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Home My WebLink AboutBuilding Permit #600 - 257 CHESTNUT STREET 4/15/2008 BUILDING PERMIT 09 040Rrh q �t�eo ,6 ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION °4n<o<wK i...c•�1. Permit NO: 0 Date Received � oq,7tO'pP �g �!J �SSACHU`'�4 Date Issued: PORTANT:Applicant must complete all items on this page LOCATION -S C��k I\ S\ Print PROPERTY OWNER L-OO,, P`nt MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village 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 PREFORMED: t:Lvs� 45 o i � ari.�l �,5� Identification Please Type or Print Clearly) OWNER: Name: J g5ep\,, k.-,o 4•rz Phone: 9n310P'5 Address: o2S7 C�s Ns ti S\, ,Un -11 CONTRACTOR Name: Phone: -Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3,UZO , 0r3 FEE: $ Check No.: ReceiptNo.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner `-- d" Signature of contractor Location ,2 5- j,Z✓ No. l U Date �oR,N TOWN OF NORTH ANDOVER f �h 3? i •O y A Certificate of Occupancy $ �ss,�C►Nstt�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ G TOTAL $ Check # �O U I '� Building Inspector 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS J t 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: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS d �- CONSERVATION Reviewed on �' Signature "COMMENTS �J O W -C-20-Cvl'1d S C;A I4 ` L4 C00 G, HEALTH Reviewed on Signature COMMENTS ZonA 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: Signature: Located 384 Osgood Street FIRED PARTMENT *'Teel Durrlpster ala slte yes" ` no f s 1 # �+ 1� y ,4 S $ �.4Cte�c`1 124( at�$tr$P+t 74 Fire Department signature/date 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 NOTES and DATA— (For department use) ❑ Notified for pickup - Date I Doc.Building Permit Revised 2008 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 ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Town of North Andover NORTH Building Department °�'(t%.EO 1611 1600 Osgood Street o ,'t'- 0 4. �* North Andover MA 01845 } ; Tel: 978-688-9545 Fax: 978-688-9542 O cocMc"§V0 " 4 DEMOLITION OF BUILDING AFFIDAVIT 9s°R4Tao SgCHUSF DATE 0 ,? ------- ---- - OWNER'S NAME &ADDRESS LOCATION OF PROPERTY TO DEMOLISH a` j DESCRIPTION CS CONTRACTOR'S NAME &ADDRESS R JDEPT. DEPARTMENT SIGN-OFFS OF PUBLIC WORKS WATER: SEWER: DEPT OF CONSERVATION HEALTH /GAS ELECTRIC TELEPHONE CABLE TAXES POLICE FIRE EXTERMINATOR DUMPSTER-ON/OFF STREET DIG SAFE NUMBER DATE RECD BLDG. INSPECTOR Doc.form demolition of building affidavit NORTH � Town of _: tAndover No. el A�_/K�- o dover, Mass., COC MIC NE WICK V AERATED `s BOARD OF HEALTH I Food/Kitchen PERMIT T Septic System // BUILDING INSPECTOR THIS CERTIFIES THAT © �c' .......,.�:v :..........4.��F.Z--............ .a.... .................................................... Foundation has permission to erect.......... ............................ buildingso ....... ?..6-. ......�:..4l'r. �7�1.4-'` ... 1......... Rough t0be OCCUpled 8S....................... .. .f: �........ .: yCh...:..................................... . . . . . . ... ....................... Chimney provided that the person accep Ing 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 VIOLAT7f the Zoning or Building Regulations Voids this Permit. Rough Final "P PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS TS Rough .... Service �- B LDING INS Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place o'n the Premises — Do Not Remove Final No Lathing or D' 7 Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 1 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 at: ' is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 115 S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section l OA. The debris will be disposed of in: (Location of Facility) Anr:n- d ;L -11 i ature of Permit plicant dS Date BUILDING PERMIT OA Or10Ry ORT�f TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 'A Permit NO: Date Received 7"y 4q ►Areo�fiy�5 'O �SS�CHU`'�.t Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION r:x"? Prim PROPERTYOWNER Print MAP NO: If PARCEL. ZONING DISTRICT: Historic District yes (no Machine Shop Village yes 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 PREFORMED: f A o r c�' X c�o1 Identification Please Type or Print Clearly) OWNER: Name: 1nS�o��Svc _ LA DtZ Phone:G7x8 (n 810 (6 J % Address: d S° q&-r+ c CONTRACTOR Name: Phone: Address:�� Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ZZdV FEE: $ Zd - - Check No.: a( \ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 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 ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature CO MENTS7771 ' 4� 111t I A EN-LA J�Zj JO 6IIA& 0,4 d"VI"o, U� HEALTQ Reviewed on Signature COMMENTS 4 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: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 924 Main Street Fire Department signature/date COMMENTS 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 NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location Q No. Date J U NORT,, TOWN OF NORTH ANDOVER O • oR Certificate of Occupancy $ _ Building/Frame Permit Fee $ 130 ncMus r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # rN Building Inspector x•10RTH Town of 4Andover 0 No. LA E dover, Mass., 107 • COCMICKEWICK 7d ORATED P'P�\ �C-1 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ..... .. ... ,. .. ! im! .....�. . !....... ...... ....................................... ••�1 J"" � Foundation has permission to buildings on .PV � Rough . .... .......................................... ............. t0 be occupied as....... . ... Chimney provided that the pers acceptingthis permit sha in every re ct con ormto th2 e tXAP pp is �n �OWn***=flie�lin 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 3 PERMIT EXPIRES IN 6 MONTHS • UNLESS CONSTRUCTIONELECTRICAL INSPECTOR STARTS Rough -- ..... Service .... ... ............................ ................ ..................... 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. NSM TOWN OF NORTH ANDOVER ��• �_ ^ OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 ;,sem North Andover, Massachusetts 01845 Gerald A Brown ' Telephone(978)688-9545 Inspector of Buildings J.. Fax (978)688-9542 HOM$OWNER LICENSE EXEMPTION Please pg; DATE: 2- 7- 0 q. JOB LOCATION: 02 5 T' C_k� y S� Number Street Address MVIW HOMEOWNER- :3;oso—1;)�'kz �q �-n— 9 7 S 6810(653 Name Home Phone work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current"emption i`nr"homeowners"was etndad to include o ma-oxipied 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 helshe resides or intends to reside,on which there is,or is intended to be,a We or two family structures, A person who crostruats mon that one home in a two-year period shall not be considered a homeowner. The undersigned'"homeowner"assumes reWmsUhty for compliances with the State Building Code and other Applicable codes,bylaws,rules and regulations. The undersigned"homeowner"cmrtifies that helshe understands the Town of North Andover Building Department mimmiim inspection procedures and requirements and that he/she will comply with said procedures and recpfiremems HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.1005 Fane H0--n=ExWv iW is TIOARD OF U'PE.V1 S 699-9541 C0NSERV.11'10.\.!688-9530 TiEA11'H 688-9540 PLAN-NNG 68g_9535 Town of North Andover KORTH Building Department 1600 Osgood Street North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542I. eyy � T O LAKE �A CONIC NEWKK`� DEMOLITION OF BUILDING AFFIDAVIT0 ATE ►P� �`� �SSgC HUS�,t DATE 7-47 —O�( OWNER'S NAME &ADDRESS LOCATION OF PROPERTY TO DEMOLISH DESCRIPTION a `X CONTRACTOR'S NAME &ADDRESS DEPARTM NT%19N-OFFS 7�OQ X DEPT. OF PUBLIC WORKS -WATER: SEWER: 07 DEPT OF CONSERVATION HEALTH DEPT: Septic Well HISTORIC COMMISSION 5-0 QZ 4 4,-"- TAXES 1/TAXES )C POLICE �( FIRE Z2if -_ATER VIV INATOR X DUMPSTER-ON/OFF STREET V DIG SAFE NUMBER 4Oa9 azo 7 ®(p DATE REC'D BLDG. INSPECTOR Doc.form demolition of building affidavit The Com Mwea k ofMassachusetts I Depar'tmenl of Industrial Accidents Office of Investigations 600 Wizsfiinbton Street .�a Boston, MA 02111 www_masS.gov/din . Workers' Compensation Insitrance Affidavit-. Builders/Contractors/Electricians/Pinm6ers A Lcant Information Please Print Leaibl Nalne(Business organizafion/[ndividual): Address: City/State/Zip: Phone#: . Are you as employer?Chmk.the appropriate box: i.❑ I am a employer with 4. ❑ I am a general contractor and I Type°f Pref (regmred): 2.❑ �nployees(foil and/or part-time).* have hired the sub-contractors 6 Q New construction I am.aSole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These stLb-contractors have working for mem any capacity, workers' comp.insurance. S' Q Demolition [No workers'comp.insurance 5. ❑ We are a corporation and its 9, Q Building addition ` Anyselt uired] officers have exercised their 10•Q Electricalahomeowner do impairs oradditions �l work right of eacemOon per MGL 11.❑Plumbing repairs or additions [No•workers'comp. tri 152, §1(4)�and we have no Insurance-required.]t employees. [No workers' 12 Q Roof repairs comp. insurance required..] 13.❑.pther "Airy applicant tient tttecics bo�l11 mast also fill out the section below ahow.ing their worken;'aompensetiori policy information r fiotneownerc who submit this affidavit indicering they ars doing all work��than title outside conm;etots must xContractom dw check this box ntustattwbed yen additional shtztstww' submit a new affidavit indicating such. showing the now of the sub-mmwtm and their worimm,cern^ ti„ ', !ant an employer tr:iat is paomd"t rWorkets'co ensatian r ;n&m�etion. informadox mp insarmwefor np employe= Below Ifs Me Policy and job site . insnranee Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: Attach a copy of the workers'coin nsation City/stat-maip: Pe policy declaration Qe showing Failure to secure coverage as required.under Section 25A of MGL c�152(can lead to the oirrtposrtionlicy bof criminer and al i�enait�esa � fine up to $1,500,00 and/or one-year imprisonment;as well as civil penalties in the fog of a STOP WORK ORDER and a fi of up to$250.00 a day against the violator. Be advised that a copy of thine investigations of the DIA for insurance coverage verification. s statement may f forwarded to the Offica of Ido hereby cerci under the pains and penalties n rP rJe ' mY that the information provided above is true and correa Si tzar: Date• '—�—Q ' Phone#: O,f Jci&me only. Do not write in this arra,te he conp1etad or town off icial by�y City or Town: Permit/Liccnse# Issuing Authority(circle one): I. Board of Iiealt6 2.Building Department 3.City/Towa Cleric 4. ElectrS. 6.Other Contact Person: Phone#: Information a nd Instructions ti Massachusetts General Laws chapter 152 mquiTM all emp Ioyers 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 enti#.y,or arty two or more of the foreping engaged in a joint enterprise,and includirzg the legal representatives of a deceased employer,ar the receiver ortrmtee-of an individual,partnership,associaboin or other legal minty,employing employees.•Iiowe=the owner of a dwelling house having not more than three apaxtrnerits 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 o►;-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 riot produced acceptable evidence Ar compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither talo commonwealth nor any of its political subdivisions shall enter into any contract for the pm form'anee of public woric until-acceptablc evidencc of compliance with the insurance requirements of this chapter have been presented to the carttracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),addrms(es):aind phone number(s)along with their eertificate(s6 of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not requirod,to cant'workers'cci-rnpensation insurance. If an LLC or does have empioyees,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 Daimu tsnent 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 timm. ber listed below. Self-insured cornpraies should cnte•their self-insraance'license number on the*appropfh&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 applii=t Please be sure to fill in the permit/licecise number which w-ill 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 officiaily stamped or marked by the city or town may be provided to the appiicant as proof that a valid affidavit is on file for future permits or licenses. A now 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 too bum leaves etc.)said porsori is NOT.required to complete this affidaviL The Office of investiaptions 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 Co=onwe$lth of Massachuse= Department of hndusiziW Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL#617-72.74900 ext 406 or 1-8.77-MASSAFB Fax#617-727-7749 Revised 5-26-05www.mass.gov/dia The C0 oweft of Massachusetts Department of Fire Serviees Office of the State Fire Marshal P.O,Boer 1025 State Road,Stow,MA 01775 PERMITDate_ 7 7 0Y Norah Andover Permit No (City of Town) (If Applicable) Aig Safe Nnm er In accordance with the provisions of M:G1..1�4 8 Chapter 1 0 as provided in section 927 CMR 34 Start Date This Permit is granted to: 16 ca-1, f7titl�/ Full name of person,Firm or Corporation Permissionto locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be . 25 ' from structure if unable to place with required Restrictions:clearance dumpster must be covered with plywood or tarp end of work -day at -7 C S E-vt + (Give location by street and no.,or describe in such magper as to prQ y d adequate identification of location) Fee Paid$ 50.00 Fire Chief This Permit will expire- / b (S ignYt&e'r-officat granting permit) vaiical granting permit (Title) AORTH Town of _ Andover 0 No. �-- LAK o dower, Mass., 2COCKICMEWICK y^' %ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING.INSPECTOR THIS CERTIFIES THAT. Q. Foundation has permission to erect........................................ buildings on /f Rough t0 be occupied aS ... ... �...� IIII __ ' ... 4 ....�... Chimney .. ^ Kms............. ....... 01011• .) provided that the person acce�ting 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 MONT��HTT��S UNLESS CONSTRU O STt�itTS ELECTRICAL INSPECTOR O44Rough . ........ Service .... ... . ...... BUILDIN...............PECTOR 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 Det. North Andover MIMAP 257 Chestnut Street July 7, 2009 0 0.0-0 r 060.0-0014 _ 060.0-0112 060.0-0107 60.0-012 060.0-0135 86b.0-0133 060.0-0136 Q�a��RUa 060.0-0113 060.0-0106 060.0-0132 060.0-0134 060.0-0131 060.0-0127 060.0-0114 0 0.0-0105 060.0-0129 060.0-0102 060.0-0130 060.0-0140 n 060.0-0115 60. -010 060.0-0128 060.0-0149 GGA 060.0-0091 060.0-0013 060.0-0010 060.0-0147 0.0-01 060.0-0090 .0- 09 060.0-0141 �r 060.0-0143 060.0-0144 ��0� 060.0-0100 060.0-0146 060.0-0145 060.0-0039 060.0-0101 C:-007 098.0-0055 098.C.-0004 025.0-0066 098.0-0005 098.0-0008 098.0-0009 098.0-0007 _'" 098.C:-0010 025.0-0035 I =: 098.C.-0006 i,• 098.0-0105 09 . : 14. r • =' -Reil Une Interstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Interstate Meters Data Sources:The data for this map was produced by Merrimack -Major Roads NORTl Valley Planning Commission(MVPC)using data provided by the Town of Roads Gf ,,so �, Nortn Andover.Additional data provided by the Executive Office of r;Easements ? �a ��00 Environmental Affalrs/MassGIS.The Information depicted on thls map Is Trells 3 L for planning purposes only.It may not be adequate for legal boundary O .,-• - le definition or regulatory interpretatlon.THE TOWN OF NORTH ANDOVER Streams p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING 0 MVPC Boundary tR ♦ THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY ♦ "s ^ OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Munlcipal Boundary ✓F o • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ❑Parcels .��^o^ �"�j THIS INFORMATION Hydrographic Features ,S$AC$4111 Wetlands Exempt Lands 1"=197 ft "�`