HomeMy WebLinkAboutMiscellaneous - 75 JOHNSON CIRCLE 4/30/2018 (4)Location - -
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No.
Date
NORTH
TOWN OF NORTH ANDOVER
3? ' • Ot
I-
p
Certificate of Occupancy
$
Building/Frame Permit Fee
$
,SSACHUSEt
Foundation Permit Fee
$
Other Permit Fee
$
AID
fer& Fee
$
Water Connection Fee
$
:'.110TAL�'Q
$
' �o�r
Building Inspector
Div. Public Works
Location 7 5- JOi49,50W r //0( /. (_
No. f y Date
"ORTh TOWN OF NORTH ANDOVER
Ott,�ao ia1ti
Certificate of Occupancy $
* �� •,} Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ i(5 �• Sewer Connection Connection Fee_ $
�pr Connection Fee `/ $
o'oL� Is'9 T� $
Building Inspector -
Div. Public Works
)IT NO.
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /'I'4 PAGE'y
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LOT NO. f
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2 RECORD OF OWNERSHIP iDATE
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SUB DIV. LOT y40.
PAGE 1 FILL OUT SECTIONS 1 - 3 !
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EST. BLDG. COST PER SQ. FT.
LOCATION
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PURPOSE OF BUILDING
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OWNER'S NAME /�+G14VIF` .I WLHk,)1/ a,�► ��GR••��17L
NO. OF STORIES SIZE
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OWNER'S ADDRESS 7- ^ao�77�j14`6 ^ i Q-
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BASEMENT OR SLAB (,j4
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ARCHITECT'S NAME i'
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME
pfcA 0 Tz'm Y Rom IRebe�,7 �rwrl�E
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET i/!`IL1 / /P
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DISTANCE FROM LOT LINES – SIDES .t
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AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION Ll% THICKNESS Q ��
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IS BUILDING NEW IV 0
SIZE OF FOOTING goi /� y /611 X
IS BUILDING ADDITION !'. VA q'Ik C y
lilt M
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION V
IS BUILDING ON SOLID OR FILLED LAND S C2
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ���
IS BUILDING CONNECTED TO TOWN WATER Y �S
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER y a 5
- ------
f !I 5
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES
EST. BLDG. COST/�®I
PAGE 1 FILL OUT SECTIONS 1 - 3 !
i,
EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12 is
EST. BLDG. COST PER ROOM
e
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
a
4 APPROVED BY
ATTACHED G'ygAGES MUST CONFORM TO STATE REGULATIONS
AFIRE
PLANS MUST BE FILED AND tUAPPROVED BY BU�ING INSPECTOR
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BOARD OF HEALTH
8 NATUR F O �R AUTHORIZED A
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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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: A C An 7"ko `( 4 o my' Phone 6$7-02-18
LOCATION: Assessor's Map Number _37 O Parcel 32 -
Subdivision
2_Subdivision Lot(s) 4 10
Street C,l Q,LP St. Number 7,5'
************************Official Use Only************************
REC MrIENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments �dNS01c'u�ce"��r, (�rnM �i err 1, erw I' 1*5 to- 2��N
A
1
Comments
Date Approved 5
Date Rejected
Date
Approved L�
lth Agent Date Rejected
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector
Date
"`� 2 4 1992 ; ,
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