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HomeMy WebLinkAboutMiscellaneous - 287 WAVERLY ROAD 4/30/2018 (2)N b Location A� No. e-) Date C;;l TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Feete,,, $ TOTAL $ Check # 36'12 Building Inspe6or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEM�iOLISH A ONE OR TWO FAMILY DWELLING 25 BUILDING PERMIT NUMBER �D DATE ISSUED ^ �� SIGNATURE: Commissioner/1for of Buildings Date SECTION 1- An INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: .u2 1 AL)EAL— y R72) JoRd a// a s Q, ' n K Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record WW '2 toAVF— I— 4D, JV, ANDayFi� Name(Print) Address for Service Signaaure Telephone 2.2 Owner of Record: Name Print • Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ `, !� 6y I p CA STW1 CDrOE Licensed Construction Supervisor: � / �� L s (v 9 License Number "POO — n nes,s- _ _ 3 g ��2 Expiration Date tgnature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ D A t9 D CSS R.1 (L: /9 jE j Company Name D, CA07-1 CID OF— Registration Number Add p ZZ/A o Expiration Date i nature Telephone 00 M 0 I R 1W O M rM rM M ^ G) SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 4 2506) 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 ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit apj2licant OFhCIAI;"'USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) 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 QR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize �y L� 5 TP I to act on My belt , all ma s r 1 work authorize by this bu' g permit application. Si nature of caner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION e I, 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 r '7-D A I I I D Pri Si a tire of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR 1TVJBERS iST 2 ND 3 RD 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 BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Y m••1'?, P M ..QO = a w c ;g.-"ia -e = r. o O 70 ,N ►.r ,.- C o K C3 CN, 4 9 z 1 • cz cz 0 C: u o u° °�' a cn w �l oG,, w° d U w w a 7 m w O a U W m C4 cn `� w O a : m w w A W CO cin o cn 0 tE o m c o c O O C H O C v V •d'O Q, C W O CD C o Cc CD N � Ea D o O C w. N E c o m o O m c CL .:. : N LO W m o 3 N m Of> C m � � m � ca ' � c A • � N m CD O CD .93 CD C �a co CL m O t: cc 4Z c o 0 o c CD Go CD m ms o a +O' m y0 H A S-. D yr .y 'dt O C C .� CS, . 'D V ca cm CD OAF C ca l0 N O r o. Y m r E CDN to 0 N C 0 R 7S cmm 12 m m 0 cm c 'c N m s O Z O s O zip LLJ _0 CO ui W W IrW co C L 0 Z � © y G R co .E— = c] 0 co 0 CD �O co ea a •f- G 'G CD V W O COD G �p R lz�Z � CD V R h C •� C _R LLJ _0 CO ui W W IrW