The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 1299 SALEM STREET 4/30/2018 1299 SALEM STREET 210/106.A-0123-0000.0 I I Location 17' d No. Date lo—'s ry s MORTM TOWN OF NORTH ANDOVER 3.t •. • O .. 9 Certificate of Occupancy $ _ Building/Frame/Frame Permit Fee $ S sAc�usE 9 t�! Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �S Check # CA 15122 Building nspector I� t TOWN F NORTH ANDOVER BUILDING DEPARTMENT PPL ICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING UILDING PERMIT NUMBER. DATE ISSUED. (( :GNATURE: Building Commissioner/I or of Buildings Date 3CTION 1-SITE INFORMATION 1.1 Property Address: 1.2 . Assessors Map and Parcel Number: IQ G � S�� Map umber Par INumber Q) 1.3 Zoning Information: 1.4 Property Dimensions: U ning Distrid Proposed Use Lot Area.s Frontage i BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided k 1, Water Supply M.4aLC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: lic 0 Private ❑ Zone Outside Flood Zane ❑ Municipal 0 on Site Disposal System 0 :CTION 27 PROPERTY OWNERSHIP/AUTHORIZED AGENT O,net of Record \ l-�lU r A GIC.R o e( tint) Address for Service nature Telephone Owner of Record: arae Print Address for Service: iature Telephone CTION 3-CONSTRUCTION SERVICES Licensed Construction Supervisor: Not Applicable ❑ 1 .used Construction Supervisor: i License Number ress Expiration Date Imam ature Telephone ! '1 2egistered Home Improvement Contractor Not Applicable ❑ 1 I pany Name I Registration Number I ess � �. Expiration Date tture Telephone 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.......0 No.......0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed lork: r SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be g x Completed by permit applicant 1. Building r 7yp (a) Building Permit Fee J V " 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 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT h ,as Owner/Authorized Agent of subject property Hereby autho ' e to act on ha Il �Ie o authorized by this building permit application. Sign6de of er Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,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 Si ature of Owner/Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR.TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DEMENSIONS OF GIRDERS R HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH T01%;M . of E -..' Over C;2 - _ � �o�H dover, Mass., %A0RA7ED PP�t-`� S H. ` BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System r' fI BUILDING INSPECTOR THIS CERTIFIES THAT....... .®.... .�cc?........... .�. �' 6�A ..................................C.,........................................................................ Foundation has permission to erect...s .�.. ............. buildings on .... .a. ...1.........�A�`ems........ ........................... Rough to be occupied as ¢ � ..rm O /a �P. .[o � �-tet 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 rel ting to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. d/4 �� o? PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids thi Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST T ELECTRICAL INSPECTOR Rough .............. ................ ...... . Service BUILDING INSPEC.TOR.. 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. .I SEE REVERSE SIDE Smoke Det. i North Andover Building Department Tel: 978-688-9545 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 a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: 5� (Location of Facility) Signature of Permit Applicant ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector