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Home My WebLink AboutMiscellaneous - 428 PLEASANT STREET 4/30/2018 428 PLEASANT STREET 210/095.0-0005-0000.0 Date. ...... NpRTH pF �.ao ,°1ti0 TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION SACHUSEt e This certifies that . . . C . . . . . . . . GA . . . . . . . . . . . . , has permission for gas installation . . . . . . . . . . . . . . . in the buildings of . . . .A14 .z/!4'1?. . . : . . . . . . . . . . . . . . . . . . . . at . . .7. . . . . . �E. . . .srrt .ST . North -ndove/r�'� s. Fee.J"��-� Lica NO..,?.. f!!�h�y� ? .. . �j� �e GAS INSPECTOR Check# X!2 7S 8� � 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) A tn'ra W OOV 6 fes., Mass. Date 05A6120) 2- Permit # Building Location 42&—+2.$ PLEASA MT $C. Owner's Name_D&M G u 10 Type of Occupancy Z FAk New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes No ❑ N N Y W N z s vj N N N tt N 0� O N = F t9Wtj W W Nit CtiUlr 2 O f- Q � Z = O } w d W 0 H y w O O CL m' _ W a H N 4 M !L W Z U W N W d a a W �t W W 9) J Q S CC rt W 4: W W �' _ (n S (7 �- Z J F- Z �. W W O > LL H J I. W Q W a w � Z, < >1 Q W 2 0 z a 0 fr Y oQc 'z o O s n, � 3 c d v G > c a o SUB—BSMIT. BASEMENT HZ I ST FLOOR 2ND FLOOR 3RDFLOOR LO 4TH FLOOR Vo STH FLOOR 6TH FLOOR 7TH FLOOR a STH FLOOR Installing Company Name COLUMBIA 6&5 GF MASSACHUSETTS Check one: Certificate #� Address 55 MARSTON STREET DC7 Corporation 1862 LAWRENCE, MA 01841 - 2312- ❑ Partnership Business Telephone 9 7 8-691- 640 6 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a cu ❑rent liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy 18( Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.- Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in abo pplication are true and accur,4te to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (/ % BY T e of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 374-5 ; City/Town Journeyman APPROVED OFFICE SE ONLY �) 0 BELOW FOR OFFICE USE ONLY FINAL, INSPECTION SKETCHES • PROGRESS INSPECTION FEE . NO. APPLICATION FOR PERMIT TO ADO GASFITTING NAME & TYPE OF 13UILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE ._19 GASINSPECTOR Location yc�,)b r1W-> SA L--'-7— S 7— No. Date �aRT►, TOWN OF NORTH ANDOVER C? .. • 0 Certificate of Occupancy $ 6-2 CN <� Building/Frame Permit Fee $ S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /—/6 r 14446 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ~ ,,1',"" BUILDING PERMIT NUMBER: DATE ISSUED: r SIGNATURE: t/ Building Commissioner for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property A dress: 1.2 Assessors Map and Parcel Number: . - 6��As - ®DC).S Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Diacid Proposed Use Lot Areas Frontage ft 1.6 BUILDING 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 ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record rn n �8 P� 'u5crn 5 �ro`` Name(Print) Address for Service: Signattat Telephone 2.2 Owner of Record: S q VVY Name Print Address for Service: q M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number Address Expiration Date Signature Telephone ti 1 SECTION 4-WORKERS COMPENSATION(KG.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.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: C� (A H 9-( 0 Y2 '-V r1✓I 0 0 4�� Cd� �@ W( �1( O LA/ Gha v+y T=rc) SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ry OFFICIAL tJSE ONLY Completed by permit applicant 1. Buildingqq , 0 (a) Building Permit Fee d4Au Q,V Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC C% 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, b avi a �V)�Ov7 as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all mai s lative 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 property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name t Si ature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS OT 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 V%ORTH Town of Andover 0VOO No. 0L over, Mass., COC MICMEWICK V ADRATED `S H BOARD OF HEALTH PERMIT TFood/Kitchen G• Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ��V�� a.. ..� ./. a4NO ...................... . .............................................. .......... Foundation has permission to erect...F? ..... buildings on ....4NAP!�� ••.• .,..,, Rough....... .. ........ &$I ettatV4 Chimney to be occupied as.1..... .00R.. �.. ........ ......... ................................................................................................. y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M 4, PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIONS ELECTRICAL INSPECTOR T 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Locationeb l� No. Date NORTH TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ v: s�CHuse Other Permit Fee $ Sewer Connection Fee $ Water Connection'Fee $ TOTAL $ Building4nspector } 1L' 104 i 210/01/96 09:34 7&00 PAID Div. ,. 1 Public Works PERMIT NO. 'V716 1 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K40. �7 I LOT NO. �— 2 RECORD OF OWNERSHIP (DATE BOOK 'PAGE ZONE 7 SUB DIV. LOT NO. LOCATION j J PURPOSE OF BUILDING 4,/ OWNEIR'S NAME U1_i ��7�Wv��►Q („ J'�� NO. OF STORIES JJ� 7SI•ZE` OWNER'S ADDRESS (1' 7- 2 �[in.!_Q��C c� BASEMENT OR SLAB r,(2-. C(L 7 �a,ftIC04, Q b, 8a,,,�evwv, Un dei'r�a'Hi�R►i ARCHITECT'S NAME fD �ir/ 2 / g SIZE OF FLOOR TIMBERS IST 4� '�J// i-^2ND BUILDER'S NAME a vi d G��`�2f f SPAN hAd ffV) / 3`eV/aL pC/I C6C� !J V DISTANCE TO NEAREST BUILDING a DIMENSIONS OF SILLS ,I A DISTANCE FROM STREET , POSTS e/ 1-4 DISTANCE FROM LOT LINES—SIDESDEAR • E` 110 Z � GIRDERS ,�t�W► 3F � X Iy 021�I2.. 3��-x�� AREA OF LOT fO voc) FRONTAGE /0 HEIGHT OF FOUNDATION ��s / THICKNESS IS BUILDING NEW jby VV SIZE OF FOOTING X /D IS BUILDING ADDITION Y,6,5 MATER:AL OF CHIMNEY V IS BUILDING ALTERATION 7 IS BUILDING ON SOLID OR FILL/E•D,LAND r` !�-)1(c WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �� IS BUILDING CONNECTED TO TOWN WATER -V )!J BOARD OF APPEALS ACTION. IF ANY Qj�r IS BUILDING CONNECTED TO TOWN SEWER C e!2 " IS BUILDING CONNECTED TO NATURAL GAS LINE Y4 5 INSTRUCTIONS 3 PROPERTY INFORMATION LAft COS ''I 4) SEE BOTH SIDES EST. BLDG. COST Q® PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APSPOVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED A/ND APPROVED BY BUILDING INSPECTOR DATE FILED O v� OUILDINO INOP[CTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E 7 OWNER TEL.N �� V PERMIT GRANTED CONTR.TEL.# Sa' � CONTR.LIC.b v H.I.C.# BUILDING RECORD I OCCUPANCY 12 SINGLE FAMILYSTORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY � OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHIS. GA.! APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE 3 I 2 13 CONCRETE BL'K. PINE BRICK OR STONELAST D PIERS PIASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA '/, �/f �/� ✓ FIN. ATTIC AREA _ NO B M'T FIRE PLACES V HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS AI B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARD%!✓'D _ ASBESTOS SIDING _ COMh10N VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY COM— STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FIOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) ) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ a ASPHALT SHINGLES LAVATORY — WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING tj 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 8 COLS. STEAM STEEL BMS. 8 COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS r 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING ..5,4. MRT f ,.ti.. No. 4/7g w 4 , , � � . ' �ove�r, Mass:,, ..• �� ,y t BOARD OE HEA.I;TIK Food/Kitchen : s, r Septic"System.. • n BUILDING INSPECTOR THIS CERTIFIES THAT... ....:..._ .. .,:. tai �?.. ...4z, I '�.N. :.. ,... Foundation Y has permission to erect.. �-., .t 'ic buildings on ........ . � ... ..fig- Rough to be occupied as.. "%-4?.a c:• ..... .. yf�l. Chimney provided that the person accepting this permit shall'in every-respect. the terms the,'application on file in: Final this office, and to the provisions_of the Codes and sy-Laws relating to the Inspection, Alteration and.Construction of Buildings in the Town of North Andover. Y g PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit Rough { k a Final PERMIT E 'IRES r1viCJNTHS w UNLESS CONSTRUC ION S S ELECTRICAL INSPECTOR ' Rough f B DING INSPECTOR �' w Final Occupancy Permit; Required espy .Building F GAS INSPECTOR Rough Display in a Conspicuous Place_ on the Premises = DO Not Remove Final i er, No Lathing or Dry Wall To Be Done ` ntil Ins ected and A roved b the Builditl Ins actor � ` FIRE DEPARTMENT P PP Y u ,� '" � � �� $ rner r ' • 1 r; Street No., " Smoke Det. s , 17040 s T S's `,d r T- 77 -7 IEE] I I r I F .t }} IT _F...._r .,7�,. 13 ►� —_ � �•- •-...N- {{ {y {� - i t� ' � � �7 i� t� '� \yam /�'� � •. �_ _.— �-� r �rr�!�. f' 4i •. 1. 1) / / Yr^ ;�i i 7a z.i►. i r0 . -.:-.,�e,.v+r-_+^�-^,-:?�a-�•-•teras+-�..-r�xr►�.�+-�+--:^-�-^ww+...r.-r..-c:�.a..a's"��t."-^ter:--a-+- -+ -+-` - (CI-1 el -FO ��o r o-Ltlr,-�- 9 it/ r I w r t I� I { r a I 1 1 1 1� -T'=,& ba ci�arlvt,� 170. c,.70e vozijve pop ` r•. , � • �aa'1....r�.tiWb— 49h..r._,( r_ —' y .env ...:/L' ter.--._+..j.rr.==.. _F^ �i�W �+•�'�—�—'� � ' � � � 1 ; s. I_.1vi 1_� 'f� �t`— i ♦- ...tet � 3 - �/ -- s s lot vN 3 � 515.5 ITa Ai iejeg 'Moo Al 61 1 � Al c 4r 3,a L .- . II �� ` 9 � ' � f t � F' - ' ' ' - � .�. �` ..� ..� � � - .. c... ._�— t — —— — _��- -- -- — .._ _ �._--. -------� — ---,'—— —..—..� •---- a•AL3 7 � � , Qj it u Li t • Alf 4-0 r I)c40 4c- 10 � ` •�,�x%= ,tea�,� ,�,�r=�,�: �tj L• L � 1 � � � � I . � ,_� �� I ' 4- �7 11 - -, ---_ 10, ' 07-6 Al ` �u - - 3S� rT IV j , i I c � `�G rSZ r-ip . I I SLoPr Z k f' 'S-Zyao . 6 .c poes Q oy t;.c-miss i — PRO 1'J o S E G Weg — 04C 14 f'---— ' IV Wkf ------------- � `��'�`/� �� - FORM — U — LOT RELEASE FORM F `! 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 �GV ' �-�e Z PHONE ASSESSORS MAP NUMBER ' _�7 LOT NUMBER /�I�I�I�►�I.AN -,,�STREETSTREET NUMBER Eonosooz OFFICIAL USE ONLY c?/7 ' PBEY V �Q �j eve RECONVAENDATIONS OF TOWN AGENTS 4>0 /�,,v � z�r so go T( �-_")C'e, DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED Co CON VfENTS IV, 6 DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTNIENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE � Q 1 p v �J Yo ' O �. � ��` '\ • � �� . •x.91 C> �cvv� -ell aSi 011 `.J s 1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Sectio» er Offi dd—Use OBI BUILDING PERMIT NUMBER: DATE ISSUED: rn SIGNATURE: Building Commissioner/IT-®ro, BuildingsDate z SECTION I-SITE INFORMATION O 1.l Property address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area sO Frontage R) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Re red Provide Required Provided Required Provided 1.7 Water Suppty M.G.L.C.4O.5 Sa) 1.3. Flood Zone Informuion: 1.8 Seweragc Disposal System: D Public a Private ❑ I Zone Outside Flood Zoae ❑ Municipal C On Site Disposal System SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record v L L."A e-r tct-n 42-s Name(Print) Address for Service - (p2- oZ Signature Telephone 2.2 Owner of Record: Name Print Address for Service: rn Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 7� 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number M Address D Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Sv Company Name rn Registration Number r _ r Address Z Expiration Date Y Signature Telephone 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 all applicable) New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: ck un LJ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by pern-dt applicant Building (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, e Z:/ as Owner/Authorized Agent of subject property_ Hereby authorized J(� ��-L.�� Z % G,,�� to act on M,behalf, in all matters re e to ork authorized this building permit application. Ov —Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DIN ENSIONS OF POSTS DDAENSIONS 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 Location No. �`S / Date 02 NORTH TOWN OF NORTH ANDOVER W � a Certificate of Occupancy $ Building/Frame Permit Fee $ �cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ p Check # '�-3 y� 16394 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. �-S DATE ISSUED. o? rJO� —l cl SIGNATURE: Building Commissioner/IRTector of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property A dress: 1.2 Assessors Map and Parcel Number: ao O Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid 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.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 O er of Record (X CT fle Name(Print) G� Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number i mn Address D e Expiration Date ic� Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name m Registration Number r Address r Z Expiration Date /1 Signature Tele hone Y� •i 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.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ 7dition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: -,,q J Al aC d h� lz 1�s 57/)4 Sr SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFIP'ICIAti;1 TSE ONLY Completed by permit applicant 1. Building (a) a �� (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, 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/AUTHORIIZ•ZE'D'AGENT DECLARATION (� V 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 Print Name Signature of Owner/ ent Date (/ 74 '37MR-571.7 OUR NO. OF STORIES SIZE j BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS Isr 2ND 3 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 _ . 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: rq pi s � X�(df,P1 (Location of Facility) Signature of Permit Applicant Da e NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector -ORTH Town of E Andover 0 0% No. 5%T9 - Z � LA over, MaSS., COC HIC ICR yt ORATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT G v Ir Z f V ..............p�a.�.�...... .......................y�.8......��r� S A N� ......a..�i.............. Foundation has permission to erect.. ............................. buildings on .........................J..................................................................... Rough �• to be occupied as..: ...... x $ Chimney ................. .....................................................C At...'4 S T, / N s ................................................................................. .... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the In action, Alteration and Construction of Buildings in the Town of North Andover. Is �� Jed � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6' MONTHS Final UNLESS CONSTRUCTION TARTS ELECTRICAL INSPECTOR C Rough Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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.