HomeMy WebLinkAboutMiscellaneous - 71 SAUNDERS STREET 4/30/2018i
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Location
A v,�Clers S -f,
No. 53Q- Date
NORTH TOWN OF NORTH ANDOVER
3 �L
►O- 9
.: Certificate of Occupancy $
Building/Frame Permit Fee $
s►cMus
Foundation Permit Fee $ _
Other Permit Fee $ C
TOTAL $
Check #
14 712
/ Building Inspector
TOWN OF NORTH ANDOVER
BIUILDMG DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
t P. ��.z AMR
�;«r M
BUILDING PERMIT NUMBER: DATE ISSUED: /
l� 7
SIGNATURE
Of
SECTION 1- SITE INFORMATION
C
Date
1.1 Property Address:
1.2 Assessors Map and Parcel
Map Number
Number:
U
Parcel Number
1.3 Zoning information:
toning District Proposed Use
1.4 Property Dimensions:
I Lot Area
Frontage ft
..6 WELDING SETBACKS 00
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Required
Provided
.7 Water Supply M.G.L.C.40. 54)
ublic 0 private 0 Zone
13. Flood Zone Information:
Outside Flood Zone 0
1.8
Municipal
Sewerage Disposal System:
0 On Site Disposal System 0
'ECTION 2 - PROPERTY OWNERSIiIP/AUTHORIZED AGENT
A Owner of Record
ame (Print)
�gnature Telephone
2 Owner of Record:
Name Print
:CTION 3 - CONSI UCTION SERVICES
I
Address for Service :
Address for Service:
L' ed truction Supervisor:
sensed Construction Supervisor:
�-7 c (4 ✓� L, s >
dress
yV'�r/, nuc ►�L� �j 78- 8 S1- `1 yY-6
nature Telephone
Registered Home Improvement Contractor
npany Name
Iress
.ature
Telephone
Not Applicable ❑
License Number
Expiration Date
Not Applicable 0
Registration Number
Expiration Date
SECTION 4 - WOREERS COMPENSATION (NLG.L C 1.52 S 21;rM
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 .......❑ No ....... ❑
SECTION 5 Descri tion of Pro osed Work check ail applicable)
New Construction ❑
Existing Building ❑
Repair(s)
❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other
❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
1. Building
Estimated Cost ( Dollar ) to be
Cont letedb ermitapplicant
CXj G •'
»�:
(a) Building Permit Fee
Multi lier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS NT OR CON CTOR APPLIES FOR BUILDING PERMIT
n �
as Owner/ uthorized Agen of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building pernut application.
of Owner
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
/`Zi -o/
Date
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
r
ri uu iName
of Owner/
NO. OF STORIES
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS
SPAN
DM ENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
SIZE OF FOOTING
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDINGCONNECTED TO NATURAL GAS LINE
Date
SIZE
THICKNESS
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