HomeMy WebLinkAboutBuilding Permit #267 - 200 CHICKERING ROAD 2/24/2003 r
TOWN OF NORTH ANDOVER.,BUILDING DEPARTMENT
•APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING m
OTHER THAN A ONE OR TWO FAMILY DWELLING
Tf113 SCCttOII fOQ'Official lT3sz�IIl
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Buildin Commissioner/Inspector of Buildings Date p,
1.1 Property Address 1.2 Assessors Map and Parcel Number:
Zoo c"% V-ES%t�G RoA� 3
�f�r 5 5rlQ, 106 ,
Map Number Parcel Number
1.3 Zoning Information: 1.4. Property Dimensions: v
91 -t 2y 1.es 1 N& 275, 92Y 7 r
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BIJILDING SETBACKS(ft) (g0,1-D JAJ 6. M
Front Yard Side Yard Rear Yard
Required Provide ReqWrcd Provided Re red Provided
AA os'.t 31./3 ' •�.
1.7 Water Supply M.G.L.C.40. M) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public l- Private 0 Zone outside Flood Zone �ag- Municipal d' On Site Disposal System 0
? 99
',. . .`.�.. ... .. .y. . 3?+-. .. Y.'..'f...,� -.= i •,vr.'Y?' .Jr 5:"k x..: < n. ..- "R ..'YS
2.1 Owner of Record
Te-relkOPEe 7765 LL G 23/ .SUTTp,v St N. A, boyrr O
Name(Print) Address for Service
f 9'71?- 697- l 2ao M
Signature Telephone
2.2 Authorized Agent
O?�CNcE CON 7�2uGTlo.�1 �CS>eP. I� (dt?yt�eq:�E belp..F 9E1,A10Au7 Nw U.37—Z6 >
Name Print Address for Service: Z
l�3-527- qoy o
Si
Telephone Z
M
3.1 Licensed Construction Supervisor Not Applicable( ❑
iAddress J `/ License Number O
-n ree4 CCVC0jr4
Licen Conqrilictton S sor: ( G 'Z� �� D
------- -- Expiration Date
3-2a 838(
Si Telephone� r
Register Home in t Contractor Not Applicable ❑ 0
Company Name Registration Number m
r
Address r
Expiration Date ^ZZ
Signature Telephone Y
I
i
Location
No. 4?67 ((1-r3-o2) F�)N-) Date
a��
NORTH TOWN OF NORTH ANDOVER
~41
9 1
Certificate of Occupancy $ r�r (r r-2z- {
'{
,SSACMUSEt�
Building/Frame Permit Fee .$ 3 ��d '
�-� Foundation Permit Fee lr z2-c
76
Other Permit Fee $
TOTAL $ & o
Check #
16183
Building-if spector
Wt-W14'"1t5
Workers Compensation Insurance affidavit must fbe 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.......❑ No.......❑
SECTIOAT S PRm SS.... ,)It SI�IY ANS STR C`1<ItItN R'1rIC`LS "(?16t$ 1k tG$ btu—CT, ':TtC3
CONSRTJC�I�BN Ct� lTRO>Z lP�f11 '0' j[AAT l Tl GF >fI+,I9 511'A1 }
5.1 Registered Architect:
BA C-" D ARoll
Name:
No. 9085
S S Ir► ►--r 1f=-- T t 'i'tr E T h1
Address A � BOSTON,
O MASS.
v 9
8co
. S
( S
tit P
Signature
N M
� Telephone OF �
A8#d�lY!f l�IrDf
Name:
�OSS�\ti SA1_�HK�pU Area of-Responsibility, STRU LT UP_AL
dIJ� Au 1 U M1y SC. �OR ISIyOy �� 03 Sd I Registration Number
Address:
403-433—x{33— $63 9 x 70S Expiration Date .'`
"Si afore
Total
30,
Not applicable ❑
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
gg
OPE�C-6+5 CDNs%ZuGnoN � R�,Q,g7?p�y Not Applicable ❑
Company Name:
ZN �E .,/
�!AY O
Responsible in Charge of Construction
New Construction 'Ji;- Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition• ❑
Accessory Bldg. ❑ Demolition _ ❑- Other ❑ Specify
f
Brief Description of Proposed Work:
I
�sieruac, (�1NSVGn� e� 8y�c�ra� # .3 - 2y unrir GcwQv By�c csN�
y-
USE GROUP Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ lA ❑
A4 ❑ A-5 ❑ IB ❑
B Business ❑ 2A 0
C Educational ❑ 2B 0
F Factory ❑ F-1 ❑ F-2 ❑ - 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑- 1-1 0 I-2 ❑ I-3 ❑ 3B .6;�.
M Mercantile ❑ 4 ❑
R residential 0 R-1 POW- R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 21 S•! BrtSe owwr 4W&Y. 5B 0
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: Proposed Hazard Index 780 CMR 34:
° a� :,
�.
BUILDING AREA EXISTING if applicable) PROPOSED
Number of Floors or Stories Include Es $
Basement levels i 6A.W PA;Ir
Floor Area per Floors
Total Areas
Total Height ft
8'-5�" (6�
Independent Structural Engineering Structural Peer Review Required Yes No ❑
SECTION 10a Owner Authorization- TO BE COMPLETED WHEN i
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject o
` /�� property
Hereby authorize �JCf E aA)S7)CVC nFa v (f1eiApZ-4-r20,J to act on
My behalf, in all matters relative two work authorized by this building permit application oe
Signature of OWer Date
ii
i
A
o-�
Rj3
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
I Print Name
Signature of eAA ent
D
t� g e
Itemr �¢,
Estimated Cost(Dollars)to be � �1r 5
Completed by percent applicant
1. Building 22-332 d Co (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
1.391320 Construction from(6)
3 Plumbing Building Permit fee (a) x 6)
22 8 e)oo
4 Mechanical(HVAC) l2 7 O d
5 Fire Protection Z y 3 Z O
6 Total (1+2+3+4+5) 4' 2 gSo as v ` Check Number
t 5..:i Zai'-rs.:3•-''�w' a. # 1 .n belY':,y V#?i ,k..1d 12k ,n ':nqq�_ ... cr
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V���"�i
h,$�' ti• .�' U.ti � �",'-ygp uo�/��r, u^eca ,r.r.,.s caw ��.�,�_�2,.-.�t�t."t
NO.OF STORIES —? SIZE
BASEMENT OR SLAB
B/-f�5�izl�NT
SIZE OF FLOOR TIMBERS A/ iST 2 ND 3RD
SPAN
DEMENSIONS OF SILLS
DEMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION PAe1ES lD/2 r THICKNESS �Z n
SIZE OF FOOTING
SAS -AvE 3-eo " x !2 "
MATERIAL OF CHIlvINEY
iA LS F '4AW
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
eF s
��k� n.ati� � "���,`��.,�'�,..���'�l';� k `'"`, �rxS:�.�-t,�.x� �p�a�,d✓': `'rya�r.� -.�n� .gtr� �^rk�.�'��� r:. �w�r r
t
r •� .e o 'r a ",-'�.� r,�.�` s..«a,<t�'���'"i"�' ,^� '� .;$��fi� �"k��'�3§�tk��Ir dr1'�`�' ` �' �e �r ,K '
I
Town of dover
0
No. Uoctr:SkUC110N
dover, Mass.
O A sZi
COC MIC V
ORATED PPI` "`Cl
S H BOARD OF HEALTH
Food/Kitchen
Septic System
PERMIT T D
0. BUILDING INSPECTOR
THIS CERTIFIES THAT..T a-A►.Rs cies 1LC►.. ..Pe=.He .���?!" �* � +...d .....
••• � • • ••• � Foundation
tq
has permission to erect....... N............ buildings on .. ..... . .� - i)q-.. -�b-7ozs.... Rough
to be occupied as........44_4 .. ....... uTi'ArS.�. + ..".4.. $................................ Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws 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 STARTSELECTRICAL INSPECTOR
C(Yf��t31 Rou h
4U RUCTION
........................... .. ...... ........ .... .................. . .
�................ Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on � T
the Premises — Do Not Remove Final
No Lathing or Dry Wall 1 o BeDDone FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
U C."= Street No.
SEE REVERSE SIDE Smoke Det.
cir