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Home My WebLink AboutMiscellaneous - 23 MOUNT VERNON STREET 4/30/2018 - - 23 MOUNT VERNON STREET 210/067.0-00440000.06. ' I I fI I i i I I ILocation fy c, No. Date t TOWN OF NORTH ANDOVER n Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ss�cHuse ui Other Permit Fee $ f Sewer Connection Fee $ Water Connection Fee $ TOTAL $ a Building Inspector 3 ! 68 Div. Public Works PERMIT NO. /cZ3 APPLICATION FOR Pf RMIT TO BUILD********NO7fH MA MAP NO. a� Q US LOT.NO. T s 2. RECORD OF OWNERSHIP DATE BOOK PAGE / ZONE SUB DIV. LOT NO. �( LOCATION 03 T !�{ / r PURPOSE OF BUILDIN�� OWNER'S NAME 7b ; NO.OF STORIES SIZE OWNER'S ADDRESS � KT BASEMENT OR SLAB v� C C.n + 'L. ARCHITECT'S NAME SIZE OF FLOOR TIMBERS ]ST2 D 3RD BUILDER'S NAME ��&I r1l d r SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE + INSTUCTIONS 3. PROPERTY INFORMATION LAND COST � c � �3 06'$ ,C EST.BLDG. COST G> PAGE I FILL OUT SECTIONS 1-3 ,/ G� rj�oZ EST.BLDG. COST PER SQ. FT. / ✓ EST.BLDG. COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4. APPROVED BY: a PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DATE FILED OWNERS TEL# 1 p� 7 /'OQ -fig Zo i LS V F; L �,n�P p, CONTR.TEL4 i!F ffi I d vf' 8a�3 �' '� � � Q 1n"� ,• a 4 is _ SIGNATURE OF OWNER OR AUTHORIZED AGENT CONTR.LIC# APR H.I.C.# �- FEE PERMIT GRANTED a 19 ` Revised 11/97 JM The Commonwealth of Massachusetts Department of Industrial Accidents — Mics oliarest/gatlons _ = 600 Washington Street ti3 Boston, Mass. 02111 Workers' Compensation Insurance Affidavit name: C-SIC n to `SPRY Location& 1,0 z"W e I/ f44' city —t k, I I A 0+ tlhC,-7— F7 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity r7 I am an employer providing workers' compensation for my employees working on this job. comaary name:. address:. . citYr ohone#- msarance co: ply# i I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comoany name: address_ SItY: _phone#. Insurance co. policv# _.:. comnanv.name address: I city: phone#• Insurance co, goNcy . Failure to secure coverage as required under Section 25A of*YIGL 152 can lead to the imposition of criminal penalties of a fine up to 51400.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby cent under the p ns and penalties of perjury that the information provided above is true and correct. Signature - Date 4�9 Print name plc CPr Phone i# 47 A 7f! —00 S' (c:ontact e only do :writen this area to be completed by city or town official n: permit license# [7Building Department C]Licensing Board f immediate rerequired C]Sdectmen's Office C]Health Department rson: phone p; Mother (r-ued M5PIA) HOME IMPROVEMENT CONTRACTOR Registration 105965 Type - INDIVIDUAL Expiration 07/21/00 GLENN GARY GENERAL CONTRACTOR Glenn M. Gary I G� �? West Lowell Ave i Haverhill MA 01830 ADMINISTRATOR p . t :� �1u �!arz�a�zanzuea�, o��l�a,�t:ia�u�ntl� Ii • DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR, LICENSE Number: Expires: Birthdate: CS 058236 091511990 @9J15}1964 Restricted To: 0@ GLENN M GARY F 501 WEST LOWELL AVE HAVERHILL, MA 01832 ' NORTH I ® ® _ �wn � ®ver No• °�A �o�Hc� -t dover, Mass., 44 A- ORATED FPS Cl BOARD OF HEALTH Food/Kitchen ijERMIT T D Septic System D 16 • BUILDING INSPECTOR THIS CERTIFIES THAT..... A �/1 To...r..r 1 % i .. .......... ........................................ ......... Foun aadation , has permission to erect..A.4 MOV K buildi gs on ....Q3...... .4 v* v%po N .,... Rough ................... �A� w o s N D teatea to be occupied as........................................................P........................ I � I '............................................. 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough iaqrc 16 PERMIT EXPIRES E\1 6 MONTHS Final ® � UNLESS CON rC , - � ELECTRICAL INSPECTOR v Rough y- LAI.. ... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occ--upy 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. 02 3 tulT V�,nN 1 3 1 1 I i i i i I i i Deed Reference: Bk y�OCo Pg. Cert. No. Plan Reference: PI. No. I I