HomeMy WebLinkAboutMiscellaneous - 766 GREAT POND ROAD 4/30/2018m
Location q 1080%LC r r po.-J o
No. QG 3 Date
NORTH
TOWN OF NORTH ANDOVER
f 9
'
Certificate Occupancy $
of
;�5'•••° • E<�
s�CMus
Building/Frame Permit Fee $Q
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 1Q,0
Check # CAS
!
15995
/
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
_c
APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Ni.
BUILDING PERMIT NUMBER: DATE ISSUED: /
'SIGNATURE: A4,—
Building Commissioner/12ECEtor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
~71og C�iPaT P0cyc� i2 ( r) (,C-
1.2 Assessors Map and Parcel Number:
6 � / °/
Map Number Parcel Number
�1 V
1.3 Zoning Information:
Zoning Dislriet Proposed Use
1.4 Property Dimensions:
Lot Areas Fronta e ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 34) 1.3. Flood Zone Information:
Public ❑ Private 0 Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name Prin Address for 94 rvice : 6 1 t
Sigh Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
�Supervisor:
Licensed Construction
M
Licensed Construction Supervisor:
�-:�'jo'n G.J /— ��°�G� S t/ V . S
Addre'
4LAof x
C L
ignature Te ephone
Not Applicable ❑
License Number
Eviration Da e
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152 § 25c(6)
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. s
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Pro oied Work cher < applicable
New Construction ❑
Existing Building
Repair(s) IDI
Alterations(s) ❑
TAddition 0
Accessory Bldg. ❑
Demolition 19`
Other ❑ Specify
Brief Description of Pro sed Work: \
oeot
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to beUFFICIALUSEkON1.Y
Completed by penrdt a licant
=_
I. Building
D
(a) Building Permit Fee
Multip,Tier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee tel X (n)
4 Mechanical 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
I, as Owner/.Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED 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
Signature of Owner/A ent Date
NO. OF STORIES w SIZE t
BASEMENT OR SLAB 1 Y
SIZE OF FLOOR TEVIBERS 1 2 ND 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DINIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
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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