HomeMy WebLinkAboutMiscellaneous - 891 GREAT POND ROAD 4/30/2018 (2)i,
Location1�-_
No. ^3 Date a {
�aRTM
TOWN OF NORTH ANDOVER
0
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Certificate
• ; ,
of Occupancy
$
J�CN�s <�
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$/lo
Check # 40�10 7 P�,
17232 7�--
=-8eilding Inspecto�/
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
n*^ €r,ri;. 4e.Y"Y ... P"• z•. fir= s..iR. �Y ,....-: ¢ C• =•- $.'. •a ...:� .�' �€ ``?,,# k. i^ }tiT' t �a z a' �,..s.rnaa.€s
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE: �l
Building Commissioner for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
C31 � � ►� D� .p
l`
Map Number ParcA Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
r.°� 1.5. Flood Zone Information:
1.7 Water SuppIyM.G.L.C.40. 54)
1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zoue Outside Flood Zone ❑
Municipal ❑ On Site Disposal System ❑
tSECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
niStonc Istrict: YES No
2.1 Owner of Record
Name (Print) Address for Service
Signature 717el'eMone
2.2 Owner of Record:
Name Print Address for ervice:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
MAi�4 S 41t^�6`�J�
Licensed Construction Su rvisor:
CAP� OSS(
License Number
�yjt� ?
Address
('goo)&S� - QlCt�
Expirah Date
Signature 3'elephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
t
S�ti
Company 14ame
�� Cl •l c e I f
--Registration Number
r s
Expiration Date
nature '-TeG6ne
SECTION 4 - WORKERS COMPENSATION (M.G.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.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check all
applicable)
New Construction ❑
Existing Building ❑
Repair(s) 9
Alterations(s), L
FAddition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify ..
Brief Description of Proposed Work:
LAD
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFF'ICIAI.USE ONZC:Ys�
1. Building,
/eaf3
1 �o
'(a) Building Permit Fee
Multi Tier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee tel 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
O RS AGENT W COPKRACTOR APPLIES FOR BUILDING PERMIT
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
I, 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/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TBABERS 1 2 3
SPAN
DIlvIENSIONS OF SILLS
DIlvIENSIONS OF POSTS
DIlvIENSIONS 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
"Certified Contractors Network (CCN)"
"Greater Haverhill Chamber of Commerce"
"Greater Salem Chamber of Commerce"
"New Hampshire Better Business Bureau (BBB)"
"Energy Star Retail Partner"
*CertainTeed Vinyl Carpentry
Siding Specialist
*Advanced Alside Siding Product
and Installation Specialist
*Alside Window Design Specialist
*Authorized Sunlight Series Dealer
*Authorized Elite Sunroom Dealer
INVESTMENT TOTAL FOR SPECIFIED PROJECT
We hereby propose to furnish all labor and materials in accordance with the above
specifications for the sum of: /
/ -;' L06- Deposit at acceptance of proposal.
— A/(o43.-' Due at remeasure.
-,579S- Due upon completion.
All work to be completed in a workmanlike manner according to standard practices. Any changes from above specifications
involving additional costs will be made only by request in writing, and will be an additional charge over the original proposal.
All agreements contingent upon strikes, accidents, or acts of god. Owner to cant' fire, hazard and liability insurance. The
above prices, specifications, and conditions are satisfactory and are hereby accepted. You are Hereby authorized to do the
work as specified. Payments will be made as outlined above. In the event Sylvain Contracting, LLC finds it necessary to seek
legal action in order to collect any payments that is overdue, or in order to perfect its mechanics lien, I agree to pay interest
on any overdue accounts at the rate of 18% per annum (1 '/Z% per month)
Signature of Sylvain Contracting Representative:
This proposal may be withdrawn or subject to change if not accepted within 10 days.
'Y--,Authodzed Signature Date
"/--Authorized Signature rt Date
Sylvain Contracting, LLC
9 Plaistow Rd. Plaistow, NH 03865
Tel. (800) 281-4995 Fax (603) 382-5263
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Board of Building�Regulations-and Standards
HOME IMPROVEMENT CONTRACTOR
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Registration' 1,0$9$5 '
Ezpiratlon 004,
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SYLYk11N CONTRq`CTING ; tl
Marc Sylvain t
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9 PLAISTOTN RI# d
PLAISTOW; NH 0 65"`''
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