Loading...
HomeMy WebLinkAboutBuilding Permit #765 - 15 COPLEY CIRCLE 6/7/2006 W AL TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,ISAC14 Permit NO: �M61, YED Date Received: Date Issued:-0 IMPORTANT: Applicant must complete all items on this page LOCATION V yq� 4 Jo I/zV '(�l Pnnt PROPERTY OWNER Print %.I,Xp NO.: PARCEL: I ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition = Two or more family = Industrial Alteration No. of units: Repair, replacement Assessory Bldg _ Commercial Demolition = Moving relocation = Other Others: - Foundation only DESC PTION OF WORK TO BE PREFORMED [dentification Please Type r Print Clearly) OWNER: Name: �r aPhon -- 4ALI Address: 's. CONTRACTOR Mame: Phone: ,address: SuperN icor"s Construction Licenser Exp. Date: Home ImproN ement License: Exp. Date: ARCHITECT. E;tiCftiEER \ imc: Phcne:. Address: Reg. No, FEE SCHEDC LE: BC Lt7l,'�G PES":51 U.iU FER.ij goo.ao OF TfIE TOT I L ESTIJI-I TED COST 1-11 U '5.,jo PER Total ProjectCbeck No.: rIU.OU FEESI Receipt No.: 113 lla�wh a Location No. s Date �� 0 NORTH TOWN OF NORTH ANDOVER + Certificate of Occupancy $ Its ACHUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 67' Check # � " Building Inspector TYPE OF SENVARGE DISPOSA _ Tanning'Massage Body Art S�imming Pools _ Public Semer Tobacco Sales Food Packaging Sales Aell — ` Permanent Dempster on Site Private(septic tank,etc. _ Electric deter location to project tiOTE: Persons cnntrtr ' g wrt a egklered contractors do not have access to the guarunty fund Signature of.gent,Oar Signature of Contractor Plans Submitted �' ans Wai Certified Plot Plan _ Stamped Plans _ THE FOLLbkING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑Water Shed Special Permit E-1 Site Plan Special Permit J Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION !71 COMMENTS DATE REJECTED DATE APPROVED r. r HEALTH L CO1t'v1ENTS Luning Board of Appeals: ariance. Petition No: 7kmin`, Decision rcc6pt mrbmittcd ,cs _ "anninr, B-)ard C')ecision: �mmcnr.; :•.;r,cn iU�n Dcci� i�n: C•.�mments u- ._:rnv:tion ;1atr.rL !ate .,.;np Dempster cn _itc ;.e..— w =ire Dgartmrnt J n arur: .iate Building OLrmit Appro%cd and Issued by: Building Setback (ft.) Front Yard Side Yard Rear Ward Re aired ProN ided Required Provides Required Provided DIMENSION Number of Stories: __—Total square feet of floor area, based on Exterior dimensions.__ Total land area, sq. ft.: NOTES and DAT 1-(For department use) �f I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application j NVorkers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Addition Or Decks Building Permit Application 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 Pian And Hydrauli Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) 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) o Copy of Contract a Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of 1ppeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One cop) and proof of recording must be submitted with the building application SER\1( ES OFT`R1IIP,':314"OR"Q5 I'.r e 4 4 1 I 14ORTH TOWN OF NORTH ANDOVER OFFICE OF o p BUILDING DEPARTMENT -4 * 400 Osgood Street •'q�'�1To TpT``.cy North Andover, Massachusetts 01845 �SShCHUSE� Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: .) K,, 7—D 6Z JOB LOCATION: r 49 19,4 Number Ajeet 4ddress Map/Lot HOMEOWNER �Wjy) 53 6 Na a tiome hone WcTk Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies- that bg she understands the Town of North Andover Building Department minimum inspection proce and req .rements nd tomply with said procedures and requirements. IIOMEOWNERIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homwwners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688- 9535 F NORTH own of : Andover No. 0 L- dover, Mass.,-154 T O � 1• COC MICC KE WICK � RATED vv 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT..... ... .. ............. ............. .. .. ...... ... ....... ............................... ............... ................. Foundation has permission to erect........................................ buildings on -IT..... ... ..�. �. .. Rough �• to be occupied as........ ' �► .. .... .' Chimney 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUW S TS Rough / Service S ...... ............I .................................................................. BUILDING INSPECTOR 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. ^ I. I I it � I J'x/a",�c i�,�I i I I hirAiii✓� yrs �� II I II II � I � I II i .-o II II � I I Ii II lo ,F,CECT,c/cAL I II � f I � s/l1 IAIO<A,eK sysi� �TIOieA�G-C � P I /oy III /vFiav �i�,CaO�✓I I G3 3E /5r/i!. �O/,c7�N.S/ON3 Age ""AfAX �tlo7E; --his is ✓' .9 /�,�.c/M�.�oA�� /!lo�Ti� 14,4. SEM /j ooe�O V471- ON zw Y 18 COPLEY CIRCLE 210/059.0-0086-0000.0 PO Sox 55098 Boston,MA 02205-5098 617-95f Oi3u� Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: FREDERICK SCHEER and OLYA SCHEER Property Address: 18 COPLEY CIRCLE,NORTH ANDOVER, MA Policy Number: HMA 0383577 Claim Number: BOS00048967 Date of Loss: 2/13/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Blake Wilder Claim Examiner 2/18/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 5317 Fax: (617) 531-6653 Email: BlakeWilder@Safetylnsurance.com Late . ... . . . . . . • 4Y,'tYT.Y{(A"',lam•' . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that G . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . in the buildings of. . . . . . . . . . . . . . . . . North Andover Mass. Fee .- Lic. No ./3.-� .r� GASINSPECTOR Check# S -; 7 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 CITY 1. �r- _ _ _ _ MA DATE "S PERMIT# JOBSITE ADDRESS I —I{OWNER'S NAME „ GOWNER ADDRESS c TE ��'�'?©�' i' — �FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL _[ EDUCATIONAL RESIDENTIAL CLEARLY NEW:[D RENOVATI0n-B REPLACEMENT: P-/O! PLANS SUBMITTED: YESE-1 NO U-/11 APPLIANCES Z FLOORS- BSM 1 2 3 1 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER — DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR - TI .. [ , - .[ �. --1 - J J .- -[ -- A__ J GRILLE - ._�.�! INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT _ _ [ TEST UNIT HEATER UNVENTED ROOM HEATER (_ _ . [. _ I, _ I WATER HEATER OTHER INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES _ NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Ej BOND -J OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertine t rovis' n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAMECite_ _�. /I�ICIc LICENSE#/3 �- SIGNATURE ._ _ � - MP 0 MGF F-� JP [[] JGF LPGI CORPORATION PARTNERSHIP # .._... ... _.11 LLC[� # COMPANY NAME: ADDRESS � CITY _ .. �'` - --� STATE /bad} ZIP D�y�ITEL ? -X36-_�/ FAX CELL_�36-Z 13 _EMAIL _ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ 42m� FEE: $ PERMIT# PLAN REVIEW NOTES . 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name(Business/Organization/Individual):� t F<< /� Address: City/State/Zip f Phone#: M Are you an employer?Check the appropriate box: Type of project(required): 1.®•Tam a employer with 3 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7 emodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ 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. t Homeowners who submit this affidavit indicating they aie 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:. Gr� Policy#or Self-ins.Lic. Expiration Date: 2Y / Job Site Address: (� /e' C��Gc City/State/Zip: Attach a copy of the workers'comp ation 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 of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided'above is true and correct - Signature: L,// Date: -3 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: i 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 employeiis 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 Commonwealth,of Massachusetts Department of lndustrial Accidents Office of Investigations 600 Washington Street Boston,M.A.02111 Tel,#617-727-4900 oxt 406 or 1-877rMASSAFB Revised 5-26-05 Fax#61.7-727.7749 wwW.nnass,govfdza Location Al 61, �-a%�Y-/ No. �� Date �oRTM TOWN OF NORTH ANDOVER ° Certificate of Occupancy $ sNus9 Buildin /Frame Permit Fee $ ,+ca Foundation Permit Fee $ Other Permit Fee $ TOTAL $ X15 L Check # U Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT ULA_%RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING %r BUILDING PERMIT NUMBER: l DATE ISSUED: / I SIGNATURE: Building Commissioh&/12Vector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel dumber: �8 CLP LCY G ACL-C -00/ - - R \ + ^ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regiured Provided Rapired. Provided I.S. Flood Zone Information: ystem: 1.7 VYater Supply M.G.L.C.40. 34) 1.8 Sewerage Disposal S Public ❑ Private ❑ zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSEIIP/AUTHORIZED AGENT L 7 2.1 Owner of Record N (Print) Address for Service oto �J . S' a Telephone 2.2 Owner of Record: Name Print Address for Service: C 2 Signature Telephone R SECTION 3-CONSTRUCTION SERVICES 9 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: C License Number Address Signature Telephone Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Q Company Name Registration Number M 'Address r- MEMO --T— Expiratwn Date Z Signature Telephone 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 it. Signed affidavit Attached Yes.......0 No.......C SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: -- D C? X IAN SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 3�/ --- 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUANORIZATION TO BE COMPLETED WHEN OWMS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 as Owner/Authorized Agent of subject property Her • uthorize to act on My behalf,in all matters relati%c 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 Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TBABERS 1ST 2 ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 -LA ��. 9� o , i Z Aaa I4 ,8z6 s F. � a 1 Z STY (wb) N k • �DGj.Oc �of2jNOTEi ALL TIES SUBJECT TO WHAT AN ACCURATE INSTRUMENT SURVEY VOULD REVEAL, THIS PLOT PLAN IS NOT TO BE PLOT PLAN OF LAND USED FOR PROPERTY LINE DETERMINATION THE LOCATION OF FENCES OR THE LOCATION OF ANY OTHER STRUCTURES, �N THISISILRTIFICATION IS MADE TDA M�KcIzD SdVi NG•5 FUTURE CONVEYANCE, AND BECOMES NULL AND VOID UPON ���ffTj� MASS, I HEREBY CERTIFY THAT I HAVE EXAMINED THE PREMISES AND ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE PREPARED BY: LOCATED ON THE GROUND AS SHOWN. I FURTHER CERTIFY • ""'`�"�, THAT THE PRINCIPAL BUILDING DID 1ilF CONFORM TO 1�1EDFORO ENGINEERING ec SURVEY DIMENSIONAL ZONING LAWS OFi 15 HALL ST. MEOFORO A4l, 02155 CONSTRUCTED, I HEREBY CERTIFY THAT DTHPROPERTY E / ��{ �`~ � 'S ANGELO B. VENUMJO-P.E.&P.L.S. ANOfIo ¢ (617)396-4466 F,1XJ; 396-8052 IS NOT LOCATED IN AN ESTABLISHED FLOOD HAZARD AREA. I ,r; y. �, COMMUNITY NUHBERi Zr�G,� �I voa a ; vENrZ11N0 4` REVISION DATE, _Susi i= 2. 1�7P� No 24342 SCALES 1 LANGELD kip ED REF.,, � g 0, IZ33O ,/� / SU DATESI� i l B, ENEZIANO - P.E. .LS, DA E• FILE No,, 1&- I o r-j6--d)3 NORTH ToVM 0 over o ; - No. _.,...a. LAKover, Mass.,- / T O E COC MICMEwICK V ADRATE D p` -`C7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System wwm� THIS CERTIFIES THAT......�,/..1„�!rr„r S �, r /, BUILDING INSPECTOR .. .... ................... .............................................. . ................ Foundation has permission to erect....ry y .... buildings on .. ... ��l0�'�.�„ �• Rough ......... r ... ..... ...... . to be occupied as..... .. /1 ....,v �� O N + r” O wV l�.L� Chimney provided that the person accepting this permit shall in everyrespect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws lat' g the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR t� VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU NJSARS Rough ...... .... ........... . ...................... Service .. . . . . ........ ...... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove R Rounal No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner aStreet No. SEE REVERSE- SIDE Smoke Det. r ?X/y .)t-cK Edi, • FORM U - LOT RELEASE FORM a 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. *****************************APPLICANT FILq OUT THIS SECTION*********************** APPLICANT �OPHONE17t -647-7769 LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) TREET LS (4nCv ST. NUMBER,J� ********OFFICIAL USE ONLY********'k**�`*******,kk****�k******** REC MMENDATIONS OF TOW GENTS: CO SERVATION ADMINIST TOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED 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 Revised 9197 jm i r c�"I North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: i�J HA90e- C DiOM PS EQe CO, )JAWLe (Location'of Facility) W . Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector �berir Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 s4c►+•+s�`�y D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION ct Number Str t Address Map/lot "HOMEOWNER G'-�S Name Home Phone Work Phone PRESENT MAILING ADDRESS SVA/k City Town State Zip Code The current exemption for"home6wners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner'assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner'certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and ruirements and that he/she will comply with said procedures and r rements. + HOMEOWNER'S SIGNATURE �' V. APPROVAL OF BUILDING OFFICIAL a 3 The Commonwealth of Massachusetts M , d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone# Insurance Co. Policy# Company name: Address City: Phone#: Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment.as.weH.as.civ.ii.penaltiesjnlhefwmd-a_STOP WORK ORDER..and..aflne.of($100.00.)-clay against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permil/Licensino Building Dept []Check if immediate response is required I] Licensing Board' E] Selectman's Office Contact person: Phone#. Health Department Other A C� ,.bcation/"� No. 3 Date /7 ,.ORT" TOWN OF NORTH ANDOVER/A Certificate of Occupancy $/L �/ J�7� + Building/Frame Permit Fee $ /L Foundation Permit Fee $ s�CHUS Other Permit Fee $ Sewer Connection Fee Water Connection Fee TOTAL r- j_ l✓ Building Inspectdr Div. Public Works Location Flo. Date R kORTq TOWN OF NORTH ANDOVER O't�•o •1tiO - A Certificate of Occupancy $ -- Building/Frame Permit Fee $ �ssACKU try Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ " Water Connection Fee $ - TOTAL $ i .'. Building Inspector i7, , V v Div. Public Works Location No Date NpRTFj TOWN OF NORTH ANDOVER ,4, O? • a pLp' - „ Certificate of Occupancy $ Building/Frame Permit Fee $ ssAc►+us Eth Foundation Permit Fee $ a Other Permit Fee $ 6: Sewer Connection Fee $ a _ Water Connection Fee $ TOTAL $ J Building Inspector =• Div.Public Works gE�R.liiT*NO �� APPLICATION FOR PERMIT^TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4.40. LOT NO. l 2 RECORD OF OWNERSHIP ;DATE BOOK PAGE ZONE SUB DIV. LOT NO. P.II ; LOCATION t PURPOSE OF BUILDING a 11. OWNER'S NAME OF TORIES SIZE 9/1 OWNER'S ADDRESS ASEMENT R SLAB G7 C! ARCHITECT'S NAMEMl6r� m2: 67 ry SIZE OF FLOOR TIMBERS IST x/ 2ND t?,W/h 3RD BUILDER'S NAME ' ' SPAN / ��. le/m- DISTANCE TO NEAREST BUILDING c i 't' DIMENSIONS OF SILLS DISTANCE FROM STREET / POSTS DISTANCE FROM LOT LINES-SIDES REAR / GIRDERS CO JL AREA OF LOT /6?1 /1 FRONTAGE / HEIGHT OF FOUNDATION D /1 THICKNESS /D / IS BUILDING NEW V��((�� !Ar' SIZE OF FOOTING IS BUILDING ADDITION D MATERIAL OF CHIMNEY r G r IS BUILDING ALTERATION n IS BUILDING ON O ID R FILLED LAND 1 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER L BOARD OF APPEALS ACTION. IF ANY f IS BUILDING CONNECTED TO TOWN SEWER •J .4 - IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPER M g,BM G PoMi� n /1��� % LAND COST +► SEE BOTH SIDES X, EST. BLDG. COST (/' 110 PAGE 1 FILL OUT SECTIONS 1 - 3 i` EST. BLDG. COST PER SQ. FT. i PAGE 2 FILL OUT SECTIONS 1 - 12 ` '� IllSBitGv'9V C EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE LED BOARD OF HEALTH IGNATURE OF OWNER OR AUTHORIZEd AGENT FEE --t L) CFj � �0'69 OWNER TEL # &x PLANNING PLANNING BOARD J PERMIT GRANTEE CONTR.TEL.'# - 1Z� .A- .S 19 CONTR.LIC.# ' s WARD OF SELECTMEN y 4, BUILMING INSPECTOR v � BUILDING RECORD I OCCUPANCY 12 SINGLE FAMILY oof STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ - _ DRY WALL UNFIN. 3 EASEMENT 11 AREA FULL FIN. B M AREA _ 1/4 1/2 �/, FIN. ATTIC AREA N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW D ASBESTOS SIDING _ COMIACN _ VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME j. BRICK N M A S UN_fY_ ATTIC STRS. 3 FLOOR _ �^ BRICK ON FRAME I ., .i._­bw,..,cw*s.�, CONC. OR CINDER ELK. STONE ON MASONRY WIRING l STONE ON FRAME i SUPERIOR I-I POOR ADEQUATE NONE $ ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. )2 FIX.) FLAT-11SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR d GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. t TIMBER BMS. &COLS. STEAM STEEL BMS. &COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G ` UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M_ TI 2nd I ELECTRICdl 1st .3rd NO HEATING FORM U - LOT RELEASE FOS r 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, o regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone A8 7_ // 2 g LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Z Coil � Street St. Number Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation AdministratorDate Rejected Comments Date Approved 9 c?/�3 own Planner Date Rejected Comments Date Approved 9/z z /X(-,-f Health Agent Date Rejected Comments Public Works - sewer/water connections - driveway permit �_ZO- �?3 Fire Department Received by Building Inspector Date 12/03/1993 11:50 508-4751448 MERRIMACKENGINEERING PAGE 01 i -f 7 ' j /ZZ4" X07- /2A�9A ` PEsrHi�y.io y p0 V W 6� as p OF r A' crs:owt•' c',iearrivs � I� �8, Pc4Al— ,�vS. oo' 'I 0 71993,,, .Z' •y •PEeY C�'.crisr Tr, I rirG6 /NS"~.wd e4O4 O T f�C.4it/ -e-4-VW rrWT rve- AW is mor',47ar-a OV cor,rs• •v.aw,0 r i7'oq�C tai , Irir.V raE rol,.v c ,�r,. , ZGwi ve .ercaaurays /-OV �lK�I.!'W. J�'7�CfCi!S Fli«/ 7�CEG�7.S ,e' Cdtt t✓whSJ. " :�'�sarr�.ecrrrr.•-rr.�ur .r.cr urru�,.+a is,vvr -�/, , ��'fh�:,,.•E;c..', �/i^�.y'. carvrca ZAv ram fEcr'44 �ldlVAr dN FCM.�' CDMAI�.�IAf/may/D.+ftlC.0 '� C+"'O t -PS-00v <aaa ]"dA"t ..Ir�oW r �-_,., M.'!� BoecvP�.rY s..i�,epirM- �✓4�.P.C"/,�YG/GC G'.Vd�E.P�i� .sE"�!'I��E..� xir -vQ' .c-arca�vs. 66 .�'.4.P,�'.tT•t�erT 4r4 AA,9,0. t a • ORTH own of ;ori i over 0 4.i''a w to No. 563 CoL A1ort 4 dower, Mass., /I�D I/• 3 d 19 9� COCHICHEWICK BOARD OF HEALTH a PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT. tx ... t, . .. ' Foundation has permission to erect J10.60Kbuildings on J �. ..�A.A.04;A i�j&t4A..A0..rJ6X Rough to be occupied as>f "..O.&OW. A. ....0A05",� ...4r.Movif....... Chimney provided that the person accepting this permit§hall in ever respect conform to the terms of the application on file in P P P 9 P Y P PP Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection AmNimorpbox" only Buildings in the Town of North Andover. REGULATED BY PARA 114.8-$. B.C. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MON FEEInr'0 O 0 Final ./�� UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR PERMIT FOR LRAM E/E Rough .. ........ ..... Service � BUILDING INSPECTOR DATE:��fEE PAID 6 f��-�ScJ Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT CERTIFICATE OF USE & • OCCUPANCY Town of Forth Andover . . Building Permit Number--5 (1993) Date JANUARY 28 1994 THIS CERTIFIES THAT . THE BUILDING LOCATED ON 18 COPLEY CIRCLE (Lot #12) - Type C MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR GARAGE IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAy APPLY. of 4CR7*1y 1 CERTIFICATE ISSUED TO Cobbles on rocs;n� Rom l �is O? •,�..o �tio �' t 733 turnpike St. , Suite 311 • --^^ ADDRESS /� � Building Inspector NORTFI Town of �r 4Andover � � m No. 563 Dd 3d :~ =Hort dover, Mass.,l� 19 '�PACOC HICMEWICK -/ DRATED F'P�\ '9S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.t�jo�..l . t.. Te.. .sex r��x��... � v�� Foundation has permission to erectA .6.0. � buildings on Itel. �.11 .. em0.Lr4D..rj X Rough C to be occupied as ir1l LN�� . .....� ,AA ...4f � ....... Chimney✓ provided that the person accepting this permit 1hall in ever respect conform to the terms of the application on file in — —g P P P 9 P Y P PP Final �Z (,L�C. � y this office, and to the provisions of the Codes and By-Laws relating to the Inspection moilbl"ON" oRty Buildings in the Town of North Andover. REGULATED BY PARA. 114.8-5. B.C. PLUMBING NSPE�cTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Mquglvoo FEE P91), PERMIT EXPIRES IN 6 MON 4 'so.o ELE ICAL INSPECTOR UNLESS CONSTRUCTION STARTS PERMIT FOR FRAME/E�►li : • Rough Service/V l DAl E f ' - "l- FEE PAID:) BUILDING INSPECTOR Final - -77 Occupancy Permit Required to Occupy Building GAS INSPECTO Display in a Conspicuous Place on the Premises — Do Not Remove /Iyl No Lathing or Dry Wall To Be Done FI PARTMENT Burner Until Inspected and Approved by the Building Inspector. d Pr J PLANNING 'Va-A �AL CONSERVATION ' 2� `� Street No. �lt;/ Smoke Det. IP-• SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT -72-t-d Town (if IiL'Ill.1)IN(; NORTH ANDOVER r,111111 .:11,11„1 I. • (`:O Nti :I tI .u'IIII:1.11••t1lttl., l IV/\'1�1ON 111\'IND IN I IF !til 71 l il{!i i .1 ' Ill '11 . I'LANNING l'l,ikNN1NG. & ('0Alr%lUNl'1'1' ' KAI I.FN I I.P. NI:I CHIAINCY APPLICAHON ANO I'L13111- �TE s 11:1iIIi i'. #�6 . 'CATION 42 NER'S NAME: I LDER'S NAME: — SON'S AME: ' ' ' ' SON'S NAME: . . ��zs' �r✓J SON'S ADDRESS: d� SON'S TELEPHONE: rERIAL OF CHIMNEY: FERIOR CHIMNEY: L'X1L'RIOR CHIMIXY: - 4BER AND SIZE OF FLUES: ICKNESS OF HEARTH: ' U ckinilley on 6i4en.Cace eon(jaA l to 41le nGrju.ilternen•t:5 u() .the cute cull! !lave :cuce.6 alid 3u.tati.ow been neeetved: rE: 3NATURE OF MASON: ZMIT GRANTED: „2—/ 1'EE 3ERT NICETTA ILDING INSPECTOR 3PECTE-O: ,1ARKS: SOLID [CLUCK R( QUl1tI:U THIS PERMIT I.ILISr GE UISPLAALO 014 111E I'UblI A m” Location U No. �� Date Z r' ,.ORTI� TOWN OF NORTH ANDOVE* ru „ Certificate of Occupancy $ # ` Building/Frame Permit Fee $ Z •o� i Foundation Permit Fee $ ,SsAcM45Es _L,j M Other Permit Fee $ Sewer Connection Fee $ N Water Connection Fee $ TOTAL $ r 0'r -7 7 Building Inspector 9 f:2 Q Div. Public Works PER'liff NO. (10+(0 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 ' MAP 4qO. LOT NO. 12 RECORD OF OWNERSHIP .'DATE (BOOK .'PAGE ZONE SUB DIV. LOT NO. LOCATION CA c URPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS i E BASEMENT OR SLAB - ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW O SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO RE UIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST Soo PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS i - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND PROVED BY UILDING INSPECTOR DAT FILE 5 _ / BUILDING INSPRCTOIrI Sl GNA E OF OWNER OR HORIZED AGENT n VEE OWNER TEL.# +— 7 3 PERMIT GRANID -28 CONTR.TEL.N r� 19 CONTR.LIC.# H.I.C.N q,48o C -zea BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S.-ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA. APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D _ PIERS PLASTER __ _ DRY YJA—LL _ _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ '/. 1/7 '/ FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARO�ND _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK N MA N Y ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I--jPOOR ADEQUATE NONE S ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.( FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING 11 MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL I'M'T 2nd _ ELECTRIC 1st 13rd 11 NO HEATING NORTH Town of 0 over 0 No. 646 � o _ , �l�l�rt dower, Mass., 19 1CI S' coc',CN,WICK AORATED �CC) 15 BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THISCERTIFIES THAT .......S......................................................................................................................... Foundation has permission to erect..AL3M4,,................... buildings on ..�S..QoP. ..��.. ......................................... Rough to be occupied as.... .. V . f Mcg..1. ►.b4...... mu_- ........QtN.��{{ ./Y�....... . ... . . . . .. . . ... . . . . ........................... Chimney ro 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 AM PERMIT EXPIRES IN 6 MONTHS Final UNLESS CON U ST ELECTRICAL INSPECTOR Rough .. . ......... ................. Service BUILDING PECTOR 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. Smoke Det. l� ' I i .,KJ,TA�( V1l `1�N eZ L `�q FJrrr,��e !' �1 StnEe r��C r057-77b l o 'Let 7 / , 1A"p Circ-J-as C V - ry s. w UTM P), TOWN of NORTH ANDOVER AFFIDAVIT Hm a hgmwimt Gmtracbor Ian A=Iena t to lit t%bmat1an M�c. 142 A regdaes that thealai, MVada4 reprar, J iXAicn, cmmmau, improvement, rel, daunliticn, cr caustnr t m of an aJibm bo any per- ex sting build- irg cmtYmi% at lit one bit not mile thaufar dellirg udts...cr bo stzurluLes wadi are adjaoatt to arh resadenm or hnldirg"be dme by registered catact=, with octan acg3twns, alag oath other rewirEmE rts. `Type of Work: V,,4fz-TI ALL-/ A�tN*cb 20 ! Est. Cost 2 --'Address of Work COPL EY 1 .7 C_J. � -"Owner Name: ,S,g yr Cs \^j —"'Date of Permit Application: L I hereby certify that: Registration is not required for the following reason(s): For offine Use Qtly Work excluded by law Rmdt No. Job under $1,000 Date Building not owner-occupied �wner pulling own permit Other (specify) Notice is hereby given that: OWNERS POLLING THEIR OWN PERMIT OR DEALIM WTIH UNRDGISIFRED CONTRACTORS-- FOR ADPL ICABIE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRA- TION PROGRAM OR GUARANTY FUND UNDER MGI. c. 142A. Signad urs pe:alties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, Ih eby ap ly for a permit as the owner of the above pro ty: Datd Owner Name