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HomeMy WebLinkAboutMiscellaneous - 15 HALIFAX STREET 4/30/2018 15 HALIFAX STREET U-A 210/022.0-0119-0000.A d 4 Location + No. Date 41 �aRT� TOWN OF NORTH ANDOVER F3? •. • L Certificate of Occupancy $ ACHUSEBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r r I5 J 1 /� Buildin J64ector Location X5- No. 5No. ��� Date -tea a� NORTH TOWN OF NORTH ANDOVER 0 70 Certificate of Occupancy $ <� Building/Frame/Frame Permit Fee $ � s�CHUst. 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # O 15324 Buildin eAector TOWN OF NORTH ANDOVER --' BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,.. T L9 for OfICi&'E Us:e�II)( BUILDING PERMIT NUMBER: DATE ISSUED: R -6200 SIGNATURE: �l Building Comn-Lissioner/Inspector of Buildin2 Date SECTION 1-SITE INFORMATION 1.l Property Address: 1.2 Assessors Map and Parcel Number: O r\,,�a�i t � Map Number Parcel Number 1' 1.3 Zoning Information: u Jt L Property Dimensions: Zoning Dtstnct Proposed Use Lot Area(so Frontage R) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reqwred Provided Required Provided 0 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2. Owner of' Record _»ovv S e N e riot) _ Address for Service RA) "gnature Telephone 2.2 Owner of Record: (�\1 Name Print Address for Service: O z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address D Expiration Date Signature Telephone L.. 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name Registration Number M Address r Expiration Date z Signature Telephone n - 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 0 Repair(s) 0 Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 5 5X� n 3a a A SECTION 6 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost Dollar to be x ` (3FFCCIAIJIISE QNLl' Completed by permit applicant i 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 -T I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 �n Pri a e,/ -NAAQh0 Si atur Owner/Agent Date I NO. OF STORIES SIZE BASEMENT OR.SLAB RD SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DilvENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i r 0 h lv+JT P, VAI A'y s 0 vfaoP �W0C-1 n j 101000 _o I I N cx> " W AORTH R 0 Of 1Andover _ .1 � 9 _ 0 No. � COC HICM WIdower, Mass., a- 13 -� 20 a T O L A CCK � op ADRATED PP�t�� 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..........0 ............ a..�� ........................................................ _ ................n Foundation has permission to erect......:?..�. ..�..I........... buildings on IS N ....... 1' A. Q4........................ Rough .....a I ..... ......... 1 1 to be occupied as....... .x.1. p m t .V e c--K mN ro ` 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 relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. �2 Q 1 ` I l S PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. g Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough �j� .............. A /.....�....... ........ ... .............. .... Service ... . ... . ..... .. BUILDING INSPECTOR i 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. v r•J 0 0 v Ot • 101 cx> //JZ Location ' No. / a Date koltT" TOWN OF NORTH ANDOVER f 1,y Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ _ Other Permit Fee $ TOTAL $ �' Check # .1.3 111»J C ' Building Inspector l " TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 22 BUILDING PERMIT NUMBER: DATE ISSUED: , aY-( a/ SIGNATURE: Building Commissioner for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Number Parcel Number �J 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard _ Rear Yard Required Provide Required Provided Required Provided 1.7 Water S ly M.G.L.C.,W. 54) 1.5. Flood Zone Information: 1.8 Sew Disposal System: Public C�/ Private ❑ Zone Outside Flood Zone ❑ Municipal l On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record -I ewe,u M 15-� t:i) I Name n Address for Service Si ture Telephone V 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 'Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supe rviso License Number ddress Expiration Date ic ignature Telephone lt3.2 Registered Home Improvement ntractor Not Applicable ❑ Company Name M Registration Number r Address rM Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this afFid#vit will result in the denial of the issuance of the building rmit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all a Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �a'p 4 b- 6 U 1--p— (, //J 9,-P&t oe SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be QI�FICIAL CTS 'ONLY Completed by permit a licant 1. Building C, -- (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(8)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 I,✓ as Owner/Authorized Agent of subject property 4 Hereby authorize to act on My behalf,in all matters relative to work authorized by this building pennit application. L/ b� Signature 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 and belief w i Print Name Signature of Owner/A ent Date Iwo 11 a NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEvMERS I ST 2ND 3ko SPAN DIMENSIONS OF SILLS DM 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 FORM - U - LOT RELEASE FORM . INSTRUCTIONS' This form is used to verify that all-necessary*proval/permits from Boards and Departments having jurisdiction have been obtained.This does not relieve the applicant and or landowner from compliance with any applicable requirements. 0..■■.............................■ ..■t.................................... APPLICANT �' �z� � PHONE � 3 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION `—`r LOT NUMBER STREET (�1 ( � STREET NUMBER C .......... ...........■ ■I..............................................1.. OFFICIAL USE ONLY RECO;:4; ENDATIONS OF TOWN AGENTS DATE APPROVED a'- 0014SERVATIONADMIT,TISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMIviENTS RECEIVED BY BUILDING INSPECTOR DATE NEAR 2 7 2001 L..BUILDING DEPT. i ppRTH 9 Town of North Andover0 Building Department ° . 27 Charles Street a c North Andover MA. 01845 �4 °4Arl "VO D. Robert Nicetta SS°""'s� Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE ' I JOB LOCATION Number Street Address Map/lot "HOMEOWNER r� J P b-?,5ass� Name Home Phone Work Phone PRESENT MAILING ADDRESS �tJ� 1 1 ��(�� j n City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does j not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) t DEFINITION OF HOMEWOWNER: ' Person(s)who owns a parcel of land cry which he/she resides or intends to reside,on which there is, or is intended to be,a one or two family dwelling,attached or detached structures ac- 1 cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, i The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirement's. HOMEOWNER'S SIGNATURE j APPROVAL OF BUILDING OFFICIAL I { NORTH F ® ®ver T �D =- - LA O dower, Mass., OD o? I� COCMICMEWICH V �- ADRATED PPP"f C S H ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..6�i.�. .. ...f.N..�ir................� ........�......................................................... ............. Foundation has permission to erect..(.l1� .....�.18........... buildings on ........1-5.......N.. .l..i...q.�.y.......a�.:......... Rough to be occupied as....AtOl -la......st.o.m.o.4..... .1.......J.*Q....... ....... chimney provided that the person accepting this permit shall in every respect conform to the terms of the apication on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Aftera ion and Construction of Buildings in the Town of North Andover. � 3 a Pill 3S ONNNO. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR ough .f. L �*1'*1­**­*****­1­­** Service ........... ... ... ......... ........ ... BUILDING INSPECTOR Final Occupancy Permit Required t0 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. NOR ►y ovm ® over y_ dower, 1Vlass., _ 0700 l �A COC MICM `y DRATED PPS �C-) H BOARD OF HEALTH Food/Kitchen PERM - IT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT Ar... . ...f.N.0............... .............................. Foundation ' .......�......... Rough has permission to erect.14.....�.Is.......... buildings on ........1.5.......i 4.. ..�i..4*v....... to be occupied as0A.....St-0—Mv ..... .1.......,1.00........6*4e....... IR. ....... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the ap Ica ion on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Altera ion and Construction of Buildings in the Town of North Andover. � 3 4& Pill 3So dmwv� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STS Rough Service M1 ........... ... ... ...................... ...................................... 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 (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.