HomeMy WebLinkAboutMiscellaneous - 250 FARNUM STREET 4/30/2018 (2).
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No. IL/. -3
Date
NORTH TOWN OF NORTH ANDOVER
` Certificate of Occupancy $
4 i ;
;� s ^° •
MuBuilding/Frame Permit Fee $
�cs
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
i
17586
/i' Building Inspe �tor
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: j DATE ISSUED:
i-69CI-6 5-
SIGNATURE: Pal Vra4A^--
Building'Cdmmissioner/12glwor of Buildings Date
e1cr1r11nwr r_ crry rnrVnnu.'rTr%W
1.1 Property Address:
2 ti v NA
1.1 Assesses Map and Parcel
Map Number
Number:
C
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area
Fronts ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Regured Provided Regaired
Provided
1.7 water supply M.G.L.C.40. § 34) �O°e 1.5. Flood Zone Information: 1.8
Pnblic ❑ Private ❑ Outside Flood Zone ❑ Municipal
QL�/'�77/1M s TifAT1TTTi) Altl�rnTe�tn�.
sewerage Disposal system:
❑ On Site Disposal System ❑
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2.1 Owner of Record
' _DA LJiD (�O F6X tju AA c�T
N e (Print) Address for Service
— (a.'3 - 2
Signature Telephone
2.2 Owner of Record:
i name rnnt
SECTION 3 - CONSTRUCTIOb
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature
3.2 Registered Home
Company Name
Address
Telephone
Contractor
Address for Service:
Not Applicable ❑
License Number
Expiration Date
Not Applicable ❑
Registration Number
Expiration Date
.i
r
r�
L
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 it.
Signed affidavit Attached Yes .......0 No ....... C
SECTION 5 Description of Propmd Work check all
a ble
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
7dition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
�i :! 4;
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed b t applicant
OFFICIAL USE ONLY
1. Building
I
(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
I, Ay t) i d t 4al r ly's e �m) M as Owner/Authorized Agent of subject property
�J
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application
e
Signature of Owner Date
SECT''IION 7b OWNER/AUTHORIZED AGENT DECLARATION
I,�-'V 13o• � 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
Pri Name
' 4
Si ature of Owner/AOU Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR 179vfBERS 1 2ND 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS 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
E
0
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:
ti 5 ,4 c. o-`-7 /U
(Location of Facility)
/ (,GC�'3
Sign ure of Permit Applicant
zy_6y
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
I
Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 01845
D. Robert Nicetta
Building Commissioner
(978) 688-9545
(978) 688-9542. Fax
Please print.
DATE
JOB LOCATION o?,
Number
HOMEOWNER LICENSE EXEMPTION
Street Address
'&)A e/
Map / lot
"HOMEOWNER IR V I D (? 1 HCl t �U !� oT'fZJWI 9),? —(o8.3 " 6 17,
/ Name Home Phone Work Phone
,•
PRESENT MAILING ADDRESS Z Sn f-A/Z N U ►M q, T
City Town State Zip Code
The current exemption for "homedwners" 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
not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1)
DEFINITION OF HOMEWOWNER:
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 dwelling, attached or detached structures ac-
cessory to such use and/or farm structures. A person who constructs more than onehome 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,
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 requirements.
HOMEOWNER'S SIGNATURE L 3AA_c! U A
APPROVAL OF BUILDING OFFIC
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