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HomeMy WebLinkAboutMiscellaneous - 40 HAROLD STREET 4/30/2018 �1 O f Location 1-/0 t1A I?U 1 d S �- No. 3 a a Date MORTR TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ cHuBuilding/Frame Permit Fee $ s� sE Foundation Permit Fee $ Other Permit Fee �hZE $ 3U TOTAL $ Check # e /Af/ 16 b 7 0 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING S�C41OE1 for Official Use®ni >:`•�,-' se.: 'k ?�"r s ��ra 5.cY, �'v�,i..`�*'�..4�-_:„r,. ..,t i BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE:/ "H Bulldln Commissloner/I or of Buildings Date i` �'�(27 bid r v 1.1 Property Address: 1.2 Assessors Map and Paroel Number: ` 10 3 t_i n VZO �ck SA,,, Map Number Parcel Numb 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area s Frontage ft 1.6 BURRING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Required _ Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record 45 Name(Prm Address for Service ig afore Telephone 2.2 Authorized Agent Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ Address License Number Licensed Construction Supervisor: Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name a— Registration Number Address Expiration Date Signature Telephone AcTror 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 Yea.......11 No.......❑ SEMON 5PRO1f ION'At OM ANAV) .OR'$1111 W-* UN TSI�f i@ Oi�1t" >I t TCD' >l 11i (COI' �f E; [ i 1 F C +flS1�D SP 4.. 5.1 Registered Architect: Name: Address Signature Telephone Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility AeUress Registration Number Sighature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date ���'� ��, i 3 Not Applicable 0 Company Name: Responsible in Charge of Construction i 111R !T3NF 1PBOPE 9V0 ,( ck` 11 appl:eable . vr New Construction !0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: ��,y/jl t=X/ITi,!/rr �S%.9th �.�,�� ` •9% ©�/�iF'F'fil� J-f USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ ]A ❑ A4 0 A-5 ❑ IB 0 B Business ❑ 2A ❑ C Educational ❑ 2B ❑ F Factory 0 F-1 0 F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ IInstitutional ❑ I-1 ❑ 1-2 0 1-3 0 3B ❑ M Mercantile ❑ 4 ❑ R residential 0 R-1 0 R-2 0 R-3 0 5A 0 S Storage ❑ S-1 0 S-2 ❑ 5B 0 U Utility 0 Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION]IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft NMI 1,1 1 Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> as Owner of the subject property Hereby authorize to act on My behalf,in all matters relative two work authorized by this building permit application Signature of Owner Date W, 0: as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Agent Date 'IF MO.-, Item Estimated Cost(Dollars)to be Completed by permit applicant 1. Building I ing 0 (a) Building Permit Fee 2 Electrical Multiplier ectrical (b) Estimated Total Cost of 3 Plumbing Construction from(6) Building Permit fee (a) x(b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number 5, NO. OF STORIES SIZE BASEMENT OR SLAB SIZE 317 FLOOR TIMBERS IST 2ND 3RD SPAN DEMENSIONS OF SILLS DENIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS FSIZE OF FOOTING x IZ 00 MATERIAL OF CHFv1NEY L() I�SBUJLDIWNG ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE JL %J VV 11 %.PLILOF JL JL JLALAL%ww%.p Y %wwA. 0 ..... No. Sea Z 0 'Hi, over, Mass., /-Af%Cr03 LA 'P 0RA T E D P"' C7 H BOARD OF HEALTH Food/Kitc'hen PERMIT D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................... 417 ................... .........1110400..................................... .. ..... ... Foundation -A has permission to erect........................................ buildings on .......... ............................. Rough -.00 ..... . ...................... Ai tobe occupied as..... .... 44 a so .4 ....... Cs. ......t....... ................................................................................ Chimney provided that the person accepting this permit in ery ret conform to the terms of the application an file in Final � this office, and to the provisions of the Codes and By-Larats relate ga to the nspection, Alteration and Construction of Buildings in the Town of North Andover. 03&OW- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations I s Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough 4�� ... ....... .................................................................... Service. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. 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: (Location of Facility) Signature of Permit Applicant S5 e& Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector