'�j N2 213 4 Date .. ... .......................... .-64. TOWN OF NORTH ANDOVER pL 0 '.'6MSjJy& 0 PERMIT FOR WIRING This certifies that A...`..:—.. ... 4 ............. ....................................................... has permission to perform , . -.e�— . -L . . ......................................... . ........ ....... wiring in the building of .......................... .............................. fig at ............................. ..:...North Andover, Mass. Fee -.5 .............. Lic. No/'9�/"? ............................................................... I r? ELECTRICAL MpEcTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ThEC0AM0AWE4L2710F+'M4SSA(H[S7j' Office Use on DEPARTME T 0FPUXJC&41UY Permit No. 4' 3V BOARD OFMEPREYEXff0NREGULATT0AN-V MR 12-0 ' Occupancy &Fees Checked APPLICATION FOR 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 To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) — Owner or Tenant S7 A -r p ic1<t TACH yl� 5JC A4'C rV P7e(Z,J �ccru.�1t Owner's Address l 50• q3aC)4 d,?A L-A w to vv Cz— XA i9 Is this permit in conjunction with a building permit: Yes n No (Check Appropriate Box) p Purpose of Building S a R (� Utility Authorization No. 900 Existing Service � Amps�Volts Overhead Q Underground No. of Meters New Service 0 Amps olts Overhead ©Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ` e C Se a- c c S Tb ',.4 G c L of a No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil Bumers No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total - Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW e No. of Self Contained Detection/Sounding Devices Local a Municipal Connections a Other iJb. of Dryers Heating Devices KW _ o. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER Inst==CaerV- Rn=bthetagtm=atsdMmmdxseZGert xWLam ItmeaajmtLikkhcurar Po yni&gCar;ide CO=WcrtsWxtwtia gmvalat YES, NO a Iha%eatmittedvalidprodc(sanebthe0ffim YES ffj uhacedvdWYE!�pk enfic*thetMxofwvw' bydvdm g'dx ; I I i ' E!J INSUR NCE BOND GUiER ® (Pt=SPM*) Estim&dVal xdElec tml Wak S f Waktostat ,!„ �A- ° c,00 _.._._ hpecdonD* d Rcugh I Final �' 20 O U SigrWWd0M%wtiMd*W. C r 3 E1ecra-1, C_ Lioa>see Sigr�/ , �� LioatseNo ` Bltsi =Td N;a G 7 2 - 6 $ 5-a 3 © / T' L ^-w e C C v� A1tTeLNf a 97 ` 6; 7- 3 e 3 Ohae WNER'S]NKRANCEWANER;I.anawaretbattheLioea9edoes l etheiresuaneco�a@eai�s�uia>tralagrivalai�tagi>IIedbyMa�adz Cstaallam aodthatrrrysaglahuernitparnitapp6r�tiai�vai�ihissr�at (Please check one) Owner a Agent N0. Telephone NPERMIT FEE $ ( l