The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 1300 SALEM STREET 4/30/2018 1300 SALEM STREET 210/106.A-01 59-0000.0 i Location/,3 C1'� No. 2-1 Date NaR,h TOWN OF NORTH ANDOVER 3�0�,/`•D •,ho�G s 1 1 : ; : Certificate of Occupancy $ a �'�s'•"°•Eck Building/Frame Permit Fee $ AC MUS i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �n Check # /6�av ` 7775 - Building Inspeto w i �r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING r ter? ar i i"%" .. ..s'�x sT.. ,r•` f `sY � -� .x�°�. s xr a 4y x . WELDING PERMIT NUMBER. DATE ISSUED. ic SIGNATURE: Building Commissioner/Igs jwor of Buildings Date SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: a 0 f� �a Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use I Lot Areas Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R 'red Provide Required Provided R red Provided 1.7 Water SupplyM.GL.C.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Pubtf ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ --1 SE "TION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT " ; '.�iC;C iSt(iCt: Y•? �,,jn rn 24 Owner of Record Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: 4 Name Print Address for Service: z y M Si Mature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 31 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construcctior Supervisor: l 3 lt7 -3 _ / 0 `6 License Number Mn Address _ Ex oration Date ae Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 X,,,� Z�d-.0 )3f� Company Name Registration NumberrM r Address C� x z Expiration Date Signature Telephone ' J 1, r 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.......❑ No.......0 SECTION 5 Description of Proposed Workcheck as a ueable New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ Other 0 Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by perrnit applicant 1. Building (a) Building Permit Fee 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 as Owne , uthorized Agent 'subject property Herebv authorize_ to act on Mye�in tersrelglive to work authorized by this building permit applicatio a. �oc Si nature of Owner 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 S and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvfBERS 167 2 NO 3 SPAN DUVIENSIONS OF SILLS DIN ENSIONS 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 NORTH Town 0 4Andover No. 3/4? _ over Mass., 0 IL Al COCKICHEW.19 AERATED 0 IT % BOA"OF HEALTH Food/Kitchen PER T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT........... ..... . .......................................................... .... ...................... ............... Foundation has permission to erect........................................ buildings on ...Z Ad..........611,411CM!T......=...................................... Rough .......... . to be occupied as.00...... oti i-i I �i............................................................................................................................... Chimney provided that the person accepting t pdrmk shall In every respect conform to the terms of the application on file in Final this office, and to the provisions of t a 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 STARTS ELECTRICAL INSPECTOR Service .............................. bOILDNG INSPECTOR 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. SEE REVERSE SIDE Smoke Det. Board of Building Regula ons and Standards t One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home lmprovementContractor Registration Registration: 136361 Type: DBA 1 . Expiration: 7118/2006 r NO PROBLEM ..3 BRIAN CRAMP PO. HAMIL ON, MA 01936 Update Address and return card.Mark reason for chang Address 0 Renewal [:] Rmpl"ent Loa!Card )P�CA1 LS 5OM-04/04-G101216 - �/ze rianvrru�ruoea`�C o�,�'�aaaae/u�aelta Board of Building Regulations and Standards License or registration valid for individul use only i HONE IMPROVEMENT CONTRACTOR before the expiration date. It found return to: 1 Board of Building Regulations and Standards Ragktratlon; 135361 One Ashburton Place Rin 1301 Etpnn: 7118!2006 Boston,Ma,02108 Type: DBA NO PROBLEM BRIAN CRAMP 34 CRESENT RD. � HAMILTON,MA 01935 Administrator Not valid without signature i I V 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 c 11, S 150 A. The debris will be disposed of in: ' (Location of F cility) c. Signature of PUrmit Applicant Date f NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I v The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name:r Location: L S7 Ci rd /�-- Phone # I am a horhdowner performing all work myself. am a sole proprietor and have no one working in any capacity aI am an employer providing workers'compensation for my employees working on this job. Company name: Address City . f !i-f` /!/ � 1,Phone* r e Insurance.Co. - Policv# Company name: Address City: �� iUr/I�_/1�' Phone# Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties af,a fine up to;1,500.00 and/or one years'imprisonment_asvreU_as_civil,penaMesinlheftxmdA..STOPWDRKORDER,.and,a.fine.of.($111o.OD)-ajday.apai .me I understand that a copy of this statement may be forwarded to the office of investigations of the DIA for coverage verification. do hereby certify un pains and penalties of perjury that the information provided above is true and correct Signatu Date - q Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/1-icensina ❑ Building Dept (-]Check if immediate response is required ❑ Licensing Board C] Selectman's OfficeContact person: Phone#. ❑ Health Department ❑ Other