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Building Permit #553-14 - 32 BOOTH STREET 1/21/2014
TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION Permit NO: / � Date Received � �I Date Issue 'Z s IMPORTANT Applicant must complete all items on this page 'ate-1'77 - 7 sest'�-� LO'AsTSIONt_ `� tPROPER'TYft®1/1INTRn 0. "l - Print 4 - 100 Year Old Structure jrerio - ry�PARCEL+ y N.I NNGD- STRIHCTistoric,tMAFN® ZODistrct' yes . no ' n- no " Machine Shop Villa e, — �g yes. TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building 4?•One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ❑ Septie ❑Well 25 ` �'Floodplai:ri []iWetlands ❑ °1Naterslied ®i t ict a . ❑111later%SewecaF = _ n DESCRIPTION OF WORK TO BE PERFORMED: R�Moi E � w�Tc�-�-� PAS a � � -r��� w,,� �, e�Q►.� w N-rR New 04�3 6S Identification Please Type or Print Clearly) OWNER: Name: t�A2yggrrH F y Phone: 91S� 1-71-lkl( Address: F>00-rK 45"t Nae-rR AN you - # - - - -mss 14, CONTRACT;QR =Name �� 1 x Phone: 30� k a Super,vl os ConstructlonLlcense jj It r. HomeIrnprovernentL�cense ;, . =xppa - v E , to ARCHITECT/ENGINEER Phone: Address: it Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F. r, � Total Project Cost: $ FEE: $ Check No.: � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund Plans Submitted a Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ---Dimet-sion Number of Stories: Total square feet of floor area, based on Exterior dimensions._ .Total land area; sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of .Electrical Inspector Yes No DANGER.ZONE LITERATURE: Yes No MGL.Chapter-166 Section 21A-F and G min.$100-$1000 fine i NOTES and DATA-- (For department use li � I I ® Notified for pickup - Date I -------------------- Doc.Building Permit Revised 2010 Building Department g p The fol!,3wing`is a-1 st df the required-forms to be filled buffor:the appropriate.permit to.be obtained. Roofirig, Siding, Interior Rehabilitation Permits ! ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/O'r 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 apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm tted with the building application Doc: Doc.Bui?,fiing Permit Revised 2012 I TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION Permit N0: Date Received I ZI Date IssueL.R IMPORTANT:Applicant must complete all items on this page - R � LOC-AATION :.. Print PROPERTY OWNER �i` _ _ ,• iZ�T GTi �R. t 100 Year Old Structure yes no MAP NQ _ _ _ PARCEL: IZON.ING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT, PROPOSED USE Residential Non= Residential ❑ New Building P1,0ne family ❑Addition ❑Two or more family ❑ Industrial Mteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other []Septic 1Nell p ' M Floodplain EC Wetlands © Watershed District 51Wate—USewer DESCRIPTION OF WORK TO BE PERFORMED: w X-r K N e W 01tJ 6S Identification Please Type or Print Clearly) OWNER: Name: --I-em6s i t✓IAPy69;Tti F" Phone: (91S� '1-71-01kl j Address: S;� &O-rt+ No27)4 owtsouyq„ CONTRAC"TL@R Nam0k1�,K[�. Address: -%T s�-)111 __� q Supervisor's Construction Licenser _ _ Exp. Date: Home Improvement License: _ Exp. Date: / ARCHITECT/ENGINEER Phone: Address: 41 -) �" 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: $���=-�-� FEE: $ Check No.:n�,� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund Signature of.i4'enOwner "' S� nature ofcortractorxr xau. ` Plans Submitted L_J Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 1I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ;TYPE OF=SEWERAGEDISPDSAL- Public Sewer ❑ Tanning/MassageBodyArt ❑ .. Swimming Pools ❑ Well ❑ Tobacco.Sales _Food Packaging/Sales ❑ Private(septic tank,:etc. Permanent Dampster on Site ❑ THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATEAPPR-OVED PLANNING & DEVELOPMENT ❑ D COMMENTS .CONSERVATION Reviewed on Signature I COMMENTS HEALTH Reviewed on Signature 1 COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: :Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow-k2 Engineer: Signature: Located 384 Osgood Street FIRE IDE PARTM� N`f Temp Dumpster on site yes no Located at 124eMairStreet �.� :r� `„' xt�;c:” Fire Departmet signature/date t ;• r COMMENTS_._ i Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 42,000.00 m $ - $ 504.00 Plumbing Fee $ 63.00 Gas Fee 100 comm. $ 100:00 Electrical Fee $ 63.00 Total fees collected $ 730.00 32 Booth Street Kitchen Remodel BP 553-14 on 1/21/14 NORTH own of _ Andover p to No. I - C% h , ver, Mass, 2COCHICHEWICK y1. AORATfo PPa,�'Qy S U BOARD OF HEALTH Food/Kitchen PERM-IT LD Septic System THIS CERTIFIES THAT . �. ........� h. .............. BUILDING INSPECTOR J haspermission to erect .......... a Foundation p ................ buildings on .................. .... ........ ..........�.......... Rough to be occupied as ........:.e................ !. ..:�.................................................................. Chimney 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final �p PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CON-STRUCTION W T Rough Service ...................... ... ....... .- .,,,�,.............. Final BUILDING INSPECTOR 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. g SEE REVERSE SIDE i �yyee ��ie�amnlanuiea.���..C-'/�tcJ��ic�r�Jefl� \ Office of Consumer Affairs&Business Regulation NOME IMPROVEMENT CONTRACTOR egistration: 175613 Type: expirationzExpiration: 5/24/2015 }pdiyidu�l; � - ANTHONYADAM ANTHONY ADAM 13 HENDERSON ST g ` SOMERVILLE, MA 02145- Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction SuperN icor License: CS-100853 ANTHONY ADAW 13 HENDERSON STREE~ N SOMERVILLE NIA 021441, Expiration Commissioner 09/23/2015 J i 7-�I � III AI -eMse#1617�� 0,���7) ��8-��q� 32Booth Street, North Andover, MA This is to.serve as a contract between the Anthony Adam trading as A Adam Construction from 13 � Henderson Street,Somerville, MA, and the owners mfthe above address,James and Mary Beth Fry. � � The projectistherennode|ingmftheNtchenandthediningnoomn.Wevvi|| rep|acea|| cabinets, countertops,windows and doors in these rooms.We will update plumbing and electrical to meet the new plans and current codes.All exterior walls that get exposed will be insulated as best as possible. Wall's will becovered and plastered tomatch current conditions. � The price includes materials for framing,doors,windows, plumbing,electrical,trim stock, cabinets and painting f new work in the kitchen and dining room.The price includes permits and inspections. i The Commonwealth of Massachusetts - Department of Industrial Accidents _ Office of Investigations 600 Washington Street Boston,MA.02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Buil.ders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): <�At t t3 G— (0,,S%ACAA0J_ Address: %5 � �.c-�-Sa.) sc �►� t �G�ei" �►`��1 ��.�k� City/State/Zip: `7 W t LLty o:Lk kV- Phone#: C(,Okl 3G% t%(110 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.KI am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers comp.insurance. Y9. ❑Building addition [No workers'comp.insurance 5. ElWe 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.❑Roofrepairs insurance required.] employees.[No workers' comp.insurance required.] 13.[i Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i-Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this boas must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lie.#: ExpirationDate: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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: Date: 01 l S14 Phone#: 6 lot - � U 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the fore of a engaged' g g g g ed m a joint enterprise,and includingthe al representatives of deceased g p eased 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 cant'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/limnse 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(ifnecessary)and under"Job Site Address"the applicant should write"all locations hi (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. Anew 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 bum 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 Ga onWeaj&ofMassachusotts -f, Department ofb dustrial.Accidents Aff"toe of favcstigatiom 600 Washington Strout Boston,MA,02111 TO,#617-727-4900 opt 406 or 1-877,7 ASSAFE Revised 5-26-05 Fax#617"727-7749 www.ntass,govfdia i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-100853 ANTHONY ADAM-` 13 HENDERSONSTRH SOMERVILLE MA 0�1 At Expiration i Commissioner 09/23/2016 _» � T ��e�po�nz��aare.taea�a�C��civaac%c«e� i Office of Consumer Affairs&Business Regulation (NOME IMPROVEMENT CONTRACTOR Registration: 175613 Type: - Expiration: 5/24/20'1-5 . p _ _ ,�Ovidu ANTHONY ADAM ANTHONY ADAM 13 HENDERSON ST g �. SOMERVILLE,MA 02145• Undersecretary p I I i e mow i Note:This drawing is an artistic LV 200 Designed: 1/7/2014 interpretation of the general TECNNOtobles Printed: 1/7/2014 appearance of the design. It is not meant to be an exact rendition. KBS KITCHEN REV 2.kit All Drawing#: 1 \ O O 0, 10 0 I Note:This drawing is an artistic 20 20Designed: 1/7/2014 interpretation of the general TECHNOLOGIES Printed: 1/7/2014 appearance of the design.It is not meant to be an exact rendition. KBS KITCHEN REV 2.kit All Drawing#: 1 r Cr Q EI Cm - - - - - - - Note:This drawing is an artistic 20 Designed: 1/7/2014 interpretation of the general Tecn oLoaies Printed: 1/7/2014 appearance of the design. It is not meant to be an exact rendition. —NM— KBS KITCHEN REV 2.kit TAII Drawing#: I 0 6 MA ci 0 Note:This drawing is an artistic L0l Designed: 1/7/2014 interpretation of the general Tec OLOGIEs Printed: 1/7/2014 appearance of the design.It is not meant to be an exact rendition. KBS KITCHEN REV 2.kit All Drawing#: 1 4D ® 4D 4D® - - 0 o � � 0 Note:This drawing is an artistic �j� Designed: 1/7/2014 interpretation of the general TECHNOLOGIES tl� Printed: 1!7/2014 appearance of the design.It is not meant to be an exact rendition. KBS KITCHEN REV 2.kit All Drawing#: 1 Note:This drawing is an artistic 203 Designed: 1/7/2014 interpretation of the general :ec oLOGIES Printed: 1/7/2014 appearance of the design. It is not meant to be an exact rendition. Drawing#: 1 KBS KITCHEN REV 2.kit All ----- --- 112 ' ---- 1273" 15" 84 13" 5" 523" 30" 0" 26'" 4831' �45" 33 —1063" �15"1 36" 1 rf 33"�1 "'�24" 983' 13" M IN.3W4533 ` IN.3W4533' ar i .W1 L IEPR 2 , "r,_ IEPLR - ag o0 iO IN DKB1 _ IN WB 8 to IN.SSSW36R � �� ESBR ------- IN.BC48L ........................... _......_._............ ....... ...........IN.2SRB33 - FHD _ iV 1 3 � � v ao ^�- ADI IN.DB36 RDB N O t` M a N IN.W1 .. .� Ce 02 L63� IN.WBI8R co IEPL F6FC IEPR F3W PROJECT#12994 KBS-AAFRY KITCHEN REVISION 2 ECM96 TBT96 FLAT96 CFM96 SBM96.D TUKIT REF SPACE - _....____...., - 36 x 72 FPHR-LG MRS ONLY — — IN.CSCD 17� LIK2UB2787RTIN.RU391890FXSRT BM ESTR RHT,IEPL _ BEADED-INSET 8" L-39 3W' _39" 108" All dimensions-size designations M20MThis is an original design and must Designed: 1/7/2014 given are subject to verification on LOGICSnot be released or copied unless Printed: 1/7/2014 job site and adjustment to fit job applicable fee has been paid or job conditions.—NM— order placed.—NM— KBS KITCHEN REV 2.kit All Drawing#: 1 No Scale. Location Date /,-2-D_3-1 3 _ pOftTq TOWN OF NORTH ANDOVER p Certificate of Occupancy R ; Building/F a&,Permit Fee $ d a SSACMUSE� Foundation`Perm it'Fee^ $ Other Permit Fee Sewer Con&ctton Fee - W8110� nectio Fee TOTAL -1% ,$$ ' Building Inspector k'• 6776 Div. Public Works afa�s" �cation 3 Date -� x. NORo TH TOWN OF NORTH ANDOVER ot,... ,•�ti A Certificate of Occupancy $ d c3 Building/Frame Permit Fee $ ss�cwuSEt Foundation PermitFee $ L� _+ Other Permit Fee $ ' Sewer Connection Fee $ __--- Water Connection Fee $ TAL Building Inspector I 6 615 Div. Public Works LocatiSn No. Date /u NORTIy TOWN OF NORTH`ANDOVER ,. „ Certificate of Occupancy $ * _ Building/Frame Permit Fee $ ,SSACHUS f Foundation Permit Fee $ Other Permit Fee $ SgS Sewer Connection Fee $ � • "'Z74-water Connection Fee $ TQTQL $ cl 00 ' B Tding Inspector =k —�~ 64 9 Div. Public Works � k-Infif ivo. � APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 ---MAP 440. 98C LOT NO- 295 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE `ZINE I SUB DIV. LOT NO. S&S BUILDERS , INC . F 85 1169 LoCATION3UTOOTH STREET PURPOSE OF BUILDING RESIDENTIAL • OWNER'S NAME S&S BUILDERS , INC NO. OF STORIES TWO SIZE 1 OWNER'S ADDRESS 65 SALEM ST. LAWRENCE , MA BASEMENT OR SLAB BASEMENT ' ARCHITECT'S NAME GUY MESSIER SIZE OF FLOOR TIMBERS IST 2X1,0 2ND 2X10 3R BUILDER'S NAME SPAN 14 ' 2X DISTANCE TO NEAREST BUILDING 6 1 ± DIMENSIONS OF SILLS 2X6 DISTANCE FROM STREET 35± •• POSTS 3-1" CONC . FILLED DISTANCE FROM LOT LINES-SIDES 25 REAR 1401 ± •• GIRDERS 4 2X10 AREA OF LOT 25 , 000 S . F. FRONTAGE 125 ' HEIGHT OF FOUNDATION 7 1 911 THICKNESS 1011 IS BUILDING NEW YES SIZE OF FOOTING 1011X72211 x CONT. I IS BUILDING ADDITION MATERIAL OF CHIMNEY METAL - DIRECT MASONARY IS BUILDING ALTERATION NO IS BUILDING ON SOLID OR FILLED LAND SOLID WILL BUILDING CONFORM TO REQUIREMENTS OF CODE YES IS BUILDING CONNECTED TO TOWN WATER PER. REQUIREMENT BOARD OF APPEALS ACTION. IF ANY NO IS BUILDING CONNECTED TO TOWN SEWER YF4 IS BUILDING CONNECTED TO NATURAL GAS LINE NO INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST 40 , 000 . SEE BOTH SIDES EST. BLDG. COST JXTI PAGE i FILL OUT SECTIONS 1 - 3 FN .R [( p F � C) EST. BLDG. COST PER SQ. FT. I{L} , Ej LI PAGE 2 FILL OUT SECTIONS 1 - 12 DUE FRAME PERMIT p o EST. BLDG. COST PER ROOM 11 , 875 , SEPTIC PERMIT NO. N/A 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 IL D XXX 08/ /93 t' BOARD OF HEALTH SIG O OWSIAWISR ALPTHORIZED AGENT FEE ® r ® 6 82-8622 PLANNING BOARD PERMIT GRANTED OWNER TEL.# i" CONTR.TEL# SAME 19 CONTR.LIC.#-(D 71� 44____ BOARD OF SELECTMEN i n ? Q-7 SF d7ll�� UILDING INSPECTOR (0 -776 1 PL.,4 N o i LOCA /YTED. / . . ?� SCALE. /,� 0 DlJTE. �CG 4-e .4 �3 CHR%ST/AIVSEN �' SERGI Pvc. , ISO SUMMER ST. --�'9AVERRIZJ- MA. 0/830 s �o T CL/ENT. S. TH/S CERTIFICATION /S MADE 4ND LW/TED TO # l THE ,4B0VE CL/ENT. , s F� I CER TIF THAT THE ,STRUCTURE SHOWN CONFORMS �i TO TPE DIMENSIONAL REOU/RE_TS OF 'TRE. s ZONING: OFHE'wBY- Lj OF /A --"WHEN CONSTRUCTED � OFFSETS' SHOWN ARE_FOR ZO/V//VG.QETERM//Y.4T/ON ONL Y AND..ARE.NOT TO BE'=USED T0-ESTABL�/S// O �a OR DETER/L1/IVE': LOOAT/ONS PROPERTY LINES O t.. O 2 9'S o OF BU/CDING .ADD/T/ONS z. 2 Z S t To 71-1,E BE57 of MSS.:Kn owLEDGE.AND BELIEF 32• z c=.:� THE PR/MARY STRUCTURE SHO`1!/V:ON TN/.S PL:4N � ._ .� /S NOT LOCATED W/Tf/I/V A :FLOOD HAZARD ZONE o `AS 51-lowAl ON DEPARTMENT_i5!LID. °FEDERI-JL' o . Z /NSURANCE O - _ ADMN/SR..`.4_ T%O� o/V. ��M5 Y /NUN/TUMBECOMMR ,4PS �t _ DATE /' - / - 43 s : 3 2�0 ZNOF MICHAEL J. fl Gcn �I r, i� 'PEg EREaQ 1 � lAK t 1 I i .'. — '' ... _ ,.a•_--max Y--�--,---------- , FORM U - IAT RELEASE FORM :t 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, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: S & S BUILDERS , INC . Phone 508-682-8622 LOCATION: Assessor's Map Number 98C Parcel 35 Subdivision BOOTH STREET Lot(s) 295 Street BOOTH STREET St. Number �� ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved �Z Town Planner Date Rejected Comments a-LO CLL�Xh(-n-h d CZe)IQC�MCAA _�D kA�'id OGL*A R6-bA C-0- oAdzidiri Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections P� `� SSU AP" _/- driveway permit Sdie /2� z- Fire Department ""'" Received by Building Inspector Date i P 3 0199 ��®RT1-!'� w O o orr over I; ® rin !iA w! lvsy. N No. 458 9 ., ioLA 'ort dower, Mass., C O C HIC M E/•/IC Knn f, GG, ADRATED P'P \ _J, ' BOARD OF HEALTH PERM IT . T D a Food/Kitchen 1z M Septic System y W I BUILDING INSPECTOR m THIS CERTIFIES THAT.....49.. ....0..401400 AS.ArrAoies....................................... ............................ Foundation has permission to erect 11+"VA buildings on .3f%..66. 40.r..7.1...+t .!t Rough to be occupied as.e1o.sgpso. �44� 4m.f .0dMI(O ► Chimney provided that the person accepting this permit slfall in eve respect conform o the terms of the application on file in P P. P 9 P every P Final this office} and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of ,d Buildings in the Town of North Andover. j#Ar 0V's PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR ° VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-SI. B.C. Rough C Final PERMIT EXPIRES IN 6 NBT FEE PAID •o ��U - 0 U ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ,STARS Rough PERMIT FOR FRAMUBUI i)ING' 14:4 ................ .... Service ` BUILDING INSPECTOR DATE: FEE PAID4YZ�' Final Occupancy Permit Pequdred t0 Occitpy BivI d ing GAS INSPECTOR Display in a Conspicuous Place on the Premises -- Do Not Remove Rough P Y p 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 r BUILDING DEPARTMENT DEBRIS DISPOSAL,FORM - I In accordance with the provisions of MGL c.40 S 54,a condition of Building Permit Number g disposed of in a properly licensed solid waste disposal facility as Is that the debris resulting form this workshallbe di pr pe y ' definedby MGL c 11, S 150A The debris will be disposed of in: �J2 Location of Facility k Signator of ermit Applicant. II , Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector r - I CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 459 (1993) Date FEBRUARY 14, 1994 THIS CERTIFIES THAT THE BUILDING LOCATED 32 BOOTH STREET Lot ON #295 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. � T CERTIFICATE ISSUED TO S & S BUILDERS INC. 65 Salem St. x `p, ADDRESS t . a k r Lawrence MA °—�.: Building Inspector F N H - )wn of over 0 .�rte' a- .i,► .'.:, �` , ndover, Mass., 1 c BOARD OF HEALTH Food/Kitchen ] IT T D Septic System f 40 ,BUILDING NSPECTOR *• �efi............................ ... � [ t �t•i' . I S /0* buildings onFcSundation.. O.O..T/�...,�,r ..�. . Rough C , ZU Y 1v11!.� ��.. O� f� Chimney n this permit stall in eve respect 9 p ct conform�o the every p terms of the application on file in Final.�lv.� of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Andover. J* PERMIT FOR FOUNDATION ONLY PL BI G R52SPECTOR Iding Regulations Voids this Permit. REGULATED BY PARA 1144& B.P. 01 :Riv1IT EXP=f- IN 6 ' &7 FEE PAID ,Q U i a LESS CONSTRUCT_CT_ cT_ -;� ��J v �% ELEC IC SPECTOR ING 47 a Rough D` Ser L' C' BUILDING INSPECTORFin •�I L.� a f wilding GAS INSPECTOR spicuous Place on the Premises — Do Not Remove °u Vo Lathing or Dry Wall To Be Done .ted and Approved by the Build!tng Inspector. FI D'EIPAR'TMENT Burner AL CONSERVATION "b 'OLMW Street No. �► Smoke Det. _FINAL DRIVE'JAY ENTRY PERMIT 8 �� � FROM ROCHWARG/FRENCH PHONE NO. 508 686 9488 r ,A,.. P01 FSLJJ. ;L4.,;Z;U�qTJ:, W 9025 PlAIS p}+oNE NO, 506 6W 9480 F.2 P02 IMCUKy 11, 1994 Vie:Pdcrbaee of 32 Koosh Stremt,Norte Aud*yWp MA 01$45 T4 wbom it UW Gov=t Wig, the tmders�n;ed,,�'�r+ot ws the�a�a�►t 32 Hood$tzcay North . f Ar4dover dw to the 06vwa in eiavafi-ou betwom tm prUe floor.aad ddvvway. Wit ttedUdUd that the wailsa w vvM addreu exp with the vompledm of the driveway fn the Spcjtg of 1404. X-16,c h- UW M I7ombroaU No 2080 Date.1`............................� NORTF� °!,"`° TOWN OF NORTH ANDOVER 3r *•.— .....1-, e OL ' PERMIT FOR WIRING F � •O'•�i�D�I°�1' ,SSACNUSf This certifies that . . . ...:...:............: ................................................ 4.'. has permission to p ........................................................... wiring in the building of ........................... at... .... `4North Andover Mass. ....... Lic.No�&9n Fee:............. ... _ ...... �7� C�(// /� f �EL•ECTRICAL INSPECTOR r WHITE: Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth Q. . :Massachusetts, FOR OFFICE USE ONLY ' Permit No. C;2f 2 4 70 Depa1'1*meB t to f'PUbiiC Safety- . Occupancy do Fee Checked -V BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 '(leave blank) APPLICATION .FOR PER TO .PERFORM ELECTRICAL WORK All work will be performed in accordance with.the Massachusetts General Code.527, R 1 (PLEASE PRINT IN W OR TYP ALL FORMATION) Date 2 City or Town of - P AtZ— To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below: Location(Street and Number), 4 J Map: Lot: Owner or Tenant ��/ 2 _J S(eL s Le w 5 � � � Zone: Owner's Address S'9 �-- Is this permit in conjunction with a build'ng permit? Yes I No 0 6 1' (Check Appropriate Box) Purpose of iiuiidin g A-z— Utility Authorization No. Existing Service Amps /2y Volts Overhead C- Underground❑ No.of Meters New Service Amps =— / — Volts, Overhead❑ Underground❑ No.of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 0 (/( Al ey^•� No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above grnd.❑In-grnd.❑ Generators KVA No.of Receptacle Qutlets No.of Oil Burners No.of Emerg.Lighting Battery Units No.of Switch Outlets No.of-Gas Burners FIRE ALARMS No.of Zones No.of Ranges No.of Air Cond. Total Tons No.of Detection'and No.of Total . Total Initiating Devices No.of Disposals g Heat Pumps Tons KW No.of Dishwashers Space/Area Heating KW No.of Sounding Devices No.of Dryers No.of Self-Contained �y Heating Devices KW Detection/Sounding Devices No.of Water Heaters KW No.of Signs No.of Ballasts Local 1:1 Muncipal Connection❑ Other NNo_of Hydro Massage Tubs No.of Motors Total HP 1,ow Vo;iage Wiring OTHER N INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its.substantial equivalent.:YES❑NO❑ I have submitted valid proof of same to this office.YES❑NO❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE OND❑OTHER❑(Please Specify) . . Estimated Value.of EI trical ork$ - -- - (Expiration Date).. Work to Start enInspection Date Requested:Rough G Final Signed under the p nalties f pe ury: FIRMNAM os_ _. LIC.NO. .Z Licensee � ,S"�,l/ p � -- Signa ure '�` 'LIC NO: Address Bus.Tel.No. 7 5'3 2'6 Z Alt.Tel.No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this perniit application waives this requirement. Owner❑ Agent El (Please check one) (Si Telephone No. . PERMIT FEE$ (Signature of Owner or Agent) w a 1 a Location J, 1 No. ���/ Date i I NaRTM TOWN OF NORTH ANDOVER OL O 0 � 1- 0 p • ; ; Certificate of Occupancy $ �ss�cMuSEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ Check # C�7 `i '7557 Building Inspector r-ERIVU'T NO. APPLICATION FOR P.IJRMIT TO BUILD***** ' *NORTH ANDOVER, I\1IA AL1PMt�J.✓ �+� LOT NO. `� -� 2. RECORDOFOWNERSIIIP DATE HOOK PAGE ZONE C/ SU 11D111. LOT NO. LOCATION PURPOSE Or�MLDING OWNER'S NAME ,. NO.OF STORIES . SIZE Z A JL �'-1 OWNER'S ADDRESS ' ° ! BASEAIENTOBSLAB ►-��o�r�l �S i�-.�l' (� )'� ��vim- ARCHITECT'S NAME ° SIZE OF FLOOR TIMBER$'" / �1�T' 2N 31") BUILDER'S NAME SPAN ` it !_ 1l /� C DISTANCE TO NEAREST BlJ(LDING DIMENSIONS OF SILLS q u U C7 (J DISTANCE FROM STREET �yI �IN zo`�t tel" bf }—�CftJ51_ DIMENSIONS OF POSTS lD 1 /'3, 1 �\ '� tea►-�-� to — O` C , DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS-GF GIRDERS AREA OF LOT FRONTAGE 11 EIGHT OF FOUNDATION (los l 11 TIIICKNESS J O r IS BUILDING NEW Nv SIZE OF FOOTING !O 0 X ,ZO 1l t IS BUILDING ADDITION No MATERIAL OF CHIMNEY Dt-4 IS BUILDING ALTERATION y E7 5 IS BUILDING ON SOLID Olt FILLED LAND 50 L l� WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTS)TO TOWN WATER yL S BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER 1 i IS BUILDING CONNECTEDI TO NATURAL GAS LINE I�1 INSIAWTIONS 3. PROPERTY 1NFORMA"CION LAND COST 1�1 EST. BLDG.COST PAGE I FILL OUT SECTIONS 1-3 EST.BLDG. COST PER SQ. FT. EST. BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERAIIT NO. .r ATTACHED G,\RAGES MUST',CONFOIIM'r0 STAII-�FIRE REGULATIONS 4. APPItOVED BY: PLANS MUSTIM fILL:D AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DA'IEFILED' OWNERS TELH Alklw � � CONTR.TELH CON ITL LICH 1, SIGNATURE OF-OWNER OR AUTHORIZED AGENT FEEVol Y PERMrr GRANTED 19 Revised 5/5/99 JAI ��������>�as�• r� s s,j .,a <.a t -21 A, Z - Town of Noah AndoverNORTfy ` OFFICE OF o4�`�ia ',y 4. COMMUNITY DEVELOPMENT AND SERVICES 0 p 27 Charles Street North Andover, Massachusetts 01845 9S'Ac S Va WILLIAM J. SCOTT S4Huse Director (978) 688-9531 Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION ib A'1� S h( SufJ i Number S.treet address Section of town n ` �I "HONIEOWWFER" MSP-y \ 1 1�I,U`�(✓�,I (c� J . ��' 3 Name Home phone Work phone PRESENT MAILING ADDRESS 1{� 5� _ Ole Citv/Town State Zip code The current exemption for "homeowners" vas extended to include owner-occupied dwellings of six 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 Sec- tion 109.1.1) 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 to six family divelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-vear period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 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 o ti / Building Department minimum inspec.ion procedures and requirements and that he/she will s comply with said procedures and requirements. e C,A HOMEOWNER'S SIGNATURE , . APPROVAL OF BUILDING OFFICL-%L Note: Three family dwellings 35,000 cubic feet, or lamer, will be required to comply with State Building Code Section 127.0, Construction Control. BOARD OF APPEALS 688-9541 BUILDING 683-9545 CONSERVATION 683-9530 HEALTH 688-9540 PLANNING 638-9535 7. HOME IMPROVEMENT .CONTRACTOR ' =; Registration 102747 Type - INDIVIDUAL Expiration 01./02/00 STANLEY 5MITH, CARPENTER' Stanley S. Smith ar.ion.. Road a" iNiSTRATOR Peabody MA 01960 ` h . - gd=llt � V6977/I7tOI7.0/PQ�CfL O�✓� .dP.�•d BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 065152 ` Birthdate: 12/04/1946 Expires: 12/04/2001 Tr.no: 11918 Resfticted To: 00 STANLEY S SMITH 2 MARION RD 's' PEABODY, MA 01960 Administrator PAGE �J rl PREPARED BY N0. DATE ! Y A I � I Fl , i m 1 1111 �L executive Town er V No. 10L s 0 dower, Mass, J42 -48 COC nIC NE WICK 0'Y '?YL RATED D P' Cl BOARD OF HEALTH Food/Kitchen PERMIT T U I Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ........Ay.... C ile 64c. w &k ; ................ .... Foundation 41N has permission to erect..... ....... buildings on .....J. 68040M Saf me Rough to be occupied as......8^&* one 40 * Aolo.......ZPJA .................... ................................. . ......I............................ ........... Chimney ..... .... . .... .... provided that the person accepting this permit shall in every respect corm..to.t.h.e..terms.rm.s..o.f..the ap.p.I.i.cat.ion..o.n..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 l� g PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ITAPyTS ELECTRICAL INSPECTOR WOW A As Rough ...0.0.0.0 ............07.... ....A............6................... 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. Date. /.-�1�:. 250 N° 425 ' TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING R � ; sSACMUS� This certifies that . . . k1 . .� . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .- y . . . . . . . . . . . . . . at .— . . ... - .� . . . , North Andover, Mass. : - . . . . . . . FeJ�. . . .4 ic. No, �~�r . . �� � . . . . . . . . . .F PIUMBINGdNSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMITTO ISO PLUMPING (Type or print) - --- _. NORTH ANDOVER,MASSACHUSETTS c (, (( Date Building Location , �C9C`j S Owners Name r)�B l e7�S I Per # _ Amount Type of Occupancy New ® Renovation Replacement ❑ Plans Submitted_Yes No FIXTURES- Q2 cil W p H w xCr a En aCCx x w w d a aEn ' x -� hx A. F W a6 d _ w d a d a d F ►.� A A a F � d a A SLIB-B C &�41�ENT IST:HBM 2M ROM FifM 4IH Fl" Sm HIM 6IH R-aR - ffi FLOOR SIH H COR (Print or type) n S)W r�� Check one: Certificate Installing CompanyName (�O(�C Tl') }J ® Corp. Address d ❑ Partner. Business Telephone [] Firm/Co. i �6Name of Licensed Plumber. R Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ro Other type of indemnity ® Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature 7 Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and install ' s performed un Perri ued for this application will be in compliance with all pertinent provisions of the Massach tate Plu ing C e r-142 of the General Laws. By igna Of LicenseciFlumber Type of Plumbing License Title - City/Town icense Tqum8er Master Journeyman APPROVED(OFFICE USE ONLY ��/-�-Z; - Location `�' I'No. ���� Date �oRT� TOWN OF NORTH ANDOVER O 9 �o ; , Certificate of Occupancy $ cMusEtA Building/Frame Permit Fee $ r�,9-5 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 0� Check " 13 C, 61 Building Inspvcxor v, r• TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ut "zeaWW 71 R,� n BUILDING PERMIT NUMBER. DATE ISSUED: O �l L.— * (� SIGNATURE: c � Building Commissioner for of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O IV n N ,`�� Map Number ar�Tajl, ber F� (/W f E 'nf`A O l��5 1.3 Zoning Information: 1.4 Property Dimensions: Zoning DiArict Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Pri t) (q� Address for Service `.Aa f�.✓`r4 J �7�,J Sigifature Telephone a 2.2 Owner of Recor : � OName Print Address for Service: � rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ 4 S1'Y�,\ • Licensed Construction S pervisor: C S ©65 p Ra 9 License Number Mn Address 2 bo vY� � �� Expiration Date Signature Telepho a t 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name Registration Number rn M Address Expiration Date z Signature Telephone i SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Tlte rations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify MO D Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAI USE`ONLY x ` Completed by 22nnit alicant r 1. BuildingXd—j (a) Building Permit Fee -0 Multiplier 2 Electrical (b) Estimated Total Cost of Construction �3 3 Plumbing — Building Permit fee(a) X (b) 4 Mechanical HVAC O[ S. 5 Fire Protection 6 Total 1+2+3+4+5 :3 OU Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN O RS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ( 0 14LA J S as Owner/Authorized Agent of subject property Hereby authorize U �yn � to act on My-be lf,in all mattArs relative to ork authorized by this building permit application. ZL11310 0 SignaturV of Owner Date SECTION 7b OW R/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS ` HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHI1vINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 1 I FORM — U — LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT ` T \c9.2y J o �" ► �S1 e r� �'f PHONE ASSESSORS MAP NUMBER LOT NUMBER Q C� SUBDIVISION LOT NUMBER STREET 3 y S� STREET NUMBER 3 a- OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS ,, 6.,.F✓ some"MEM...E..E.ME.MEMmom mesons.......■............................... SEMEN DATE APPROVED *3 COITION ADMINISTRATOR DATE REJECTED CON 4ENTS / ( v (7-) DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTO7HEAL DATE REJECTED DATE APPROVED SEPTIC,W�§yCT -HEALTH G DATE REJECTED COMMENTS PUBLIC WORKS—SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: S1 Location: - trY1 t Pe 01.c0 1, . A-N A (0c) City Phone am a homeowner performing all work myself. 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. Policy# i 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 well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day 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 herby 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' ❑ Building Dept []Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Town of North AndoverNORTH O�stereo ,6 gti0 Building Department o 27 Charles Street North Andover, Massachusetts 01845 o �` 978 688-9545 Fax 978 688-9542 A�4 `oclc""' 11 �SSACHUS�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location �n Signature o pplicant J �8 act Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. t HOME IMPROVEMENT._CONTRACTOR j F Registration 142747 +F Type - INDIVIDUAL Expiration 07/02/00 STANLEY SMITH, CARPENTER Stanley S: Smith I r.ion Road i A MINISTRATOR Peabody MA 01960 ___, fze t�om�mwnaea o�✓ aclauaelta oT i _ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR $; Number: CS 065152 i Birthdate:'12/04/1946 Expires: 12/04/2001 Tr.no: 11918 G; r: Reincted To 00 STANLEY S SMITH 2 MARION RD PEABODY, MA 01960 Administrator t ` AORTH Town of 0 d No.all? 0�A �oCL E - dover, Mass., �.9 ORATED 5 S SE BOARD OF HEALTH Food/Kitchen PERMIT T Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT......., � 0........ �.C...O.�!�..�!�/. .. �......... """ :' Foundation has permission to erect.... .�X.a ........... buildings on .... �I..0...ap0*� ��. Rough p ......................... . ........................ Chimney to be occupied as......Dl C ....... r�����/�rN� 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 nd Construction of Buildings in the Town of North Andover. 07 r 8 P/// IV 62 S PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR P Rough 4000!�� 000................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Benal No Lathing or Dry Wall To BDone FIRE DEPARTMENT Until Inspected and Approved by the Building- Inspector. . Burner ' Street No. SEE REVERSE SIDE Smoke Det. CERT%F/ED FOUND,4T/O/Y OCA TION C, PLAN, LOCATED /N SCALE. /„ _ 0 DOTE. ,DCG. .Z-e 4y%3 � CHR/S T/ANSEN 4 SERC/ iivc. /60 SUMMER ST. ---9,4VERPILL, M,4. 01830 j z 9-g CLIENT.' . S. .r TH/S CERT/F/CAT/ON /S �5�..4DE AND L/M/TED TO � THE ABOVE CL/ENT. z � I a F� I CERT/FY THAT THE STRUCTURE 1514OWN CONFORMS TO TI-IE D/MENS/OA1,4L REQUIREMENTS OF -THE y j ZONING BY- LAWS OF :THE �! Zoo - 5 s OF /V . AN. '� '�e `WHEN CONSTRUCTED. OFFSETS SHOWiV ARE.FOR.Z01VIA10 DETERS/N,4T/ON ; ONLY. AND ARE NOT TO BE USED TO ESTABL/SH PROPERTY L/NES OR TO DETERMINE LOC,,4T/DNS �.: z�S o OF BUIL D/NG ADD/T/ONS. s 2S� TO TI-IE BEST OF MY K1V0WLED&,E AND BEL/EF $ o Z . 3 _ THE PR/MARY STRUCTURE SHOWAl ON TN/5 -.PLAN /S NOT L OCA TED W/771/1V: A 'FLOOD HAZAR ZONE AS 5A10W/V ON DEP,4RTMEwr q..LID FEDERAL '� Z IN URANC ADM/N/STRAT/ON M,4PS. ' o S E O ' COMMON/TY NUMBER. - T 3z.� " ss DATE: a . . . �p0 � EA�t� OF G i�:7 A,- J MICHAEL yon, oJ. c.' Q cn LAN