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HomeMy WebLinkAboutApplication - 602 BOXFORD STREET 2/18/2016 . Sao arr� BUILDING PERMIT ' of 4eP TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0 74 n_ 1. Permit No#: Date Received 7RQ��ATEP pAY L� �SSac t+us�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION � - Print PROPERTY OWNERS ' Print 100 Year Structure yes gno MAP � � PARCEL: ,� ZONING DISTRICT: ._Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ` New Building VOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other ep 1 �ell 1=10 c i etla ds ® INa er -ed str ct - u a er gem avx f t t DESCRI TION OF WORK TO BE PERFORMED � EAR 1, 4) C25 . : Identification, Please Type or Print Clearly OWNER: Name: Ufir.... Phone: I P, Address:AddreSs: ` ai: & r_ ora a "'.0 Ci,. -. "t r " E Contractor Name: ;._,x Phone: Email ` 0 cavt� ""fi-{ :,;, q Address: a 'QAA pwar _ Supervisor's Construction License: �, ~� kt�,V ,A Exp. Date:. Home Improvement License: Exp. Date: ARCHITECT/ENGINEER V �-F,b - `QAd �� ��` (44 Phone: y Address:_08 RP0 '1C 5, BAH ni �l .� Reg. No. .w� r FEE SCHEDULE;BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST"BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund e it Pens Submitted F1 Plans Waived L1 Certified. Plot Plan L1 Stamped Plans L1- , 0 4_ YPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuin.g/MassageB ody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging(Sales ❑ Private(septic tank,etc. Permanent Dumpster on Site ❑ THE FOLLOWING SEGTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF Q U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Sig nature ` COMMENTS C, 4 t�,�-Oa©s—J wOS_ HEALTH Reviewed on L° 0 signature 4 COMMENTS .2 pk { r P n > —q�ut* Zoning Board of Appeals:Variance, Petition No: Zoning Decisionfreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connec:`!on/S[ n Da q Drivewa Permit � ]DPW Town Engineer; Signature: 11�4 Located 384 sgo d Street %SIRE DEPARaTMEIVT ; ;emp� mpste ongs�te, eyes ono; = i � � .ar"„� ?}y ✓'...� k^, ,,J`.xfrGw ex ,. , ,M. ^, , a x , are. ,y' �I y (iocatedat1�24 Main Street: � , 1 �x ,�� .. �Fire�Departmen��,�igr�atureldatei - t � �� �� COMIViENTS kf ,, n Town of North Andover NORTk q Building Department 0 1600 Osgood Street Bldg 20, Suite 2035 North Andover MA 01845 0 Tel. 978688-9545 Fax: 978-688-9542 T � � 4b DEMOLITION OF BUILDING AFFIDAVIT °.�A coc"IC ew,IK`ti1� ATOP ok ��SSACHUS����a DATE OWNER'S NAME &ADDRESSS A L �6 i d (`n i 17D�(zZ s'�`�( v �v� �— ®Ise 7 LOCATION OF PROPERTY TO DEMOLISH DESCRIPTION U,, s a i ._ . v CONTRACTOR'S NAME &ADDRESS DEPARTMENT SIGN-OFFS PIA- DEPT. OF PUBLIC WORKS -WATER: SEWER: p TREE WARDEN !U fry rt►Mev Yt TOWN ENGINEER DEPT. OF CONSERVATION, Xu }} :r HEALTH DEPT. 4� { ,. SEPTIC �I/VELL n L HISTORIC COMMISSION PLANNING GAS ELECTRIC 1.� I4 a. off' C TELEPHONE TAXES '0t3V4_At,,,,, POLICE FIRE EXTERMINATOR DUMPSTER-- O OFF REET ' ' S� + A DIG SAFE NUMBER BLDG. INSPECTOR Building Demolition Affidavit PEST CO NTROL SERVICE AGREEMEh ft AGREEMENT NUMBER Dennis lei Pest Elimination Experts 30 Years 29 Locust Street No. 1555 Lynn, MA 01904 701®592®0023 9 Fax 781-592-9513 Lic. #f• MA 18197 SERVICE LOCATION CUSTOMER tv eS STREET (.0 r� PERSON TO BE CONTACTED SERVICE PFIONE CITY,STATE,and ZIP PHONE TYPE OF PROPERTY TO E SE VICED RENEWAL SERVICE TO BE PERFORMED DATE s5]RVIC BEGINS EXPIRATION DATE 0 [] Monthly ❑ Quarterly Other PESTS TO BE CONTROLLED: SPECIAL INSTRUCTIONS: TERMS AND CONDITIONS: r _ SERVICE GUARANTEE: We agree to apply chemicals to control above-named pests in accordance with terms and conditions of this Service Agreement, All labor and materials will be furnished to provide the most efficient pest control and maximum safety required by federal, state and city regulations, SERVICE RENEWAL: This agreement shall be for an initial period of one year, and will renew itself annually unless either party cancels this agreement by giving thirty days written notice before any expiration date. ANNUAL e AGREEMENT CHARGE �t INITIAL SERVICE=CHARGE $ r5� COMPANYAUTHO ZED AT RE AT MONTHLY/QUARTERLY PAYMENTS $ C 13D Z,�11" $ CUSTOMER AUTHOR2ED SIGNATURE DATE Rapider Product N 7052 from-1-800-252-4011•E)Copydght,Cf C)"MAX Town of North Andover � -ORTFi q Building Department ®���`¢° 7600 Osgood Street Bldg 20, Suite 2035 North Andover MA 09845 Tel: 978688-9545 Fax: 978-688-9542 DEMOLITION OF BUILDING AFFIDAVIT ew,cK\V't Argo SsgcHUS� DATE it r►��t '�' N� i' OWNER'S NAME &ADDRESS S A L 6 I O {Yl i-D\ SPA LOCATION OF PROPERTY TO DEMOLISH ` DESCRIPTION._ c; r _il " �•. fa'. ° ,) _ CONTRACTOR'S NAME &ADDRESS DEPARTMENT SIGN-OFFS i!4- DEPT. OF PUBLIC WORKS -WATER: � SEWER:/ TREE WARDEN 00 TOWN ENGINEER DEPT. OF CONSERVATION, i' HEALTH DEPT.,'ti SEPTIC LGIIVELLk j HISTORIC COMMISSION PLANNING GAS ELECTRIC TELEPHONE TAXES POLICE FIRE EXTERMINATOR DUMPSTER— ON/OFF STREET DIG SAFE NUMBER BLDG. INSPECTOR Building Demolition Affidavit