HomeMy WebLinkAboutMiscellaneous - 280 GRANVILLE LANE 4/30/2018 (2)--' S 0 Gr4v () t /I%, -
Location 04/-
,557
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Date
Inspector
TOWN OF NORTH ANDOVER
'A
Certificate of Occupancy
$
'4CHU
Building/Frame Permit Fee
349
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$ SO
)�10 4 'S
Check # I
Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONST RUCT !!!�M
!M2VA% OR DEMOLISH A ONE OR TWO FAMILY DWELLING
see"
BUMDING PERMIT NUMBER
DATE ISSUED:
SIGNATURE:
/W/ C,�
Building CommissionCr/In3wor of Buildings Date
sEcTION I- SITE INFORMATION
1.1 Property Address:
Z) 'A
1.2 Assessm Map and Parcel Number
-� 6 /,� 0
Z &
Map Number Parcel Number'
1.3 Zoning Inlbrmation:
Zoning District Proposed Use
1.4 Property Dimensions.
Lot Am (sf) Frontage (11)
1.6 BUHDE14G SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
Required Providc
RcqWred Provided
Required Provided
1.7Wder Supply NMLGLC.40.134)
public 0 %+date 0
1.5. Hood Zone Infosunfin:
Zen Outside Flood Zow 0
1.8 Sewetage D4%d System
muoicipal 0 On Site Disposal System 0
SECTION 2 - pRopERTY OWNERSIUP/AUTHORMD AGENT
Uistrict: Yss —�,10
2.1 Owner of Record
/r)"q /",n
Name (Print)
61,?19 /V V1 Z- Z�A/
Address for Service:
7-1pature,
Telephone
,7.2 Owner of Record:
Name Print
Address for Service:
Sionature
Telephone
SECTION 3 - CONSTRUC77ON SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature
Telephone
Not Applicable P/
License Number
Expiration Date
1.2 Registered Home improvement Contractor
.4
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature
Telephone
I SECTION 4 - WORKERS COMPENSATION (KG.L C 152 9 21-Wida
Workers Compensation Insurance affidavit must be COMPhftd and submitted with this application. failum —to provide this affidavit will result
in the denial of the issuance of the building Permit.
Signed affidavit Attached Yes ....... 0 No ....... 0
SECTION 5 Description Proposed Work (cd1mwW&
nowleabb I
New Construction 0
Existing Building 0
Repair(s) 571
Alterations(s) 0
Addition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
zz&
.16y A" Y' -
'Q,
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Itern Estimated Cost (Dollar) to be
OMCUL USK ONLY
Completed by permit applicant
I . Building
(a) Building Permit Fee
0
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanic4d (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 PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize
act on
—to
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner,_/73 Date
SECTION 7b OWNER/AUTHORI2ft AGENT DECLARATION
1, 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
Print Name
I Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLA13
SIZE OF FLOOR T]MBERS 2Nu- 3KD
SPAN
D1MENSIONS OF SILLS
DJMENSIONS OF POSTS
DRvIENSIONS OF GIRDERS
MGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CH[MNEY
F17S BUILDING ON SOLID OR FILLED LAND
I IS BUELDNG CONNECTED TO NATURAL GAS LINE
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