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Home My WebLink AboutMiscellaneous - 716 FOREST STREET 4/30/2018 (2)Location f (9 No. 063 Date III TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 132. 32. _ Foundation Permit Fee Other Permit Fee TOTAL Check Check # ` � 7 15667 J� v i 62�' — Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING FLIfv BUILDING PERMIT NUMBER: /� �j� DATE ISSUED: SIGNATURE: cc�� Building Commissionerfln§L=toribf Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number TJ 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot. Areas Fronts e ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide RequiredProvided Required Provided 4- 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ame (Print) Q Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: T Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 09 M X Z O SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 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 DescNi tion of Proposed Work(check au applicable) New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) 0 TAddition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify BriefDescriptionof Proposed Work: ';Z -Q_ •�� .�a <31 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be CoInpleted by permit a licant OFFICIAL USE ONLY 1. 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 1, 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 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 j f ! Signature of Owner/A ient Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST 2 3 PO 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 m �c I O z 00Cdaw w° cn a A w° ate' U w ra a�' ii a W w�' cn ii 7tA 00 ate' W W w CO zcu 8 cn o cn R, C0) ;2� • r.a Cl E L v V Z a3 0. O CO) 0 C co o, Io� coLa m m Q co � H .0 0- _ a••• 3 .o CD Cl IS CD OL w i. a ey o -o., CL C Q C ccC.2 C CD V y OU = O m C VO C-2 : d= Cc ev m = O � m, E So- O r c -o to = C co e E C L cm : r :+"may va = r M In Ci O v V •jZ p ycm O = fl. � Q L y m= p o T ~' o o mw N o COO v� 'm .E Q � o .y O V W v CM y CL 'D O � ��y•o CD x $ CL i R, C0) ;2� • r.a Cl E L v V Z a3 0. O CO) 0 C co o, Io� coLa m m Q co � H .0 0- _ a••• 3 .o CD Cl IS CD OL w i. a ey o -o., CL C Q C ccC.2 C CD V y OU 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 02 3 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) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 .7..:(978) 688-9542 Fax . HOMEOWNER UC -NSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map /lot "HOMEOWNER Name kfo� Phone `` J 1- Work Phan, - PRESENT MAILING ADDRESS S�v� City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does. not possess a license, provided that the owner acts as supervisor. (State Budding Code Section 109.3. 5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is irrtended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures_ A person who constructs more than one home in a two-year period shall not be considered a homeowner The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC If 4-1-0 Date......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION • o a ! 'q This certifies that has permission for gas inst llation ... (%Y�a 4 .............. . in the buildings�of..� !.."............. . at .r�l ?. �� : , . , North Andovef; Mass. �SPECTOR Check # / ,5140 A . Y (.�ilr, , Cf T—) E'-11din La-a!jon / � r� i J r.e,-,GYa..iO l! P.eriacemar", C Pia, ,s Cu':'rntn--: Yes', IN:) :.J (:5T FLOOR I I jI I I I I f2.1i0 F L 0 0 A .2A3 FLOOR I I I I I I 4TK FLOOR I I I I I I I I STH FLOO;; I I I I I I I I 6TY. FLOOR 7TH FLOOR ZTH FLOOR I^s'.aifing Ccmr,,ny Na„•e TOWNSEND PROPANE SERVICES 75 WEST MAIN STREET GEORGETOWN, MA 01833 S'-'s:imess Teiephoine 987 3528711 t:a-;e of ucen.se-d PSuimber cr.,G2s Fr,",ei Check one: --v Corporation C Pa-tneis`ip CI Fir,—,,/Co, le Ile LD i JTI-n — 1 i � t. i L :: C C C 0 I �• � 1 C 00 0 z C 1 t. < — �' _ - C. C om' I C: C ` �' U L �� L < C C L I I - 0 _ _ - � �: r u r c^ = - F- _c I I< c> - < << C C � � O V } 0 L I -.. I C 0 J U 1> G f- O I (:5T FLOOR I I jI I I I I f2.1i0 F L 0 0 A .2A3 FLOOR I I I I I I 4TK FLOOR I I I I I I I I STH FLOO;; I I I I I I I I 6TY. 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