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HomeMy WebLinkAboutMiscellaneous - 210 GRANVILLE LANE 4/30/2018 (2)N J J ^� l! Q V O O O O O 0 0 N QL O Q N � C O � � �O Rca LL � LL J N U) Q N LO 0 O L N _ N 70 2 0 O \ co VD 0 z iE E -oZ o a I.L — LL .2 o TT N a .i. A/ LL N LL > p E p LL >Z r CN D o O cU m Q O cn L N Z 0 w C > iii Q G N 0 O > 0 O F— O U .0 c � U) � Q LL N _W N ° Z O c� E CO LU o� `� 4-Z E � �� (n o Q m J c W • .. O 0- +' J J i M N �y, ? > �_ N '^ L Q04 J _ O N O �� O O Z N L L (0 (0 L U � L L � (6 J z.; Location 9 10 6o No. sJ `1 �o Date &ONTO, TOWN OF NORTH ANDOVER 1� f ;o Certificate of Occupancy $ Building/Frame Permit Fee $ 30 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 30 Check # (11 Ll q r) A4 Ak Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING TiliS fb1' OfflC a i3ae oil BUILDING PERMIT NUMBER: � / / DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION s�1.1 Property Address: vc jd 46'/41 V) L L E L A64 1.2 Assessors Map and Parcel Number: / 0 b C I/ p� Map Number Parcel Number KN6 , #A00 (�* /L M�1 o r f ¢sJ 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 on Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record S 1•fR t�� $ �i-�O (3HR %Z6�1 210 h1r�)le Lr, ^J e, �yj,,nV � f� &jl Name (P nt) n p Address for Service Si nature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor. Address Signature Telephone Not Applicable 0 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone T rn M Z O 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. affidavit Attached Yes ....... 11 No ....... ❑ -Signed SECTION 5 Description of Proposed Work check all a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �C 7 C_bd d v& ,l`S=V'Kq Act 6 u '7)('-1e 1✓-� s F�e,� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL, USE ONLY 1. Building IC ,SG O (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction o2 r^D© �— (� 3 Plumbing Building Permit fee (a) X rot 4 Mechanical HVAC 5 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 PERNHT II, �e�le as Owner/l1�nt of subject property Hereby authorize J i to act on My e alf, in all matters relltive to work authorized by this building permit application. gnatur of 04mer Date SECTION 7b 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 Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TI1vIBERS 1 ST2ND 3Ku SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHWINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION************************ APPLICANT 5 Ht4-R,+3 RA S T0I�i 1 PHONE S 1ky- 6 LOCATION: Assessor's Map Number 19 to C PARCEL__Tq SUBDIVISION LOT (S) ✓STREET 2 10 45W P 1Vl LL.,L Lni tK/ 6 T. NUMBER 2/0 ************************************OFFICIAL USE ONLY*(****************************** RECOVIMENDAT1OM Of/TOWN AGENTS: CONSERVATION TOR DATE APPROVED DATE.REJECTED COMMENTSSfial� i o1a � �rec� o bA�K — does hey ^le,,—,+ -me- fk, 05ko Q TOWN PLANNER COM FOOD INSPECTOR -HEALTH a: S DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED _ p, DATE REJECTED COMMENTSkt 2A 5 `'� � 40.1\ S S �) s PUBLIC WORKS - SEWERAVATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm hV «c., 4616ryC Town of North Andover Building Departments q.r;• 5 27 Charles Street 9SSACHUSEt( North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Z tO 161 Rt1N ►/ILLSCIL 6194f` Number Street Address Section of Town "HOMEOWNER SaL Number Home Phone Work Phone PRESENT MAILING ADDRESS 2 C�� h 1i1 I2 L SCS City Town State The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) Zip Code DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requiTrgents. , HOMEOWNER'S SIGNATURE � 4 APPROVAL OF BUILDING OFFI Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. z xC-4 o u O w N u v 0 U (� o co 70 p w L O c4 C U cz C u. o F U 9L r -i �'' ° °7 p rZ �v C w x o W � „� W G °�° p w v ch cz C w U z .G 00 O cL G " W A q. qj a M Zp V)cn v Q v o • � m c o C N _O C �1i' L o C3 m V E a ac s�oa� o `E� c- 0 4 0 0 u a CL'R m a. L N cm m al` N c v p N N O vEc�_ N m CD C: t L O CI c ;rya mom m lw O O H_ ro c a Q � ��mc co CIO L ,. 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