HomeMy WebLinkAboutMiscellaneous - 452 MASSACHUSETTS AVENUE 4/30/2018 tsachusettsAve,452,033 Parce10027
- --- ..
Location '�,0,2
No. 17lezIf Date /—0
�oRTM TOWN OF NORTH ANDOVER
F A i
r o
Certificate of Occupancy $
7Ss,CMUSEtBuilding/Frame Permit Fee $ --f-�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
141148 1/ Building Inspecdor
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
t
� '(e, by k � .y. •�.� „may.. ..... .. .. `,'Y«,"L! :� ��: �� „�:
BUILDING PERMIT NUMBER: DATE ISSUED.
SIGNATURE:
Building CommissioRELnSpclor of Buildings Date —0 v
SECTION 1-SITE INFORMATION O
1.1 operty Address: 1.2 Assessors Map and Parcel Number:
t/6,.33 �a7
U }-� Map Number Parcel Number t�
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 ❑ Municipal ❑ On Site Disposal System ❑ J
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m
2.1 Owner of Record n 077
o
Name(Print) Addfess for Service
.ff�(A C
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service: O
M�
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES 1 90
3.1 L' Construction Su
i o t /` � of Applicable ❑
Licensell Construction SuPe rvisor. Z
License Number
VC, G v C�^t
1 �
Address
Zai
C/ � � Eacpirati n Date
Sign er LU Telephone
r
-t
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number r
Address r
_^2
Expiration Date
S� nature Telephone P)
SECTION 4--WORKERS COMPENSATION(AG.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 Descriptio of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to besrOIECYA)( USE ONl✓Y ..
Completed by 2ennit applicant
1. Building (a) Building Permit Fee
�3CJ v
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 PlumbinE Building Permit fee(a) x(b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTH61&ZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CON C APPL OR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
�Here thorize to act on
y in a natter ative ork tth ' ed by this building permit application.plic�n. �?' p
S' ure of Owner hat-
ACTION
CTION 7b OW.NER/AUTHORIZED AGENT DECLARATION
I, As Owner/Authorized Agent of subject
t
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
O
Print Name
Signature of Owner/A ent Date
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIlVIBERS Igr2ND 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
NORT►y
Tovm ' o 4 over
0 �w
No. 4/6(,
h
COQ _ LA COCMICMEWICOK dover, Mass.,
xA
.95 RATED
7 H BOARD OF HEALTH
PER T Food/Kitchen
Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT..... . ....... ........................ . .... ...... ............ .............................................. Foundation
has permission to ere .. ....... ..................... buildings on. .....................................................CN�!4�......... Rough
to be occupied as.... ... .............. ...'�'. ...... ......... ....................................................................................................
Chimney
provided that the person accepti this permit shall ' every respect conform to the terms of the application on file in Final
this office, and to the provisions f the Codes and B -Laws 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
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION ST S ELECTRICAL INSPECTOR
C � Rough
..I..... .................. ................................... 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
Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT
Street No.
SEE REVERSE SIDE Smoke Det.
F
' � ✓.die ioamirnan�uenl�a�../�nmae�ivae%ta '
HONE IMPROVEMENT CONTRACTOR
Registration: 101752
Expiration: 06/29/2002
Type: OBA
ANDOVER CHIMNEYS
David Hawkins
td0 South Union St
ADMINISTRATOR
Lawrence NA 81643
c
I t
Town of North Andover ati tAORTH
�t120
Building Department o
27 Charles Street * _
North Andover, Massachusetts 01845 4
(( � � �978 688-9545 Fax 978 688-9542
l 7 a�RgTEo PPa`y�5
�SSAC b1U5��
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit# the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl.1, sl 50a.
The debris will be disposed of in/at: yet (3,3
r
F cility location
ature of Applicant
Dat
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
I