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HomeMy WebLinkAbout- Permits - 740 TURNPIKE STREET (5) SECTION a-WORKERS COMPENSATION(MG:t,c I52§_25c(� Workers Compcnsat Insurance nl -`it most be completed and submitted with this applicatian.Failure to provide this aoiidavit will result in the denial of the ma— fit,.buildi rent. SECTION DESC.RIPTIOSi`QF FROP(DSED O (ahe8katiapplicabla}'<';- Signed aflid.,it Attached Y..... N........❑ New Construction K Existing Building ❑ Repains) ❑ Alleraticnigs) ❑ Addition ❑ , SE ION 8-PROFXSSIONAL DESIGN A"CONSTRUCTION SERVICES FOR BULL DINGS AND STRUCTURES SUWECT TO CONSTRUCTION CONTROL PUFMANT TO 180 CM 110(CONTAINING MORE THAND 35,00 C.F,Of',ENCLOSED SPACE) Accessory Bldg. ❑ Demolition ❑ Other 0 Specify 5.1 Registered Architect: gAEp R$C Brief Description of Proposed Work Name: �`�BR"roc, Addr� Ik� �z z llylik,'I 1-i8 �No.5056 ess MI�gS�a� Signatu e Telephone OF 5.2 RegtsteredPeofessinnat:Bngtncer(s}:::'.;. SE':;. ON T-USE Gld(? •e4I!1D CUl'�STRlICT10N'i'XPE. USE GROUP Check as applicable) CONSTRUCTION TYPE YZUC 7'UR_ A Assembly ❑ A-1 0 A-2 ❑ A-3 ❑ IA �> Area of Responsibility A4 ❑ A-5 ❑ IB 0 Name: ASAP 5`P B Business 2A ❑ E J/� a C Educational 0 2B ❑ e3 C'it YA Ja— 10 Re istrationNurnber F Ad � SfRUGTURAL � g � _ Fasiory . C6 ,P-t ❑ P-2 ❑ 2C ❑ No.3 9 6-36-Oz H High Hazard ❑ 3A ❑ -,�,U Expiration Date I hrstdutional ❑' I-1 ❑ I-2 ❑ I-3 ❑ 3B Signs 0181 'total MMercantile ❑ 4 ❑ Rresidential ❑ R-1 ❑ R-2 �0 R-3 ❑ 5A ❑ Not applicable ❑ S Storage ❑ S-I ❑ S-2 ❑ 5B U Utility ❑ specify: Name: - M Mixed Use F tSpccifg: S Special Use 0 Specify: Address Registration Number COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Signature Telephone Expiration Date Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: Nate Area of Responsibility BUILDING AREA EXIS"PLNG ifs licable PROPOSED Number of Floors or Stories Include Basement levels Q Address Registration Number Floor Area r Floor s Total Area s Total Height(fl) Signature Telephone Expiration Date _ Independent Structural Engineering Structural Peer Review R El Yes No I Name SECTION 10a Owner Authorization--TO BE COMPLETED WHEN Area of Responsibility OWNERS AGE T OR CONTRACTOR APPLIES FOR BUILDING PERMIT Address Registration Number jt 1 as Owner of the subject properly Signature Telephone Expiration Date ` { p g yam/ !� i 5 Gamsal G2iiit c a Hereby authorize !✓�L)dz C.- /Y f[�_M 4e24� to act on /� y behalf,in all matters plati e awork authorized by this building permit appli ;fort SCOT`r C s�r'e-Po' l o• 7 liLc_ Not Applicable [It Ct T Compan Name: /�j� f IG1i�U� Responsible in Charge of Construction Sigma Of Owner 0 eA�Pc� 4w 44, TOWN OF NORTH ANDOVER WELDING DEPARTMENT lxl- s APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CLIYGE THE USE OR OCCUPANCY OF OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING I I '_j A as Owner/Authorized Agent n - -- , This Section for Official Use Ont ,.v BUILDING PERMIT NUMBER: DATE ISSUED. Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my 3 7 knowledge and belief. pDm a !p Z oo O y�o3 fe+! Signed under the pains and penalties of pequry ; qI ATURE: � 1 1ty SIGN O p iJ `j' { (, d ll F Bmldin rn Comr oner/Ins for dBuildin Date Pr tCName ,,/'` 1.1 Progeny Addre<s. 1.2 Assessors Map and Parcel Number: O Si nature of Owner/A ent --' Date? 7 __y j� ��'1.�hV�✓`/ �/^�-(,F 5 Map Number Par Numha (Dollars) If:fAI3 USFi O1vLY 1.3 Zoning InfornWim: 1.4 Property Dimensions: hem Estimated Cost Dollars #o be t, _ �1 ry q p Completed by permit applicant V C t .3 oZ� ry-(t i d� 1. $nilding _ (a) Building Permit Fee Zonin Distrid aced U. Lot Areas Praua e ff <d iw� Muhl her 1.6 BUILDING SETBACKS(ft) 2 Electrical (b) Estimated'I'mal Cost of Front Yard Side Yard Rear Yard r ! cxso moo <' ? Construction from(6) r Required Pr e R uired Provided Required Provided 3 Plumbing Building Pemut fee (a)s(b) aa9 1.7Wo pp1y UG.LC.40..54) I.S. 77ood Zone ln!'vmsatioa: 1.8 Sewerage Disposal9r1—: 4 Mechanical(HVAC) +eg,,q,F to Zna oaa rtaaz brmoi a1 . oa sae DhPosa Sri—❑ 5 Fire ProtectionXI iI . r e d- t7 a O o :x 6 Total(1+2+3+4+5) t 2.1 dGo Ch Owner of Record e� 7F✓' d� ,'l� 1� ameC��) - AA foervice:r flyTtttt �lr/'N�L 0 N i s v �IlN v tJl�!d r�p O tTi NO.OF STORIES © SIZESignatnre; �/� L Telephone C y� BASEMENT OR SLAB GO� " Gay - 22 Aml razed Ag rat SIZE OF FLOOR TIMBERS r( I 2ND 3 p l 1 D SPAN t-I • '4tc> ` t c c=cc r 1. 41lt f tR' i Y'/l- Gl !v Name Print— J Address or Service: Z DIMENSIONS OF SII,LS ! q 70 v r)li C/© O D>EMENSIONS OF POSTS y(/—f�.. Signahtre - Telephone - / �T( m DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION 1�t/ l( THICKNESS 3.1 Li/censsee/d Construction Supervisor Not Applicable ❑ SIZE OF FOOTING t 7{ Address License Number 0 MATERIALOFCH[MbTEY /,r-�,,,,,., � rPK5"W t s�,� IS BUILDING ON SOLID OR FILLED LAND r'V P'+��A^U A rr, � � (t O v� ( �n r` ^ Licens nstruc[on Su ry r. � ,�CJU�. IS BUILDING CONNECTED TO NATURAL GAS LINE Yf � _/�5-- Expiration Data A�H ed ome Improvement Contractor Not Applicable ❑ 0 n,t Company Name, Registration Number M ild r 1 Address r t a� 1; Expiration Date Z NOV t , Signature Telephone BUILDING- -