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HomeMy WebLinkAboutBuilding Permit #164-15 - 271 CAMPBELL ROAD 8/14/2013 NORTH BUILDING PERMIT t<`E° '60 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION , .r � �j� Date Received Q0gATE°'PP`�y permit No#: gSSACHV`'�� Date Issued: must complete all items on-this page IMPORTANT:Applicant m p -s- v_ _ OCAT:ION. y ' ROPERTY OWNER _ ._ - __s _- -_ - P. _ -_ -_ - _ 100 Year Structure Lyes no Pnnt - c ZONING,DISTRICT HlstoncDistnct ye no AP l PARCEL: � ._) e M _ - = 4Machine Shop Village _ �.� TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ;?(Drn-e family ❑Two or more family ❑ Industrial ❑Addition E] Commercial [I Alteration No. of units: ❑ Repair, replacement ❑Assessory Bldg ❑ Others: z -� ❑�Otther t Wetland. _ _ '❑ Demolition -' - t Wd --- 9y i I. -p Sepflc owl,wll r Water/Sewer:.r DESCRIPTION OF WORK TO BE PERFORMED: iv, 71 o�5:)-Z—, d tiff ation- ale Type or Pr' t Clearly ! v��9�277 � 1u)9-Al Phone: OWNER: Name: / Address: - y - - ContractorF -- _ n- -r / I ;S 0116,101-0�struct oM,,Licens- 0 � ; H®�rne, Improvement�License Phone: ARCHITECT/ENGINEER i Reg. No. Address: E SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. FEE FEE: $ Total Project Cost: 0-7 Check No.: � 2 Receipt No.. n NOTE: Persons contracting 'h r to d contractors do not have access t Si natureof contracto -i i ii I Location -,D No. --��� Date i • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 30•z-i-) Foundation Permit Fee $ 1 Other Permit Fee $ TOTAL $ Check 2188 .Bu ding Inspector V i - IM i i y s Plans Submitted ❑ Plans Waived Fl. Certified Plot Plan ❑ Stamped Plans ❑ ( TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ I Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ I Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ i I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF ORM I PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on Signature I COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments Water & Sewer Connection/signature& date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street �a -•�Y l `FIREDEPARTMENT -`TemptDumpster[onsite" ,ye`s _ w A6 {Located,At 124#6a ,$treet. NORTFI Town of ndover 0 to h _ " ver, Mass, coc"Ic Nl.m.t AERATED S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ............ ��' -....k.......................................................................... BUILDING INSPECTOR' ...... ........ has permission to erect buildings on �� Foundation ....................... . .... .......�...... .................... \ N I Rough t0 be occupied as �° !�.....1 . .. ,.....�. 2:OA{ �...... .......................... Chimney p .... . .. .............. provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 CONST TIO Rough Service .. ...... ....... .o........ ..... ...... .......... ................ Final ILDING SPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. t f t� f a t r} 4 v� 4 a f s 3l t'a27ria, ee..`��"\r'' .'\ v.F. �'\ �"`•�:���\fi�a£ e�' tt'2r�{��xlej Z`st a t tst v;es a r u t t s�J 4\�ze � a s,41eVv}A#^ 4 i� �"' t � } S s sx. + ? �vy�� Ala�s� "'�''\�\v�,�2,�•A, a l' t;t tk Y ` 1 } t 'r t� `?� •��kt k4 t�S�i is}�\?��?��1�`°fsz �)��� \. '\., x a r t }.tr}t,t}�#h��i�� F. \���,s ��i'Trv`j�k"r.1ff•4� �i^;�\� S c \ t 2 �t�ks'' \�><• ,}t�}^�c�`�.5k�'k�`t`l�ik"�`\ 'all`i ,,�-". l �} � \��£* .Zy`�` l., ` p s � f i, a ; L Sa k k} Ort ar t rt 5 `enF�'t1 a 3S"rte\\L'it� a #Z2 \ ';ficptt �y�t ir4+.?irft't�)Zi,`2 , z � tts \ e vt� v a a takeslggl: i _ HOME IlMPROVE`-IENT COfVI'RACT �jiq PLEASE READ THIS i Sold. Fumished and lnstdled bv: Branch Name: Boston North&South DateL/Y/14/ THD At-Home Services. Inc. dIb/a The Home Depot At-Home Services Branch Number: 31 and 33 908 Boston Turnpike.Unit t"Shrewsbury.MA 01545 Toll Free 877-903-3768 Federal ID#75-269M60;ME Lie#C 02439;Ri Cont.Lie#16427 f/ CT Lic#HIC.M65522;N1A Home improvement Contractor Reg.#126893 Installation Address: f I �' � Al l City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: Pj Horne Address: ! (If different from Installation Address) City State Zip E-mail Address(to receive project cornmunicatiom and Home Depot updates): ❑ I DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersigned("Customer").the o\\ner,of the property located at the above installation address,agrees to buy, and THD At-Horne Services. Inc. ("The Home Depot") agrees to furnish, deli\er and arrange for the installation ("Installation") of all materials described on the below and on the referenced Spec Shect(s). all of which are incorporated into this Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders (collectively, "Contract"): Joh#: (internal Rcrerenm Products: Sec Sheet(s)#: Pra'ect.Amount �— -- � I Rootim Siding Windm%s ntiulation uT— — 1 $ �� I 17200o_;-1 ❑Gutters/Co�cr% ❑Entry Dams / ❑Roofine Siding WindoNrs U insulation -- ❑Gutter`/Covers ❑Entre•Dam, ❑ ❑Roolin Siding LJ 5.'t'indo"s ❑ Insulation ❑Gutters/Covers ❑Entry Dcx-)rs[�'--- _-_- Rooting, ❑Siding ❑NNindotvs ❑hisulation ❑Gutters/Corers ❑Eintr:Door; ❑ Miniinum 25Sr Depusit of Contract Amount due upon execution of this contract. Maine Purchasers may not deposit more than one-third of the Contract Amount Total Contract Amount ` [`C) Customer atrces that. immediately upon completion of the work for each Product, Customer will execute a Completion Certificate (oric lim cacin ProdUl t as defined by an indi<<iduai Spec Sheet) and pay any balance due. As applicable. each Customer under thi, Contract agrees to hc;oilltir and severally obii«ated and liable hereunder. The Home Depot reserycs the right to issue it Change Order or terminate this Contract or any individual Product(s) included herein,at its discretion. if The Home Depot or its authorized,,ere ice prox ider determines that it cannot perform it,,obligations due to a structural problem with the home, environnnental hazards sueh as mold, asbestos or lead paint, other safe(\ concerns. pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary # included as part of this Contract. sets loath the total Contract amount and payments required for the deposits dnd final payment%by Product (as applicable). NOTICE TO CUSTOMER Vou are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined In indkidual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract, Customer agrees to pan- The Home Depot the costs of materials, labor, expenses and services provided by The Home Depot or Authorizer) Service Provider through the date of termination, plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYML•'NT OR OTHi:R PAXAIENTS MADE. WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Anreennent is the entire agreement between Customer and The Homc Depot with regard to [he Products and installation services and supersede;all prior discussions and a`=reements. either oral or written, relating to said Products and ln%tallation. This Agreement cannot he as,i,ned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and a-rces that Cti%UNnner has read. understands. voluntarily accepts the term,of and has received a copy of thi Agreement. o lhlork area will be contained _ Et x f Pre-Renovation Form Date: Y � f NAT-19276-1 requirements of the Federal compliance This form is used to document com with the re p' q Lead-Based Paint Renovation, Repair,and Painting Program after April 2010. s fY� Customer Address Job Number(s) 57 Y Yf Y 4 OCCUPANT CONFIRMATION Q Dust will be rnWmized Pamphlet Receipt I have the potenal received sk of p he f the lead 1ead hazard information pamphlet informing me of exposure from renovation activity to be Kr r performed in my dwelling unit. I received this pamphlet before work began. f y Home Year Built Y�rY"'-`sj; /�� -v"� � ,r"fY� Yr�,'� Y e'� � � ✓,pY..r Enter the year my home was built. If my Home Year Built is Pre-1978,my home requires lead paint testing to determine ci W�t� �t �n�rt {�, whether Lead-Safe Work Practices are necessary per EPA or State regulations. ork area will l l Da cleaned u p If my Home Year Built is 1978 or after, Lead-Safe Work Practices are not required. thoroughly Printed Name of Owne occupant I� i i ature of Owner-occupant I Sign tur of rs n Eying Lead Pamphlet Delivery SEE STATE SPECIFIC FORMS ON REVERSE SIDE oaTE(MMioonYYY) ACC RD . CERTIFICATE OF LIABILITY INSURANCE 021,9120,4 THISCERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND;EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW:: THIS CERTIFICATE.OF.INSURANCE DOES NOT.CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE-CERTIFICATE HOLDER. IMPORTANT: If the certificate holder isan ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CQN ACT PRODUCER NAME: MARSH USA,INC. PHONE aC No TWO ALLIANCE CENTER IA E-MAIL 3560 LENOX ROAD,SUITE 2400 ADDRESS: ATLANTA,GA 30326 INSURER(S)AFFORDING COVERAGE NAIL I INSURERA: 100492-HomeD-GAW-14-15 Sleadfast Insurance Company 26387 INSURED INSURER B Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC. New Hampshlre Ins Co 23841 D6A•THE HOME DEPOT AT-HOME SERVICES INsuRER c 2455 PACES FERRY ROADINSURER D illlnois National Insurance Company 23817 ATLANTA,GA 30339 wsuRER ...:. E: - INSURER F: I COVERAGES CERTIFICATE NUMBER: ATL-003242685-01 REVISION NUMBER:3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN.ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIM_ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR . ADDL UB POLICY EEF POLICY EXP LIMITS LTR TYPE-OF INSURANCE POLICY NUMBER- MMIDDlY % MMIDD/YYYY 9,OOD,OOD A GENERAL LIABILITY GL04887714-04 - 03101/2014 03101/2015 EACH OCCURRENCD E S DAMA 1,000,000 X PREMISES(Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADEFE OCCUR LIMITS OF POLICY XS MED EXP(Any one person) $ EXCLUDED OF SIR;$1M PER OCC PERSONAL 6 ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9,000,000 PRODUCTS.COMP/OP AGG $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER $ X POLICY PRO= LOC 9AP 2938863-11 03101/2014 03/0112015 COMBINED SINGLE LIMIT 1,000,000 8 AUTOMOBILE LIABILITY Ea accident) BODILY INJURY(Per person) $ X ANY AUTO ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED Per a cldant HIRED AUTOS AUTOS S - I UMBRELLA LIAR. OCCUR EACH OCCURRENCE f EXCESS LIAR CLAIMS-MADE AGGREGATE f f DED- RETENTION S WC STATU- 0TH C WORKERS COMPENSATION WC049101BB2(AOS) 03101/2014 0310112015I_IMITSFR AND EMPLOYERS'LIABILITY 1,000,ODD I C ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N WC049101884(AK,AZ,VA) 03101/2014 0310112015 E.L.EACH ACCIDENT. f OFFICER/MEMBER EXCLUDED? E N/A WC049101883(FL) 0310112014 0310112015 E.L.DISEASE-EA EMPLOYE f 1,WO,000 fl D (Mandatory In NH) 1,000,000 ifes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 1,000,000 j C WORKERS COMPENSATION WC049101885(KY,NC,NH,VT) 03/01/2014 03/01/2015 (EL)OMIT C WC049101886(NJ) 03/01/2014 03/01/2015 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addloonal Remarks Schedule,If more space Is required) EVIDENCE OF INSURANCE i CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2010 ACORD CORPORATION. All rights reserved, _s Arrnon 11'e2 �G�ia;frJE2'�t�°u�Fii? �j l�c'�,i��CJ'Z1eri°i S . q` �ey7Cs.rtT3'$e;Eta?flT:d�Stlitzc��CCideTij,i OffiOe O'Iinvestigations 600 Washington.street _ Boston,ll_4 02111 www.mass.gov/dia Workers' Compensation Insurance Afffidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Name (Business/Organization/Individual): Wo—m- ��"✓�-mss --r Address: City/State/Zip: 10__fUk�_ - b�. 3OL31 Phone#: 177�1 f 3 Are you an employer? Check the appropriate 4pa: Type of project(required): 1.❑ I am a e to er with 4. R I am a general contractor and I mP Y 6. ❑ New construction i employees(full and/or part-time).* have hued the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling ship and have no employees These sub-contractors have g. Demolition workingfor me in an capacity. employees and have workers' o Y P ty• t 9. ❑ Building addition [No workers' comp. insurance comp.insurance. required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions j 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ of repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. Other comp.insurance required.] °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 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 state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the polies•and job site information. MeW /il �1Insurance Company Name: fCLPI 5!1 -f- �/.S (�D . Policy#or Self-ins.Lic.#: t 0 Q g Expiration Date: .311 �J� Job Site AddrG ess: 7� C�� g� 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance coveraee verification. I do hereby certify U'a er t pal and a Ities ofterjury that the information provided above is true and correct Signa e: Itai Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: { � | I | ` , �. 2: y � . »�� r Gci oll--�,Up ;y%specratv. - : CSS402A • - | DONA L URNE ~ - - | 3 TMARION WAD | MARBLIREAD�■ \ \. . . 1210612014 ( � I I , I , � Hermit bervlces 4U1 Lob Lt$t)d p.L ' .. v AL2 '22 ,C� Off ce of Consumer Affairs and Business Regulation -�- 10 Park Plaza - Suite 5170 {'l Boston, Massachusetts 02116 Home Improvement-Contractor'Registration Registration: 126893 Type: Supplement Card THD AT HOME SERVICES, INC. Expiration: 8/3/2016 RICHARD TROIA --------- 2690 CUMBERLAND PARKWAY SUITE 300- --- ATLANTA, GA 30339 Update Address and return card.114ark reason for change. SCA 1 0 2W-0555111 Address , Renewal �11 Employment =1 Lost Card � .L ��Jji• 1,itll�lNOiy/'P///ill'�^� J�il�r�_iai�J 0fticc of Cuasumer Albirs&Business Regulation License or registration valid for individul use only DOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: k �.��•�: Office of Consumer Affairs and Business Regulation s Registration: .1266.93 Type: 10 Park Plaza-Suite 5170 :}��•> Expiration:.8M2016 . Supplement Cana Boston,MA 02116 THD AT HOME SERVICES.INC- THE HOME DEPOT AT_'HOME SERVICES RICHARD TROIA ' 2690 CUMBERLAND PARKWAY S ��----r At ,GA 30339 tindersecret3ry Not valid w" out signature l 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) r ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) o Building Permit Application Li Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) -- ❑ Copy of Contract o Mass check Energy Compliance Report o 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:Building Permit Revised 2014 V Lgcationd 22 No. Date 5 lam^ l/ �oRTM TOWN OF NORTH ANDOVER_. . ' p Certificate of Occupancy $ Building/Frame Permit Fee $ ~�$ t� Foundation Permit Fee $ S�CNUSE Other Permit FMA2-"-L $ Sewer Connection Fee $ "`- Water Connection Fee $ TOTAL $ dovz�yel', Building Inspector 7216 Div. Public Works PER,%tIT NO. �S APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE; i MAP INO. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZOO'E SUB DIV. LOT NO. �— LOCATION�,I + Ca,v1.(�b QLL �� A,_ ^ ���� RPOSE OF BUILDING Je 10 7L 1= �•s- 1V Nki. A W0 J 7'l h �; i Lt is�^f� NO. OF STORIES SIZE NER'S ADDRESS C r.� BASEMENT OR SLAB _ ARCHITECT'S NAME J SIZE OF FLOOR TIMBERS IST 2ND 3RD LI-SIT.-LDER'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 BUILDING NEW �/ /11(1 ,W r SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS 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 BLDG. COST f72 42Z) PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 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 FIZ;�- AND APPROVED BY BUILDING INSPECTOR ✓" 1 0 `/ 9 .Q 1 BOARD OF HEALTH SIG AT RE OF OWNER O�^R',1AU HORI AGENT F E E L�S� V ��rnlhjp ER TEL.# PLANNING BOARD PERMIT GRANTED ITR.TEL. #I ki, t#-7 19 CC"#TR. L!C. BOARD OF SELECTMEN l BUILDING INSPECTOR e � Y BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 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 RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE d 1 2 I3 CONCRETE BL'K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER — DRY YJAII UNFIN. 3 BASEMENT 11 AREA FULL I FIN. B-M'TAREA _ '/, 1/1 '/, FIN. ATTIC AREA _ NO B MT FIRE PLACE5 _ 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 COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING L. STONE ON FRAME _ SUPERIOR POOR 11 ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 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 ROOFINGMODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 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 B'M'T 2nd ELECTRIC 1st 13rd NO HEATING • r i MORTGAGE INSPECTION PLAN LOT 2 CAMPBELL ROAD NO. ANDOVER , MASS . SCALE: I"= 40' MAY, 1986 WILLIAM G. TROY REG/STEREO LAND SURVEYOR 12 EUCLID ROAD - TEWKSBURY# MASS. cr - h � m h 2.81 Ac. a EXISTING DW£L L ING )i Y i U O O ' NOTE_ 1. FOR COMPLETE BOUNOARY, SEE 150.00' NERO PLAN 10007 CAM X10 I HEREBY CERTIFY TO THE TITLE INSUROR AND TO THE BANK THAT THE DWELLING IS LOCATED ON THE LOT AS SHOWN AND THAT IT DOES ~' CONFORM WITH THE TOWN OF NO. ANDOVER ZONING REGULATIONS REGARDING SETBACKS FROM STREETS AND LOT LINES. o I FURTHER CERTIFY THAT THIS DWELLING ISNOT. LOCATED IN THE WILLIA1.4 °o FEDERAL FLOOD HAZARD AR AS SHOWN�N OAP DATED JUNE 15, 1983 . tor% 1.19947 Ln o rlet� o REGISTERED LAND SURVEYOR �� - — --- ------------------------.... .........----------------- ---.____.—_ — 'O SUR z THIS PLAN FOR MORTGAGE PURPOSES -NOT FOR BOUNDARY DETERMINATION. Z BOUNDARY INFORMATION TAKEN FROM' N .E.R. D. PLAN 10007. D c: NORTH ( X Town of ,` � Andover 0t No. 152 _ LA ort 1) " dover, Mass., MAY 19ly' COC HIC HL\1.'I%K AQRATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... .It...M..... �.....SMf.Af A#.*.4............................................ Foundation hasermission to erect... .. t............... buildings on ..... .. P � ... g Ol..N..C�•OV-�A44.6.....� . .. Rough to be occupied as.... .....� �•�. ... �./R. .. �il�/� ...�i �Xi Y 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 • f. Final PERMIT EXPIRES IN 6 MONTHS ' ELECTRICAL INSPECTOR ='t. UNLESS CONSTRUCTION STARTS j • Rough i ... Service B DING INSPECTOR Final r 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 PEP,3t1T 40. 6 < 7 or w APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP NO. I LOT NO. 12 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE �_ SUB DIV. LOT NO. .— LOCATION n�ny�( �) y� PURPOSE OF BUILDING P Nor OWNER'S NAME NO. OF STORIES SIZE t2, 0do,� $ . , OWNER'S ADDRESS ///� Q� - , BASEMENT OR SLAB ARCHITECT'S NAME ll t►p L� SIZE OF FLOOR TIMBERS IST 2ND poi(glI '�' 3RD BUILDER'S NAME OU V c•: SPAN 1,3 DISTANCE TO NEAREST BUILDING �� �ti.SS DIMENSIONS OF SILLS DISTANCE FROM STREET J O �r POSTS Q1 �/� r-L r�r �. DISTANCE FROM LOT LINES - SIDES 9a♦ REAR 3 4r.73 GIRDERS 46 ."© AREA OF LOT .�+J Q� �l�5, / FRONTAGE / HEIGHT OF FOUNDATION �'n r� THICKNESS /O I♦ IS BUILDING NEW e7 Ab lc�.,5„� � �n SIZE OF FOOTING 1-6k Q X IS BUILDING ADDITION /��� MATERIAL OF CHIMNEY O?Rl ►'V � IS BUILDING ALTFo•'- �l /_ L IS BUILDING ON SOLID OR FILLED LAND WILL BUILDII, IS BUILDING CONNECTED TO TOWN WATER BOARD OF API , I' IS BUILDING CONNECTED TO TOWN SEWER �•V/�/'� V"F�/ �e IS BUILDING CONNECTED TO NATURAL GAS LINE ry� x 3 PROPERTY INFORMATION 1 LAND COST �O, DCO SEE BOTH SIDE: EST. BLDG. COST 5- �„o-U EST. BLDG. COST PER SQ. FT. PAGE 1 FILL OU' 40tQ,4* PAGE 2 FILL OUT EST. BLDG. COST PER ROOM ("-Q /�(\, SEPTIC PERMIT NO. ELECTRIC METER: �Q v� AO�O 4 APPROVED 11Y ATTACHED GARAG PLANS MUST BE�FI j DATE FILED BOARD OF HEALTH SIGNATURE O OWN _.... rtIZED GENT .,/1 FEEIF '/' PLANNING BOARD PERMIT GRANTED 19 BOARD OF SELECTMEN / BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYsroRlEs 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 $ INTERIOR FINISH _ CONCRETE �D CONCRETE BL'K. PINE BRICK OR STONE HARDW D ✓ _ PIERS PLASTER y_ DRY WALL I _ UNFIN. 3 BASEMENT I � AREA FULL FIN. B M AREA _ '/, '/i 1/. FIN. ATTIC AREA N_O B MT FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS ++ CLAPBOARDS B 1 2 3 �I DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDVV D ASBESTOS SIDING COMMON r VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR U BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET �1J— O ASPHALT SHINGLES LAVATORY too WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING `0 _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING 11 HEATING ! ^0 Qd WOOD JOIST PIPELESS FURNACE �3D" _ FORCED HOT AIR FURN. , TIMBER BMS. & COLS. STEAM y�'`O GO STEEL BMS. & COLS. HOT W'T'R OR VAPOR G/V �✓ WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd `J ELECTRIC 1st 13rd I NO HEATING �` ' ` PEP,'MIT K2, . APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 NO. I LOT NO. 12 RECORD OF OWNERSHIP IDATE BOOK !PAGE — ZONE �_ SUB DIV. LOT NO. n/w L �- LOCATION 1 /) y�.� PURPOSE OF BUILDING lot OWNER'S NAME �t` � � NO. OF STORIES SIZE a� O�� '�fl ► OWNER'S ADDRESS /J/� 4 �1 BASEMENT OR SLAB 'i�reew#ar �- ARCHITECT'S NAME f\ t'1 / L ++' SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME DCG// V •C SPAN 11.3 OC�- DISTANCE TO NEAREST QUILDING �� • �I��� DIMENSIONS OF SILLS �-rea ) DISTANCE FROM STREET �i O 1--r ,I 11POSTS \,Tkp "') 4(L t ( 5 DISTANCE FROM LOT LINES - SIDES,L"Dr_ 4a, REAR J G 4r-7,? GIRDERS / V1p AREA OF LOT �C I�7S ! FRONTAGE / 0 HEIGHT OF FOUNDATION �i0 ov THICKNESS /Q,I IS BUILDING NEW f�,„ �,, z»„) V SIZE OF FOOTING ,6 X IS BUILDING ADDITION i� MATERIAL OF CHIMNEY �R��•►6/ �' A „ /� C IS BUILDING ALTERATION r1rO IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE `/,I Cr+ IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY �� �y IS BUILDING CONNECTED TO TOWN SEWER •CVD , �C��'O IS BUILDING CONNECTED TO NATURAL GAS LINE IV Q G INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST FT COST PER SQ BLDG. . . Qy PAGE 1 FILL OUT SECTIONS 1 - 3 EST. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. I ELECTRIC METERS 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 FILED 04/ BOARD OF HEALTH SIGNATURE O OWNER OR AUTHORIZED GENT FEE '/' PLANNING BOARD PERMIT GRANTED I p-f `! BOARD OF SELECTMEN / BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 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 RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION $ INTERIOR FINISH _ CONCRETE d I 2 3 � D.5 00/ CONCRETE BL K. PINE _ BRICK OR STONE HARDWD V PIERS PLASTER DRY WALL -- _ _— UNFIN. 3 BASEMENT AREA FULL N. B'M'T AREA _ '/ '/r '/ FIN. ATTIC AREA NO B M FIRE PLACES HEAD ROOM _ MODERN KITCHEN III 4 WALLS 9 FLOORS 1 CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD"✓'D L�,/ ASBESTOS SIDING COMtACN �! VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR U BRICK ON FRAME _ CONC. OR CINDER BLK. _ STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR JN POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I I HIP Je BATH (3 FIX.) 0. 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 MODERN FIXTURES l _ TILE FLOOR TILE DADO CIS 6 FRAMING 11 HEATING n WOOD JOIST PIPELESS FURNACE �3 lOO'� _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM I O,�C STEEL BMS. & COLS. HOT W'T'R OR VAPOR CL�JD O/� �� WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd 11 ELECTRIC 1st 13rd I_ NO HEATING r a i CERTIFICATE OF USE OCCUPANCY "own of Amlotevrr Building Permit Number $14 Date May 8, 1986 THIS CERTIFIES THAT THE BUILDING LOCATED ON Lot 42 Campbett Road MAYBE OCCUPIED AS DwaUna 9 gotcacie Under IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. HORTh o? ° CERTIFICATE ISSUED TO Woodchuck Reatty Dw/st oil ADDRESS 48 S Zve�ste�c S Lawrence Ma. �,SSAC MUSE Building Inspector ORT f own of NOAndover T T er, Mass., 19 CC__C nE.'. Rq SS'q BOARD OF HEALTH �r-3 PER I THIS CERTIFIES THAT .. .................. ..... ... . .. ..... ..... .� .... .. ., ® BUILDIN NSEECTOR has permission to erect ........ .... ..... buildings on ............ Rough ' s .. ..... .. .. ...... .. .. . .. �� e Chimney �^ tobe occupied as..... ............. ... .... .. ............ : � .. ... Final` ' provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTR this office, and to the provisions of the Codes and By=Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTO � Rough UNLESS CONST ION . Service Final, LTJ/ , BUILDIN E' GAS INSPECTOR Rough Occupancy Permit Required to Occupy Building Final .Display in a Conspicuous Place on the .Premises l Do Not Remove Burner FIRE DEP . .-���1/�.�- No Lathing to Be Done Until Inspected and Approved by smoke Det. Building Inspector •r