HomeMy WebLinkAboutMiscellaneous - 62 WINTERGREEN DRIVE 4/30/2018o
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TOWN OF NORTH ANDOVER
Certificate of Occupancy $
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FORM U - IAT 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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: Phone ^
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street 4L_�At; �, �-�, ,� �,� St. Number
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Conservation Administrator
Comments
Town Planner
Comments
Food Inspector -Health
Septic Inspector -Health
Comments
Public Works - sewer/water connections
- driveway permit
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Suggested Affidavit for Home Improvement Contractor Permit Application
For orrice Use only NAME OF CITY/TOWN _
Permit Na
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, inprovement removal demolition.
or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units .... or
to structures which are adjacent to such residence or building" be done by registered contractors, with certain exceptions, along with other
requirements.
Tpe of Work: �L1�1 �� 1 2L–� 1i'1 �� C ` / r {� Est. Cost -c,-2 1��Z y
Address of Workr n P v rT7
�W
Owner Name:
Date of Permit Application: c-2 / e— cl 3
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
_Job under $1,000
Building not owner -occupied
ner pulling own permit
f—Owther
(specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL
c. 142A.
Signed under penalties of perjury:
I hereby apply fqr a permit as the agent of the owner:
Q
ate Contractor Name
OR:
Registration No.
Notwithstanding the above noti e, I hereby apply for a permit as the owner of the above property:
0Owncd
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