HomeMy WebLinkAboutMiscellaneous - 898 SALEM STREET 4/30/2018 (2)c
1,
Location
No. � ��' Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ �' `5•
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check # ` l^
147;'8
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER:/ n� DATE ISSUED:
SIGNATURE:
=----4�-,-t--) Ll- 2:1&,�
Building Commissioner/Inspector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1/.2 Assessors
M Number
Map
Map and Parcel Number:
Parcel
1.3 Zoning Information:
Zoning Di;—& d Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
RegWred Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54)
Public ❑ Private ❑
1.5. Flood Zone Information:
Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) U
Address for Service
Signature
r
Telephone
2.2 Owner of Record:
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
GAN/V
Licensed Constriction Supervisor:
Licensed
+ f N C �� �Q p /)ll` �J�
Address C �C G ( '
Signa re Telephone
Not Applicable ❑
� 3
5�
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
iAz od2 t^4 /I/Company
Not Applicable ❑
3
Name
/� 1,e
Registration Number
O
Address�1
Expirations to
Signature- / Tele hone
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 rmit.
Signed affidavit Attached Yes ....... 0 No ....... ❑
SECTION 5 Description of Proposed Work Lcheckall applicable)
New Construction ❑
Existing Building ❑
Repair(s)
❑
teration�() ❑
r .
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by pern-dt applicant
OFIHICIAL USE ONLY #'
`, x
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
Q
Check Number
SECTION 7a OWNER AUTHORIZ 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 permit application.
Signature of Owner Date
SECTION 7b OWNER�/A^UTHORIZED1AGENT DECLARATION
I,�1'1) K L 0 ,S Al- 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
05
Print Name
Signature of Owner/A en
wmw
NO. OF STORIES
Dat
Ell
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1ST
2 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING
X
MATERIAL OF CHRANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Siding
Windows Jerry Lavallee Remodeling
Roofing P.O. Box 374, Bradford, MA 01835
Carpentry Cell. 508-633-9141 • Home 978-725-8086 fft
PROPOSAL SUBMITTED TO PHONE DATE
Gam.,-., d' /1.� /� 923— s Z 1;? —k -v/
STREET JOB NAME
k F k- S -F X", /
CITY,, STATE AND ZIP CODE JOB LOCATION
/f/ 1
/ . A �L d ✓ -1°i✓-
ARCHITECT DATE OF PLANS JOB PHONE
................................................................................................................................................................................................................................................................................................................................I..........
...........................................................................................................................................................................................................................................................................................................................................
e PrOP00 hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
�^-
dollars ($ � [—D
Payment to be made as follows: j
v
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner
according to standard practices. Any alteration or deviation from above specifications involving
extra costs will be executed only upon written orders, and will become an extra charge over and
above the estimate. All agreements contingent upon strikes, accidents or delays beyond our
control. Owner to carry fire, tornado, and other necessary insurance. Our workers are fully cov-
ered by Workmen's Compensation Insurance.
Zirceptance Of 3propowit —The above prices, specifications and
conditions are satisfactory and are hereby accepted. You are authorized to do the
work as specified. Payment will be made asoutlinedabove.
Date of Acceptance:
Authorized
Signature
Note: ,
This proposal may be withdrawn by us if not accepted within
Signature
Signature
days.
F
0
L7
p /,�i oyO . %%sac/ur6eltd `;
,.✓�ie v� omvmoreurea � ;
BOARD OF BUILDING REGULATIONSt
C�cense: CONSTRUCTION SUPERVISOR
Number. CS 055823"
(birthdate: 06/07/194.7, 4
Expires; 06/07/2002 TF no `4942 ±`
xw.
)Restricted To: 00
JOHN CONSTANTINOI? ; !
X226 LINCOLN AVE'"�,
K %HAVERHILL, MA 1 7'61'830`&»aAdministrator'
_COMMONWEALTH OF MASSACHUSETTSDIVISION OF REGISTRATION
�[
05 ELECTRICIANS ?
-AS -A REG JOURNEYMAN ELECTRICIAN,p
s ` ISSUES THIS LICENSE TO $4 S }
JOHN `COSTANT,INO � �s' j'
160" N. AVE:
.fie g
IHXiVRHIOf p
LL�
f17l31/01 '6-67031, I
�
w
w
p
q
a
w
0
a
CD
o
a
O
•y
`
a
o
a
�
y
0
O
a
d
R-•1
A�
o
a
u
o
O
u.
�
U,
v
U)
p
w
o
rx
C
U
m
q
x
0°'
'oon
p
w
G
w
w
o
a4
C
w"
c�
'foo
0
a
G
w
w
x
w
►C.
o
z
Q
o
cn
W
W
co
c c
CD
: ;,= O
w
OCDH
c
C3 V
p, c
�v m
m g
;r
o CD
CD
Ea
CF
= w
�
CL
Eca
om
Q $
�CM
m c
C36ca W
160.
H
� 3
C �
'= C
y O
rclD2L:*:SC-D
0
0
Oco ZO
cc
m
MD O C
O 0 m •NN
O.0 C
m •� O 'O
a4 m
EL-
it
MA
r
H
a
y
C
ca
m
ac
m
O
C
•C
N
m
O
Z
O
0
O
E
L
_O
v
z Q.
O y
G C
I Ccn
O•—
ca ®'p
O
M
Eow
m m
L � _
CD
�3
C O
O O
L
cco�
cm<
ca
c
ev
a o 0
c Z CD
CL
V CO)
� C
C
CL
W
U)
w
W
w
w
CD
ca
YJ
O
•y
`
�
y
0
LU
d
R-•1
C**
�
s
c c
CD
: ;,= O
w
OCDH
c
C3 V
p, c
�v m
m g
;r
o CD
CD
Ea
CF
= w
�
CL
Eca
om
Q $
�CM
m c
C36ca W
160.
H
� 3
C �
'= C
y O
rclD2L:*:SC-D
0
0
Oco ZO
cc
m
MD O C
O 0 m •NN
O.0 C
m •� O 'O
a4 m
EL-
it
MA
r
H
a
y
C
ca
m
ac
m
O
C
•C
N
m
O
Z
O
0
O
E
L
_O
v
z Q.
O y
G C
I Ccn
O•—
ca ®'p
O
M
Eow
m m
L � _
CD
�3
C O
O O
L
cco�
cm<
ca
c
ev
a o 0
c Z CD
CL
V CO)
� C
C
CL
W
U)
w
W
w