Loading...
HomeMy WebLinkAboutBuilding Permit #408 - 124 BLUEBERRY HILL LANE 12/4/2003 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 1 APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING r-.r -•� _; ro x,--;fit s.�r`��,, t t,+.",a. r , T s Section for Official Use Onl BUILDING PERNUT NUMBER: 7 D DATE ISSUED: Z SIGNATURE: Building Commissioner/I or of Buildings Date 1.1., Property Address: 1.2 Assessors Map and Parcel Number: Q Map Number Parcel Wmber 1.3 Zoning Information: 1.4 Property Dimensions: v Zoning District oscd Use Lot Area Frontage(ft) m 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Re red Provide Required Provided ReqWrW Provided � I s d_, lf: :50 i 6 1 `r 1.7 Water Supply M.G.L.C.40. 54) 1.5. Mood An biformstion: 1.8 Sewerage Disposal System: Public ❑ Pnvate ❑ Zane Outside Flood Zane ❑ MunicipalOn ne Disposal System Q 2.1 Owner of Record .-e'esPy���� � ,�i�/�.� Name(Print) Address for Service Signature / Telephone 2.2 Authorized Agent Name Print T Address for Service: Signature Telephone .m 3.1 Licensed Construction Supervisor Not Applicable ❑ Address License Number 0 Licensed Construction Supervisor: �1,5� d Expiration Da Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v G Company Name , Registration Number m Address 4 r Expiration Da Z Signature Telephone scT3rox ac� Rl 1&0 ©x �. ? 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.......❑ SECTION . .,PIP-OF% iUI!FAL)d $IGN ?G` I TSTRUCTIO OR"tu P ;BUII.0 tGS ANd S7'RIIC f JIt1 S St1 �T TZ? COPtSTR7CTAQN C'01TROI PIR3�T17' R llt6Y1� Nf� "A' UI I�NGIShb !A } k. 5.1 Registered Architect: Name: Address Signature Telephone 5 2 Reistened':Prnfaxia>�ta � neer� ,t Name: Area of Responsibility Address: Registration Number Expiration Date Signature Total Not applicable ❑ Name: Address Registration Number Signature Telephone Expiration Date L_ Nom. Area of Responsibility A d s Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number �Signature Telephone Expiration Date Company Name: Not Applicable ❑ Responsible in Charge of Construction New Construction ❑ Existing Building Repair(s) ' ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑---[Other ❑ Specify Brief Description of Proposed Work: 471 3 USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 0 A-3 ❑ 1 ❑ A4 ❑ A-5 ❑ 1 B 0 B Business 0 2A 0 C Educational 0 2B ❑ F Factory ❑ F-I ❑ F-2 0 2C 0 H High Hazard 0 3A 0 IInstitutional 0 I-1 ❑ I-2 ❑ I-3 ❑ 3B 0 M Mercantile 0 4 0 R residential ❑ R-1 ❑ R-2 R-3 5A ❑ S Storage 0 S-1 ❑ S-2 ❑ 5B ❑ U Utility 0 Specify: M Mixed Use ❑ Specify: S Special Use 0 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: Proposed Hazard Index 780 CMR 34: ,,0 a ' BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft r_ Independent Structural Engineering' Structural Peer Review Required Yes ❑ No Ct�' SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as 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 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 Signa a of Owner/Agent Drafte .sx Item Estimated Cost(Dollars)to be , LAI Completed by permit applicant ` L1=2 L ;y 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 31 Plumbing Q Building Permit fee (a)x(b) O 4 Mechanical(HVAC) s�- 5 Fire Protection/ 6 Total (1+2+3+4+5) Check Number i s �a4 ,� �:4..✓CCL���_*�njr }.r��..r^?v(}� ,:r���:cG:q))tr�a �.��:e,a l!3 tet.- Tx ���:x y� -b�-� r�.. � �' : ��S� h: . �sll✓' .: � ��_.. � q i ,�<!<E c^��n.. 1"4 i�FS k R � '��y+jZ}. 'N,fl h �,n... T�x ''l,'h .."Ityz'h'� i...y,) 1.�. �:� :�,,.f� L t h��a"'�$'[14.' b.Q� � p� tr' �,Q• �24 i 4�,i. ppr,r ✓,.:E�„ 4i..i r r,,�2ca ¢ t�. .,t u rSt t -ig, ,.,. l,dr. '1: ."sY `4 G� �w t:?t�tio �'t;, F.r .'� 'c NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE