HomeMy WebLinkAboutMiscellaneous - 52 LINCOLN STREET 4/30/2018 -+� -52 LINCOLN STREET
210/056.0-00240000.0 J
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Locationc� --'
No. \:5 74/ Date
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N°RTS TOWN OF NORTH ANDOVER
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Certificate of Occupancy $
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J'••14U Building/Frame Permit Fee $
MUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ ���•
Check # 17YT
�� Q Building Inspecto
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT KLARENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
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BUILDING PERMIT NUMBER: `� DATE ISSUED: R L /r IT
SIGNATURE: WON
B ssidjg for of Buildin Date
SECTION 1-SITE INFORMATION 2
1.1 Property Address: 1.2 Assessors Map and Parcel Number. C
c�`G mac,
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use LA Area Fronta g
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
1.7 Wats Supply M.GLC.40. 34) I.S. Flood Zone Information: vli
l.a Sewera6e Disposal Syatem:
Panso ❑ Private ❑ zees Daturae Flood Zane ❑ Mnnicipal ❑ Ou site Disposal System ❑
SECTION 2-PROPERTY OWNERSIMAUTHORIZED AGENT %� {: l 'ti!Ct; �!;; �,�❑ rnl
2.1 Owner of Record
,COGAB�-C'GE�,�G�ys? �Z �/�G Off/✓
Name(Print) Address for Service
Signature Telephone
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2.2 Owner of Record:
Name Print Address for Service:
Siseature Telephone
SECTION 3-CONSTRUCTION SERVICES 9
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
�E�/G O �/• License Number
Address
Expiration Date
Signature Telephone a.
3.2 Registered Home ment Contractor Not Applicable ❑ v
Company Name
Registration Number M
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Address rM
OWNS
Expiration Date z
Signature Te hone_ ^
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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 ae a ble
New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) 0 Addition 0
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
TO ,',PGS'% -C C,11 S
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building �y (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 �4r2/NHG CO ysi, 1,-16 . to act on
My behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTI��O-N,�7b OWNER/AUTHORIZED AGENT DECLARATION
as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are L*ue and accurate,to the best of my knowledge
and belief
�NlE</GG
Print Nainq
Si antre of Owner/A Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS i2NU3RD
SPAN
DIMENSIONS OF SELLS
DIMENSIONS OF POSTS
DIlbiENSIONS OF G.0 DERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOO'L'ING X
MATERIAL OF CHIMNEY
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1S BUILDING ON SOLID OR FILLED LAND
IS BLUDING CONNECTED TO NATURAL GAS LINE
C NORTIy .9
own, o � � _ � Andover
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ago
C,odower, Mass.,
I� COCHICHEWICK
ADRATED P'f C2
`T BOARD OF HEALTH
Food/Kitchen
PERMIT T Septic System
THIS CERTIFIES THAT.......... ...
i............ .. BUILDING INSPECTOR
.......................................... ................................................ Foundation
474
.... ............................
has permission to erect........................................ buildings on ...... ............
Rol,gl,
to be occupied as Chimney
provided that the person ac ng this permit shall everyrespect conform to the terms of thii ea IiCation on file in Final
this office, and to the prowsi s of the Codes and -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
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
..............................
................................. . ............ Service
WUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burnet
Street No.
SEE REVERSE SIDE smoke net.
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)
SignodreXf Permit Applicant
O i3 G S
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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