HomeMy WebLinkAboutMiscellaneous - 29 ALCOTT WAY 4/30/2018 (2)v
FORM U - LOT RELEASE FORM
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1 RUCTIONS: This form is -used to verify that all necessary y
I
approvals/perr
rds and Departments having jurisdiction have been obtained. This does not
e applicant and/or landowner from compliance with any applicable or requirern
I -------------- """""""APPLI CANT FILLS OUT THIS SECTION*-****,-&*******,
APPLICANT jh/4n
LOCATION: Assessoes Map Number—
SUBDIVISION
STREET
4
I.......... " ........... ""OFFICIAL USE
TOWN AGENTS:
'(PHONE—Y2,�-al,,16 7a
PARCEL
LOT (S)
ST. NUMBER
C NSERVATION ADMIN�TRATOR DATE APPROVED
DATE REJECTED- P
me -c+ �1�0
COMMEN
rOWN PLANNER
COMMENTS
FOOD INSPECTOR -HEALTH
DATEAPPROVED
DATE REJECTED
DATE.APPROVED
DATE REJECTEQ
SEPTIC INSPEGTOR-HEALTH DATE APPROVED
DATE- REJECTED
COMMEPTS
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR —DATE—
Revised 9N97 jm
SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6)
Workers Compensation Insurance amdavit must be completed and submitted with this applicauon. Vailure to provide this affidavit will result
in the denial of the issuance of the building permit.
kttached Yes ....... 0 No ....... 0
SECTION 5 r Proposed Work �ag!pphkable
-au
Alterato,*s,
��mg
New Construction D Existin]gBuilding 0 Repair(s) 0 Alterations( Addition 0
-----------
Accessory Bldg. 0 Demolition 11 Other 0 Specify
7777777—
Brief Description of Proposed W
k 04OLpe- 4&� rtpke e
-SECTION 6 - ESTIMATED CONSTRUCTION COSTi__
Item -----------
Estimated Cost (Dollar) to be
Compl -ted by permit licant
=2pph_
I - Building
YMulti lier
2 Electrical (b) Estimated Total Cost of
3 Plumbing Construction
4 Mecham a] (HVAC) Building Permit fee (b)
5 Fire Protection
() I Dtal (1+2+3+4+5)
SECTION 7a OWNER AUTHORIZATION TO BF uumpLE'TED WINN
OWNERS AGENT OR CONTRACTOR APPLIES FOR.BUILDING PERMIT
1,
as Owner/Authorized Agent of subject property
Hereby authorize
Abehalf, in all to act on
�elative to ork authorized by this building permit application
ture of �_;_ �10 5
SECTIO V
0 JA rTTJ4nv' Date
SECTION OWNER1W/AUTH0RT7V" A"'TI)ECLARATIoN
property as Owner/Authorized Agent of subject
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
_�j �ature of 014 mer/Agent
NO- OF STORIES
BASEMENT OR SLAB SIZE
S17, )F FLOOR TIMBERS ST 2 ND
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HE fT OF FOUNDATION
TMCKNESS
SIZE OF FOOTING
x
MATERIAL OF CHIMNEY
-IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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