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HomeMy WebLinkAboutBuilding Permit #13-12 - 113 CHESTNUT STREET 7/7/2011 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Received 1 Date Issued: IMPORTANT:Applicant must complete all items on this page i LOCATION Print PROPERTY OWNER \� WAdUnit# Print MAP NO:60 6 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFO ED: (Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: j CONTRACTOR Name: ` _,\���� Phone: -�� '� —V3 )3 Address: \ 01 A LA Supervisor's Construction License: Q ljc� LCQ_!S; Exp. Date: Home Improvement License: To Exp. Date: 1 aV L ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASE ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: / D'J—d Receipt No.: C3- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty and 9- --- - 9- ignature of Agent/Own Signature of contract_ _ r' 11 Location No. / Date —w �oRTM TOWN OF NORTH ANDOVER F?O•`•,•o .•,MOOR + Certificate of Occupancy $ s i � �sskN�SE<�. Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # .2461; 7 Building Inspector ' f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on-Site ❑ 0 1 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature i COMMENTS f HEAL,-'§ H Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signatbre: - Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS _7 i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine I NOTES and DATA— For department use i i ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. �I Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi NORTH Tovvn of _ or,� dover, Mass., •7r LAKE COCHICHEwICK %ds RAT E D � �C 7 U BOARD OF HEALTH PER Food/Kitchen ' T D Septic System �� v BUILDING INSPECTOR THIS CERTIFIES THAT.w0..!Y4A^J.......... ............... .......................... .... Foundation has permission to erect... ........................... ..... 4bi.1 Ings on ............ . . ........ .................� t.... ... Rough to be occupied as..... Chimney provided that the person Le ng this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC O TS Rough .................... ................................. ........ .. ...... .. Service . ... ............ . ..... ... ...... BUILDING INSPEC R Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE_DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of IndustrialAccidems Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual):` ,- -",,— Address: ,Cpl (Qs `4J City/State/Zip: YV1 - Phone#: Are you an employer?Check the appropriate box: _ 1.❑ I am mployer with 4. ❑ I am a general contractor and I rE f project(required): e New c o ees construction y full and/or art-time have on ( part-time).* hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet. t Remodeling shipand have ave no employees These sub-contractors have 8. El Demolition working for me in any capacity. workers'comp.insurance. [No workers' comp.insurance 5. 9• ❑Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp,insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office ffice of Investigations s of the DIA for insurance coverage verification. I do hereby cer nd th ains and pen ti ofperjury that the information provided above is true and correct. .Signature: -� Date: 4, 1 Phone#: EOther only. Do not write in this area,to be completed by city or town official. n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers',compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of - insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy;please call the Department at the number listed below. Self-insured companies should enter their ,self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CORI►` o wealth of Massachusetts Department of.Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 w.mass.gov/dia w '�'�aSS;lCfi gra, u�ctr.p, It'V Of �P:l1'Qi�.. Const ct�inS Rc.ul.lrint of Public'Saf License. on SuAerviso;ri.� .lnc/Stand.c tr CS 68105 r Licens !!'dv e CHRIS7-OpHE - 179A LAKESHpJ MELILLO BOXPORD, MA pR ZRD --� ' . Si EXpirdtion. 5/19/2012 Tr#: 2965 fie 'C�an��zoozu� ���ac��ucaelZa Office of Consumer Affairs& usiness Regulation HOME-IMPROVEMENT CONTRACTOR Reg istratio n ,,'t124536 Expiration:_ 7/1.5/2011 Tr# 287041 Typo:.~ �Individual., Christopher J. Melillo:;'- Christopher Melillo;- 179A Lakeshore Rd.` Boxford,MA 01931° Undersecretary j _ CHRISTOPHER J 179A LAMSHORE ROAD B03CFORD MA 01921 6aoeta`�cstst�aof pasto�i¢Bnc rs» oa�1�e :Tarraaa sm Tpcaae Uouuttudanradd�sc) t > rb� »Phase easrraWa r s sme zipcu&- • nt�.ua���es®�ei >3�l'boae TIDorSS 1 �mtbaaltbewadcmao��. ��,baad.magadear stobeme�seezd�e5aud'n�v"1 g T 'yCaL Qw.es R PMs-IbeTo�ccioRbmidmgpetamrsatesegaars p:ap—astaataadC S: -lbef is s ewtlf amiw�bese�medbgime Elbe moot beadht¢dtomleac-&=m9M=b*mndit GMWWane (Olsslst8,�sstsaae�ertlsvaaHl� �� ftnmtlaeGa>x>�ipiTi�psspisiea�el / ru�ncacs,�be�m .�wt Total Canua�Piiocandb*aym�st� -(� lt3C�.� TheCaatr�oregmstopafo®drewod, �cm�oFat�l�ba'�"Tadaboeefar$xmld�of •� . (� Payime,�/s�w/dlhewadeawm+�g�odiead�c a 2> l"7tvV uponskPinBamnae[(notMowafamcmd pdoC Sttleopataf mdi[io�s a evCji�s�e��v) rl 71 wf lh�J1C C�«� s3i4`S:°USy✓d P3iarapmtwavof 'ice -a� i;`S3c� '�— cl - g ���ugwnoomp5�anofdteaoma>a.clad. d��H�m9l000tmct��eaM6od<Qen�se ) The6dlm�g kgm�rao�bespe®I S mbepodfor addedl fl 000 wdkbegaasinadr oo®adt4eoomple= rl Y mbepoidfor ITfWMt9ft*zdiusafidmWML— m7de@�ard rego�dbgffieaom br�envdcDq®nsma� mt®setda�raf(a)aaa3tl3tdaFmemml r�ttu�aeaNTmeoaa�watofaafslco+tsgmpmm[vacoommedemu�l Vd",anbespedetmv Hnadmme��eomptr�no .a.rm+oels�te..;dea lwmee�aa,.�_fl ttn�yesrana�ws.rmr.�sml.�v9r _�enrccaohndi - a-'lUaao�a��ubcsudd9fa<aa�a��acda�ad s of�e ai+maafmy�aa >mTmedbgtbaa fe el tobcsolayaapoillesnrsepapawnmaBs awaesf r I�tsa��oo�Erm-Upma�y�isdoeaagatbaer�samsaawdWlaw_ me t��>�uap>yema�timmoders�tY�lsas7empl�edan>ba�ideeas.Reaiow�do@awis���d� =few, rta iz ad staaaari o Dadtbapn�madmmsppstgR+cads�actTa>aef�emaeadmIISetlysmdamtaod A* ffa� Iu�eamatl�mmaQrtcbospva5dplamei '[belaan�Oeesmmtb�impo��awmedmsaad �bowsaobangi 'Resisbaffm Yaame98sboatm * oo oabywditw Dhl jajopmkpl w,RwmSMBawn.i ►a¢llsa<byaa>�sn s�aras�ta��rn Does�ecaa>cauotffire ?Rsk�Caabenurforlesn�ao�myso/batlAac�ao�Saov�a6Garmkm soeaaopytrFa"pcoaftdsnsa�rs K�w7 � -gmdgta�posttalbafosma4onan�esedemasdeofdataffisodg�neapyoflbeCata�a Ooideiatbeb�Lm�avesamtCol�rL� Yw�rsae!$salpe�tifrt§a4bem ffiapkAaolhera t-ao sa—ipb wafboabtcmpasrmlod9W=T9d em inwditsdb%wmamt-ffi 4 bom2cbm�mbpaiffis-9atmRp-w4bjorSo SE M40rbyatidrj'=3thM d==i&mFftGffiW ffisdbas� �eeS�mgtff�a�t Sdd�emra�md�ol'tm�Lamtarao afd,isrigAt DO NOT SIGN THIS CONTRACT IF TII MAM ANY BLATI K SP CXSm— ltmidnmda'�dY��aaaslS���o�aags�onrymaemmea�msabs��taasep.eiae�ae: s Cancm®m's _-� S aJ 2DJf S13 1C)i - i i N° 1 3- 57 Date..-/.�.. !�.. • NORTI� ;•_'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING •o•�TOO•��� �,SSACNUS� This certifies that ``'.................................. ............... ........................................ has permission to perform Ate' � ~� `z ...................U.....................................�............ r wiring in the building of ..... ...................................................... at.� ......:�...f�a ....... ...�.................... .North Andover,Mass. i Fee 4.6....`......... Lic.NOFO`T f�. .......< ^-!-'�.�E'-.��"Pc—'........ ELECTRICAL INSPECTOR 03/22/9916:05 60.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer TIHG0MW0AffF'`ILTHOF1rItiu.3tiCHV5= Office Use only DEPART1iF1VT0FPUBLICS9FETY Permit No. BOARD 0FF7REPRE ENTONREG)L4TI0ASR7CYR 12.00 'F4 Occupancy&Fees CheckedPPLICATION FOR PEI Aff TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CAR 12:00 /J (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat y Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to performthee cal work described below. �A/ Location(Street 8c Number) �j � � i Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No r7 (Check Appropriate Box) Purpose of Building />//�0=a- y= , Utility Authorization No. Existing Service Amps / Volts Overhead Q Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.ofLightung Outlets J/J , No.of Hot Tubs / No.ofTransfotmers Total r _ I KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA _ ground Eound Jo.of Receptacle Outlets l•/ No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets �` No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Cottnections F7 No.1of Water Heaters KW No.of No.of Sins Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER IrstrarreCaerage Ptaarar't�thet�ar��cfivlGenaalLaws Iha,�eaamaiL bLyhmrarxPobcvmdu6ngatiot>sC veraEperits sibirid a4tival7t YES NO Ihaw s Ndidptooffsarnelothe Offm ESNO F-1 If}cuhmect>6cedYES,ple�nhoAetheNmcfwmz2pbYdakzngthe wsUR CE BOND � OU>fR F-1 (P�e sp�fy) /Q/Jm Eqraocn Dam Estim> d Vahte dElectrical Wodc S Wads iDStart dim DEk Rewested Ragh Final Sigted underlie Pa>aities cfpet jtay. FIRM NAME LioseNa Lirxttsee �l� ��r� l� 6� Btsiric�sTeLNa �Q,,�''S�.3v� D SIC�)-- Adrist�c ��C,r� • Q X c S. L" R> I`2 �4 (4— 0 0 ,3 4�' � Ah.Tei Na OWNER'S INSURANCE WANFR;I am awarethattheLetices not Mve the itmraa its s�zsaraaaf e�ma3atas ta�taitadbyNts Cerrral Laws and thatmy secn this pearitappfiaidw wanes this tmpizmlat a (Please check one) Owner r7 Agent Telephone No. PERMIT FEE� Location ' 13 0 "o-'j�� S No. ` Datt NORTH TOWN OF NORTH ANDOVER p Certificate of Occupancy $ l Building/Frame Permit Fee $ . . • . �NusEt� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTALf 3 $ A —ILL4, Z �� Building Inspector lc':54 L�211D. PAID Div. Public Works ��+cn�t rtv. /►1 1 L,1L71 t ttl1� 1 l/ll 1 lLl\IY11 1 1 \) 111111.1/ "I'it IPL I II A1`I1)IL)Y1-1t1 MA .: :. i;==• -:r.;7� .ii_': trm l u ND. 0(o o c- HI l'11HU III IIa'N111S1111' ImTF. HOOK PACE 1` +It.l SITU 111,•. 1(1I NO. • ��c"fi y V yo y y o . 3 4 Ilii;IIIIN ST 11111,11%till VIII III IIINIi Sc.2.4 c.J 1 �DO� t J�fGrC IWNIc R's NALlliJ txl. OfSIIIHIIS ?.E SO ScZ _ Qc�r3t2i D'�8oy� -� o,.�A rfSI c,� o Iwr+LR's Alaau:ss !� 124-11-ST-1-J01- S 1i uAsEMrN1(*4t sl An oL 2 + fQ- -� from ��C dt1III 1E('1'SNAn1E � SI IL-'('*lllxt(t Ililt 11kHS It III D1:R'S N V.IE ./) /J-17- C,o,.J oq SPAN � ♦ S � [/ ASIANt'F.IONEARESTBtI1lDING (NnIf.NSUINSIIt SUIS v -1 1 J S 3 t r-d )IS l'A11t'E I HOI-1 STREET 60 0 / C 3 O („MGNsl(INS I If Ir C l s HSIAWE FROM IOfLINES-SII)ES REAR � ?a DIMENSIONS OfIiIR1tR5 LL S ,Itf:A(1TIOf Z�206 Sr- FRO"IAGE7 2 3 Iu:IfdrrlltflxlNl)wruw THICKNESS Y UIIll-Di"i NEW ' c.aJ SIZE Of I(x)IItJ(i S IIIHLDINGA")ITION MArERIAr.Of CIIIMNEY n /a•e ASci Aq Il� 'S BI)it.DIN(;ALTERATION �` IS BUII OIN(i ON SOI 111014.fit LCC LAND „11 I.BUII DING CONFORM TOREQ111REMENI'S OF.WOE IS BIIII DING CONNLCI ED lO TOWN WATER YtGs III titt)OF APKAIS ACTION.If ANY ..) " Is BUII 004 CONNECT L'D IO 10WN SIiWL'R IS BUII f)ING C'ONNEI_"I L:D TO NA*IllRAI.GAS LINE >eL S INS I11("1toms 3. PROPERTY INF01161AI-ION LAND COST 2c@C ��C?oti� ks1.ullxi. l(nf ' dou - / 7 o o v Pkr.E I Fit I.0111 SECTIONS 1-) 1 EST.01 IX;.COS(PLR SQ.FT. $� 5—' ra r ES(. W Ixi.C'116I IL'HHlx74 L:1 L:C`MIC METERS MUST BE ONOtITSIDE OF BIM DING ` I SEPI IC PEN1 11 f W. ` An ACI IFI)GAR AGES MUST CONFORil'ft)SfATEFIRrREMILATIONS 4. •\1.1.11OVEDB\•: PIANSMUSTBEFIIEDANDAPPROVEDDY81111DINtiINSPECT(IIt 01111.111 GINS11CUrOH DAItTHI:I) 23'� / ()WNERslrla -7-7 rP, ii CON`IR.tta b SII:Na IURI:(Y OWI II:R t V1 AU/11r11Yu71iD AGlih(T CYk�l1 R. I(-# 1 ` lit j / �..! 111 r.q ^ �It:11 V'L.• F't_C Y-6�.t1'V i,-I16 1'1 Nntll li1tAN1[D I') e 1 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. FILLS OUT THIS SECTION APPLICANT /`� ��I -�- �J -J PHONE CS 3- 3 77-? LOCATION: Assessors Map Number © � PARCEL �- SUBDIVISION LOT (S) STREET / /;3 C-k/ST/'J11J'TS ! J ST. NUMBER USE ONLY"* 777 TIONS OF TOWN AGENTS:- J _ CONSE A ION ADMI S,TRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED j� DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE - - >;-: �.�':... _ ■out� s�' • ow � t�i�0 rwrp�a�tpo�t��+RAt+�P�l { �1 w1 WdA OMOA W R Yor�ay ��Oys M Y INOMOV�...I..�'.Iy1 4Mp � AMM q.,•yy,�jiy;;•y',.v:�:q;..,.yylyjq.t.�.y7J�iMif11''G'+r " f _ .Y.- w•+.�..r. •��-i�.��.�•�.a.�...-w."�' �". ..,mss ���}�" ' �.. -' ..�,.. ... ., w.+/•'sSCt- .. tee' s. • ;` �,Il•`C';„� - -:.$•T.h.t'i � s, i'S 4 .- .l fy�ra;;i,•r� ` •'t H �3�71Vy. - • aoewr � 133 UVI �A ,o N ILL 07 'z s,rz • . oma ,o£ _ . /V007V.Dw -/a r-7ood ' vr.,rov Nvid 10191- 3OVDINOW - �r�':._ .'.`4ia�'•L w': ...- r � ... � ...:f...�^�.'-~`��.Iunsy.��.. -_ .GG.� �...+.. - ....tea I I � i •I � I � ' rl �•: ' ' I , Be4p i i j j i I i I i i I j i I j i ; •�1.! � .. P,T 10, I i I I � I i i i � I ! i j i � ! � �• em M I I j Q O I i - � I j t I ! on ,boa /�'� - --/,� ;����•��� � _.._ :_ .. , _ - /� Q , I I : 43��Orn sri<"OvI S I s�2r� w�-%l ori I � i � ! I I I I ! I � � � � ► l ( � I _ � _ - -, eq ' • t y.1, I I j ; I I I I ,5�e •fes - :. -1114 047 i ! I � I ' � i I ( ( �' _ 11 __ _.x_. ► .F����.� I � r ........ moi• I t�, 34 1 �� t cedfrt 6e pyL �yC�olce dale ' � a I eAd I � r i � � I i ' I•. 71 r .. I TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, 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 exception, along with other requirements. Type of Work: 200 Est. Cost � 2, Address of Work i iii. S Owner Name: �' Z. r o� '�"J Date of Permit Application: 3 I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner-occupied ,_Owner pulling own permit Other (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 FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: q Date wner Name ItA R T H - D Town of dover No. 7�! dower, Mass., ADRA TE D P, C), S 5` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System j� BUILDING INSPECTOR THIS CERTIFIES a THAT.. C.0 I�.O.......�. ... �iri ........ ..Up AV Foundation has permission to erect...t.Q...RN ......._. buildings on ......03......C...1�.±�. �� .....5 _ Rough to be occupied as. ....... 1 Y l... rN o �� p .�... ...........P�o.�.... ..�..�. .l.L Sc r�eN...........rc�........."�.� Chimney ......BECK provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough ;I 4p C i6 PERMIT EXPIRES IN 6 MONTHS Final 3 o a UNLESS CONSTRUCTO �T TS ELECTRICAL INSPECTOR Rough . ....................................... Service M­* *'***"*** BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Dec.