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HomeMy WebLinkAboutMiscellaneous - 863 TURNPIKE STREET 4/30/2018N O O Location No. L�'—// Date �oRT►, TOWN OF NORTH ANDOVER 0` 9 / b'd + Certificate of Occupancy $ llt? • i a ;� s' •' tt� Building/Frame Permit Fee $ �cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �7 i Check # 1115-z r 2 2'1 2 9 y�------� �,� Building Inspector NOITq CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Permit # 511 Date: June 18. 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 863-865 Turnpike St MAY BE OCCUPIED AS Commercial Fit UP ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. . Certificate Issued to: Structural Systems, Inc 16 Haverhill St Andover Ma 01810 Building Inspector O • al �b o � CD H Oci v o 0 cf NW O G c ~ ° p, c cn Cl) al z O U 0-1 L 0 E c L 0 s Z CD CL O y � C a) cm C C H Q m h 0CD co 0 Q CL 3.0 as � � L CL cria c ev CO2 Z CD C.3 v2 c C C� C cc 0. CO3 C uj U) W W V9 W N CD H Oci = : w+ C ci C.3 p, c L O Q r c '^ vJ a y e 0 C2 Ca $ v sem.. ..1 m c E �•�mm co�m3 'z (n H [j, v _m O zip y c O W 1 �ca a -co aU m y m Lcm % md C ea . ^W� L m 1- -1 m C-1 H Z0 dMMI* : �+ C � aC C Q � v •O = m m«L+ p y m s N m W o 0:: L "r .y ac 'E CL=C Sl 'o a �',La Z o CL' m3 :_ = A L O` H = o H- L 0 rL z O U 0-1 L 0 E c L 0 s Z CD CL O y � C a) cm C C H Q m h 0CD co 0 Q CL 3.0 as � � L CL cria c ev CO2 Z CD C.3 v2 c C C� C cc 0. CO3 C uj U) W W V9 W N STRUCTURAL SYSTEMS, Id S■ I Y\i/1 16 HAVERHILL STREET a ANDOVER, MASSACHUSETTS 01810.3000 phone 978.623.0000 fax 978.623.0088 AFFIDAVIT To the Building Commissioner of the town of North Andover, MA In accordance with Section. 116.0 of MA State Building Code We certify that to the best of our knowledge, information and belief, the wood partition framing at 863 & 865 Turnpike Street has been completed in accordance with our requirements and DrawingA2 by Structural Systems, Inc. April 13, 2009 OU'I r •� ' , • . 34338 STRUCTURAL SYSTEMS, INC. 16 Haverhill Street Andover, MA 0 1810.3 000 Then personally appeared the above named Jay H. Brown and made oath that the above statement by him is true. April 13, 2009 Notary Public Before me, A U My commission expires 12-29-11 A Location W d< ow S o C N a b Awi r - No. `{ Date NORTH TOWN OF NORTH ANDOVER O H R 9 Certificate of Occupancy $ �'�s'•"°' E<�' Building/Frame Permit Fee s�CMus $ 8 Foundation Permit Fee $ Other Permit Fee $ a �— TOTAL $ Check # "16661 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: S a� a � c SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: g J O, A r O n L) Z +: Map Number Parcel Number 1.3 Zoning 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 1.7 Water SupplyM.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes NO 2.1 Owner of Record W1 In �A) U) SD ilt4 6.0 JA) -CO A.SSC,G • �S �� �J�W til LCu �` i Name (Print) Address for. Service: 018K Signa re Telephone 1 2.2 Owner f Record: Name Print Address for Service: IL Si tlature Telephone Sfr-TION 3 - CONSTRUCTION SERVICES 3.1 icensed Construction Supervisso-r:/� Not Applicable ❑ �© -14-yo -0 Licensed Construction Supervisor: �r f i •J ® _ t PI� A 16 1p J �Uli �f % JV Id 1 License um r Address I?6-6�-8 ?Ks Expiration Date Si ature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ �j f Company Name G- Vz ik C SA il) 6f 6tf,qr 9VDz In ; RegistrationI(umber ®/ Addressk4a�� Expiration Date signature Tele hone M T M 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 it. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Workcheck all applicable New Construction ❑ Existing Building V, Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other. Specify Brief Description of Proposed Work: Wv �- �� nJ`5 i 1� &QC- S41 P6_4 FS SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item 1. Bui Estimated Cost (Dollar) to be Completed by permit applicant Me IAL�1ISE111NLY .,, (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 AUTHO TION 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 pennit 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 Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD SPAN DRYIENSIONS OF SILLS DIN ENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHFMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ll The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: Cifi/ Phone # I am a homeowner performing all work myself, I am a sole proprietor and have no one working in any capacity ® I am an employer providing workers' compensation for my employees working on this job. Company name. (flow S`1 co IAU Address � ! C%i� 18) e 1, K aw AIYi �l-�y�� i�� i� ` M 1^� �Qq Phone# 228-6V—PRK Insurance Co. Ko , N '-t-In (do UA -1 -LEY 1AMAWYPolicv# -3a D©O c/O Company name: , A. ddress. C'rtir phone #- Failure to secure coverage as required under Section 25A or MGL 152 can lead tothe imposition of criminal penalties of;a 11118 u040 V WC and/or one years' imprisonrnent-m_vmLw-ciW penatieslo-tboSmn-da-STOP IWOWDRDERandarm-Cf j,$Io=)-atlagaga nst. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under fte pains and ppna/tTes ofpegury that lite inlormabw provided above a true and correct Print Official use only do not write in this area to be completed by city or town officiar ,?W City or Trn+m Perry U_ censi . OCher k if immediate response is required Q BuifaGng, Dept0 Licensing BDam p Selectman's t Contact person: Phone # Health Departm, o Other 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: o W /q s c 6ER U I C E /, I c (Location of Facility) NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a O z is A c� v w° y cn O z w° a°' G U u. a P U � r u: w a W v a w W a w W ° 2 cn u I 4-4 a 2 V 0 CD 0 co O V Z CD O CO) cm y Q � n �E m m CD 0 co CL— -4--f CD 3� co co cc O CK a vs Q ca C 0 ccC C.3 J •p C Z CD 0 CL V y C ca is o as c :;c c O L C N 1 O: �O O c ;t O op (D low N : J = E ¢ o^ CD •; Soap H 0 O dli I �. m H C GO: �. •� H H O O :Em's v s �ymmcmCD cm cs c o �, p•CL m 3 �. CX•y O i Ci � Z O � o � cm d •C F•" y C ~ N ~ m W w, C h m w0+ ; :S ,O •tq MD is ed c a t. Z 4coj •h Co cm h i a m� C: J A -0 i A •O CD a�m> I 4-4 a 2 V 0 CD 0 co O V Z CD O CO) cm y Q � n �E m m CD 0 co CL— -4--f CD 3� co co cc O CK a vs Q ca C 0 ccC C.3 J •p C Z CD 0 CL V y C ca is