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HomeMy WebLinkAboutBuilding Permit #433 - 37 CARLTON LANE 12/14/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 2 '�r V j IMPORTANT: Applicant must complete all items on this page LOCATION 3' 1 C �� + LoNt %1�61 �VNL'q rint. P PROPERTY OWNER SCs4C V3X\\\� Print MAP NO: C PARCEL: ZONING DISTRICT: Historic District yes go Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential V 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 PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: ki � as� --a9�10 Address: �� Cir\�s� 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�b� . FEE: $ Check No.: 1 S Receipt No.: Z Z CP59 NOTE: Persons contracting with unr'egister'ed contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 3 Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 3T� Print PROPERTY OWNER SC\)* W\N\\MN Print MAP NO: C PARCEL: ZONING DISTRICT: Historic District yes so lMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential J 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 WellFloodplain Water/Sewer,. 'Wetlands i V1/etershed Districfi' y. 1 DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: ;LW Address: C��r\��°� Lave ��c ���..�•r�� t. CONTRACTOR Name - -Phone., Address: K e F> Supervisor's.Construction License Exp Date Home Imp rove ment License: Y:Exp. Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ 3� FEE: Check No.: 1S%S Receipt No.-—9=f' Z (p51 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ` v Signature of contractor Location 3 -- Cj�-4 r ! No. - Date MOR,M TOWN OF NORTH ANDOVER Ot . o ,h 3? i • -0 L Certificate of Occupancy $ s�CM Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I 22' G �� Building Inspector i i Location Date No. MpR7M , TOWN OF NORTH ANDoNIER p� . o ,• tip i 3 - • Certificate of Occupancy , . r ♦ "s ^ ' �. ' ' +, ••.,..o.�'`� Building/FramePermit Fee $ �Ss�cNuStt �-- Foundation Permit Fee $ Other Permit Fee TOTAL Check # f__—= Building Inspector i 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. VI/ 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 e COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: 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 CONSERVATION Reviewed on_ Signature COMMENTS HEALTH Reviewed on Signature "tOMMENTS 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�Dumps'ter on=site yes no,.. Located at 124 MainStreet Fire'.Department signature/date COMMENTS Dimension I Number of Stories:-_____—Total square feet of floor area, based on Exterior dimensions._ Total land area, sq. ft.: � i ELECTRICAL: Moveme nt of Meter location, mast or service drop requires approval of Electrical Inspector Yes No No i DANGERM66section2�IA � TURE: Yes i MGL Chaptemin.$100-$1000fine J i NOTES and DATA— For department use) l f I ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 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 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 i ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit j ❑ 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 P P Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract Li Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ BuildingPermit e mlt Application o Certified Surveyed Plot Plan L3 Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o 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 L3 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) o Copy of Contract ❑ Mass check Energy Compliance Report L3 Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008 NORTH Town of 4Andover O No. 433 dover, Mass.,p 1 T O LAKE ' /� COC NIC ME WICK V 7�S RATED �� BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT............S-04W........... ........ :. ... !4�►............. .... ................................................ Foundation C has permission to erect........................................ buildings on ..3;1!........ �r......... ....Irl►..........1.0.w................. Rough to be occupied as...... i��. ....,Si.�40......... .. ......... ... ..................................................... Chimney provided that the person accepting this permit shall in a respect conform to the terms of the application on file in Final P P P g P �.. . �P 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 qj * . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough Service 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. Smoke Det. SEE REVERSE SIDEJI The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations k1i 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information C Please Print Legibly Name(Business/Organization/Individual): �✓� \, �\\�aVF Address: 3'� Cess L tl, City/State/Zip: �1 p� � �h � .Y �� �IS�,Phone#: 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.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3A I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13 comp.insurance required.] .� Other__ Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Y 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 Investigations of the DIA for insurance coverage verification. Ido hereby c fy and r thepain andpenalties ofperjury that the information provided above is true and correct Si ature: /( Date: a4 1_0 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." I 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),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia -312 Y//4 Date................I................ 0*"0Rr#j TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Hu This certifies that..... C, dfl),�j ............................ ............... has permission to perform........... 5kil- ......................I...................................................... plumbing in the buildings of . ................................................................ Cioo� /-��,.j L.................... .. at.....3........7................................................... ....... North Andover, Mass. Fee.A.0...Lic. No. TO ................... . . ............................................................... Y/70 PLUMBING INSPECTOR Check it e MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY �s� _ I MA DATE dry ( PERMIT# JOBSITE ADDRESS ,L OWNER'SNAMEL& '1 POWNER ADDRESS r►-t TEL[,,' ,, .�S FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: � RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YESE11 NOF —1 Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM ! i ! ._.. 1 I _f ._..__ ___A DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM t 1 1 _. i DEDICATED WATER RECYCLE SYSTEM _( _.! -._1 DISHWASHER DRINKING FOUNTAIN I ) _-..-- I I==( ._.1. __.._..! __j FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL ( - 1 _ ! _! _ . --A –J -I _.._-.,i _..-__( SERVICE 1 MOP SINK TOILET URINAL i ---.__i ._.__.-f ...__..._j _— WASHINGMACHINECONNECTION ._r -------11 l^' TER HEATER ALL TYPES WATER PIPING INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES�O 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0/ OTHER TYPE OF INDEMNITY 0 BOND 0 11 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the -- Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge r and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMEQ�i�-,_ �_n !/ (LICENSE# SIGNATURE MP01 JP K' CORPORATION D# PARTNERSHIP D# LLC COMPANY NAME &-P ; ADDRESS CITY STATE a/Cr ( ZIP 113? TEL 3a � FAX _ ( CELL _ .��EMAIL j ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No Y `� THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES y A The Commonwealth of Massachusetts - - Department of IndustrialAcci6nts Office of Investigations 600 Washington Street Boston,MA 02111 kvi www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): n/- Address: bf., d-- s--7 City/State/Zip:.Ae�i f e 4-C� Phone#: 0 e- J 02- - Ya w;? Oz Are you an employer?Check the appropriate box: Type of project(required): 1.F1 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.[Pam a sole proprietor or partner- listed on the attached sheet.# 7• Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers' comp.,insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.[J Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 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 a-re doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box 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.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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. X do hereby certi r the pains and pen a ofperjury tliat the information provided above is true and correct. Si ature Date: o� l 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.PIumbing 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 foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. 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 COMmonwealthofMassac u.,setts DOepart ent of Industrial Accidents Office of Investigations 600 Washington Street Boston.,MA 02111 Tel,,#61.7-727-4900 ext 406 or 1-877,MASS.A.FB Revised 5-26-05 Fax#617-727-7749 Ww.Mass�,govaa Location 0,4 No. Dated NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ s Building/Frame Permit Fee $ �c"u i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # i , r _ r!u 114,JY ro-1� � L, I Building Inspector R TOWN GE NORTH ANDOVER BUILDING DEPARTMENT . APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ..';. �i.'. '.� ...� uk F I. .. .�,,,�2t✓�,,',^yam, �;•yVi:��1���l� n�7 _ _ � BUILDING PERMIT NUMBER. / DATE ISSUED: H`a _ ©Q ` SIGNATURE: A Ilk Building Commissioner for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: (� Zoning District 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 ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Na a(Print Address for Service: Sign ture Telephone 21 Owner of Record: Del— Name Print—��- Address for Service: M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: D D 0 tt t A License Number D l- S�• t� J"'� dress 1 +- '5- Expir noa trDate ic Sign rc Telephone 3.2 Registered Home Improvement Contract Not Applicable ❑ c � 1 Company Name `may Registration Number A dress 3Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes...... No.......0 SECTION 5 Description of Pro osed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / 7- All SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to ber OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbingBuilding Permit fee(a) X (b) Mecha 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 1j ? Check Number SECTION 7a OWNER AUTHORIZ ION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH.DING PERMIT _T I� N I, �'-�-� Q✓x �t/ D A,as Owner/Authorized Agent of subject property ereby authorize �� �4 to act on I Iy behalf ar a tatters rela ive t` w rk authorizeg ltyAis building permit application. 11 / Si na$are of Owner Date S C ION 7b OWNER/AUTHORIZED AGENT DECLARATION I, I e as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief t h L Pr'nt rrfe t' L� � a � Si lure of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ,� 2ND 3 SPAN DIMENSIONS OF SILLS DMIENSIONS OF POSTS t DIMENSIONS OF GIRDERS t HEIGHT OF FOUNDATION `` THICKNESS SIZE OF FOOTING < X t MATERIAL OF CHIMNEY G IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL,GAS LINE FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from 3"(5 Boards and Departments having jurisdiction have been obtained.This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT M` (`MSC HONE a-1$-"7Z5-CJ l-'j ASSESSORS MAP NUMBER ! y CLOT NUMBER SUBDIVISION LOT NUMBER STREET o, STREET NUMBER_ 3- ........................................................................... OFFICIAL USE ONLY RECONA1ENDATIONS OF TOWN AGENTS DATE APPROVED 2� D C.NSERVATIO ADMINISTRATOR l � / DATE REJECTED COMMENTS Y 0- L.1% DATE APPROVED TOWN PLANNER DATE REJECTED CON &MI S DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED /C DATE APPROVED SEPTIC INSPECTOR-HEALTH 4 COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED CONQAENIS RECEIVED BY BUILDING INSPECTOR DATE Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers'Compensation Insurance Affidavit Please Print Name: ` t kJC.LC Location: 3-� C ,G:...Ak-Ur-, 1_s1 �J City Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name Address City: K) 1 t._, �-��� `'`a Phone Insurance Co. CUL- Policy AA Ll �.• Z� Company name: Address City: Phone# Insurance Co. - Policy# 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 understan�thc at a may be forwarded to the Office of Investigations of theDIA for coverage vercation. do herbytify andpe /f/es of rju that a i provided above is bye and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' C3' Building Dept C]Check if immediate response is required Building Dept Licensing Board p Selectman's Office Contact person:_ Phone A- Health Department Other FORM WORKMAN'S COMPENSATION NO. 37 CARL TON LANE PROPOSED ADDITION IN NORTH ANDOVER. MASS. MIDDLESEX SURVEY INC. LAND SURVEYORS 131 PARK STREET NORTH READING, MA. 01864 SCALE 1"= 80' DA TE' OCT. 31, 2000 GRAPHIC SCALE 80 0 40 80 160 320 ( IN FEET ) ZONE: RESIDENCE 2 SETBACKS 1 inch = 80 ft. NOTE: LOCATION OF TANK AND 30' STREET DISPOSAL FIELD TAKEN 30' SIDE FROM AS—BUILT PLAN 30' REAR ON FILE WITH THE BOARD OF HEALTH `. LOT 26D F�3 DRIVEWAY EASEMENT B DRIVEWAY EASEMENT A LOT 25D 50,772±sf lO Q yOOJ� •�O •99, 30'x21.5±' PROPOSE �' W �\ /O IQ �•• 9 ADDITION STARTS 3' \ �• �'� FROM EX. DWELLING \Np OFM,4S'S' I� 3$04, ALPHONSE yGN DECK TO BE 0 D. t^ RAZED U HALEY ti h N0. 31312 • /`� Cp Z �z O',�N O Fs G :OA s 1sT �Al LANO I CERTIFY THAT THE EXIS77NG DWELLING IS LOCATED AS SHOWN. DETAIL DA TE.• 10/31/00 ED 6 \ SCALE: 1"=40' Regit red Lanu yor REVISED: 11/9/00 Town of North Andover NORTH 6 0 Building Department o 27 Charles Street North Andover Massachusetts 01845 _ .^ (978) 688-9545 Fax(978) 688-9542ATe 9 K. ��SSgca�uS��R� 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 locat' ]4 Sign re of Applicant lZ C Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Gw111 of North Andover .i,. r-E�_,E l E 0 � a JOYCE Offic_e Of', e 'Zoning Boa-rd-of Appeals TOWN CLERK Tod r: Comm-unity Development and Services Division HIOR T H AiNDO 7 ER William j. Scott, Division Director q'R1fc�A�R�`0 200I APR I q AIL O 27 Charles Street North Andover,Massachusetts 01845 Telephone �7 a V D. Robert.Nicetta p ( 8) 688-9541 f3tri!ding Cotr�rf�issioner This is to certify that twenty(20)days Fax (978) 688-9542 have elapsed fnxn date of decision,filed without filing of an appeal. Date le, ATTEST: Joyce A.Bra ahaus Town Clerk A True Copy Any appeal shall be filed Notice of Decision Town Clerk within(20)days after the Year 2001 date of filing of this notice in the office of the Town Clerk Property at: 37 Carlton Lane NAME: Yvette&Michael Dambach DATE: 4/11/2001 ADDRESS: 37 Carlton Lane PETITION: 009 2001 North Andover,MA 01845 HEARING: 4/10/2001 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday,April 10, 2001 at 7:30 PM upon the application of Yvette&Michael Dambach,37 Carlton Lane,North Andover, f�_ MA requesting a Special Permit from Section 4.121,Paragraph 17 of Table 2,to allow for a proposed atr addition of a family suite within the R-2 zoning district. The following members were present: Walter F. Soule,Robert Ford„ Scott Karpinski,Ellen McIntyre, George Earley. Upon a motion made by Ellen McIntyre and 2°d by George Earley the Board voted to GRANT a Special Permit to allow for the proposed.single story addition of a family suite,on the condition that the family . suite be occupied by the following person: Donna Bonin, (mother of Mrs. Yvette Dambach). lin accordance with the Plan of Land by:Alphonse D. Haley,PLS, #31312,Middlesex Survey Inc., 131 Park St.,North Reading,MA 01864, dated:October 31,2000,and refer to the architectural drawing prepared for Michael Dambach. Voting in favor: WFS/RF/SK/EM/GE. The Board finds that the applicant has satisfied the provisions of Section 9 Paragraph 9.2 of the zoning bylaw and that such change,extension or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Furthermore,if the rights authorized by the Variance are not exercised within one(1)year of the date of the grant,it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore,if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced,it shall lapse and may be re-established only after notice, and a new hearing. Town of North Andover Boardof Appeals, I�11/Decisions2001/9 Walter F. Soule, acting Chairman BOARD OF APPS iiS 688-9541 BUILDING 698-9545 CONSERVA!ION 688-9530 I-Er688-9540 FI L 1'i VCT X88-v53S hof ++s . RpQi N7+Lmrn &sf6 ct[awm� °° G+« am HA %%0 F-TTF � m kFa 1rr TypePIm J .Of) 47, per. ropips est } \ lvf Dpm / . P e , Total . %,3 .A . . . # �� �mmt %7k . THAW m� m¢ hGe pepj-zte ROf Ms X22 : /R 222g \ 3 Or)33 A NORTH Town of over 0 _:" ._ '. ". rn R No. 5 T 0 LA dover, Mass., COC­CME-ICK 0RA T E D H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.A.1.9 ....... . .................................................................... Foundation . ................L.A.Aj.-k............... Rough has permission to erect..02 41 ... buildings in ... .T. NA.PAJ .... .... ..... ..... Chimney to be occupied as...Pq�r`..... ................................................................... fo........ .....Y.... ...................j..41 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 toth Inspection, Alteration and Construction of Buildings in the Town of North Andover. �' O & C 4 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 7 Rough 4 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 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. FAMILY ROOM KITCHEN (EXISTING) (EXISTING) REUSEEWIND❑WNATWINDOWPROPOSED ADDITI❑N EATING PATCH WALL TO MATCH EXISTING (EXISTING) z ci 3'-0' `8• ALIGN NEW WALL NEW GLASS LD❑RG 4'-60 WITH EXISTING BOX BAY PANTRY II CL. N � 0 KITCHENII •9;� � o 4'-0' II z D❑ N d F- I I I I u — °° — -� rNNEW TREATED WOOD PLATFORM & STAIRS ISLAND COUNTER ILIVING ROOM EATING AREA PRELIMINARY 211-2• FIRST FLOOR PLAN JOWNII > II NEW DOUBLE HUNG WINDOWS TO MATCH EXISTING (TYPICAL) H❑WE 'q.2 EXH, / BAT)-t REUSE WINDOW T 3 FROM EXISTING DWELLING `ORAWA2100WPLANS FOR MICHAEL & YVETTE DAMBACH B E D R❑❑ WALK-IN 1°'-9 CLOSET 37 C A R L E TON LANE 100-01 NORTH ANDOVER , MA . E:1 SCALEi1/4' = 1'-0' DATEi 2%3/01 _ 22'-0' I ' • r I PRELIMINARY PLANS FOR I MICHAEL & YVETTE DAMBACH PROPOSED EXISTING 37 CARLETON LANE NORTH ANDOVER ,MA, SCALEi1/4' = 1'-0' DATEi 2/3/01 PRELIMINARY LEFT ELEVATION NEW GLASS DOOR NEW DOUBLE HUNG DECORATIVE WINDOWS TO MATCH RAILING EXISTING (TYPICAL) OUTLINE OF HIP EXISTING ROOF (SHOWN DASHED) j IFYEX TING DWELLING OOF AS H❑WN _fJN OR- EXIST G EATI AREA BOX AY PRO CTION LLI [=_11 FINIS 1ST FL R FINI GRADE LEVATI 100 +/ (SHOW DOUBLE HUNG WINDOW AT BASEMENT FIN H BASE NT FLO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ---------------------------------- - ------------------------------------- --------------------------- - ------ - PRELIMINARY PLANS FOR - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - -- - - -- - - - - - - - - - - - - - EXISTINGROOF PEAK MICHAEL YVETTE DAMBArH - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 37 CARLETON LANE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - NORTH ANBEIVER MA . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _ - - - - - - - - - SCALEi1/4' = I'-C' DATEi 2/3/01 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - EXISTING - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - DECORATIVE WINDOW - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - WEATHER RESISTANT TO REMAIN--,, - - - - - - - - - - - - - - - - - - - - - - - - RAILING - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- 'Ile PRELIMINARY DECORATIVE REAR ELEVATION RAILINGA MODIFY EXISTING EATING BAY ROOF AS SHOWN in LE I r H 1.7i I 'RUBBER'11111111111 IWMEMBIRANE ROOVF ml -,le 1.41 APPROXIMATE ROOF PEAK a 111111 - - - - - - -- - - - HE wFw-y,- ,W,y Mw - - - - - - FINISH aND F-1 QnR I it NEW GLASS SLIDING DOOR FINISH 1ST FLOOR SILL ELEVATION 105.03' FR� I V FINISH GRADE ELEVATION 100 (SHOWN) \40-UBLE HUNG WINDOWS AT BASEMENT (TYPICAL) SIDING TO FINISH BASEMENT 'LOOR MATCH EXISTING _NEW TREATED WOOD STAIRS & LANDING EXISTING PROPOSED PRELIMINARY PLANS FOR MICHAEL & YVETTE BAMBACH 37 CARLET❑ N LANE NORTH ANDOVER , MA . SCALEi1/4' = 1'-0' DATEi 2/3/01 PRELIMINARY RIGHT ELEVATI❑N OUTLINE OF 'FLAT' HIP ROOF (SHOWN DASHED) DECORATIVE RAILING RUBBER MEMBRANE R❑ F REUSE DH PICTUREEXISTING WINDOW UNIT FROM EXISTING DWELLING BWELLING H FLOOR CASE NT W DOW LLffi IIEEEEE�Eill jlL—J i zo F ISH 1S L❑❑REEE r, R SIDING El I d M H EXIS NG F ISH GR E ELEV I❑N 100 +/— (SHN) f INISH B EMENT ❑❑R BASEMENT LEVEL DH WINDOWS (TYPICAL) CONCRETE FOUNDATION i I EDGE OF EXISTING (EXISTING) DWELLING BEYOND MASTER BEDROOM WINDOW ABOVE ALTERNATIVE DH FF- — —11— — —_ — -7,,—TYPE WINDOW AT MBR, I S'- 1 1/2' ABOVE FINISH FLOOR ALTERNATIVE AWNING TYPE i ^ ALTERNATIVEMBR, �' '� \ L — �_ — J (EXISTING) BOTTOM WIND❑W 4112 ROOF SLOPE i MASTER BEDROOM (RECOMMENDED) i 1 1/2' ` (EXISTING) FINISH ZO FL1 — — — a 2�v o ( \ (EXISTING) \ FINISH 1ST FLOOR TYPICAL SILL DETAIL ANCHOR BOLTS AT 4'O,C. SILL SEAL FOAM INSULATION DOUBLE 2 X 6 TREATED SILL CONTINUOUS RIBBON JOIST FINISH GRADE S �: ',�• SLOPE. FINISH GRADE r � FOUNDATION PE TER DRAIN] A' DIA. PERF❑RATF�PVC PIPE FINISH BASEMENT FLOOR • t ,. — — 3/4' CRUSHED STONE deeed„ r i + FILTER FABRIC r: t•- "'',,,,,� �; s•;.; DISCHARGE AT APPROVED LOW P❑INT V I^F,^SUITABLE SOIL BEARING Town of North Andoverof tkoRTit q tt4"° • Office of the Health Department Community Development and Services Division William J.Scott,Division Director ' 27 Charles Street "ssqcH�s North Andover,.Massachusetts 01845 Telephone Sandra Starr p (978)688-9540 Health Director Fax(978)688-9542 June 14,2001 Mr. Michael Dambach 37 Carlton Lane North Andover,MA 01845 Re: Application for 3 room in-law apartment Dear Mr. Dambach: Your application for an addition at 37 Carlton Lane has been reviewed by the Health Department. The application was denied on May 17,2001 for the following reasons: 1. V Missing information 2. ❑ Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable To address the problem(s): If#1 is checked, please supply: 'Da: Floor plan of existing and proposed addition b. Certified plot plan showing house, septic system and proposed project in scale If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If#3 is checked: a. Relocate the project Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, P Sandra Starr,Health Director Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 �a No J (, Date.................................... NOR7M °ft"`°:•�"� TOWN OF NORTH ANDOVER - = PERMIT FOR WIRING 3cMusE� This certifies that - - ............................................................................................. has permission to perform ...........................r..:...........:....j......................... wiring in the building of ............. ....o................................................ .............................. 1.... .......................... ,North Andover,Mass. 1 Fee-,F ...... Lic.No: 'v....✓ . ................................ ........................... i ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer DEPARTMF.IVTOFPUBMC&4FM7 Permit No. `-3g600 BOARD 0FMEPREVEW0WRE6MT10AN527CMR12. 0(k WA Occupancy&Fees Checked PPLICATIONFOR PERMIT TO PEUORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL.INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) J CG r —/U h c,, Owner or Tenant 1'Y)/Ke 5ct G Owner's Address am i Is this permit in conjunction with a building permit: Yes® No M (Check Appropriate Box) Purpose of Building Sr\GI2 Utility Authorization No. j Existing Service Amps Volts Overhead M Underground No.of Meters New Service Amps` /� Volts Overhead M Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work` 22X :O uj No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures KVA Swimming Pool Above Below Generators KVA ground around rl No.of Receptacle OutletsO No.of Oil Burners No.of Emergency rg y Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pum s Tons KW Initiating Devices ti No.of Dishwashers Space Area Heating KW No.of Sounding Devices I No.of Self Contained ..�.�..� Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Oth'r' No.of Water Heaters KW No.of No.of ID Connections Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER htsttta=Cotei RttsuatttbthetaWwmrtlsdM=xhuscftGffvWLaws Iha%eaa�Liabt�'ybstr>ta=Pbhcymck&igC Vide .CbmaWorissubsbrtialeguhWat YES NO IhmestbtnitiadvalidptoofofsameloftOfm YES If}mhmedw&WYES pkmmdc*thetmxofoomaWbydmckffgthe F I1V5<JRANCE © BOND OU-M �1..�(Pfea9eSPaafi') F5aaLal[)* BlJm*dVArdE1mwal Wade$ WatcbSttt hq3ectiatD*Reguested Rough Final Si�edutxia�teP�taltiesafpajtay. FIRMNAN E Lioa�seNoe Signe _ Lioa> l b 0-c),G BtmmTdI OWMR'Sll�LAJRANCE. WAIVFRI.anawm hattheLdcest�tseAItTeLNo �t tt�ethean�xatneoo�ol-Rss�t�ialec�rivalartasl8cg�dbYGeaalLaws aodtl�atmyaernitlis}�mt� vmi�stl>iste�na>k. (Please check one) Owner a Agent Telephone No, PERMIT FEE�C �`` Date. j �. > N° L+ � � v TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 41 ,SSACHUS� This certifies that . . . ... . . . . . . . . . . . . . . has permission to perform . . . .`. r.�. `. `. !. .. . . 1411 plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l . . , North Andover, Mass. Fee. . S ". .Lic. No.. . C. : . . . . . . . . . . . . �. .--�- . . . . . . . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date 8 Building LocationJ9 eArI TG'Y� L I�/ Owners Name !I1 1 '_J�/�i�„ IQ t�G Permit Amount — Type of Occupancy New Renovation Replacement Plans Submitted Yes ElNo FIXTURES r z w x a w EQ,, w t� d 04 Cr a x C E-� a s z d Q ►.7 A A ..1 H d SCRBSW &�41VII�II' Y ISI:FLOM MHOM 3M FLOOR 41H FLOM 51H ROM 6IH FLOCK 7IH FLOM SIH FLOOR (Print or type) Check one: Certificate Installing Company Name ��C��e���1✓1 p�G F� Corp. Address U Partner. Business Telephone 63 3 z j —L g 0 Firm/Co. Name of Licensed Plumber. zl�� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy M11 Other type of indemnity ❑ Bond En 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 Owner F1 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 installations orm er Pep3lit Issued for this application will be in compliance with all pertinent provisions of the MassachusW Stat lumbintitleode d'Chapter 142 of the General Laws. By 1pa o7` cens um e Type of Plumbing License Title /- �8%J City/Town Icense Numoer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Date. . .;�.. . �.'. . . :. .! .. . Of ,ORTH 1ti 3= °` '6 TOWN OF NORTH ANDOVER CS 0 .� A • PERMIT FOR GAS INSTALLATION �4 1SSACHUSEt This certifies that . ,S.{ ' ,� : . ... ..... . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . .9Z'.!'.'. n.c-I. . . . . . . . . . . . . . . . . . . . . . . . at . . . ... . . .. .. �.I.C. . . . . .`. :. . . . . . . , North Andover, Mass. Fee. � .. .". . . Lic. No.. .� . i sC . . . . . . �,.� . �':.�. . . . . . . . GASINSPECTOR v Check# f r, c- 'I 37 . MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations 3 7 ��^��' Permit# �� Amount$ Owner's Name �/l<e- New❑ Renovation �-- Replacement ❑ Plans Submitted ❑ U O d p O F b SUB-BASEM ENT BASEMENT 1. 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR 8TH. FLOOR (Print or type f ` one: Certificate Installing Company Name e'f� ,0 1 h 0 Li Corp. Address v -44-- 2-0 ❑ Partner. G2 _ 11j, FE Business Telephone 1-0 03 3 Firm/Co. Name of Licensed Plumber or Gas Fitter &-e,,lP_ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes R2- No❑ If you have checked yes,please indi a"W-coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(- r en ove appl' tion are true and accurate to the best of my knowledge and that all plumbing work and installations,Pe orm and r Penn ed for this application will be in compliance with all pertinent provisions of the Massachusetts Sta ��an apt er of the General Laws. By. Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber 9g)0 City/Town ❑ Gas Fitter License Number aster APPROVED(OFFICE USE ONLY) ❑ Journeyman aoarrd Zoning Bylaw Review Form 3`�v..•, •.,, a oe Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 SACH13 Phone 978-688-9545 Fax 978-688-9542 Street: 3 C_ A OtcAt ' J4_A.4v_)f Map/Lot: () 6, f 9 4 R_a Applicant: M le a w_-.I -i- Oetfe- A m c. Request: aI ' X-.30' A Date: I.Z _Q3 DoE i Please be advised that after review of your`Application and Plans your Application is /DENIED for the following Zoning Bylaw reasons: Zoning Item Notes Item A Lot Area Notes • E• Frontage 1 Lot area.Insufficient 1 Frontage Insufficient 2 1 Lot Area Preexisting 2 Frontage Complies �1 S 3 Lot Area Complies S 3 Preexisting frontage 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building Area — 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required e S 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply e .5 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies y S 3Left Side Insufficient 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient In 5 Rear Insufficient I Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Inform, D Watershed 2 Coverage Complies 3 Coverage Preexisting 1 Not in Watershed y S 2 In 4 Insufficient Information Watershed j Sign 3 Lot prior to 10/24/94 4 Zone to be Determined 1 Sign not allowed 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district e S 2 Parking Complies _E] �S 3 Insufficient Information Remedy for the above is checked below. Item # Special Permits Planning Board. Item# Variance Site Pian Review Special Permit Setback Variance Access other than Frontage S ecial Permit Fronta a Exception.Lot Special Permit Parkin Variance Common DrivewaySpecial Permit Lot Area Variance Congregate HousingSpecial Permit Hei ht Variance Continuing Care Retirement Special Permit Variance for Sign Inde endent Elderl Housin S ecial Permit S Special Permits Zonin Board S ecial Permit Non-C' Use ZBA Lar a Estate Condo S ecial Permit Planned Develo merit District S ecial Permit Earth Removal S ecial Permit ZBA S ecial Permit Use not Listed but Similar Planned Residential Special Permit R-6 Density Special Permit S ecial Permit for Si n Watershed Special Permit Other Sup ly Additional Information The above review and attached explanation of such is based on the plans,request for or Information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for this action. Any inaccuracies,misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled°Plan.Review Narrative"shall be attached hereto and incorporated herein by Tferen he b ilding de a5ment will retain all plans and documentation for the above file. $uilding De me Official SignatureC�2 c2j' Application Received Application Denied Denial Sent: If Faxed Phone Number/Date: Uacation = } No. 1117 Date NORTIy TOWN OF NORTH ANDOVER O F S • • • � ; , Certificate of Occupancy $ CHUs tBuilding/Frame Permit Fee $ �- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # i " J Building Inspector Cl i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING a x x_ 00 , r �. BUILDING PERMIT NUMBER: ��'� DATE ISSUED: , /� e? _p�, M SIGNATURE. �" Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O 3 � CwV-110 P7 61V d lollo G - o0v � q Map umber Parcel Number 1.3 Zoning Information: ` 1.4 Property Dimensions: \ Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide 'red Provided R red Provided 0 1.7 Water SupplyM.GL.C.40. 54) I.S. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT i 2.1O ner of Record Nanta(Print) Address for Service: p • I Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone MM SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: N License Number Address mn Expiration Date Signature Telephone 3.2(Registered Home Improvement Contractor Not Applicable ❑ 'A c` � �_c9(I�� Company Nathe " (,C) �l may- K- 3k C �O� Registration Number r jAd ns a313JI100 -Expiration Date zure Tele hone i A IMPROVEMENT.CONTRAVOR ration 03/31/2002 �pe: Private,Corporatio f Sop Mahoney, AbMINIS7RATOWO. READING NA 01964 i .f - f � NORTIy � Town 0 4 over 17 o dover, Mass., �jCOCHICHEWICK V I�pRATED PP � � r 7 H 4` BOARD OF HEALTH p Food/Kitchen PERMI T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................. ........................ Foundation I has permission to erec ... . p buildings on.. � ..... ...... .. .. Rough to be occupied as...woopp. . Chimney provided that the person accepting this rmrT shall in every respect conform to the terms of the application on file in Final t this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of i 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 CONSTRUCTION ST T Rough ...................................................................................1........................... Service BUILDING INSPECTOR Final I 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. eORTFJ gb,; tln c'•�"oo Zoning Bylaw Review Form Town Of North Andover Building Department 27 Charles St. Norah Andover MA. 01845 ° .nqy 'kqs Air. i S"`"°5F• Phone 978-688-9545 Fax 978-688-9542 Street: 3 ( A t/f-cA> �,A/v f Ma /Lot: 1061 1/9 1' 1 1. R__), Applicant: M iC a e.1 •t tJeife.. - A r) Request: cR l ' X-3 c,,' A '• l 0 x `FFA Date: Please be advised that after review of your Application and Plans your Application is /DENIED for the following Zoning Bylaw reasons: Zoning Item Notes Item A Lot Area • F Frontage Notes 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting 2 Frontage Complies H 5 3 Lot Area Complies S 3 Preexisting frontage 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies _EEE�4 Special Permit Required geS 3 Preexisting 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply e S 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies y e S 3 Left Side Insufficient 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient T_-Building Coverage - 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed `t cs 3 Coverage Preexisting 1 Not inWatershed y .S 4 Insufficient Information 2 In Watershed Sign 3 Lot prior to 10/24/94 4 Zone to be Determined 1 Sign not allowed 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district S 2 Parking Complies �5 3 Insufficient Information RemedY for the above is checked below. Item # Special Permits Planning Board. Item# Variance Site Plan Review Special Permit Access other than Fronta e S ecial Permit Setback Variance Fronta a Exce tion Lot S ecial Permit Parkin Variance Common DrivewaySpecial Permit Lot Area Variance Congregate Housing Secial Permit Height Variance Continuing Care Retirement Special Permit Variance for Si n Inde enden..Elderl Housin S ecial Permit S ecial Permits Zoning Board S ecial Permit Non-Conformin Use ZBA Lame Estate Condo S ecial Permit Planned Develo ment.District S ecial.Permit Earth Removal S ecial Permit ZBA Planned Residential S ecial Permit S ecial Permit Use not Listed but Similar R-6 Densit S ecial Permit S ecial Permit for Si n Watershed S ecial Permit Other Su I Additionallnformation � S �Id I t'r`y;-�— The above review and attached explanation of such is based on the plans,request for or Information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for this action. Any inaccuracies,misleading information,or other subsequent.changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled°Plan.Review Narrative"shall be attached hereto and incorporated herein by referen . he b ilding de 5ment will retain plans and documentation for the above file. Building Departme Official Signature}' Application Received Application Denied Denial Sent: If Faxed Phone Number/Date: Plan Review Narrative The following narrative is provided to further explain the reasons for the action on the property indicated on the reverse side: ✓ 6'c A ' IGLSr '3vlXF Referred To: Fire Health Police Zonilnq Board Conservation DPublic Works Plannin e artment of Historical Commission Other BUILDING DEPT ZomngBylawDenia12000 Sol l � TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING XW R11 BUILDING PERMIT NUMBER: DATE ISSUED: M SIGNATURE: Buildin Commissioner/1for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 3-1 K) . ^ y c(, A 4 cx�J I Map Number Parcel umber 1.3 Zoning Information: C I 1 `� 1.4 Property Dimensions: � � oQc�,v�tz� nu+. Cu4e� 50 77-�, Zoning District Proposed Use Lot Area(slo Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R aired Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHWIAUTHORMD AGENT 2.1 Owner of Record Name(Print) Address for Service Sign re Telephone 2.2 Owner of Record: Name Print Address for Service: O z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number M Address ru Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work check all a Ilcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be r (3C USt(}NLY s Completed by permit applicant N' ` wP,. u i 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUMDING PERMIT 7 as Owner/Authorized Agent of subject property Hereby uthorize to act on ye alf, 'iall ma ergrelative to authorized b this building permit application. 40 Signa e of Owner------- Date SECT ON 7b OWNER/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 Si ature of Owner/A I ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2 RD 3 RD SPAN Dl]v ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOO"TING X MATERIAL OF CH \4NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NO. 37 CARL TON LANE PROPOSED ADDITION IN NORTH ANDOVER. MASS. MIDDLESEX SURVEY INC. LAND SURVEYORS 131 PARK STREET NORTH READING, MA. 01864 SCALE- 1'— 80' DA TE. OCT. 31, 2000 GRAPHIC SCALE 80 0 40 80 160 320 ( IN FEET ) ZONE: RESIDENCE 2 SETBACKS 1 inch = 80 ft. NOTE: LOCATION OF TANK AND 30' STREET DISPOSAL FIELD TAKEN 30' SIDE FROM AS-BUILT PLAN 30' REAR ON FILE WITH THE BOARD OF HEALTH `. LOT 26D FoJ �� 211• DRIVEWAY EASEMENT B // DRIVEWAY EASEMENT A — y1��0 �, LOT 25D� i 50,772±sf - I"�w ��15tY• Yr� _5� • 9 30'x21.5±' PROPOSE ^� W 4\ /p 9�� ��• 3.1g' ADDITION STARTS 3' 1 \ N O 6� FROM EX. DWELLING ,_SN OF MAss�c I\ 38.04. ALPHONSE yG,p W IF DECK TO BE 0 D "o,0 RAZED o HALEY N0. 31312 �l 40• y SS. QEGI STER� nNo CONAL LAW 6\0, I CERTIFY THAT THE EXIS77NG DWELLING IS LOCATED AS SHOWN. DETAIL DATE,• 10/31/00 w \ SCALE: 1"=40' Regi t red Lan u yor REVISED: 11/9/00 �/ Location � 17 N No. ` t" Date 140 Th TOWN OF NORTH ANDOVER F � 9 • ; : Certificate of Occupancy $ �'�;'••• E<� Building/Frame Permit Fee $ 4u5 Foundation Permit Fee $ U Other Permit Fee $ TOTAL $ Check # �� ! C J / J n v Building Inspector a 0 T BUILD*******"NORTH ANDOVER, MA � PERMITNO. l � APPLICATION FOR PERMIT O ` P LOT NO. GN Z. RECORD OF ONVNERSHIP DATE BOOK PAGE MAP NO. V / ZONE SUB DIV.LOT NO. A l ,,^ LOCATION �7 `AeO� � PURPOSE OF BUILDING jl� ` `TJ v ' OWNER'S NAME NO.OF STORIES lz SIZE j OWNER'S ADDRESS BASEMENT OR SLAB /e&A1 .57 �U- lJl� ,q E7/c46- I r 2 D 3RD ARCIIITECT'S NAME SIZE OF FLOOR TIMBERS BUILDER'S NAME �'�( C7SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEN SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION `2� ���-���C/�Ey C�,8/pl/�/_S 4r x- IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN NATER BOARD OF APPEALS ACTION,IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTUCTIONS 3. PROPERTY INFORMATION LAND COST EST. BLDG.COST PAGE I FILL OUT SECTIONS 1-3 EST.BLDG.COST PER SQ. FT. EST. BLDG.COST PER ROODI ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. ATI'ACIED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST BE FILED APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR No DATE FILED OWNERS TEL# / - / CONTR.TEL# V z i CONTILLIC# SIGNATURE OF-OWNER OR AUTHORIZED AGENT II.I.C.# FEE $ 91 PERMITGRANTED �f ✓ D/� tJC V i 1 Revised.5/5/99 JM f I 7 I `I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations = ~ ,� Boston, Mass. 02111 `5,0 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # aI am a homeowner performing all work myse!f. aI am a sole proprietor and have no one working in any capacity QI am an employer providing workers' compensation for my employees working on this job. Company name: &?. C-' hr.4-1Z Ccr�/ saT,%s�S Address RO. R.,=)r 3S3 City Phone Insurance Co. . Policv# "0 c:71//e;­4A�4 9C9 Comoanv name: Address City Phone#: Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imccsition cf criminal penalties rof 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 rine of($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations cf the DIA for cc,jerage verification. f do hereby certify under the pains and penalt ie s of perjury that the information provided above is true and correct. Signature ' G:G 06,P00- Date / � Print name,/', p,/2 holgzG Phone Official use only do not write in this area to be completed by city or town official, City or Town Permit/Licensina ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person. Phone"t ❑ Health Department 7 Other North Andover Building Department L Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) /, 14 000 Signature of Permit Applicant ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector �...F,,,. O; e -iOQryIypEOMw 6�✓I�GQdG EIIOeL[a '' ' BOARD OF BUILDING REGULATIONS i•.; License: CONSTRUCTION SUPERVISOR Numb040752 x 8irthd�O X09/28/1960 EXpires 09/28/Z Tr.no: 3747 - l'( ='jRestricted To: 00 j MARK G.HALL PO BOX 383/12 UPlO�J�,AVE;`>`' � ' . N READING, MA 01864-- Administrator I. i ME wj r Q S� r A, 86 i I I ACORD�,C'E(�1 I Ci4TE OLIAB� 'I1 ��NSU ' � �03/16/z000 r l � ROOUCER (508)655-0522 FAX (508)655-8853 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION arl i n Insurance ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE '33 West Central StreetHOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. dtl ck, MA 01760 . COMPANIES AFFORDING COVERAGE ' _�—. — --'----.._....- COMPANY American Employers' Insurance Co. (CU) .tin: - Ext: A •4SURED M.C. Hall Inc.— ------------- COMPANY Commercial Union Insurance Company M P.O. Box 383 B North Reading, MA 01864 COMPANY The Northern Assurance Co. of America (CU) C ......................—.._._..------'— COMPANY D ;OVERAGES . na `"•. - :. , t ' . Xt .. 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION LIMITS DATE(MWDD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE S 2,000,000 X j COMMERCIAL GENERAL LIABILITY I PRODUCTS-COMP/OP AGG 1$ 2,000,000 A CLAIMS MADE IFT' I OCCUR PERSONAL&ADV INJURY 1$ 1,000,GOO_ BR557102 04/27/1999 04/27/2000 — OWNER'S 8 CONTRACTOR'S PROT 1 EACH OCCURRENCE $ 1,000,000 _----. ---- ..._ ---.._._......---...._. FIRE DAMAGE(Any one fire) S 100,000 MED EXP(Any one person) $ 51000 AUTOMOBILE LIABILITY ANY AUTO , I', COMBINED SINGLE LIMB S - 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X !SCHEDULED AUTOS (Per person) B I BXB17461 04/27/1999 04/27/2000 X : HIRED AUTOS ( BODILY INJURY X NON-OWNEDAUTOS j I (Per accident) $ _--.---..__...--..------...-----........._...... PROPERTY DAMAGE I$ GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $ ANY AUTO 1 OTHER THAN AUTO ONLY > -- ( EACH ACCIDENT;$ I AGGREGATEIS EXCESS LIABILITY EACH OCCURRENCE $ 3,000,000 B X UMBRELLA FORM CBDW14326 104/27/1999 ( 04/27/2000 I AGGREGATE ,a — 3,000,000 �' --- --- OTHER THAN UMBRELLA FORM ! 1 I I s WORKERS COMPENSATION AND 1 L—I ERy+' 4 EMPLOYERS'LIABILITYLIM_TOFW THE PROPRIETOR/ :N B 00 H16 44 98 04/27/1999 04/27/2000 i EL EACH ACCIDENT 5 500,000 PARTNERS/EXECUTNEINCL If EL DISEASE-POLICY LIMIT S _ 500,000 - OFFICERS ARE: EXCL; I OTHER ELDISEASE-EAEMPLOYEE $ 500 QQO I I I ESCRIPTION OF OPERATIONS/LOCATIONSMEHICLES/SPECIAL ITEMS f For informational purposes. r _'ERTEFIC" Y ,4 .. ANGELlJ1 SOI rsc16 NOx. . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DA�HEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. TO WHOM IT MAY CONCERN AUT D D RESENTApI�E \COR • ©ACORDFCO OPR—'�"'-RATf5W 98 NORTH Town of Andover No. 46 = LA o dover, Mass., COCHICHEWICK ORATED 3 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System A BUILDING INSPECTOR THIS CERTIFIES THAT..... .�� `� Y � .............................. .................. .......................................................................................... Foundation has permission to erect....��. LON....W!�1. buildings on .... ...........0*4 :e N..... ............. Rough to be occupied as...............��flo 4✓V '4e- A rs* W`tyC ti................... 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. M /614 C )0 W PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 911Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIO ST S ELECTRICAL INSPECTOR 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. Smoke net. SEE REVERSE SIDE Z-� 39 In (� C 'DAM A c h `�V`� NO. 37 CARL TON LANE PROPOSED ADDITION IN NORTH ANDOVER, MASS. MIDDLESEX SURVEY INC. LAND SURVEYORS 131 PARK STREET NORTH READING, MA. 01864 SCALE. 1'= 80' DATE. OCT. 31, 2000 GRAPHIC SCALE 80 0 40 60 160 320 ( IN FEET ) ZONE: RESIDENCE 2 1 inch = SO ft. SETBACKS NOTE: LOCATION OF TANK AND 30' STREET DISPOSAL FIELD TAKEN 30' SIDE FROM AS-BUILT PLAN 30' REAR ON FILE WITH THE BOARD OF HEALTH `• ��oaa LOT 26D DRIVEWAY "Y EASEMENT B r DRIVEWAY EASEMENT A LOT 25D 50,772±sf J XX m w 9 30'x22' PROPOSED l� V \ N 3Lo -� �. •29• ADDITION ��. \.O+ 6, Hca. P�-,N OF A/ASS�c I `;8 04, 0) sj( . OtiG IF/ DECK TO BE � ALPHONSE U, RAZED � D. HALEY NO. 31312 O IST 0 SAL LANG /' 62 I CERTIFY THAT THE EXISTING DWELLING IS LOCATED AS SHOWN. DETAIL DATE.• 10/31/00 W \ SCALE: 1"=40' egi red Lan u yor w�