HomeMy WebLinkAboutMiscellaneous - 213 MASSACHUSETTS AVENUE 4/30/2018N
W
o a
a
i
o �
'P m
O �
O
o a
o m I
Z
m
2 L
Location _;,
4 No. �,-2'22,2 Date C::�
A- - 1 0- 1 �,,, .. TOWN OF NORTH ANDOVER
Check #
16179 1) 2 ��
— -Building Inspector,
Certificate of Occupancy
$
CHUS
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check #
16179 1) 2 ��
— -Building Inspector,
P.
TOWN GE NORTH ANDOVER --
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, OR DEMOLISH A ONE OR.TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED: •7 d
c3
SIGNATURE:
114
Building Commissioner/Inspector of Buildings Date
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
eve
Map Number Parcel Number
yv V
1.3 Zoning Information: 1.4 Property Dim suns: {yi
.oning Distrid Proposed Use Lot Areas Frontage ft
.6 BUILDING SETBACKS (ft)
Front Yard I Side Yard I Rear Yard
Required Provide I Required I Provided I Required I Provided
7 Water Supply M.G.LC.40. 34) 1.5. Flood, Zone Information: 1.8 Sewerage Disposal System:
ablic ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
ECTION 2 - PROPERTY OWNERSEUP/AUTHORIZED AGENT
1 Owner of Record f7
-keV-� � � �V� l3 ►�,��-� /�li�
ame (Print) Address for Service:
gnature Telephone
2 Owner of Record:
Flame Print Address for Service:
nature Telephone
,CTION 3 - CONSTRUCTION SERVICES
t Licensed Construction Supervisor: Not Applicable ❑
tensed Co�nstniction Supervisor:
License Number
} h k L
dress _ , d'.i7< ° ,� y. +�* r
Expiration Date
nature Telephone
Registered Home Improvement Contractor
.ej ---,>
npany Najme
A(� �
cress
iature Telephone
Not Applicable ❑
. t3-1 )C(3
Registration Number
S�
Expiration Dat
P®
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 ticable
New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition 0
Accessory Bldg. ❑ Demolition ❑ Other Specify
Brief Description of Proposed Work:
2 - 0) F -F
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be16
Completed by t aprlicant
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 . Plumbing Building Permit fee (a) a (b)
4 Mechanical HVAC
5 Fire Protection
6 Total (1+2+3+4+5) 71 L4 17 (M Check Number
SECTION 7a OWNER AUTHOR ZAT ON TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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
SECTIjON 7b OWNER/AUTHORIZED AGENT DECLARATION
L
I, �_) • l l�(,C 0 as Owner/Authorized Agent of subject
property
Hereby declare that the statements d information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Prit Name ) � \ t-�
Signature of Own er/A ent Date
i�Mw -win gill
NO. OF STORIES- SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TI11MERS I Sr 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DINENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CE vINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
a
r
i
0
C/)
M
m
C/)
0
m
CA CM)
CD
Z C
r
CC3
0■
CU C
�=
O y
a� -o
�N
CD
CD O
rF
CLQ
"C d CD
CD O CD
ca 3
c CD �/,•
CD
CL O y
C
� v
CA O
'v Z
CD O
,C)
O �
CD
O
CD
O
�a
•C2,
Oti�CD
COt12
OmCD
CL�
m
ti
d y
CL C
`W
�CD
m
y
:
.7
O 0
CD 0
1 :
ICO)
CD
CO
=C
C2 CD
.i co
� o
CO
dm:
o -
C-) c)
5 :
C
0
CH
n
m
T
Fn'
CO2
6
Cn
El
cn
"
f
cr
d0 sCD
H
fp O 0
C2 d n
O
ca
-X
7 of d
H•
CL .s.
��
=
O CO y
O
--1
o
Wim:
m
CM
CDO
.Y
�a
•C2,
Oti�CD
COt12
OmCD
CL�
m
ti
d y
CL C
`W
�CD
m
y
:
.7
O 0
CD 0
1 :
ICO)
CD
CO
=C
C2 CD
.i co
� o
CO
dm:
o -
C-) c)
5 :
C
0
CH
n
m
T
Fn'
CO2
6
Cn
El
cn
"
f
V,
V
p
z
7d
-X
C
fD
Py
o
y
��
C
r
00
cn
orf
a
z
0
w
onq
0
91
V
V,
V
1
r
I
1
2
11
k
L
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
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:
(Location of Facility)
Signature of Permit Applicant
C)
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
Y
a
m
f� e,., .•.+y,*+9.w �'1'•� .i:y�1�¢�;.,..s�r. `�-•--`;:;"'_aY-•�,..»_, Tom.-`...��_'�
�'* '� � � ✓fie, �ryrn�n`aoiuueal�o�✓�iiaaair�iecae�3
Board of Bu110ih9:Regulati6ns and StafiBard`s,
HOME IMPROVEMENT CONTRACTOR
-:r N
' Registration 37193
# t
Expiatton 16/15/2004 s:
type PObte Corporation
BAY STATE ROOF I{VC` z
`WILLIAM LORD
240 PARK ST.
y NREADING SMA 01864.
Aduuuistrator4`
_ _.y •�-„-.i��_.....�....'�:._. _ _r'��.. _.__�..,......-._.�,. _::,.-�.:,.u:fi..; �x.,,�-:tea.- 1
J
r