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Home My WebLink AboutMiscellaneous - 223 FOREST STREET 4/30/2018 (3) LJ �� le�ll� �■�I r �f � Location p?'a3 korr-& S No. Date NORTH TOWN OF NORTH ANDOVER Of•"•O :',�O F 9 i r • ; , Certificate of Occupancy $ MUS E<� Building/Frame Permit Fee $ AC Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 30? t 18 '1 6 z ✓ Building I��n--sppeec""to'orr�� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 3 S` DATE ISSUED:A �' m i SIGNATURE: =I Building Commissioner/I for of Buildings Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: I C) 17 r7 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: (/h Zoning District Pr osed Use Lot Area Fronto ft !! 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G L.C.40. 54) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private Zone Outside Flood Zone Municipal ❑ On Site Disposal System i( SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 $wner of Record �E1;N EQ C"tTE- Cl PP-6 0 QQ 3 Fa pCST 2 7-. 0.r N&"e(Print) Address for Service 6".&.4LX= 7� - 1F _P/`/ Q Signature Telephone 2.2 Owner of Record: '�NRrs G�rcRA �1 aa3 F,, Z,7 Name Print Address for Service: z a M Sianature Tele on 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ,6r Licensed Construction Supervisor: License Number +-n M Address r Expiration Date F Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number rua r Address r Expiration Date Signature �, Telephone 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 unit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Workcheck ad apoRcablt New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition Accessory Bldg. 0 Demolition 0 Other ❑ Specify Brief Description of Proposed Work: �G �X o7(' ' oni ancK or- igous F. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed b•permit applicant 1. Building (a) Building Permit Fee chi,O'n o 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 BUELDING PERMIT I, as Owner/Authorized Agent of subject property It Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature ot'Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION s I, as Owner/Authorized Agent of subject t property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge e and belief Print Name L_Signature of OwnerhA entb gate NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMBIRS 1' 2• 3 SPAN DUVIENSIONS OF SILLS DIMENSIONS OF POSTS DMIENSIONS OF GMDERS r HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY ��- 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE bxaC,) pec FORM U -LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. I APPLICANT FILLS OUT THIS SECTION ' APPLICANT tB C t O E�& CRPA r..► PHONE g 6-&//Y LOCATION: Assessors Map Number /0 b 4 . PARCEL 77 SUBDIVISION LOT(S) STREET_ Eac-sT ST ST. NUMBER 903 OFFICIAL USE ONL RE M N 10 F TOVYN�A E S: 'v CONSERVATION ADMINISTMATOR DATE APPROVED DATE REJECTED u I' COMMENTS ��b�'l IGS V1 W/I VI 1 Un r TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR SALT DATE APPROVED DATE REJECTED SEP INSPECTO -H H DATE APPROVED 4 �j DATE REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE RevhW 07 Jm M I Y / 1 1' I 0 v 1 r f i � 1, NORTH TOWN OF NORTH ANDOVER 0 OFFICE OF p BUILDING DEPARTMENT . ; 400 Osgood Street North Andover, Massachusetts 01845 ,SSACINIS�� Telephone(978)688-95454 D. Robert Nicetta, Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: April 20 , 3OoS JOB LOCATION: IR a-:; j v RE sT Sr. /0(0 A 177 Number Street Address Map/Lot HOMEOWNERCiARxs + 56RPKI)67"6 C1 rzlzA u 7I�-q7S- Ell 975 4F0 -9S3( Name Home Phone Work Phone PRESENT MAILING ADDRESS as 3 Fo Res% S7- . N Alvl)OoFR AA City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER . Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. h she understands the Town of North Andover Building The undersigned homeowner certifies that e/ $Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE kZ,,j�� APPROVAL OF BUILDING OFFICIAL I I(MIZI)OF APPEALS 6980541 CONSFIRV TION 689-9530 I1FAL I'll 68x0540 ITAN iI\G OX-9535 Ox6 PTIC PosT1 v i l t' ( I r I � � , �► G 4 N'i \ I 16 ea eA � 2 t : ° 1� t4ORTH Town of Andover No. aft 30 0 �— LA over, Mass., y a 7 d S OC - HICHEWICK ORATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT....a.�tPOAGI**&- BUILDING INSPECTOR ............................................................................................................................................... has permission to erect... ........ buildings on...... Foundation Rough ..........AP .....WCOM a J? r*a P to be occupied as ............... ............................ Chimney provided that the person accepting this permit shall in every respect*conform to the terms of the application on fle in Final this office, and to the provisions of the Codes and BY-Laws rel ng to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. /406*4/ #747 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS.-CONSTRUST TS C Rough .... ..... ...... ........................ . ....................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner ba Street No. SEE REVERSE SIDE Smoke Det.