HomeMy WebLinkAboutMiscellaneous - 281 MIDDLESEX STREET 4/30/20181 09
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TOWN OF NORTH ANDOVER
Certificate of Occupancy s
Building/Frame Permit Fee $
Foundation Permit Fee
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4PP -�Sewer a��nn Fee
Alek�;onnection Fee
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PYtk3fff NO..
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
PAGE
MAP# -JO.
LOT NO.
2 RECORD OF OWNERSHIP DATE
BOOK iPAGE
ZONE
SUB DIV. LOT NO.
F -
LOCATION vu,
PURPOSE OF BUILDING f
OWNER'S NAME 4&p-fj L4 L".) --5�,UMO L
NO. OF STORIES SIZE
OWNER'S ADDRESS,
_a'a I
IV 1).
BASEMENT OR SLA 8e),fli, A4jA4
ARCHITECT'S NAME
BUILDER'S NAME S/�Md ltM,4A):
SIZE OF FLOOR TIMBERS tST 2ND 3RD
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES
REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW No
SIZE OF FOOTING x
IS BUILDING ADDITION mo
MATER:AL OF CHIMNEY 1P196b A)klY-
IS BUILDING ALTERATION y6-9
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
Y97S
IS BUILDING CONNECTED TO TOWN WATER Am
BOARD OF APPEALS ACTION. IF ANY A/b
IS BUILDING CONNECTED TO TOWN SElW
IS 13UILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 3
PAGE 2 FILL OUT SECTIONS 1 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED " tz', c �;� lyq I
PERMIT GRANTED
OWNER TEL 0.4 - 0 /
ms"U67
CONTR. TEL Las- -
*a �-2161 ff -
CONTP, LIC.
3 PROPERTY INFORMATION
LAND COST
EST. SLOG. Cox -IT
a
EST. BLDG. COST PER SQ.'FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF GELECTMEN
NUIL-DIT44a INDPECTOR
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Location. aw *Wles-ev-
N. c 17V Date,
Check # f7S-0
182,185
Building Inspector
TOWN OF NORTH ANDOVER
Certificate
of Occupancy
$
CHU
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee eoef
$
TOTAL
$
Check # f7S-0
182,185
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCr REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAIMILY DWELLING
BUELDING PERAT NUMBER DATE ISSUED:
SIGNATURE'. lt� /a '
Building Commission (/I tor of Bui
SECTION I- SITE INFORMATION
1. 1 Property Address:
C�Q / MA & P
14J A;�� el Ker..
1.3 Zoning Information:
Zoning District F�oposad Use
1.6 BUTLDING SET!I�KS �ft
. Front Yard
R emlLi red I Provide
Date
I.:z Assessors Map and Parcel Number:
()0q 00
Map Number Parcel Number
1.4 property Dimensions:
— J12t-
Side Yard
i Provided
Rear Yard
Provided
� 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
1.7 Water Supply M.G.1-T.A.54) Zone On Site Disposal System
0 Zone outside Flood Zone 0 Municipal 0
Public 0 Private 0
SECTION 2 - PROPERTY OWnRSHMIAUTHORIZED AGENT
2.1 Owner of' Record
SDB�2 �2 0--f
Name �Print) Address for Service
071-
Sigingerl Telephone
2.2 Owner of Record:
T. C) =e Address for Service:
Name Print
JN 3 - CONSTRUCTION SERVICES
3. 1 Licensed Construction Super -visor:
E,7c—,—n,,d 6,—,,truton Supervisor:
Address
Signature
3.2 Regi.stered Home Improvement Contractor
Company Name
;�d-dr �ss
Sipriature
Felephone
Not Applicable 0
License Number
Fxp—.-ti.. Date
Not Applicable 0
Registration Number
Expiration Date
T
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0
SECTION 4 w WORKERS COMPENSATION (M.G.L C 152 § 2S
Workers Compensation insurance af davit must be completWand —sbittd
in the denial of the issuance of the building permit.
Signed affidavit ached Yes .... :--0 No ....... 0 ----------
f sed rk check a licable
0 RU'
g g 0 S)
'Pro�
—Fiso
SECTION5 DEesc=rniptiono ProlJosed Work (check Repa
on 0 Existing Zu�ilding 0 Repair(s)
New Constmction
. . . . ......
t . his 11, ap '' plication. Failure to provide this affidavit will result
Alterations(s) 0 1 Addition 0
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
ft 1 (7,//'
SECTION 6 - ESTIMATED CONSTRUCTION COSTS 77777777777—
C '77777.
(Dollar) to be
Estimated Cost
Item
Completed b mut applicant "W, —
(a) Building Permit Fee
I Building Multi lier
(b) Estimated Total Cost of
2 Electrical ConstructLon
3 Plurnbing Building Permit fee (a) x (b)
4 Mechani - (HVAC) 16 -6.�
5 Fire Protection 'go Check Number
6 Total (1+2+3+4+5) --7
SECTION 7a OWN ?�R AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLILES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
to act on
He reby authorize
. I ---= — — — — -- — —ii i , —g rii t a p p I i c a t —io i i
in all matters relative to work authorized by this building permi app ication
;ate--Z�-
31 ORIZED AGENT DECLARATION
SECTION 7b OWNERJAUTH
As Owner/Authorized Agent of subject
1,
property
Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
�-i �ature of �Q,
�ert
NO. OF STORIES
�TA—sENENT OR SLAB
�IZE —OF FLOOR TINMERS
SPAN
DlIvIENSIONS OF SILLS
DINE'4SIONS OF POSTS
D9vENSIONS OF GIRDER6
HEIG OF FOUNDATION
SIZE )F FOOTING -----------
MATERIAL OF CFDNINEY
IS 13UILDING ON SOLID OR FILLED LAND
ISB ELDING CONNEC-Ibu IU NAIURAL GAS LIKE
Date
SIZE
PA
TMCKNESS
X
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,;� q i m iddles-,et SYrec�-
061,�M
44 pr
eh) vel- ,
U - LOT RELEASE FORM
FORM
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
APPLICANT /t-� 0--V21'Cal PHONE I? 7,F— -7,)��-3k 3
ASSESSORS MAP NUMBER _0 0 _0 LOT NUMBER 00
SUBDIVISION L OT NUMBER
STREET REET NUMBER
OFFICIAL USE ONLY
...................
RECO NDATIONS OF TOWN AGENTS
INE900 UNSEM988,80 Me
moo 0 m 0
DATE APPROVED
.. A
CONSERVATION ADMINETRAT DATE REJECTED
COMIAENTS
DATE APPROVED
TOWN PLANNER DATE REJECTED
COMMENTS
TO-ODINSPECTOR - EEALTH
DATE APPROVED
DATE REJECTED
DATE APPROVED
SEPTIC INSPECTOR - HEALTH DATE REJECTED
COMNIENTS .
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
COMMENTS
RECEIVED BY BUTLDING INSPECTOR
DATE APPROVED
DATE REJECTED
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