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Home My WebLink AboutMiscellaneous - 146 HIGH STREET 4/30/2018 146 HIGH STREET 210/053.0-0019-0000.0 Location No. Zo V Date C�F,6 4 � MGRTq TOWN OF NORTH ANDOVER F 9 40 Certificate of Occupancy $ Building/Frame Permit Fee $ �cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a- Check # f 18532 'Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREP RENOVAT E, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,: MO. kz'" ,.W .. t fi s'' :✓ '�. .,w?N ;— BUILDING PERMIT NUMBER: ?TIATE ISSUED: �a O X D SIGNATURE: c.-�—�— Building Commissioner/I rf Buildings u11d1n Date SECTION 1-SITE INFORMATION I Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O 11<-7 3 Map Number M A qC�� Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide ReqWred Provided Required Provided v 1.7 Water S 1.5. Flood Zone Information: 1.8 nPPh M.G.LC.40. 34) Sewerage Disposal System System ❑ Public ❑ Private ❑ Zone Outside Flood Zaae ❑ Municipal ❑ On Site Disposal SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Mstorfc Uistrict., yes No 4 2.1 Owner of Record Name(Print) Address for Service: 1 Signature Telephone O O 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone i SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number 0 Address a" Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name M M Registration Number r Address r aa. Expiration Date Z Signature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L.C t52 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will res, in the denial of the issuance of the building permit. l' Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work(check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg.- ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFF C7A L IISE ONIS.Y Completed b permit a licant 1. Building (a) Building Pen-nit Fee 0 Multiplier 2 Electrical b Estimated Total Cost ( ) of Construction 3 Plumbing Building Permit fee , 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 Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all inatteq�W work authorized by this building permit application. G _ _ <:T( �o`� Signature of O e Date SECTION 7b 6WNER/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/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS • DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X ' MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED I,AND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH TO" of tAndover No. over, Mass., 91 A( V COCHICHE WICK V ORATED C2 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT ..A 4.............W41!............................................................................................ Foundation . has permission to ere ............................buildings on .... ..:�ir..... . I... ............. ......................... Rough ok . .... .... 4 ��1�0 �w....................'t 1 A Al Chimney to be occupied as.......................................................... .... . y . .. . . . . . . ........................................... .. provided that the person accepting this permit shall in every respect conf 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 6 /39' VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough .............. ..... ..................................................................... Service BUILDING 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. • 4 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 at: Anjjis 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. Also, note Permits are requited under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date Date. l f HpR7M ,� TOWN OF NORTH ANDOVER: PERMIT FOR GAS INSTALLATION SACHUSES . �1 r.a f Gam. This certifies that . . . . . . .:t. . . `. .. . . . . .`. . . . . . . . . . . . .v has permission for gas installation . !. . . :. . . . . . . . . . . . . . . . .. . . in the buildings of . . :. .Y. '. . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . at . . .!. . . . . . . . �. . . . . . . . . . . . ., North Andover, Mass. Fee. !. '. . . . . Lic. No.. :: . . . . : . .' f GAS INSPECTOR. OI ` WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING (Print or Type) �`�l_� NORTH ANDOVER Mass. Date L�uilding Location Tele 1-4/ S7 Permit # �{ • 'Owners Name 2_422D • � New 77 Renovation Replacement Plans Subrr�'tted =] #� FIXTUPp c N CC CC Ch W Q O U m F� ` bill S N a t- x o t- O w d tr a O ' O x r _. .G1 a M w d W W F N A. cc W 4 N tG N O V W Z rn Z � Q O c > W w W W z a a Lr a a W r W v z a W z m z d u0 > � W Z d 4 < O O W O W !" tz x o E SUQ-$SS.1T. � BASEMENT IST FLOOR _ 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTK FLOOR tj 8TH FLOOR (Print or Type) Check one: Certificate Installing Company NamessAr&�( Corp. Address /0 ',�`( brna Partner. D Fi rm/Co. Business Telephone Name of Licensed Plumber or Gas Fitter_ //Zry Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy r--] Other type of indemnity D Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signatur f owner/c e property OwnerAgent El 1 hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issced for this application will_be in compliance with all pertinent provisions of tho Massachusetts Slate Cas Code and Gltapter 141 of the General Laws. By TYPE LICENSEd!ig�nat4& lumbererTitle Gasfitter of Licensed Master Plumber or Gasfitter City/Town: Journeyman APPROVED (OFFICE USE ONLY) License- Number