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Home My WebLink AboutMiscellaneous - 41 May Street cc WON" r C7 Location No. L-/-Z 3 Date l 6"U NORT" TOWN OF NORTH ANDOVER h O' �ao ,•,4•C 41 A + , , Certificate of Occupancy $ Building/Frame Permit Fee $ s�CMUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # c' 17907 U Wilding Inspgc;dr ti TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: X SIGNATURE: Ad--,W � 3 Buildin Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION z 1.1 Property Address: [ 1.2 Assessors Map and Parcel Number: O L�/) T (-)/g 0 v// N- nyl to C/� Map Number Parcel Number 1.3 Zoning Information: 1.4 Prey Dimensions: Zoning District Proposed Use Lot Area Frontaxe 8 1.6 BUILDING SETBACKS fit Front Yard Side Yard Rear Yard iFz�red Provide RegWred Provided RecIttired Provided 1.7 Water SupplyM.GL.C.40. 34) 1.3• Flood Zone Information: t.8 Sew Zee Outside Flood Zone ❑ Mmici.8 ❑�Disposal Sys On Site D' Public ❑ Private m. ❑ 4osal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT ' U��t: �( t�!Ct: ��, m rf o 2.1 Owner of Record �) y� h I //I (I Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: J o h >n UO U Name Print Address for Service: Signaturo Telephone SECTI N 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Signature Telephone Expiration Date .... r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name / 3 Jv W / Registration N/urn [ M A re r aa" 7� 6s UNIONS IA Ar Si ture Telephone xPt talion Date G) J �S 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 permit. Signed affidavit Attached Yes.......0 No....... 0 SECTION 5 Description of Proposed Work check aH a ble New Construction ❑ Existing Building V Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed b mut applicant 1. Building n (a) Building Permit Fee 1 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, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. —Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject pro Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge an lief Pr-mIj't Dkme n-0 Si attire of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DUVIENSIONS OF SILLS DaIENSIONS OF POSTS DI1IIENSIONS 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 Board of Building Regulations and Standards License or registration valid for individul use only 1 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: � Board of Building Regulations and Standards / Registration:'-137640 One Ashburton Place Rm 1301 Expiration: _12/13/2006. Boston,Ma.02108 Type: Private Corporation AC EXTERIORS it4C t ANNA CURRAO -y c 67 LOWELL BLVD METHUEN,MA 01844 Administrator Not valid without signature NORTH Town of : t. 4Andover No. LICA-3 -=-. - �.zo = dover, Mass., COCMICMEWICK ORATED P'P�\ �y S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT............ 0.V. ........... ...................•.... ........................................................................................ Foundation buildings on.... 4�........ ........ ....... ....�1.............................. Rough has permission to erect.......... g to be occupied as ... !.�. Chimney provided that the person acce g this permit shall in eve respect conform to the terms of the application on file in Final this office, and to the provisio of the Codes and By-Law 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 Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIO S �' ELECTRICAL INSPECTOR ��"'1 � " Rough ............................................................ ... 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) gnature of Pe it Applicant X62-2 OV Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector