HomeMy WebLinkAboutBuilding Permit #195 - 1160 GREAT POND ROAD 10/3/2001 TOWN OF NORTH ANDOVER AVMDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
This Section for Oficial Use Onl . 'x7'"'.. =&'.,9z Mff='
BYMDING PERMIT• R: �j U r A" DATE ISSUED:
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SIGNATURE: y O
Buildin Commissioner/1 or of.Buildings Date
1.1 Property Address: .s: 1.2 Assessors Map and Parcel Number:
I dZeMap Number Parcel Numbs C\
POA 9'd, -lop,y
1.3 Zoning Information: BU j 1,!Ai Twp 1.4 Property Dimensions: v
Zoning District Pr used Use -Lot Area Fronts ft
1.6 BUILDING SETBACKS(ft) M
•� I
Front Yard Side Yard Rear Yard
Requited •_ , Provide Required Provided Required Provided. 0
1.5. Flood Zone lnfmmation: 1.8 Sew System:
1.7 Water�S�up�pl �•G.L.C.40. 54) �e Disposal � 1
Public 1)/ Private ❑ Zone Outside Flood Zone Municipal l_,."- On Site Disposal System ❑
t t
2.1 Owner of Record S
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ZVI,, o
Name(Print) .9 Address for Service:
�ql 6) M
Signature Telephone N
2.2 Authorized Agent
Name Print Address for Service: Z
O
Signature Telephone Z
90
3.1 Licensed Construction Supervisor Not Applicable ❑
y3V38-LI)
Address f License Number O
Licensed Construction Supervisor: Q
?g •s ley -' ' Expiration Date
Sig i Telephone r
3.2 Registered Home Improvement for Not Applicable ❑
Company Name Registration Number
M
r
Address r
Expiration Date Z^
Signature Telephone ^
I
,as Owner/Authorized
Agent '
Hereby declare that the sta a ents 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
C • vrNf� t� clbm IO2 OI
Print Namer,,�% ).
^'
Signa a of bwn r/Agent Date
Item Estimated Cost(Dollars)to be 0
Completed by permit applicant
1. Building (a) Building Permit Fee
Z Q Multiplier
2 Electrical (b) Estimated Total Cost of a o
2 Z Z y l Construction from(6) 4Q1 378
3 Plumbing Building Permit fee (a)x(h)
1 l0 5 31 C 3 00
4 Mechanical(HVAC) ) — I u c
115
5 Fire Protection ���
6 Total,(1+2+3+4+5) q C 13-1
3 Check Number
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NO.OF STORIES Z SIZE
BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I sr x�b 2 D ZX 3
Zzx 10 r IT-0 S 5
SPAN )3" t
DEMENSIONS OF SILLS ZX to
DEMENSIONS OF POSTS
r T S+vd 5 2x iv$ ct.
DIMENSIONS OF GIRDERS
3--max li' LVL—
HEIGHT
VLHEIGHT OF FOUNDATION + THICKNESS
SIZE OF FOOTING '�. X
MATERIAL OF CHRANEY
1S BUILDING ON SOLID OR FILLED LAND _
IS BUILDING CONNECTED TO NATURAL rzGAS LINE
.- ,q, '-'��,yp^'1d'F. ) ''`kr. .�� C c 3 � �n >el` H` 't,� - /3 ."✓fy
". :,r � p.� } a : sr^ k°ti �'7n 3��xS.z�' � •'��.;&�. �"t .]: f^
f
Slur ; 1@Q)CSI ! atC (clteck all lie&blej
New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
ZZ-e-6
l'.�/npUS 1La.t? �1C��j�i/ ovSi�t/9'
USE GROUP Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA ❑
A4 ❑ A-5 ❑ 1 B ❑
B Business ❑ 2A ❑
C Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
IInstitutional ❑ I-1 ❑ I-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R residential W,' R-1 ❑ R-2 L9--"' R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34: yy Proposed Hazard Index 780 CMR 34:
i k •3 }y Yh
BUILDING AREA EXISTING if applicable) PROPOSED
Number of Floors or Stories Include
Basement levels
Floor Area per Floors sr '-3 51 Z-d
Total Areas Y3-7q
Total Height ft $-1 t
Independent Structural Engineering Structural Peer Review Required Yes ❑ No
SECTION 10a Owner Authorization- TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, (13'V4A4--t-4$ Rk%-r 'vtR 014' as Owner of the subject property
Hereby=au ��� to act on
My beative two work autli4fized by this building permit application
Signature of Ter Date
SECTION 4 .WORKlRs ° xAOly:
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.
Si ned affidavit Attached Yea.......❑ No.......❑
SEMOx RNGSA7
CONSTSIICTION 3S, SFT:C6 �€ T4TLP O7RIIC'# 3R) S TO
7F ExC ?S1 Il!5I'A �
5.1 Registered Architect:
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�z.,- �C �`p�1�9� �. 1 ti R y�l
AT lIC�/�� J'�d/"�VIS ,�) t) "'�` J. o Fcr
Name: T s
2
0 11
os
Address Ma s
q�A_,5% .*h C
Signature v Telephone
F9�rH of gas
qReO 5
ea of Responsibil ty
Name.
kA
Registration Number
Address:
Expiration Date
ignature Total
Not applicable ❑
Name:
Registration Number
Address
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Not Applicable 0
Company Nam
Responsible in Charge of Construction
�9so�v l�s���ev sv�ee%ti>LPr�¢�w�
Location I I to D
No. C( Date
wORTh TOWN OF NORTH ANDOVER
O�i . o 1h
3? � SOC 1
0 9
a Certificate of Occupancy $
�'�a ••°^E<�' Building/Frame Permit Fee $
JACHUS
Founda;°cn Pe;mit Fee $
Other Permit Fee $
TOTAL $ 3 O.T 3
Check #
AA M
5 I Building Inspector
Location b c Y� CP 'C CO
No. — �- Date
TOWN OF NORTH ANDOVER
to ;• �O
o�
I F s
Certificate of Occupancy $ �p
Building/Frame Permit Fee $
C" '0'. ►
Foundation Permit Fee $ —L
Other Permit Fee $
TOTAL $ 0.7 00
Check #
i5 - 5
9 / Building Inspector