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HomeMy WebLinkAboutMiscellaneous - 520 GREAT POND ROAD 4/30/2018 � �-- 520 GREAT POND RO r 210106300000.0 - _ J Location No. � Date , �oRT� TOWN OF NORTH ANDOVER Oft..•° ,•�,y O 3? • OL Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ ss�cMusE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � Check # l! 14 ! c 4 - � - r„-�-• /” -''Building Insp�tor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. /�y DATE ISSUED: SIGNATURE: Building Commissioner/InEeEtor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: i� G12F-1 7- P W /2 G � 3 Dd A Z E& Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ZoningDistrict Proposed Use Lot Area(sf) 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 0 Municipal 0 On Site Disposal System ❑ --p SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record / -r/ 1D (� �iyLCd, y C�u/g /Q�1�r�0Nl� /�D , IV, /1/�yey' Q Name(Print) �— Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Mn Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 70AJ Is ���,�� g� Company Name _ -S 6 / Registration Number S i C 7-7—0 A) S C Al, AA)DO JF- re, M�4- •yam/ � ��Lo -- 3 Y-2–� Expiration Date Si nature Telephone SECTION 4-WORKERS COMPENSATION(10LG.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 rmit. Si ned affidavit Attached Yes.......❑ . No.......❑ SECTION 5 Descri tion of Proposed Work Lcheck all a Ucable New Construction ❑ Existing Building Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify ♦,t'f l 4t. f � Brief Description of Proposed Work: U/lI E /11I SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFCIA)(.[TSE ONLY Completed by permit a licant 1. Building - (a) Building Permit Fee F� © Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 7 L. V 6 Total 1+2+3+4+5 Q U 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 to work authorized by this building permit application. V/g0 � a l Signature of Owner Date SECTION 7b ,/OW' / N9 ER/AUTHORIZED AGENT DECLARATION 1, ))4 V I P l A � �l (!'�,Q A) 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 s c.d�t1 r Print am Si ature of Owner/A ent Date nummm NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2 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 P own . of . 4 over No. 78h dover, Mass., Al -%.3 a •670d/ 17) COCMICMEWICK RATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT V ....V.......... .. ............................ Foundation V """"' " has permission to erect, buildings on ,.... Rough 2 to be occupied asChimney provided that the person acc pting 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIONS ELECTRICAL INSPECTOR "' Rough a . .................................................................. ........ .. 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 I Smoke Det. 1 96ard of Building Regulationi Ani dStwidards -. HOME IMPRO EMENT CONTRACTOR Regiptration 194569 ,114/0,2 9 Tyke PltlVATE COkPORAT ION A MD CASTRICONE�rcOOFIKIG 7 l:. �§-ncone 7 Hillside Ro.'j I Bisxfotd MX64:92.'.. „1dm�n.§trator i, Town of North Andover o¢ tAoR ao Building Department o -' 4, 27 Charles Street North Andover, Massachusetts 01845 ti (978) 688-9545 Fax.(978) 688-9542 ° R pe �9SsAcaau5���� 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 c11, sl 56a. The debris will be disposed of in/at: Facility location Signature of Applicant 4 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector.