HomeMy WebLinkAboutBuilding Permit #264 - 200 CHICKERING ROAD 1/22/2003 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT
_ APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING III
OTHER THAN A ONE OR TWO FAMILY DWELLING
S•mt.' -�Thus Section for Of Use Onl � {
BUILDING PERMIT NUMBER: DATE ISSUED:
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l- 12-
SIGNATURE:
ZSIGNATURE: 2 Z v o
Buildina Commissiorler/I or of Buildings Date r✓. .
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Zoo Rom)
Y41 3s y(f 4' /vG o
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: v
B 1. eq, Z7.n 3z y -ft Z 3yG.Z 7 >
7 n District. Proposed Use Lot Area s. Frontage ft rn
1.6 BUILDING SETBACKS(ft)
Frorit Yard r Side Yard Rear Yard
Required Provide Required Provided Required Provided
9 T3 2 Z
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone LsFomration: 1.8 Sewerage Disposal System: N
Public jet Private ❑ Zone Outside Flood Zone $ Municipal I- On Site Disposal System ❑
- ; ,�I. :I AS �..MON-
2.1 Owner f--Record
�I2 en LLC 23/ �vr�a,.r SiE AlAYWYOR M Olgy,r
e(Prig) �.\ Address for Service
Signature r /�?/I2 - Telephone
2.2 Authoriz
,� r2.uE A c �� COG�iew� �,e �LMo.•�T itJy O� Z� Z
N e Print Address for Service:
r
527- 9 019 0
Sign a Telephone Z
M
3.1 Licensed Construction Supervisor Not Applicable ❑
Gs 07 9s22
Address License Number O
lZ/' , > -S-L 6waeb
Lised Construc 0 n pervisor: 10 -27-10Y
oo
03-22 - 838 Expiration Date
r-
Sign Telephone
. .Registered ome Improvent t Contractor Not Applicable ❑
ti
Company Name
Registration Number M
r
�,�ss r
Expiration Date ^Z
Signature Telephone u
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 Yea.......0 No..."...0
SEC)t]EOPI 1-TR VMIO,fI��i[ ,7 �y1�TyZC17y+C"`�s�yRC1S{ [$1s � ;/ yL� �Drg�fiyv�
5.1 Registered Architect:
VB Aq�
E,�'.T �/O PL F��s1 N
�kV����J.VOq���jcrC,�
Name:
y
—('L E Tt� i-3 �-�1 A 1 o No. 9085 +
Address BOSTON, W
Oy MASS.
Signature Telephone
S.� iste�eal€Iii
iWX
SOS S \w SA LAN KFS p i l Area of Respons'
! Name: ST t 3'S9C+
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NOTOAt,:�, ST.. �6�\SMO U\t� 0 �Q 1 Registrati IN
Address: EHKHOU
UCTURAL w
o.38367
&-,3�- 433— 6 3 c1 7C ZOS-
Siq,ffire Total C1S f EP
Not applicable 0
Name:
Address
Registration Number
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
�S G• �
T2 '7&7O N CORPo dlt a
Company Name. Not Applicable ❑
rAeNEy
Responsible in Charge of Construction
I
i
Cew Construction Existing Building ❑ Repair(s) ❑ Alterations(s) 11Addition 0
Accessory Bldg. 0 Demolition ❑ Other 0 Specify
BriefDescription of Proposed Work:
Oezzlc44 2 Ek HJFzN4NC•a L
PLUMB/'JG- . FLEGnZ/C4I- FSE' Pi2072-5C no,ci,
Val � �E
USE GROUP Check as applicable) CONSTRUCTION TYPE
A Assembly 0 A-1 0 A-2 0 A-3 0 lA ❑
A-4 ❑ A-5 ❑ 113 ❑
B Business 0 2A ❑
C Educational 0 213 ❑
F Factory 0 F-1 ❑ F-2 ❑ 2C 0
H High Hazard ❑ 3A ❑
IInstitutional 0 I-1 0 1-2 0 1-3 ❑ 313
M Mercantile ❑ 4 0
R residential ❑ R-1 R-2 0 R-3 ❑ 5A ❑
S Storage ❑ S-1 0 S-2 ❑ 5B ❑
U Utility ❑ Specify:
Mixed Use P1 Specify: S-1 _7.j 84ScMeA.r
�>pecial Use ❑ Specify: .
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE
ii
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
a
. 1yz
BUILDING AREA EXISTING if applicable) PROPOSED
Number of Floors or Stories Include
Basement levels
sro ,es I BA.uzWex.17-
Floor Area.per Floor(s `19 7S SF
Total Area s
39,sio s•�
Total Height ft
.,
Independent Structural Engineej!!I&Structural Peer Review Required Yes ,fes No ❑
SECTION 10a Owner Authorization- TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
Hereby author ze DPFc&,5a Lo,6.5 7-x jc17oN Co eA-y4 77,01 to act on
behalf,
in all-matters relative tvvoework authorized by this building permit application
Signature of Owner t f / Date
i %) f
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I> as Owner/Authorized
Agent
Hereby Clare that t statements am information on the foregoing application are true and accurate, to the best of my
kn edge and llief.
gned under the pains and pe Ities of perjury
Print Name
Signa _.._ __._ Date
Item Estimated Cost(Dollars)to be
Completed by permit applicant
I. Building (a) Building Permit Fee
3 7 2 Sim=` Multiplier
2 Electrical (b) Estimated Total Cost of
Construction from(6) 3 I¢2 fro aa-
3 Plumbing Building Permit fee (a)X (b) '
37•¢20 �-`
4 Mechanical(HVAC) eo
ta-.S F0ta (II-I$-d2) �o
5 Fire Protection 3 oma
6 Total (1+2+3+4+5) �3 2 eS! Check Number 04+7,z N
0 10W
tv a tF.. '•�` - x= s'_ 7 i:•.A,Y .+"a -
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y.`✓. fk '';.;fit ;vi 'r':.��t�.s'i.:.r S f Lt i7r uS41..! t ttE.'�°J+ost -_ ;}., 'yt }.fir. .,: YT' O ''s
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1`?fv,1...5 3Krs�`+�'s`C »�..t`?.: �'"' - ",�t.;�.ria err ,v>,xf`F'� `�x'��'.sf4,h�.r`,�J}�8 �.a a ::>.v1','+ �,f.a'+* ��M�(y�:.. : @x}����r ati 'j,��_�si,f��a"�i r�4k�,•t
NO. OF STORIES -3 SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS N� 1ST 2ND 3RD
SPAN
V42i6.3
DEMENSIONS OF SILLS NA
DEMENSIONS OF POSTS NA
DIMENSIONS OF GIRDERS VA Z IES
HEIGHT OF FOUNDATION ` — THICKNESS
Pge VAZ1FS 9-6
SIZE OF FOOTING VAIZ 115 x
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
NG .S�2VlCE Tv BU/t,D�N(r.
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