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Home My WebLink AboutMiscellaneous - Exception (245)TOWN OF NORTH ANDOVER BUELDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Section for Of ficial Use O��l*--�-4�',�,��11-1-1.4i.*i-�--��x BUILDING PERMIT NUMBER: 6. . L-) —P�— ISSU2 SIGNATURE: 42�—k�� Buildina, Commissi2nSEIRs or of Buildings Date . . . . . . . . . . . . ....... ...... 101 RM 1. 1 Prop=crty AJdr=- 1.2 Assessors Map and Parcel Number. �jc Map Number Parcel Number f 1.3 Zoning Information: 1.4 Property Dimensions: ---r- ?"- 0 Z06,594 --rP , 48q Zoning District Proposed Use Imo' Frontage (K) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Req Yard Re red Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: 1.9 Sewerage Disposal System: Public 0 Private 0 Zone — Outside Flood Zone 0 Municipal On Site Disposal System 0 2.1 Owner of Record L) Name Orint) Address for Service VA -LRA", J0 &In ikAtj t4 -,D Signature( Telephone A , 12Autho#edAfent -ZI 95, 1,AJAJ,.,�:XAeFZy— CR'56- C-1 644y") 601 sr., Name Print Address for Service: (31Y) 5'29- -r/00 Signature Telep6one 3.1 Licensed Construction Supervisor Not Applicable 0 dA 0' Q 0 IS a I Address — License Number Licensed Construction Supervisor: Expiration Date Signature Telephone 600.Q;1 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name- Registration Number Address Expiration Date Signature Telephone '0 XM ic C/0 M Z I as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Agent Date Item Estimated Cost (Dollars) to be A-- A Completed by permit applicant 'D 73; 400 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number 0 AA - N A'0 'MAN M��'w aw '0 qg ON' NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS OT 2 No 3'D SPAN DEN11ENSIONS OF SELLS DEMENSIONS 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 �g I New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify 5 Brief Description of Proposed Work: z�Tc,-rr.��rz 7-ti►.��1...-�%r►� L �...,�woyk (�,,.rrx-�',5 Ot A-2 A-5 ❑ A-3 ❑ BUELDING AREA EXISTING if applicable) PROPOSED Plumber of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height (ft) Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,� / —1 c1�� {Z i l� J� �? �.-% as Owner of the subject property Hereby authorize C_L A q C<,,) C -.A?/ ,' IPA- it--., Gi, Af 'S to act on My behalf, in all matters rel tive two work authorized by this building permit application Signa o r �, Date USE GROUP Check as applicable) CONSTRUCTION TYPE AAssembly 0 A-1 ❑ A4 ❑ A-2 A-5 ❑ A-3 ❑ 0 1A 1 B ❑ ❑ B Business 0 2A 2B 2C ❑ ❑ ❑ C Educational ❑ F Factory ❑ F-1 0 F-2 0 H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ 1-1 ❑ I-2 ❑ I-3 ❑ M Mercantile ❑ 4 0 R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ 0 S Storage ❑ S-1 ❑ S-2 ❑ U Utility M Mixed Use S Special Use ❑ ❑ ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: BUELDING AREA EXISTING if applicable) PROPOSED Plumber of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height (ft) Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,� / —1 c1�� {Z i l� J� �? �.-% as Owner of the subject property Hereby authorize C_L A q C<,,) C -.A?/ ,' IPA- it--., Gi, Af 'S to act on My behalf, in all matters rel tive two work authorized by this building permit application Signa o r �, Date 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 Yea .......❑ No ....... ❑ 5.1 Registered Architect: Name: � 6A� Address o OF Si ature Telephone 0 0-0 SA C-a4e-a Vn� &X4 • Area of Re - j QF ,^,•• l� 4941 Re n_ "jr�°' .`,` r ^ iM;1,, EY T � t -i 1;7 E at' n rE b . a I E tea ,,,.., Name: too cIa-A-W4 OID ST - , s.) LTC- 4o( o lajv A Signa a Not app Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility x Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone GLAYcc cor�STlYua�n.✓ cor�/�rs,�y Company Name:,}--- G72EGG �h2,✓.ST .�-G��--G�-.�J Responsible in Charge of Construction Not Applicable ❑ Location '3S 1 Ii -T- Cc��t 2) No. rJrL Date /;?- t MORTp TOWN OF NORTH ANDOVER 0L .. 9 Certificate of Occupancy $ Check # S U 5 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee i-) e -m u $ � Lz TOTAL $ /', Building Inspector . -Taw --o -North-Andover - B-iRding department 27 Charles Street NOLrtILAndover,_Massachusetts -0184-5 (978 688-9-545 Fax (W8) 688-9542 DEBRIS DISPOSAL FORM Inaccordance-with-the.ptov.. ns.ofMGL_c 40_s-54,_andazondition of Building permit=# - 2� the- debris resulting -from the -work shall be disposed of in-aproperly licensed salidmaste�isposal facility as defined by MGL c11, s156a. 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