HomeMy WebLinkAboutBuilding Permit #265 - 200 CHICKERING ROAD 11/13/2002 Py
TOWN OF NORTH ANDOVER BUILDING DEPARTMENT Q�'A
v
'0
APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING M
OTHER THAN A ONE OR TWO FAMILY DWELLING /U
This Section for Officiw,'s
,. al Use On]
BUILDING PE ER: _ DATE ISSUED:
►� r+a>'t^% ti`t3 cz. CONTROL sJ►�i �s'7Z 6
iL
1
'SIGNATURE: r• // 3 D
'
Building Commissioner/Inspector of Buildings Date w
SECTP 1 STi"E tt)IYQiI�' :n'. Qui
y 1.1 Property Address:.. 1.2 Assessors Map and Parcel Number:
Cw1CK'e911J6 1400
Map Number Parcel Number/ ,
.3,
Zorii6jInforrrt ion: 1.4 Woperty Dimensions: e
Zoning' Districte, 1 ';","-.Proposed Use Lot Areas Frontage ft C?
L6 BUILDING SETBACKS(ft) m
Front Ydid,,' Side Yard Rear Yard
Provide Ruired Provi Re red Provided
s14 o.. CHEv
1.7 Water SnpplyM.CrL.C.40. 54) 1:5. ood Zone InT'mmatioo: 1.8 Sewerage Disposal System:
Public Private ❑ 'Zone Outside Flood Zone Municipal On Site Disposal System 0
SBCTifh F
( 2.1&ner of Record /
LamePrint) �,s'�'� � Ad ss for Service
4
Signature / Telephone /X
2.2 Authorized t Q6
D
Name Prin Address for Service: Z
K l O
Z
Signature Telephone M
90
3. Licensed Construction Supervisor Not Applicable ❑
Address License Number O
/o
Licensed C struct" 1 : T
Expiration Date _
_ r
Si na Tele ho
g P •�
rt
1,��R,4.,istered Hom Improvement ontractor Not Applicable ❑
Company Name Registration Number
M
Address RECEIVEDF
Expiration Date N,®V ,O � 200 ^
Signature Telephone ( , G)
PT.
" , Location CRLC k wr P��,-� - 8Lr `
No. � Date /✓tedT
T�cl.kL�-�
NORTH TOWN OF NORTH ANDOVER .
i Certificate of Occupancy $
�'�s'••a°''��' Building/Frame Permit Fee $
s�CHU
Foundation Permit Fee $ I 1 o
Other Permit Fee $
TOTAL
Check # 031362_
16035 ►
Buitdrrnspector
t
3 �
INI
I/ r
LocationP-yNd- e0r9 D �LD�-
No. �S Date �1�A tip"
CF 0,1-, Wim r z7- -t-)Z)
'' •. "OoT��ti TOWN OF NORTH ANDOVER j
3s .�., •.�` i
1
Certificate of Occupancy $ �' � (11-12 °Z 1
s�Cw�s Building/Frame Permit Fee $
Foundation Permit Fee?Rd) $ I I
Other Permit Fee $
TOTAL $
3 FX0 2 I
j
-4 Check # 112
16L6 ,
Building--Inspector
C
e
SECTION.4 W—OPMERS COMPENSATIONKG;)L
T
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.......❑ No.......❑
SECTION 5.-PROFESSIONAL:DESIGN ANA,CONSTRUCTION SERVICES,:;FOR BUIMINGSAND STRUCTURES SUB3;gCT;TO
CONSTRUCTION COMMOL PURSUAi!1T T0'M Cb7R i' -CONTAIl�III+1O MORE:TE[AND 35 000 --K-Of-
"'.d ENCLOSED SPACE)
_. : ,
5.1 Registered Architect: 013111
�d ` 6vL c� kV �Q�J.Vp9
Name:_ /f
�.�. 06 l S SS�nI l�.`�t�S� L,,AL 085 �
Address t MN,
t�
Signature Telephone
IsTr
5.2 Registered Profess�al Eng�neer(s), r � � ;;; " . `- .
F
Area of Reser °ti s
potYHOSSEIN GN
Name: i SALEHKHOU m
TRUCTURAL a,
i A VTUh-1 N 5T-, 7?0 R Ti ZH U T H 1-1 N 03 8 01 Registration 38367
Address: 9F(i'I ST
01
Y33-- & 9 ex: 205 xp atioiD"ate
Signa�zC Total
0><P/geS JlsiaE 30 z00�
Not applicable ❑
Name:
Registration Number
Address
Signature Telephone Expiration Date
Name Area of Responsibility_
Address Registration Number
Signature r Telephone Expiration Date
Name Area of Responsibility
1
Address Registration Numbed
Signature Telephone Expiration Date
Not Applicable 0
CodiFahy Nam
no N �,�
Responsible to Charge of Co truchon
Y F
'SEECTI(31�I 6 p�ES ,.. aN QF PRUP4STi<A.;WURS:,Echeck.all applicable) .
New Construction Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition 0
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work: JJ ( ( (�
� �JTi �.r 3u.,' lcl;r� ` � � � T//'Pd Cnasl�
SE .' IQN =.USE GRflL'P Al!ID CO1S FRIIG'TIQIY TYPE ✓/
USE GROUP Check as applicable) CONSTRUCTION TYPE
A Assembly 0 A-1 ❑ A-2 0 A-3 ❑ IA 0
A-4 ❑ A-5 ❑ IB . ❑
B Business 0 2A 0
C Educational 0 2B 0
F Factory ❑ F-1 0 F-2 0 2C 0
H High Hazard 0 3A 0
IInstitutional - ❑ I-1 0 I-2 ❑ I-3 0 3B
M Mercantile 0 4 0
R residential 0 R-1 0 R-2 R-3 5A 0
S Storage ❑ S-1 0 S-2 0 5B 0
U Utility '0 Specify:
M Mixed Use 0 Specify:
S Special Use 0 Specify:
COMPLETE THIS SECTION IF EXISTING BUELDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
-"sting Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
1 BUILDING AREA EXISTING if applicable) PROPOSED
Number of Floors or Stories Include -
Basement levels S
Floor Area per Floor(st) SF
Total Areas "' Lc-
Total
Total Hei t ft — .3/FE
Independeni Structural Engineering Structural Peer Review Required Yes No ❑
L SECTION 10a Owner Authorization- TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, "Q as Owner of the subject property
eby�iithoSall 'atters
to act on
half, in relative ` o work authorized'by this lding permit application
Signati of Owner Date r
. If
6.
g t
S
MOM
I, Earw�N��� 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 pedury
Print Name
Signature of e Date
Item Estimated Cost(Dollars)to be x ) TI�`IALI3SE UNtlr
Completed bypermit applicant t t
1. Buildin � ��
- — -
_ g �v a .. Building Permit Fee
Ito 600 ...-rte. Multiplier
2 Electrical (b) Estimated Total Cost of c o
Construction from(6) /1 pr�c
3 Plumbing Building Permit fee (.) x(b) l t I v off,
4 Mechanical(HVAC) co`� o
S Fire Protection �6u W 0 P"'..*A I O o�
6 Total (1+2+3+4+5) Check Number O 39 3w
ob
NO.OF STORIES SIZE
BASEMENT OR SLAB J� .
SIZE OF FLOOR TIMBERS � Pit 2ND 3RD
SPAN
I
DEMENSIONS OF SILLS
DEMENSIONS OF POSTS
t f
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION 1 U I e i THICKNESS
SIZE OF FOOTING x
MATERIAL OF CHRANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
t.
Li:, _
TERRA PROPERTIES LLC 1124
CONSTRUCTION ACCOUNT
Town of North Andover 3/27/2003
Rennie's Development Costs:Permitting 73,970.00
I
i
lConstruction Acct-BankNo Building C Permit Fee 73,970.00
