HomeMy WebLinkAboutMiscellaneous - 71 Brightwood Avenue3 �
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Location
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No. -2 �t Date
_.1. ZT TOTOWN OF NORTH ANDOVER
9
Certificate of Occupancy
$
i ,s .d`
�ITS�CMUSE<�'
Building/Frame Permit Fee
$ J
199•
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
_
$
Check # e�iq/
x;6437
r Building Inspector
TN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
y.n .., .. .. . r: _ i ...te.i .. _. -: . ..... .. ..... .... H, .....,...x,. .., .. .. ...�. s. ,. .... ......, is .... ,.: x, .':
BUILDING PERMIT NUMBER: DATE ISSUED:
o
�C
SIGNATURE:
Building Commissioner/1for of Buildings Date
Jl31,16y1y 1-J11E INFUKMA-110IN
1.1 Property Address:
1+u i ✓.
1.2 Assessors Map and Parcel Number:
6 IV (.0
Map Number
D
arcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area (sf) Frontage tt
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required I Provide I Required I Provided Required Provided
1.7 Water Supply M.G.L.C.40. St 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
2.1 Owner of Record
r r�
Name nnt�) Address for Se ice
jo rD --2.,, ;> <9 e
Telephone
2.2 Owner of Record:
Name Print
SECTION 3 - CONSTRUCTION SERVICES I
3.1 Licensed Construction Supervisor:
A?� A. PAPPA1 a o
Licensed Construction Supervisor: 1
21 6A
Addres �n G
Si6nature Telephone
3.2 Registered Home Improvement Contractor
A A j
Company Name —�
rAddre Telephone
Address for Service:
Not Applicable ❑
06-317-3
License Number
Expira ion D to
Not Applicable ❑
1 �-3 39c
Registra'tiion Number
!1t , '
Expiratio Date
A
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 permit.
Signed affidavit Attached Yes .......p No ....... 0
SECTION 5 Description of Proposed Work check ail applicable)
New Construction ❑
Existing Building 0
Repair(s)
Alterations(s) 0
Addition ❑
Accessory Bldg. ❑
Demolition 0
Other ❑ Specify
Brief Description of Proposed Work:
Qw Si
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFIOIAI.AUSE
x .
I . Building
a
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Z) O C9 ^_
3 Plumbing
Building Permit fee (a) x (b)
�'--
4 Mechanical HVAC
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
Pr" as Owner/Authorized Agent of subject property
Hereby author e(�j�-�7✓�j to act on
My beh, all tt s r 1 n e to wor authorized by this building permit application.
Signatur of Owner Date
b-i-H4AY in OWNER/AUTHORIZED AGENT DECLARATION I
as Owner/Authorized Agent of subject
property
Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
of Owner/
Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS I ST 2 3 RD
SPAN
DIN ENSIONS OF SILLS
DIMENSIONS OF POSTS
DIWNSIONS 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
.`./11f.' t!/slll/NLO)LH.dflG6il, �•t..17LCA16�f'i3p'
BOARD OF BUILMNa-
license: CONSTRUCTION St1REMSOR
A.
Number. CS 063173
Birthdate: 0121/1968
Expires: 01212002. Tr. no: 15958
+ Restricted To: 00
FREDERICK A PAPPALARDO
71 8MHTWOOD AVE
N M[DOVER, AAA 01845
Administrator
A .l�f.' [/.'O l7t J/tltrrtf: efr�ilt pj, s�7.Z.:J/Zr/7ild6i�1
�\ Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 123349
Expiration: 02/0312003
Type: DBA
PRO.BUILDERS & DESIGN CO
FREDRICK PAPPALARDO
71 BRiGHTWOOD AVE`
N. ANDOVER, MA 01845 At!tnit:istrator
IN
mmonwealth of Massachusetts
The Co
I Department of industrial
-�cc:dents
Gtfice of Inve-s 115
Gaston, Mass. 02
� a q,�davit
Workers' Compensation insuran��
please print
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I
, crm work myse. .
am a hcmecwne• pe• inc all �, ac r/
I
am a sole proprietor and have no one Working in any Vp_
ing on this lab.
mployer providing workers' compensation for my efrtFlayees work
I am an e
oanv narne'
x.
Y
FOIiCf T nee up to 51.�CG.GG
iiion & c�minal Penalties of a ainst me.
a^ can lead to the imecscR �d a line cf (S1 co. cc) a day -9"
trance CO. or, �tGL 1 - ,r/CRK ORC� a verii:caticn.
�uirya under Sec :on 2_ STCP r ccvera9
verage '�d veil as evil penalties in tt e form C a Investigations cr ;he GIA to
ire to secure c ^ a
or one years irrorscnrrent as ' n e and c„ rre `-
of ;his stae'nent Tay to fcrNarced to the 4 1Ce Prov'
accve is .• '
:stand ,hat a C r /
penalties of penury that the irtrcrmaticn p
hereby certRy unc
the Fains and Qate
phone
-int namele:ed by ;own
do not write in this area to to ccm.c
t:c:at use only.
p,rmdiUCen-inc
;ty or TCNn
Check
required
Y immediate response is phone
::Zntac: ^erscn:
❑
Building DePt
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Licensing Board
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Se!ectman's
Health ealth Depa t T ent
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