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Home My WebLink AboutMiscellaneous - 169 GRAY STREET 4/30/2018 (2) 169 GRAY STREET 210/107.D-0012-0000.0 i I I i Location 440. v'c IL Date 0 � 40RT#1 TOWN OF NORTH ANDOVER O F R .. D + ° Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r F Check # 22,64 r 15752 .� . f Building Inspect6/ C TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: X SIGNATURE: Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �y S� (ZA � � Map Number Parcel Number hy Ar 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Regilired Provide RegWred Provided Required Provided 1.7 Water Suppty M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHWAUTHORMI)AGENT 111 2.1 Owner of Record TLltA, AAURP6 OCOA 1� G�eAy S I Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: �eWCO�?-P ®/27(r ��i�% s �6 C�Pi��°y 5 /�uc�Sortr�� /7�9 0 e Address for Service: z az Lano�,e �A Si ature Telephone( SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: O License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name M Registration Number r r Address •—y b Expiration Date Signature Telephone v' w 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.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction Q--*($w Emoting B� din ❑ Repair(s) ❑ Alterations(&)=fI❑ �r,. Addition ❑ ". Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: P14,_-A P Fu eve%I�� S�rya'� q0 X'4(6 FP-Ann,e 4?ArCy OAf SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be :t3Fk`ICIAL USIA UNI:Y" Completed by permit applicant 1. Bpi .. g (a) Building Permit Fee P / Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) a ' 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 G-G "&1., Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PER 1, as Grier/Authorized Agent of subject property s 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 I, � {L RY FEAC ,as 9wncr/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 P int e /-0 Signature a 04_�r/Ag7nt Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS D�NSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHI?VMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Nvr� � h OVM . of O No. " 70 _ * - - h _ - LA O over, Mass., COCMICKEWICK V A0 ATE S BOARD OF HEALTH PERMIT. , T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............................................................ .. . ............................. ... •••••••••• Foundation has permission to erect........................................ b Wing on ....... . ...�G.. ...... ... Rough to be occupied as • Chimney ............ . .. ............... . ... ............................................................... provided that the person acceptin his permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions f the 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST T 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. s m� (11katiffitrate of Ntatne testatance REGISTERED ISSUED BY APPLICATION �,' ' s ANCHOR INDUSTRIES INC. Date of Manufacture NUMBER F EVANSVILLE,INDIANA 47711 r 7 V MANUFACTURERS OF THE FINISHED F121.4 TENT PRODUCTS DESCRIBED HEREIN T0880 4-2-86 This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: NAME: TAYLOR RENTAL CORP. CITY NEW BRITAIN STATE CT Certification is hereby made that: The articles described on this Certificate have been treated�rith a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code, equal to or exceeds NFPA 701, CPAI 84 MIL—C-43006D Method of application: LAMINATED Type, color and weight of canvas/vinyl: 15 oz BOYLES BIG TOP VINYL LAMINATE 40 X 40 SQUARE END PARTY TENT TOP Description of Item certified: Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric JOHN BOYLE & CO 4u"'' X; Name of Applicator of Flame Resistant Finish Signed: STATESVILLE, NC TEWLWAN T—ANCHOR INDUSTRIES INC. I I I i v ar i WORKERS' CO "EN&47ION INSURANCEAFF AVIT PPJNT Now LM Hokft Co.,Inc MA Encore Party Renals Wood= 90 Cherry St.,Hudson MA 01749 ❑ I am honmeovaw paftming al work wpW ❑ I am sole pmpdetor and hwe no one waddag in any caacity I an an employw pwvidrwg wadme comps for my amphcyaesworhang on this job. cowpq Name LPM HoklhV Co.Inc.,DBA Encore Party Rends Ad&= 90 Cherry St Wraaa-- Hud 'MA Phone# 976-�t62-002 Iaswoce Co. Eastem City InsLawm ftft# 917230307 Plana# ��+��wr��irrm r��r�rrrrrr�rrr+ur�ri rrrr�rr.wrrr�rr�� ❑ (&Ck one) I am a $do plop $' ',c r hammowaer and bwe h kvd the coWactors head blow who h m the&%wi%wmkers'compensation policies; t C mpwNun A&km cwrmm Phone# . Inswanoe Co. ply# Phe# Fathw m saga w regaited=ft$action 2SA of MM 1S2 can kid to tha impotdtio n of ahwAd pwv"m of a 6da up tD$l,%O 00 Mft GwY"Whqd=Uvw=wdUdvApmdfti8 the form eta S"VMM OR=and a tine of sto0 oo aft ma. 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