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Miscellaneous - 10 KEYES WAY 4/30/2018
O� m kA o4- p 3 4 8 0 10 SS CHU '� :�9 -/ Date .... :':� .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................. .. ......... ................................................................ has permission to perform--.-.�: .......................................................................... -,4 wiring in the building of ..................... ......................... at ............................................................................... . North Andover, Mass. Fee= ..... : ............ Lic. No......." ...... ............ .................................................. / ELEcTRicAL INSPECTOR Check # � /, 2 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer DEPARTMENTOFPUBLICS MY BOARD OFFIREPREVEM70NREGUL4TIOMSS27CAfR 12DO Office Use only Permit No. �!� ter Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) 6 Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes [�No r7 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead r,-1 Underground No. of Meters Number of Feeders and Ampacity j Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA and ound No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets U No. of Gas Somers FIRE ALARMS No. of Zones No. ofjRanges / No. of Air Cond. Total Tons No. of Detection and No. of Disposals / No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices . No. o Dishwashers Space Area Heating KW / No. of Self Contained Detection/Sounding Devices LocalMunicipal Other No. of Dryers Heating Devices KW Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• IrR==Ca Rtrsuat�bihetagt>$anabs�GalaalIaws Ihawaa=tLdn7dyLmm=Pabcymdxb tgCat m Co Qisaht34ale*&ala# YES M NO E3 Iha%e%hnhedvaldpvo(ofs&neiothe0ffi= YES M NO IfjcuhawdwcWYESplemmdc&theWcfamawbydtemtgthe INSURANCE M BOND OTHER M ftweSpacity) Exlxrabm D& Esti� ValuecfF moral Wade $ WakiDSult hqpactimD*RaVestod Rta>gtI Sig�edutlder�ieP9�albes�perjtay. , FIRMNAME u� o LiornseNa _ � Fa `3 197 Licaisae 1� ��C�/Gi G Sigr>�tue �' + Lioa>SeNo Bisitr�sTel.Na ��Z � � 5' % Ak.Td% ( OWNER'SkNSURANCEWANFR;IammNmettAtbeI doe ird etheitutra�oeeoveraget Te�rivata�ascecp WbyM G=raham aad � my sigr�taealfl»s pts this ra�arertr. (Please check one) Owner Q Agent 1....1 d Telephone No. .PERMIT FEE ��� � Location. //0 X<we S a"� /v No. k-, � 3 — Date Z) /� 0/- 140RTN TOWN OF NORTH ANDOVER i� Certificate of Occupancy $ Building/Frame Permit Fee $ Z 4CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 4 S', - Building Inspector Sent bVIG Feb -88-01 09149 from 9783723960 /Ss 0 g Z) /oma o50 -B 0 Ap- 35 1 49 f LOT. 1 t U, l . LOT 2 21,5r,O.F j ELEV. -161.6' FX/STING 1 £AsurNT FOUNDATION s� i t,. � YDS ;�:. ° *, FOUNDATION LOCATION PLAN iamw R ► w m W ng CL/ENT:• JAMES CARROLL .wrUM rrw.a�, a pWT WgW oaannuc,m °,�°� 'f' OW liZ cnowr� ;� tl,M�! 6'e7mfkAll�oyv Is AUM AHO CU = ro mumm ++®a ra urian roe rwr r �rr ` V6(iR1. 1 MW MT WUW • f !1!!If 11t powbow aw ' LOCA IrE'YES WAY LOT ? �'� aV nr �e�rn ,w� �. &W NORTH ANDOVER, wA� lair nrwMMAWW wr ar W AW I a� � Wnm Ownum 3 ' $CALLD " 4a' DAM FEBRUARY S, ?OOl s CHRIST NSEN &$Ml F" SAMM zwomw o to MW A. IMMNU.^ fine ft IPi-+ m-wd T;. �t„ •sae: �r � tulip► � is ,�•,,.. DRAWING NO. 000030 f 6 ot 'rot f,e 0 4F o SACHUS Date. 7-. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that C.7�ihl 4--.7A.A. 19 .... N V ................ has permission to perform .... RIC A-1 . 4 !— - 4 / -� . . . . . . . . . . . . . . . . plumbing in the buildings of . SA. ;. / 4 ...................... at. ./0 ... .............. North Andover, Mass. r T lzi� I Fee. Lic. No.).- 5' )'!-:�Vf. ............ . LI -ON LUMBING INSPECfOR Check # 6364 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MAS ACHUSETTS wh � � Date � Building Location Ilue- Owners Name � Permit # Amount ,r L -- y TypeofOccupancy A'561olocd New Renovation Replacement Plans Submitted Yes No ❑ FXT1RES Im OMMOMMOMMOMMMOMMMMMMMMMM (Print or type)r 2 1 �- Check one: Certificate Installing Company Name /y'/� ❑ Corp. Address G _ �� Partner. Business Telephone r) 9s3- I Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of ' surance coverage by checking the appropriate box: Liability insurance policy ® 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 Owner Agent El 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass usett t P tubing Code and Chapter 142 of the General Laws. BY ign ure icens um er Ty of Title Plumb' g License Cit/Town Y icense um r Master ❑ Journeyman APPROVED (OFFICE USE ONLY O fl F I�j o oorum S �` OQ`�� O.L 3 F° M 0 z r�7 d CL N t N N O r. e� N C1 V m O 0) c 0 N d t O g 0 IN Q rz -6 C C m th C -0 3 o a m ,J u Ln a to a u c O al al ac c a _Q 4. Q Q s..e E Ui a a In m Q� L7 - Date... . / Z/ . .. . P5— ..... ........ .... .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... tu ......... L .. 9/t/ - 9 .. q - .. I .................................. ....... .... .......... ... .... .. .. V has permission to perform ..... 61�� ..... wiring in the building of ....... :��6w ........... 5:1��.� ................ at ............ /1.0. ......... k .... 47..'YE—S ......... AV�K ........... . North Andover, Mass. Fee..Z—too / 7dP&ZoF— ...? 1� .......... :-:= Lic. No . ............. .......... jpllroy ....... Check # ELEcrRICAL ilN;P�i��R 5635 Lim UULMIlylulYYlrflL.!n Ur Irltlaotit."v usi1 DEPARTA1FVP0FPUXJCSAFE7Y Permit No. BOARDOFFMPREVFI MONRFgJMHONSM7aMl2O Occupancy & Fees Checked APPLICA77ONFOR PERMIT TO PERFO LECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELE ICAL CODE, 527 CMR 12:00 ) QS (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work Location (Street & Number) /p XG tlG 5 W A Owner or Tenant To the Inspector of Wires: Owner's Address vSJtj07e, Is this permit in conjunction with a building permit: Yes © No a (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps�Volts Overhead a 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 ASP Mp %1�CAi/IDt_ L No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above 0 Below ri Generators KVA round round No. of Receptacle Outlets Sr No. of Oil Burners No. of Emergency 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 Disposals No. of Heat Total Total Pumps . Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Connections _ Othe No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of signs Bailasis No. Hydro Massage Tubs No. of Motors/ Total HP �e OTHER. hia>ra =o=range. R>rmttothete4memaysotl4amadugmGalaalLaws IhaveaamotLMtdtyhsiaanoettbcyr<=ngt.;o F—M trove Ihave&ftri advddpcdcfswW1Dt 0ffKZ YES r dled�►gthe box 1••• NSURANCE 0 BOND a OrIIIFR a Wodcosm .71J44/oc- L�spacaronDateReglested FIRMNAME dart . YES © NO ffyouhavednia®dYES,pkv:n d c*thetypeofooveWby I r- ?am**) EStuld VakleofExWcR1 Wade $ Rough I Final LicawNo. J700c2 A 1 Liaerlsee S' /1'!P. Sigrnhae ������`� LioerrseNo /%ODoI' �l Bush essTel.No. �adm_P1019Ox AltTdNa 2yR'1f%9 S�oSI OWMCSINSURANCEWAIVER;IamawarethattheLxe wdoesinthatethemaaarlceoavetageailsmubftiWepvalatasmpWbyMassmd>usMGalealLaws andthatmysignaanecn.Mpanicfficatimwaivesthisregt mlat (Please check one) Owner Agent Telephone No. PERMIT FEE $ signature of Owner or Agent 11W L U1VVV1U1V VVl.fi" n Ur trltl hYil,n v wi i u �• w -�- � DEPAR TA1EVTOFPUBUCSAFEIY Permit No. BOARDOFFMPREVF1 MONREGUlAHONSR7(:MR l2VO Occupancy & Fees Checked r t/ APPLICA TTONFOR PERR'VII'l TO PEUORMIELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSS/ELERICAL CODE, 527 CMR 12:00(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DateTown of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work descfbed b Location (Street &Number) /0 /rCG t G 5 W A Owner or Tenant .7o 14A) Owner's Address 5ANC., Is this permit in conjunction with a building permit: Yes © No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps I Volts Overhead Underground [:3 No. of Meters New Service AmpVolts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work a SP Meo &r)— 11c,"n0#0 L No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures G Swimming Pool Above 0 Below Generators KVA round ground No. of Receptacle Outlets r No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets , r '7^ No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps . Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP )THER- fmtra =GDvaage. Rttsuantmthemgtman &dNb%a tmse CataalLaws U%CaomaltLiabt7ityhmaanc>rR) ymdx*gCanpi* CbmrWorAsst>l�ia Wegxvalart YES © NO havesubm�advatidptooiofsatrtebtheOffica YES Fyouhavechad0dYES,plea9eth NXOfooArWby box. Sl BOND p MUM p ftmS>*) /os EsMrkdVakleofEatcbcal Wdk $ —kWeWMD*ReWesbd Rough Li=wNo. /700a A iicalsae . Siq/y!(� Sigt== � Li=wNTo J2'0V4fi Bt1s TeLNa 9ig1,GC4.C— _3Q tJim - ©/fox 4.7/ Re gVAV5! ln,6 t9/r, Ane1Na 55'9lf71 S/oSl iWNQt'SINSURANCEWAIVfl;IamawarethattheLicawdoesnothavetheillst rmtemvw,WantsstlbbWaloalequivalentascaq} byMassactllsetlsGalealLaws Mid d>at my sgnatilte on this pewit applir�al waives this legtmerrlalt :'lease check one) Owner EJ Agent a Telephone No. PERMIT FEE $ signature of Owner or Agent MASSA (Type or print) NORTH ANDOVER, Building Location 1 New L:..1 Renovation UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Date Name �J�C�h �/1/%((/j Pe rutt / / Amount -- ipancY �S�il, t?f1 %rGt Replacement ri FIXTURES Plans Submitted Yes ❑ No ❑ (Print or type) �/j Check one: Certificate Installing Company Name r�, �� cr �"�) L �y, /Y f � j1 c4 ❑ Corp. Address /J Partner. Business Telephone v _. � Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the typesurae coverage by checking the appropriate box: Liability insurance policy13 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 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 installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass4e�usettyOt to Pjumbing Code and Chapter 142 of the General T .aurc By: Title City/Town APPROVED (OFFICE USE ONLY Ty�'e of Plumbfbg License Eic`ense NumDer Master Journeyman E] TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING :..WS SCttIOR BUILDING PERMIT NUMBER: ( 'rl�' A / DATE ISSUED: tJ rte. SIGNATURE: 1#a4&f 147a�— - Building Commissioner/1for of Buildings Date I alul ji. jLu P 1- all L' jwi r VAlrlA l iVPt F 1.1 Property Address: 0 Yes W 4 1.2 Assessors Map and Parcel �/' 6 Map Number Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water SupplyM.G.L.C.40. 34) Public ❑ Private ❑ Zone 1.5. Flood ZonSjufmruitioa: J—T� t)niside Flood Zune ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ am%-alvllq c - ralvrr.lnlZ vvr111. iAu lllVKiZ14L 2.1 (,ner of Record /l (Print) iST.i JCi; Yr. 1_ � f 0 A/ C. ; c-,, .v'T > for Service : -1 GIGpIIVIIe I - i)s—.2fC-iCYs' Owner of Record: ame Print ECTION 3 - CONSTRUCTION SERVICES I Licensed Construction Supervisor: Z>,IV; /?Jf,fa"0 �1 .( tensed Construction Supervisor: go <<a✓A c% F / ldress ,nathe Telephone Address for Service: Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Q 1 o any Name u a, J-J� Q J e, t V j Registration Number Address Expiration Date Signature _ Tele hone 00 rn z O v rn 0 z M 90 M z 0 SECTION 4 - WORKERS COMPENSATION (NLG 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 es .......0 No ....... 0 SECTION 5 Description of Proposed Work check as applicable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: S>4J'Ci�jC'-1 I gVCTION 6 - F.STiMATF.n rnNCTRTTCTTnN (YIRTR I Item Estimated Cost (Dollar) to be Com leted by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 0. O 'r- 3 3 PlumbingBuilding Permit fee (a) x (b) ' 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number JEl.11Uf4 is UWNVKAU1riUMIZAIMIN lU BE UUMPLE-JED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby auth ' e��'''�—''�_ to act on My be in all matters relative to work authorized by this building permit application. '— ? 3— C' X55 S'i'gnature of* Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are Lrue and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1' 2' SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GMDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 3 E ,, r P-OSAL P ' P a, : ° Y lI Ci C3 f� J DATA i WORK TO BE PERFORMED A PROPOSAL SUBMITTED T0: T: ADDRESS I l I DATE OF PLANS I ARCHITECT Wherepropose furnish the materials and perform the labor necessary for the completion of o e 1, S • ^� / taora, f� I u �.1 i j , j AP 51 4f CNOc' n 0 Clr i .I. i / 0 O ter / rr %OJ nJ i j7p r / o° fj0 p f,rrgr/ j a1T '1 COKS, PRl "C 'r D T Lj ;Pa ► l t f rr. , ! I iI I I material is guaranteed to be as specified, and the above work to be performed in accordancerwi(h 4h� �drawirgd specifi- All g ,i �v cations submitted for above work and completed in substantial workmanlike manner for the sum of o, a 0 ! ✓ C % u o 1`w T 1` t% o l/orf Dollars ($ ,l ) ar'r�p J'!c'C fo wi �X f��,f o re.��°v1ij�c-Q with payments to be made as follows. jjofl�15 0 V,ht„ rr`lr 9 �`/ 9�0. oa h P Respectfully submitted Any alteration or deviation from above specifications involving extra costs Per will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, ac - This —This ,(0 :osal may be withdraw cidents, or delays beyond our control. I by us if not a lce ted within day j (ACCEPTANCE OF PROPOSAL Is are satisfactory and are hereb accepted. You ar.. �th rized to do the wo The .above prices, specifications and condition as specified. Payments will be made as outlined abpve. I I Signature I Date Signature NC 3818-50 PROPOSAL MADE IN USA r e of Mot ,y �aawcwf� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 6 P 3 Date 11-16-01 THIS CERTIFIES THAT THE BUILDING LOCATED ON �dc� I d Ilse MAY BE OCCUPIED AS ,4MI e5l deo,'h C -P— IN ACCORDANCE WITH THE PROVISIONS OF T MASSACHIfSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. io i&vms, o;? -6- 13,4 r145, 3 57`all vAvz>p- R , CERTIFICATE ISSUED TO J �A Co U e lZ 0l . ADDRESS /®d✓ohnJ,y Building Inspector uml z U o O N t � c COL O C A ;= O m .� E¢ m c y 0 * � N E u cm ti Tye 0 01 z3� Hm .. ~ m (a .0 �•O o H = C c N A O m CLC.) m h m S.00 C CO3 Q N O O ev ` Z Of rt5 C O C Q ma mCD c o H o y m$~ m C,aCD MAA dt O C Z LU E m .y O_ ci •m` v m v cm F-- V� a m� O� _ A O y 'O C H t s a=..m �10 y CD .E CD a m c O CD v cc h O V .CL H c O V cc L O co C. H C CO 0! c O Moe W W 3� �a O a c Q c O Z m CL CIO c , 9 O '\ � rh w a\ i O E 5T\ \ a o w ;�)- a o w a G og .. o c% w cw U w w w IO C/) V) uml z U o O N t � c COL O C A ;= O m .� E¢ m c y 0 * � N E u cm ti Tye 0 01 z3� Hm .. ~ m (a .0 �•O o H = C c N A O m CLC.) m h m S.00 C CO3 Q N O O ev ` Z Of rt5 C O C Q ma mCD c o H o y m$~ m C,aCD MAA dt O C Z LU E m .y O_ ci •m` v m v cm F-- V� a m� O� _ A O y 'O C H t s a=..m �10 y CD .E CD a m c O CD v cc h O V .CL H c O V cc L O co C. H C CO 0! c O Moe W W 3� �a O a c Q c O Z m CL CIO c , C t1C I.U1VJiy1U1Y VVVd LJ [I yr Irlrs.�.xit,rlt✓.u.i DEPAR7NW0FPUBIlCSAFE7Y Permit No. J��S BOARDOFFIREPREVEMONRBgffA77ONS527QtitnVO Occupancy & Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 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) /0 Owner or Tenant S0 NAI Owner's Address 1,504 '7e, Is this permit in conjunction with a building permit: Yes [M No 0 (Check Appropriate Box) Purpose of Building / AA n J, L1/ Utility Authorization No. Existing Service Amps�Volts Overhead Underground [z) No. of Meters New Service Amps�Volts Overhead Underground 1:3 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures G Swimming Pool Above Below Generators KVA KVA round around No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners 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 s, lo. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Othe_ No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of SiBailasis No. Hydro Massage Tubs 1Op—m-f Motors Total HP rEeLpMar- M14MUDUlete9IDetrl3sc[N lmlls=C81®1L.aws aamaiLiab�tY�uareR�ficyinci>ditlgCotnp)e� ar><ssub�arrialequivlllalt YES10 NOID submkWdva6dptoofafsameblhe0li>x YES. lf)ouharec n1WYMpka9ecldc lhelyFcfaon=Fby nethewc ond&hox u hnpec�citD�oeRegt�d EM*dVaileofHwu alWcik$ Ra* Foal uaaw.u: i�rr�v �i . r.�•rvi r r V I[ Li=wNQ Slgr>atiae Lk=No Bt>s¢1e Tel Na 9iS G G4 In A1tTe1Nb. g%'1f%9 SCSI --1fPIER'SINSURANCEWAIVER, cDveWoritsakauWquabtasmqmWbyNbmftmG=WLm thatmysgnatueeonthisptsit�app)icabotlwanestlism4zmn t; Please check one) Owner Agent a Telephone No. PERMIT FEE signature or Ownergen R a u p ,� - t e- - �a-M .y�� �� y - /3- oS 13 �T� Town of North Andoverr10RTN OFFICE OF oy t, �. o e 11rO0 COMMUNITY DEVELOPMENT AND SERVICES 3? p 27 Charles Street North Andover, Massachusetts 01845 �9SsacHuS���y WILLIAM J. SCOTT Director n -� L- n, -Au,, z --v- V4 03, (978)688-9531 Fax(978)688-9542 CHIMNEY APPLICATION AND PERMIT DATE �� i C ` PERMIT # L(A t/ LOCATION OWNER' S NAME CV\ew v 0 l BUILDER'S NAME L n -� L- n, -Au,, z --v- V4 03, LL -41 MASON'S NAME C) MASON'S ADDRESS n )UY 0(,- S MASON'S TELEPHONE MATERIAL OF CHIMNEY r ��j� i (�j� U�1(, �� C P�C,r:�,� a 1 U✓ C �CL INTERIOR CHIMNEY EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES THICKNESS OF HEARTH 3 `` Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: DATE 31 9��\U SIGNATURE OF MASON i'�l�t U� J-<rc,� �C.l��z,.v" CONTR. LIC. j EST�. CONSTRUCTION COST/CONTRACT PRICE PEPWIT GRANTED `�' U FEE c�S ROBERT NICETTA, BUILDING INSPECTED_ REMARKS BOARD OF APPEALS 688-9541 INSPECTOR (— SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Location -W -/� e� (/ -,---5 No. 6 3 no C�- -?,z26 & / Date E TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ fe T, I— �A - - Other Permit Fee $ TOTAL Check #- ZL 14.5-,2 /g (6-- — Z Building Inspector Town of North Andover tkORTH o Building Department 27 Charles Street o :".w North Andover, Massachusetts 01845 _ ' (978) 688-9545 Fax (978) 688-9542 4 SAC�iU5���� APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS ® ee.ye.� LOT DATE REQUEST FILED 2 SUBDIVISION lPA u C7 U 1 DATE READY FOR INSPECTION I I I ? FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TE\dE FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE `r ROUTING Ag (--CONSERVATION �DATE 5 - PLANNING PLANNING DATE h/, - 0,,/ D.P.W. — WA METER De J DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRI INSPECTION REQUEST DATE. SIGNAT / EWW AUTHORIZATION TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING # lIIi3 ix7",T t BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/In-for of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: df/ Ll Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Regaired. Provided Required Provided 11 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone on: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ Public ❑ Private ❑ SECTION 2 - PROPERTY OWNS /AUTHORIZED AGENT E i,> •„r +�- lstri ct; 1'^ fan 2.1 O ner Record /of �J J//0 /`i C e- J' 4V iT % Nalne (Print) j- ' Address for Service P Sig'hature Tele one .t / b 9 Y n 6 2.2 Owner of Record: Name Print Address for Service: Si ature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ t• 4” YI''ii /?'1 1 Er n 1 ( Licensed Construction Supervisor: z License Number T go Address `�/— / v Expiration Date r14, �iJi/--- ! / + igna a Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ U Comfany Name Registration Number S�fa J n o C T r /l Address Expiration Date Signature _ _ Telephone 00 M M z O v n m 0 z M 90 0 ass SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2! Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check ao a Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ with this application. Failure to provide this affidavit will Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ Demolition 0 Other 0 Specify �f119 ;� -/?15 0,,, -° " Brief Description of Proposed Work: - ',p � n o r' I SECTION 6 - ESTIMATED CONSTRUCTinN rncTQ 1 Item Estimated Cost (Dollar) to be Completed b 'permit applicant OMCIAL USE ONLY .. 1. Building �r (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction O. O 3 Plumbing Building Permit fee (a) x tb> 9221 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 le Check Number JJJl,11V1� /a V'rVL1 l%t1V 111V1C1GH l ll/1l 1V Illi. %, V1YlrL'Z IX" WHEm OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Herebyauth eto act on _ �—- My be in all matters relative to work authorized by this builduig permit application. ?_ 3_��` Si iature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Suture of Uwner/AEent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1' 2 ND 3 RD SPAN DM ENSIONS OF SILLS DINIENSIONS OF POSTS DEMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED I:AND IS BUII.DING CONNECTED TO NATURAL GAS LINE U r e Location No. Date TOWN OF NORTH ANDOVER 0 0 w Certificate of Occupancy $ CHU Building/Frame Permit Fee $ !�9 q-3 Foundation Permit Fee $ Other Permit Fee $ TOTAL s 4 F-3 Check# 18( 34 Building Inspect6l i Board of Building Regulations and Standards r lug HOME IMPROVEMENT CONTRACTOR Registration: 132308 E `xpirati on 12/28/2006 � Tj►,pe:' OBr4 CY MUGFORD CON , STRUCTION. 'q NSTRUCTION.'q r 1 CYRUS MUGFOR�',JR , 'I 80 CARMEL RD #5 Q..,✓ ANDOVER, MA 01810 Administrator � � ✓fie Coomvino�rtu�ea�i o� /�aaaaciauoP,dici � BOARD OF BUILDING REGULATIONS I License: CONSTRUCTION SUPERVISOR ' { Number: CS 007330 Birthdate: 06/0511953 d. i y Expires: 06/05/20.05 Tr. no: 11235 Restricted: 00 . CYRUS C MUGFORD JR 412 FOSTER ST �i a N ANDOVER, MA 01845 Administrator North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by :MGL c11,S150A. The debris will be disposed of in: (Location of Facility) .0 Signature of PertgitApplicant a� Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of /nvesdgedons Boston, Mass. 02111 Workers' Compensatbn Insurance Aflridavit Please Print rlarrte• fl,", (f 4 Loc fon: /or C- i r Cr' n > CRY- phone # % l � y I am a homeoNirter performing all work myself. I am a sole proprietor and have no one worldng in any c apedty 0 I am an employer MvAdrtg walkers' compensation for my employees worldng on this job. CompM name:M d l3 r v 61m s Address %l era 09 J 7 Phone t I Y Insurance. Co. Poticv Ckxnww name. NGS- oma l (o rzu n c e.. den } M r- Pa r �h q_ T -7s - �w1 Address VID Loi ac o,4 age }3�I�ar�✓ale s� C%G `L<- Nom{ Phone; G 7�'- lvvr'7 . �`/0 0 Fd kve to soon coverage w required under Section 25A or MGL 152 can lead to the kr*=Nm d aMmi pw Miss a/,a fine w to !1,500.00 andfor cne yeah' ImprinannarR-w.wd.n.chd1 mnsffi=Jolbetcw dA STAP.VMW ORGEAand.a fkre d.(S11n.0q-2A* aanko m , 1 understand that a copy of this stdoment may be forwarded to the Office of Invesegaftne d the DIA for coverage vwftgdon. I db herby cerfly under ft pdha and penelflw d perjury bW flu krlbrnr dm provided stow Is true and caned signature � �i✓t�� nit .a�� � Date .� " .3 J ol Print name �' } `' 1 /7 ° P Phone % 8 Offldal use only do not write in this area to be completed by city or town dwar Cky or Town [] Bu/lcov Dept []Check N Immedlefs response Is required [] Lkwmtg B pard p Se/ectrrren's ofte Confect person: Phone t [] Heanh Dint 13 Other )1 �o ►� jrr,,' T ��y !e oo/h ,Reom HAt� CAr (r�r�}fc PROPOSAL 1, r rS Cay %f ci ,� PRnPnSAL SUBMITTED TO: WORK TO BE PERFORMED AT: DATo�j , © J ARCHITECT We hereby propose to furnish the materials and pertrm the labor necessary for the completion of ! �, N f / p t1 �y;,,,t'J p� � `Lr r1lf % Vv 19' / ✓7 p 1'i o a N !1 t' . W o •N' �? o i%: ':f f! r p 1 ,✓ t> tY / i p f C` I ; eeAr L, It/I f v f C N Oc' AIJfAll Hf 19 d4f �,� c.o.fjt yup oi'C' f`�i�o ! �i'�,r l D % oW N S /'/4r fi %?S Cts % j -m C ®..i,.r Nc J; ID d P. 0 1% i tt� r/ ft rr r (r n l . lh r +1 It N Q t C I ,t All material is 1. guaranteed to be as specified, and the above work to be performed in accordance with tp'drawings and specifi- cations submitted/for above work and completed in substantial workmanlike manner for the sum of j�''� Al/ N 4 V/ e !> /9 u o ; ?e.► �- w i r? ° // o l _Dollars ($ a? o • ° ° ) 510 QOO. Wi CoN! r19C/ ¢r0 0 +1G� e with payments to be made as follows. -� o ° f , x i u CJ /19' r 4r s! ! /9 oA/D !S !!°tiC /?Nr�/ N t4Nd CA% /S Po 4j C, yo 0. hru c!t ad h P ' / 11Ar r N Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents, or delays beyond our control. Note —This 'ro osal may be withdrawn by us if not a Ice ted within days. !ACCEPTANCE OF PROPOSAL } i .The, above prices, specifications and conditions !are satisfactory and are hereby accepted. You ar4 Eth'rized to do •the ,work as specified. Payments will be made as outlined above. Signature Date y �i Signature ` f- 381850 PROPOSAL MADE IN USA p NORTH ANDOVER BUILDING DEPARTMENT 400 Osgood Street Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLER% DATE: NAME: ZONING DISTRICT: TYPE OF BUSINESS: - BUILDING LAYOUT ot �7 AVAILABLE PARKING SPACES: ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE As Revised 11.5.04 BUMESS FORM FOR TOWN CLERK ^i w p a w a w c �a a a o � a a C a CJ cow -ate U w o w w o w c�' o w o rx X ca z Y cn o cn e 0 E=4 IN UJ z CL a 0 z O U ZI v O O v v O O O v ZC. O y Q C CM C C y Q � C A O O .— m m CD Hz ct Z O"No% 3� O O Q O m CD CL Q Ce s c O CL 0 O C Z CD O C. V C C c CL Q LLI W LLI U) 19 W W ce W U) c �a o � C CJ cow -ate ac ca o AD cc O � Ea •O+ C 0 d N O O c — VO M :ts c -O c_ CL 'mm � o OLDz cm c O N •_ ca N O O N • CD o C w& m v, CD �Sw, z ac o w o C=M,•. c _c m p m V c 0 01 C_ TQC Q m ` • c = m O.w p o ~ w aq ~ • m-0 .. c O _ _ C.) m CL • 1§O° C � �- .0 O 2 a42 M a 0 z O U ZI v O O v v O O O v ZC. O y Q C CM C C y Q � C A O O .— m m CD Hz ct Z O"No% 3� O O Q O m CD CL Q Ce s c O CL 0 O C Z CD O C. V C C c CL Q LLI W LLI U) 19 W W ce W U) TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �'s <,.� "a � r Y,� b"� � x.uY� fO>E•u���;k��"�1:1 ,��k "� -,�5 k a s,r*'� BUILDING PERMIT NUMBER: j Q DATE ISSUED: l� SIGNATURE: Builr Lng Commissioner/IpVector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: °.f es �J 1.2 Assessors 4's Map Number Map and Parcel Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 30 3i o a23 3o 33 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomnation: Public ;V Private ❑ Zone Outside Flood Zone 1.8 Sewerage Disposal System: Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record n P �(J�TN f//VG'aliEJ�/)fAL��Dfi'P, %D0NNa'CCAJ:E` Noy AAdl'VCrl)TgS,.r Name (Print) Address for Service: C 6 cqr ks A Ca rr-a Signature] a (xlc ee phone o ?.1-77-.)ff 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Con,Rtruction Supervisor: Address s/ v /Z L I Signatur ) Telephone Not Applicable ❑ License Number e S �3-�(4, 3 Expiration Date �7 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone IN Q SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) V 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 buiWing permit. Si ned affidavit Attached Yes ....... 0 No ....... ❑ SECTIONS Description of Proposed Work check all applicable) New Construction 0 Existing Building [IRepair(s) 11Alterations(s) , 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other ❑ Specify Brief Description of Proposed Work: JJ�� C0 N5Tr�UC7` Twa STOJ3 Y W ooD FrzigmE H6&,c-e W14k rNii�f' CaA l7 gRh1CC !moi NCJ09 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar) to be Dollar ( Completed b ernut a licant �� � �?FFtCIAL USE ONLY ' , _ .. 4. 1. Building (a) Building Permit Fee Multiplier 2 Electrical !D U d U (b) Estimated Total Cost of Construction 3 Plumbing /C 00 0 Building Permit fee (a) X M 4 Mechanical HVAC 00p-5 /a'006'- 5 Fire Protection 3.0.4d, 6 Total 1+2+3+4+5/ y Doo. ' Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED DECLARATION %AGENT 19 t e n ,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 1low �� �d�.A/RaL C12,�rlPs C'2r r,0 P1e5�1d4(' jt% x Print Namr," ," '9 Signature of Owner/Agent Date f NO. OF STORIES SIZE 8 x 38 BASEMENT OR SLAB Aw5e SIZE OF FLOOR TMERS 1 ST 2 x /d 3 0 SPAN DMIENSIONS OF SILLS Yk DM ENSIONS OF POSTS Vx G DIMENSIONS OF GIRDERS 41'>rlo HEIGHT OF FOUNDATION Q' THICKNESS /0 " SIZE OF FOOTING X MATERIAL OF CHEVINEY 3�icK IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE es Location / 0-� c->), &UAf No. - 69-2 Date ,90 TOWN OF NORTH ANDOVER Certificate of Occupancy $ 5,0 Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check # — ISY �' 14431 /�l -1 Building Inspector FORINT - U - LOT RELEASE FORM Pew 46 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 IVO 1-4k Pn d ay er ReO 6� CorP PHONE ' 7 7.1 V ASSESSORS MAP NUMBER �s LOT NUMBER 7 SUBDIVISION SA) R CT 114R LOT NUMBER STREET rl E Yrs V/7 r STREET NUMBER �O ............................................................................ OFFICIAL USE ONLY RECON AENDATIONS OF TOWN AGENTS i . ....'.....r■..■■...........t.........■■.......r.....................■ �' Y i DATE APPROVED 7✓ Z L (1 C SERVATION ADMINISTRATOR DATE REJECTED COMMENTS � � S S� U� DATE APPROVED zI v J TOWN PLANNER DATE REJECTED CONRVIENTs Y1 DATE APPROVED FOOD INSPECTOR -HEALTH DATE REJECTED vV DATE APPROVED SEPTIC INSPECTOR - HEALTH / DATE REJECTED • UMMER y , PUBLIC WORKS - SEWER / WATER CONNECTIONS a4& DRIVEWAY PERMIT X A fir» COMIyyiENTS DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE Building Value Calculation - for Property at..... b i F J S re� Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 27 14 378.00 65 $ 24,570.00 Living Room 20 14 280.00 65 $ 18,200.00 Dining Room 14 14 196.00 65 $ 12,740.00 Family Room 16 26 416.00 65 $ 27,040.00 Study 12 14 168.00 65 $ 10,920.00 Laundry 7 8 56.00 65 $ 3,640.00 Garage 23 38 874.00 35 $ 30,590.00 Entry 14 17 238.00 65 $ 15,470.00 Basement Finished - 65 $ - Deck 5 16 80.00 10 $ 800.00 Screened Porch 16 12 192.00 35 $ 6,720.00 Breakfast Nook 4 9 36.00 65 $ 2,340.00 Bedroom 1 16 23 368.00 65 $ 23,920.00 Bedroom 2 14 14 196.00 65 $ 12,740.00 Bedroom 3 14 14 196.00 65 $ 12,740.00 Bedroom 4 14 15 210.00 65 $ 13,650.00 Bedroom 5 - 65 $ - Bathroom 1 6 10 60.00 65 $ 3,900.00 Bathroom 2 14 10 140.00 65 $ 9,100.00 Bathroom 3 8 10 80.00 65 $ 5,200.00 Bathroom 4 - 65 $ - Bathroom 5 - 65 $ - i� L f S O r2C'd"s j/Z 104 M '/ &'- /-/. y a drn-► s a 43A -A QA d ,51/6 !72«4 b R v0 "11 Q /fix J3 A. Y -h s 3 S ja // uivc%Pv-I )o `f 13 ILr)rli- ., I 51),— f= N d 4 o p l 'TaL I Dur- Fr,tmt GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. 1Vo A71JQverAea ffJ Carp. Z0 .2 Key es Wd— Permit Applicant Property address Map / Parcel � 9� - 77.2 y Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this fort does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more ofthe following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land. For purposes of this section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS GR SS F R REFUS4BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLICANTS SIGNATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION N � O OLO � N co N Cq (L w 0 M F q) Z Z O p M O O J_ U p o F�- 5=)CO 0: °i N LL C/) r `. O a V d y .. . 'a Z W. u i m O J` co O o J Q Q � U U) N W j a LLJ aZ C,4Q, Q .r The Commonwealth of Massachusetts '} Department of Industrial -Accidents Office of Investigations Boston, Mass. 02111 �- Workers' Compensation Insurance A,T'davit r\lame jY'0 , A. �,j D o v e- to Rfa r; v-rq Copp • Meese runt I N;�me cit/ Fhcre T l am a hcmecwrer performing all work myself. I am a sole proprietor and have no one ,aorkine in any c :pac;ty / I I am an emcicver Providing workers' compensation nn7for my employees working on this job. � Ccmcanv name: NO i N D" Tr r Address 16 U ,J o(VAV`>-Cj);� era S6.91) `� ' .4Iv00✓CR d ' ! fis Fhcne T. �`77.2 V Insurance Co. G'G��l�D %Ns'URRN<'F_ G6yvr- Pclicv T /WW C ft o 3!6 Comcanv n2me: Address Cit,/ Phone --' Insurance Co. Failure to secure coverage as recuirec under Section 25A or MGL 152 can le=d to the impcsiiion era criminal penaities cf a rine up to 51.500.G0 anc/cr one years' imonscrrent as -,veil as c:vii penalties in the f.crm cr a STCP `/\/CRK ORCER and a rine cf (5100.00) a day against me. I understand that a c#Py of :his statement may to fcrvarced to the Office cf Invescgaticns cf :he GIA,'cr coverage verincsticn. I do herecy certify u5p�r rheAins and penalties or SIcnatU that .he inrcrmaticn provided accve is .rue and correct. 7 Date Print name 2 r jPS %� !"moo �l Fhcne, C;iic:aI use a n 1 y co not write in this area to to completed ty c: -,y cr town crfiaz( C ty cr Tcvn P=rmit/Lic�!nsirc 7C`eck .f immediate res.ccrse is required nract son: Fhc.^e ; . //-- 2e,,—aa -7 7a� Building Dept Licansinc Board Sa!ectman's Ofliicc^ C Health Department Other BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: OF N(4- SAI NCIVORJ ELIffal VI -S 14A) Location of Facility Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector MAScheck•C-OMPLIANCE REPORT Massachusetts Energy Code MAScheck-Softwa-xe. Version 3.-D3 .-Release .3 TITLE: PLAN NO. 6421 CITY: Andover STATE: Massachusetts HDD: 632 CONSTRUCTION TYPE: 1 HEATING SYSTEM .TY.PEs DATE: 12-8-1999 DATE OF PIANS--. 2-8=9B PROJECT INFORMATION: COLONIAL ,HQLISE COMPANY INFORMATION: NORTH ANPOVE:R .i EAAL-TY COMPLIANCE: Passes Maximum UA = 684 Your Home = 536 or 2 Family, Detached Dther.-.4NOn-Eler:.tr1c ..Resistance.) Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter 'R=Value R-Va-lue 'U -Value I UA ------------------------------------------------------------------------------- CEILINGS 1945 30-0 0.0 68 WALLS: Wood Frame, 16"..Q -C_ 3168. 13..0 0.0 260 BSMT: Conc. 8.0' ht/7.0' bg/8..0' insul 1945 0.0 19.0 76 GLAZING: Windows or Doors 284 0.350 99 DOORS 93 0.350 33 HVAC EQU{-PMENT--Fttrna-ce, -a7;-G -A-FUE --------------------------------------------------- ---------------------------- COMPLIANCE STATEMEUTs The proposed building -design described -here is consistent Frith the.buil..dlmg.plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed -to meet the requ-im_ s €- the Ma-ssachu-sett-s Energy Code. The heat jzrg lozd�br-rthlz buiiz3ing.; mrd -the -=. -=.-g IBa-d -if appz-opri-at-e, has beenlldetermined using the applicable Standard Design Conditions found in the CQde. -The --HVAC--equ pment---sect-ed -to -heat -or-cool -the -builds-ng shall be'no greater than 125% of the design load as specified in Sections / UDCMR 131- and U-4.4. Builder/ Designer Date ! 2 ' �� Z>% I and cooling equipment and service water heating equipment must be I providers.-3nsu±a-ti-on R-vai-a-e-s, --giaz n-g-U--val-ues, and---h-ea-ting I equipment efficiency must be clearly marked on the building plans I or speci-ftcations.. I I DUCT I-NS=T=: [ l I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: ( ) I All accessible joints, seams, and connections of supply and return I ductwork_-Lor_atedoutside.._conditioned space-, .including _s -d bays ar I joist 'cavities/spaces used to transport air, shall be sealed I using piastic -and fibrousbae-king t-ape Lnst-a3 3-ed -according to the I manufacturer's installation instructions. Mashwtape may be I omitted-where gaps-gaps 1-ess -than 1-/-8 inch. -Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and--wetter -systems. I - I TEMPERRA.=RE-_CONXROLS-: [ ) I Thermostats are required for each separate HVAC system. A manual I or automatic means to -parti-a-fly -restrict or shut off t-he heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated-ou-tput -capacity of -tie -heat-i-ng/coo i-ag--syst-em i-s I riot greater than 125% of the design load as specified I in Sections 7-84ZMR -1310--a-ad J-4- 4_ I ' I SWIMMING-POOLS: [ ] I All heated swimming pools must have an on/off heater switch and I require-a- coir er_unless.--aver--2.0% of-the ...heating .energy is from I non-de'pletable sources. Pool pumps require a time clock. I I HVAC PIPING INSULATION: [ ) I HVAC.-.piping co-nueying-fl.ua.ds..ahove..-12C .-F...or -chi11-ed .f.lu.ids I below 55 F must be insulated to the following levels (in.): I I PIPE SIZES (in.) I HEATIN�G.SYSTEMS-: TEMP .(.F) -2" AUNOUTS -0-.1" _1,25--2" -2-5-4" I Low'pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low .t-emper-atur-e 124-2-H -0.5 1.-0 3.-0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING-.SY-9T.EMS; I Chilled water or 40-55 0.5 0.5 0.75 1.0 I r e f-r-i-ge r,:i-n t -be low -4-0 1.-0 1.0 1.5 1.5 I I CI RCUL$JNG _HOT --WATER .SYSTEMS-- [ ) I Insulate circulating hot water pipes to the following levels (in.): I I PIPE SIZES (in.) I NO --CIRCULATING CIRCULATING -MAINS - .RUNOU-TS I HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" I 170-1-H 0.5 1 1.-0 1.5 2.-0 I 140-160 0.5 I 0.5 1.0 1.5 I 100-1-U .0_5 I -0_5 _0-5 1-0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- TITLE: PLAN NO. MAScheck INSPECTION CHECKLIST Massachu,92tts.--Y ergp Code MAScheck Software Version 2.01 Release 3 DATE: 12--8-199 CEILINGS: 1., R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., Corrpents / Location R-13 BASEMF,NT -WALLS: 1. Conc. 8.0' ht/7.0' bg/8.0' insul, R-19 continuous CommentaV Locat ion WINDOWS -ANiD GLASS aOORS : 1. U -value: 0.35 For windows without labeled U -values, describe features: # P,anes -Frame Type T'lrermal -B-reak? { ) Yes .{ ] No Comments/Location DOORS: 1. U—vai-ue: -0.35 Comments/Location HVAC EQUIPMENT: 1. Furnace, 87.0 AFUE or Make and -Mode-1 Number higher AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope -t-hat -ar�e .sources -of -a3-r leakage -must -be sealed. -When installed in the building envelope, recessed lighting fixtures shall meet.. -ane -of --the-..tollow.dng- requirement-s-1. Type IC rated, manufactured with no penetrations between the i"We -of the -r ce-E-sed-fi-xtur-e -and-Gei-l3rag--c-au3t-y -a-nd seal -ed -or gasketed to prevent air leakage into the unconditioned space. 2. Type ..I -C rated, in..accardance ..with -Standax-d .ASTM. E 28.3, -with no more than 2.0 cfm (0.914 L/s) air movement from the the coyiditioned--spa-c-e to -t-taecei33-ng -cavity. The light -i -ng 1-3Lxture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure di�-fezence And shall .-be J abe.l ed_ VAPOR . RETAR-DE-R- Required on the warm -in -winter side of all non -vented framed ceilin( s, walls, -and f_Loors. MATERjATrS -IDENTI ICATION: Materials and equipment must be identified so that compliance can be detexmi-ned. Manufactuxex-manuals far. -a-11 ..installed.. -heating O z� 0 � CL Cld ov, C50 LIL I. Y a <u LU 0 -13 m x c �VxGoy P °!' p c LnNaj a c 3 o H c c ° ro O 3 �30 o ° u c E'= in o •° E c t a a m '�` °' o °°f ' � c' 0: a) 0 °-" o v y Q c -� • u o Q o�°-c m ac .. casco c ° U o W 0uo cos m ° acs' c �o,_ P An 50°� '� c W D. `o C U 0. s o 3 N LL . cl LUcn H .0 .c Ln ° J02�OC%6.- Z o u g C3 gL t`0 _p w in Z s`rx r O z O v W o o w N a v cn W A G o w °�° o c2 U q W. 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I O ,O La O O 03 �E m co CLCD CD O OL � O d CL C Q ca cc L3 c Z CD �..� y C rempo _o co CD w w ccw U) 'E 2012 Massachusetts Electrical Code Amendments 527 CNR12.00 § Rule 8: in accordancc-mith the provisions of M.G.L. c. 143, 3L, the appointed pursuant to Ni C permit application form to provide notice of installation of wiring shall be uniform throughoutthe Commonwealth, and applications shall be filed' on the prescribed form. After a permit application has been accepted by an Inspector of Wires ' Y.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on, the permit application. Such entity shall be responsible for the notification. of completion of the work as required in maL. c. 143, �., 3L. Permits shallbe limited as to the time of.ongoing consfraction activity, and maybedeemed-by-tiae-Jnspecto�-of-Vires abandoned-audJavaliddfte— or shebas determined t�at the authorized work has not commenced or has not pro'gressed during the preceding 12 -month period. Upm written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 23 8 of the Acts of 2012. The purpose of this act is to promot6j&'growth and long-term economic recovery and the Permit Extension Act Ruthers this purpose by establishing an automatic four-year extension to certain -permits -and licenses concerning the.use or development of real property. With limited exceptions, the Act automatically dxtends, for four years beyond its other*wIs e applicable expiration date, any permit or approval that was "in effect or existence'during the qu"alifying period beginning on August 15,2008.and extending'through Augast 15,2012. ,�Cule 1 8 — Permit/Date Closed: Z Z -16,--h_ 4�Z 0_V_, Note:.Reapply for new p P*ermit Extension Act — Permit/Date Closed: This certifies that ......... 77 has permission to perform .'.5-ec. I'a wiring in the building of ........ P. YIJ U.". Z,./,. 0 ........... at ... 5 ........ North Andover, Mass. -ee. F .,�ic. No. 1.7.? . ........ 14 EL �TRICAL I�NSPECTOR t!�heck # 1774 10975 1-1 4 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS (Please add zip codes & electrician's cell #; contract # & bid permit # if applicable.) Official Use Only Permit No, _ 6 0 9 7S Occupancy and Fee Checked :ev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 2.00 (PLEASE PRINT M INK OR TYPE ALL INFORMATION) Date: / City or Town of: Ue-)r Y-;� I)Ajd U,,e� To the Inspector of WiNes: By this application the undersigned gives notice o his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant – Telephone No. /"/tfllK/� (0!520Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ iiinnber of Feeders and Ampacity Location and Nature of Proposed EIectrical Work: \GZ c� No. of Meters No. of Meters (�ctS —1e rn No. of Recessed Luminaires ulptultunuj No. of Ceil.-Susp. (Paddle)Fans T ouowtng tante may be tivaived by the Inspector of Wires. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. o me rg ng rnd. grnd. Battery No. of Receptacle Outlets No. of Oil Burners _Unitsit FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices of Ranges No. of Air Cond. Total No. of Alerting Devices of Waste Disposers [No. Heat Pump Number Tons KW No. of Self -Contained Totals: " ""' """ Detection/Alertin Devices of Dishwashers Space/Area Heating KW Local Municipal ❑ Other tion No. of Dryers Heating Appliances KW ecus Systems:x No. of Water Heaters Kms' No. of No.of or Equivalent Data Wiring: Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: OTHER: L/n-3 No. of Devices or Equivalent n� Estimated Value of Electrical Attach additional detail if desired, or as required by the Inspector of Wires. �j (When required by municipal policy.) Work to Start: .12 Work: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE O VE GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER X (Specify:) Self Insured I certify, under the paints and penalties ofperjury, that the inf rmafon on this application is true and complete. FIRM NAME: ADT LLC DBA ADT Security % LIC. NO.: C-172 Licensee: Thomas J, Lee Signature j'/rr f LIC. NO.: C-172 (f pP Q........ f- – _ 1 a hcabla. enter "exempt" in the /' ense number lin.e.) % L Address: < <{ Bus. Tel. No.: C i n' 1 m '� . r 1�a \\ks, to 1-E 0,S014 Alt, Tel. No.:_ "Security System Comraetor License required for this work; rf applicable enter the license number here: 001779 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMH FEE. $ J�- _ COMNIQNWIEALTH OF MASSACHUSETTS •. ELECTRICIANS .-A`. REGISTERED SYSTEM CONTRACTO 18SUES THE ABOVE LICENSE TO: ADT'LLC DBA ADT SECURITY 1HOMAS J LEE. 41:UN;IVERSITY AVE.�� WESTWOOD MA 02090-2311 172 C 07/31/13 2019341 E ON rold, -then Detach Aong All Feriora tions i V