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HomeMy WebLinkAboutBuilding Permit #274 - 15 MAPLE AVENUE 10/15/2003 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI4,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. _ DATE ISSUED. ic SIGNATURE: Building Commissioner/Inspector of Buildings Date —041 Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number rN 9M ez`f er, or11A O t�- y-s 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Ptoposed Use Lot Area Frontage 11 1.6 WELDING SETBACKS ft Front Yard Side Yard Rear Yard Reqttired Provide Required Provided red Provided 1.7 Water Supply M.G.L.C.40., v 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:, Public ❑ - Private ❑`' _ = Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2—PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic Distract: Yes No P/ m 2.1 Owner of Record �Tohr Tr ���C1.iS 1S^17 mc>�1ee Name(Print) Address for Service: 97 - a5 -Ct 13 Sigfiture loor Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address t Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Com any Name S �� Registration Number r Address Q / -7 -t -3 37' `7�,Z Expiration Date ^� Signature Telephone Y� 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.......0 SECTION 5 Description of Proposed Work check all a Hcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. Q Demolition ❑ Other ❑ Specify Briom@sari.tion ofProposed Work: Re C, C -e aJn,::J_ V-kc,-vt,�, _0 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be I CIAI{.II r � ; Completed bv permit a licant � 1. Building (a) Building Permit Fee -Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 00© , o a Check Number SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/ thorized Agent o subject property Hereby authorize to act on f My behalf,in all matters relative to work authorized by this building permit application._ Signature ofl5wner Dat 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 L Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS isr2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMIENSIONS 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 NORTH Town OEf Andover No. �4 over, Mass., og?4 TED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System t BUILDING INSPECTOR THISCERTIFIES THAT................. ............ . .................................................................................................. J�� Foundation .. ..... . ................ has permission to erect ...................... ........... buildings on ./ .7/7 91,. .................. ................. Rough tobe occupied as I.............. . ....=.a*..... .. .. ... . ..... ........................................................... .................. ........... Chimney provided that the person accept' g this permit shall in e respect conform to the terms of the application on file in Final this office, and to the provision of the Codes and By-La s relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9! 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: rn (Location of Facility) Signature of Permit Applican Date NOTE: Demolition permit from the Town of North Andover must be obtained for this projec through the Office of the Building Inspector Board of.Bnzld�n Reguiaiiotis and Standard: NOME`IMPROVEMENT CONTRACTOR Registration ::113494 �xp r`at n A6/2492005 ELAVIO'S CONS -RUCT O ;� FLAVIO MENESES 29 NORTH ST ELL,MA 01852 " Administrator Flavio'S Construction Proposal This Proposal may be withdrawn by us if not Complete ReHa,b. - Fiat Roofing accepted within ___ °-0_ days Replacement Windows - Painting Date: da -1 /.. customer ldentlflcation Subritted to , , Home Phone Wor0hone St et ° City, State and Zip Code Discriptlons of work We hereb submits ecifications and estimates for...:. 0 0. �....9.......it. .r.l:?. , ....................•....................................................................,...........................................•.................................... .....1:C,4......C-UN +...:w.v o.... TS' ' ....4, M.08,......Qz.....lic11 it. &.... i........ ...................................... .................................. ..... ......................................... ............. ...... .... .............. . .. .....: . .. . ..................... ...... ................................................ .. ...... ... .... .. .... ...... ..... .... ....... ... .... .......... �� ...... ... c ..., .......................................... .. ,c.......... .. ..� ..... .�..!1.......... ........................................... ............................... We propose hereby to furnisk mated III d labor—in acc, rdance with•above spec' cations for the sum of $ f U C,, L � _ 10 ' ��" ' dollars) Payment to be made as follows: I . . e y ---- -------- -------- �N All service is guaranteed to be as speclfled.All worts to be completed In a worhnan�ke rrrarrner acs arWrrg to standard practices.Any alteration or deviation from above specifications involving extra costs MI be executed only upon written orders and W11 become an extra charge over and above the estimate.All agreements contingent upon striPes,accidents or delays beyond our control.Owner to carry fife,tornado and other necessary insurance our worWrs are fully covered by Workmen's Compensation Insurance.. Authorized Signatures—� � �. �r: _,., 1 �' 15 Acceptance of Proposal-The above prices, specifications and conditions are'satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance ! 6 /_4agQ.3 Signature r '' Signature — — _ Location No. f Date NORTH TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ ��s'••'° tc� Building/Frame Permit Fee $ AGHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # A92 1 168 ' j Building Inspector