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HomeMy WebLinkAboutBuilding Permit #622 - Exception 12/27/2000TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING S Section for official Use OnI 21, M-1- YE -21-2 BUILDING PERMIT NUMBER: & 22- DATE ISSUE] SIGNATURE: 2- /;Z;Z Buildiu Commissionerfla�,poqor of Buildings Date 1.1 Property Address: 3SI L10Z-7— &,�)4,0 1.2 Assessors Map and Parcel Number. Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: 1, z,0 9,/ 3-5,y -rF YI?71 zo Lot Areas Frontage (ft) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard ReqWred Provide ReqWred Provided Re red Provided 1.7 Water Supply M.G.L.C.40. V54)-- Public )9L Private 0 1.5. Flood Zone Information: 1.9 Sewerage Disposal System: Zone - Outside Flood Zone 0 Municipal On Site Disposal System )(T Wrl, NOW 2.1 Owner of Record ,01. Name (Print) Address for Service : V44,"44h,, AJeW XPRk 165-9'S— Signatu Telephone 9 14 - - 7 01 - 2 .2 Aut�A�Int GREGG 672NS7' C419Y-ep Name Print 6 A7�� �� 7- /7-7 11V,-"&W9ei2' AUS1,-03:r 47X. OR Con/STa2ycno.✓ co. <7. 40aa.1 17,0. Address for Service: 3e29- 4'SI,,b 4AX Z�Ker Signature Telephone W1 3.1 Licensed Construction Supervisor iqL f- 1, 11IN` Not Applicable 0 . C .-S . 0(0-?> Address /'/P/ COiqAL- J2,9cj, IqO License Number Licensed Construction Supervisor: zoo -a/ Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name'. Registration Number Address Expiration Date Signature Telephone 0 M X Z 0 z M z 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 Gh'ftG Print Name (� � �Ina4si L..n�/ x///3/00 Signature of er/Agent ate j Item Estimated Cost (Dollars) to be Completed by permit applicant ' ..Y. �. 1. Building J2so'Go0 (a) Building Permit Fee Multiplier 2 Electrical .+►%QOM poa (b) Estimated Total Cost of Construction from (6) 3 Plumbing �S Building Permit fee (a) x (v) cb ' 4 Mechanical (HVAC) sS dGD 5 Fire Protection 34:2i GaD 6 Total (1+2+3+4+5)Z±44-* ,,,4Check �/bS`J Number 0�j9 T M1)^X }F+4I�Rst `t\- fi Z 3' Lr5!C,r r{ii.. t NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 sr 2 ND 3ko 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 + * Rom "!` ( d, ESL !'I` ©I ? PR 3 �,01 ap*able ''` New Construction ❑ Existing Building ❑ Repair(s) ❑Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ A Assembly Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: py�S r -I G zwk Wl14erf/aa ,"&Y,) Relw Y tr/ Of j8 wo SQ Op: /JJ JnJ*61-V4 'S Grit%GyjQGJ/�t'r /9 .C'E3Ti1?�% �D/N!�- � �G�//gLG IJ�?1/S/NG Gv/yLL� ,d�//GO//✓G �% ���' /'10D�f�L�I7"/�1 1'� �`' S�i�P/�✓.�LL�2 SY,ST�1, ��.��1LJ� N� D� .Cbua?S ��'�i?17�W,% - - B Business ❑ BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Heieht (ft) Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 ❑ A-3 ❑ ❑ ]A 113 ❑ ❑ B Business ❑ 2A 2B 2C ❑ ❑ e C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ 1-1 ❑ 1-2 ❑ I-3 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 S-2 ❑ U Utility M Mixed Use S Special Use ❑ ❑ ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: � � Existing Hazard Index 780 CMR 34: � Proposed Use Group: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Heieht (ft) Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 c x- Workers Compensation Insurance affidavit must be completed and issuance of the building permit. Siened affidavit Attached Yea .......0 No ....... 0 SECTION S DgS)€GN ; "NS" with this application. Failure to provide this affidavit will result in the denial of the 5.1 Registered Architect: 44" ImL �, /d���pc'E . /i/•4 f�/E�'cE 19R-y/TAT xS�ED �Cy�r Name: /7 Zl� 13E.�,QY-Si72E�1 SNG�-i� th o/97a o 6401 "' Address v r �o SALEM, MA J 97s >5`s- 3330 S atur Telephone Not Applicable ❑ Company Name: Responsible in Charge of Construction Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility y Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Not Applicable ❑ Company Name: Responsible in Charge of Construction Location No. 2, f�-. C Date I &ORTN -1 TOWN OF NORTH ANDOVER 0 � + Certificate of Occupancy $ CID Building/Frame Permit Fee $ U Foundation Permit Fee $ Other Permit Fee $ TOTAL $ S Check # �� 50 3'1 75 Buildinrinspector