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HomeMy WebLinkAboutMiscellaneous - 103 LANCASTER ROAD 4/30/2018N O p� v b rn N O Op O O Date......... .. ..................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0 A ,9-,-3 H �� IL-�r -4 Thiscertifies that ............................................................................................................................ 5>�PSo\A.4—' P& IQs . .1 S ILLJ has permission to perform .................... ......................................... j ......... ...... ! .................... wiring in the building Of I�L(' t' � .. .... ......... 103 0 .. aA C ---z ........ ­....' *****"***"*'*"*'** ... *-*-*-************-**** ... * ... * at......................................................................... . .................... * .......... . North Andover, Mass. Fee.... l ....................... Lic. No. ...... .................................................................................... ELECTRICAL INSPECTOR ec 1 3073-j to►n►►wn7uoailrl+ o� IllaaaacftuasEla Official Use Only IN Permit No. 9701�� eLJsloar�iurt:E o��iro �orvico3 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1107] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MGC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -Z 1 1 1 1 (,o Cityor Town of• NO [ -Irh ftn d pyt r To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) o-� L a n c as irc r Rb o_A Owner or Tenant D O M en t G _Y=a I Telephone No. Owner's Address Is this permit in conjunction Hith a building permit? Yes �_<b No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install Solar Electric - Photovoltaic (PV) system 3(01 panels rated Iq •19 1 kW 0— STC Grid Tied. In conjunction with a Buildina Permit Camalerioft offhe fol/nivint: tahle rani, he ivnivpd ho flip himprtnr• of rfirnc No, of Recessed Luminaires No. of Ceil.-Snsp. (Paddle) Fans 10. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above El'a-d.❑ rnd. rnd. o. o mergency Tg mg Bfitter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. or Detection an ill Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump umber Pons Dtecteon/Alerting Sel&ntainTotalDevices No. of Dishwashers Space/Arca Heating IM' Local ❑ al Cmmc lion El Other No. of Dryers Heating Appliances KW SecuritySystems: No. of Devices or E uivalent No. of Water KW Heaters o. of I o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. I•Iydromessage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of I-Pires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: ASAP Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: 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 Q BOND ❑ OTHER ❑ (Specify:) 1 certify, under the pairs turd penalties ofperjui3�, that the informadon on this application is true and cotuplete. FIRM NAME: SOLARCITY CORPORATION LIC, NO.:1136MR Licensee: MATTHEW T. MARKHAM Signature LIC. NO.:1136MR (lf applicable, enter "exempt- in the license number line) Bus. Tel. No.. 774-25"18D Address: 24 ST MARTIN DRIVE (BUILDING 2- UNIT 11) MARLBOROUGH, MA 01752 Alt. Tel. No.: 774"258-8505 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Sai'ety "S" License: Lic, No. OWNER'S INSURANCE WAIVER: l 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) C] owner owner's aent. Owner/Agent Signatnrc Telephone No. PERMIT FEE: $ 115 — I � �/r¢t�! �a�lrjjt{1rrt.,r«,{�►tfl,� Cif �. f67,�'�1:1trrc`Ott�<1'd �)I � Ce of t.(�ntiillllt nt-1 Business Regulation 10 Park Plaza - Suite 5170 Boston, Massael`IUS tS 02116 Home Improvement Contractor Registration SOLAR CITY CORPORATION MATT MARKHAM 3055 CLEARVIEW WAY SAN MATEO, CA 84402 w , •� d arae+nitr�i��,�e 1 41 Registration 168572 Type: Supplement Card Lxpiration: 31812017 Update Address and return card. Mark reason for change. Address Renewal Employment Lost ('ard !Iffier orConsumtr A lt'eir%A business RvVidation license or registration v,tiiid for inihie ideal use only L hefiire the ex irwtiun date. llfound return to: E HOME IMPROVEMENT CONTRACTOR 1 1 .f Office of Consumer Affairs and Business Regulution ftocllstrntiun: 1�ttF77. TYPO Ill Park Plaza Suite .5170 ' I:xt itat+on: 1,12017 Supplement Caid Roston. NIA 02116 Sh:LAR C i V4 -)Ph; QN, MATT Mz RF iA'S 24 sr MARTIN SI RLL I BLO ZUNI N/\F`i1.L30ROUGi1, MJt 01752 Undermcretarl 1�ot valid without signattire t)7' ELECTRICiAUS ISSUES THE FOLLOWING LICENSE AS Av,�' RE.G f STERUD MASTER ELECTRICIAN SOLARCITY CORPQRAT ION MATTHEW T MARKHAM � 24 SAINT MARTIN QR ; RL 00 2 UN I T l I AARLBOROUGH MA 017� 2,3060 LAr~ 07.1.31/.16,, ---- f �' +► e a The Commenwealds of l assardiwetits Department oflndustrialAccidents Ogee of In vestigadons TV] I Congress Sired, Suite 100 Boston, MA 02.1.14-2017 lvtuw.mass goVAU4 Workers' Compensation Insurance Affidavit; Builders/ConiracterslElectricians/Plumbers AppLigeant InLarmation Please Print La ffl Muerte (Business/Organixation/ludividuaD: SolarCity Corp. Address: 3055 Clearview Way Are you an employer? Check the appropriate box: 1.1r l' am it employer with 5,000 ernplayees (hill and/or part-ttmc).x 2. ❑ 1 am a sole proprietor or partner. - ship and have no employees working for tote in any capacity. No -workers' comp. insurance required.) 3. ❑ I ant a ltgmeowner doing all work tnyselL [140 workers' comp. insurance required,) t Phone #: bbb-/b5-L4bV 4. [} I am a general contractor and I have Direct the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurer er? 5. 0 We are a corporation and its officers have exercised their rieet,of exenvaon Pet MG1, c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): b.] New construction y. ❑ Remodeling R. ❑ Demolition 9. [j Building addition 10.0 Electrical repairs or additions I 1.3 Plumbing repairs or additiow I2.❑ Roof repairs 13EPther Solar/PV *Any applicant tient checks box N t must alko rdl out The section below showing their wortccrs' contpeasntian petro y infesme<titm. { Homeowners who submit this affidavit indicating utey are doing all work and then hirm outside contradws mast submit anew atridavit Indicating such. tCostraaw that check this box must attached on additional sheet showing the tmme of tte sub-connaaors and state whether or not those entities have employers. ffthe sub•contnown; have cmployces, they must provide {heir workers' comp policy number. Y aFrr an ernploper that iaprorlding workers' t ampensutfan fosurance for I7ty ¢tttployees. Below is the porky arid job sire lrrfornralior:. Insurance Company Name: Zurich American Insurance Company Policy -9 or Scir--ins. Uc. #: WC0182015-00 \ Expiration Date: 9/1/2016 —1 Job Site Address:_( 3 L (-n Q etcr �O 0.(3 City/state/zip: N O t-tnd a/ e -r Attach a copy oPthe workers' compensation policy declaration page (showing the policy number and expiration date). Failure m secure coverage as required under Section 25A of MGL c. 152 ran lead to the imposition of criminal penalties of a fine up to 51,500.00 andlor one-year imprisonment, as well as civil penalties in the Form of a STOP WORK ORDER and a fine or up to $250.00•a tray against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA fbr insurance coverage verification. I do hereby cerfi y under the pnfns and penvirles ofperjury that the information provided above is true and correct. Phone OfTC181 rase attiy, DO nae rentor i, -s ibis area, to be completed by city or taM aj}'%lat, City or Town: PermitR• ceitse # Issuing Authorlty (circle one): I. Board of Health 2. Banding Department 3. City/Town Clerk 4, Electrical InSpector 5. Plumbing Inspector 6, Other Contact Person., Phone fl: n AC40Roe CERTIFICATE OF LIABILITY INSURANCE DATi;{MWODrYY�rY)a F k..-- . 08117016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT hAm€-- MARSH RISK& INSURANCE SERVICES ............. PFIONE.._... . ................ ..... ... ..r FAX... .._... .... ..... _. _._..__ ._.. 345 CALIFORNIA STREET, SUITE 1300 1Ats�n,J";ni .................._ _ ... _......... ...........ln(c..Nvf:...... _ ..........................._ CALIFORNIA LICENSE NO. 0437153 E•Maa SAN FRANCISCO, CA 94104 _APQR€:..... .. ......... .....:.............:._ .......... . 7 ......... .......... _. Attn Shannon Sooa 415-743•$334 INSURERjS] AFFORDI#G COVERAGE MAIC 9 998301-STND•GAWUE-15.16 INSURER A; Zurich American Insurance Company 116535 INSURED INSURER 8: NIA SolarCity Corporation t .. ......... . _. 3055 Clearvlew Way INSURER C.: WANIA...................... _..._. ..... _.....i......_. ......_ . San Mateo, CA 94402 USURER n : Americazl Zurich Insurance Company 40142 GEN'L AGGREGATE LIMIT APPLIES PER' INSURER E: 6,0000x0 INSURER P: COVERAGES CERTIFICATE NUMBER: SEA-002713MOB REVISION NUIMRER-4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR..... _ ...... _..... .i)FJL$IIBRT .— ................._ . _._...............`. POLICY EXp." ........._. ...._ . _... .................. ...._ ...... LTR TYPE OF INSURANCE POLIC NU DER I LIMITS A X COMMERCIAL GENERAL LIABILITY ICLOO1820MOU _ .. ... 0910112015 :0910112016 EACH OCCURRENCE j . ........ ... ...... .... � s - 3,000,000 --3,aoa,aaa GE TO RENTED CLAIMS -MADE f X l OCCUR ; � I .....MISES {E.a aogurrenceZ ....*...... _._._ .._.. _.. X Slft; $250,000 I MEO EXP (Arty one person) S 5,000 --..._................... __................ .... I PERSONAL & ADV INJURY S 3000,000 GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE g 6,0000x0 X IPRO- POLICY I JECT t....J LOC E ...... ........ ... PRDDUCTS • COMPlOP AGG : $ . ................ .... 6000,000 i OTHER $ A AUTOMOBILE LIABILITY BAP0182017-00 1:0910112015 `0910112016 DI EDS GLELIMIT § 5.000,000 r ;SEN accider?i). .... )( •ANY AUTO BODILY INJURY (Per person). $ X.. r ALL OWNED X SCHEDULFA,..... AUTOS AUTOS .. LBODILY INJURY (Per accident); $ .... _.... ....... X �HIRED DAMAGE I..X..NON•OWNED tPROPERTY ac.Clden) +SAUTOS .. ...... _... _._.........._ COMPICOLL DED, E $5.000 '. UMBRELLA LIAe .:.00CUR ,..... i I EACH OCCURRENCE S f. .. _. ... . _ .. ...... .... .....} ._ ..... .......... _ .. .... EXCESSLIAB CLAIMS MADE FAGGREGATE i. S_ DED RETENTIONS I s D !WORKERS COMPENSATION WC0182014-00 (AOS) 09lat12015 0910112016 X ' ORH ' AND EMPLOYERS' LIABILITY}._._...�__.......... A YIN: ` WC01B2015-00 MA ANY PROPRIETORfPARTNERIEJ(ECUTIVE N ( } N IA STATUT ,......i �. ..... `... . 0910tl2015 09101Y1016 EACH ACCIDENT ? r :..---- OFFICER/MEMSER EXCLUDED? I NN WC DEDUCTIBLE' $500,000 .......................... ........ .1.000,000 1,000,000 {Mandet In mY 1 I N E.L DISEASE - EA EMPLOYEES _ ....._ _..._.. ..... . _ _.... ....... ._ .. ... ........ . yes, describe under DESCRIPTION OF OPERATIONS below i E L DISEASE - POLICY LIMIT 1 S 1.000,000 I I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AC ORD. 101. Additional Remarks Schedule, maybe attached IS more space Is required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SolalCitY Corporation 3055 Clearview Way San Mateo, CA 90402 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IM ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Charles Marmalejo ©188&2014 ACORD CORPORATION. All rights reserved. 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Box 250 Chelmsford, MA 01824 978-256-8586 Fax: 978-256-8590 July 30, 2014 Building Commissioner/Inspector of Buildings NORTH ANDOVER, MA 01845-2148 Board of Health/Board of Selectmen NORTH ANDOVER, MA 01845-2148 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, cause of loss and LA file number. Insured: DOMENIC A KALIL Loss Location: 103 LANCASTER RD NORTH ANDOVER, MA 01845-2148 Policy Number: PHD00871761\11400 Date of Loss: 7/16/2014 Cause of Loss: Water LA File Number: MA -2-24885 On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Kevin Lafrenais Adjuster LaMarche Associates, Inc. - 800-349-1525 Page 1 of 1 Date ..1.D ...... 0,TOWN OF NORTH ANDOVER O 9 PERMIT FOR GAS INSTALLATION s o • � This certifies that ... ....... has permission for gas installation ... . ..... in the build* of ---G--"-----atA. ��, ,'-N�.orthAndov r, -�Mass. Fee. ... Lic. No.V'3';�.. .......................... GAS INSPECTOR ~ fheck # r ~`4703 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ' Gi Mass. Date tr� _ZCo`� 'Je mit # Building Location �L� �l� Owner's Name , -57- Ot Type of Occupancy I New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑ Installing Company NameCjAe Z T A • :rlm MA Trl i Q Check one: Certificate Address 30 CDA C H ih A ry i- t\[ . ❑ Corporation M E 7,H U e fJ 01 rl U l k q ❑ Partnership Business Telephone /,o �9 — 9 9 "7 ( 2-'Arm/Co.Name of licensed Plumber or Gas Fitter -'R o 13 E P T A • 58 M m ,g i A L) INSURANCE COVERAGE: 1 have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 2' No ❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box A liability insurance policy 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 (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe i ed for this application . be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner laws. By T of Ucense: C� Plumber rt ure of Licensedu or Fitter %e tter 8333 er Ucense Number /l�/Town O I N Journeyman NI W S V WUl I W N v Z P H W N J Q = o 0 c W O N M' IWi. O W O Z d � m O O W W 3 z o O W m a V i J d a a W W LL NI W S V WUl I W N Location// %%"�l%���, foo. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ 0::-Pj rj k Building/Frame Permit Fee $ 3 &V .,.Foundation Permit Fee $" f -—Other --Other Permit Fee 5 Sewer Connection Fee %A-�j (vWater Connection Fee 15 199'J)TAL I $ - �f uilding Inspector 6546 Div. Public Works bocationa Z"i7d No. Date o,,"ORT" TOWN OF NORTH ANDOVER Certificate of Occupancy $ 4K jjo�a Building/Frame Permit Fee $ S .°•''��' Foundation Permit Fee $ DO <D C1 �- �cNusE OtherlPermit Fee $ ` Sewer Connection Fee $ Watir Connection Fee $ SEP 2 IOTA L $$ Building Inspector 6522 Div. Public Works Location No. Date �3 40RT" TOWN OF NORTH ANDOVER . ' p Certificate of Occupancy $ * ; • Building/Frame Permit Fee $ r Foundation Permit Fee $"- s�C14 Other Permit Fee $ A10' Sewer Connectior�Fee $ /z .� m AYE z(6 Water Connectic�r�i Fee $ '0ey a TOTAIQ j s 3 , ,. rr Building Inspe for . 6454 Div. Publid Works v APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PAGE 1 MAP KBO. LOT NO. EBT. BLDG. COS z d • 2 RECORD OF OWNERSHIP IDATE BOOK iPAGE ZONE SUB DIV. LOT NO. 0 �I LOCATION OWNER'S f1AME / -C� EST. BLDG. COST PER ROOM PURPOSE OF BUILDING NO. OF STORIES SIZE — OWNER'S Ar)DRFSf op, BASEMENT OR SLAB :i �� �vimuj. ARCHITECT'S NAME ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING SIZE OF FLOOR TIMBERS IST t2ND ,/J� 8 Rb BUILDER'S NAME _ _ „, 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS SPAN '' DISTANCE TO NEAREST BUILDING / DIMENSIONS OF SILLS r ar '" "" POSTS DISTANCE FROM STREET r' DISTANCE FROM LOT LINES — SIDES ri� REAR /,c'O tJ (/f "" "" GIRDERS AREA OF LOT FRONTAGE LO / ✓ HEIGHT OF FOUNDATION �! THICKNESS IS BUILDING NEW c y'p SIZE OF FOOTING / X OY IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FIL D LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER?� BOARD OF APPEALS ACTION. IF ANY �+ IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NAT JJR�AL GAS LINE INSTRUCTIONS PROPERTYllNFORMATION LAND COST SEE BOTH SIDES va.1—JIMI.{ 'o EBT. BLDG. COS z d • mm '.p PAGE 1 FILL OUT SECTIONS 1 - 3 0 EST. BLDG. COST PER SQ. FT. "� 7Q {' 0 EST. BLDG. COST PER ROOM - PAGE 2 FILL OUT SECTIONS 1 12 �wra jj'� pdezr Iwr_ SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR 1 DATE FILED OF OWNER OR AUTHORIZED AGENT FEE rte/ Vr7(/(Jy °firms-d,� Lam_ PERMIT GRANTED % 19_ AM A. _ BOARD OF HEALTH OWNER TEL.# % PLANNING BOARD CONTR. TEL. # CONTR. LIC. # O BOARD OF SELECTMEN s /1 A'Yl it A 1 OCCUPANCY SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 I3 CONCRETE BL'K. PINE _ _14�1•_ BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY VJALL UNFIN. 3 BASEMENT AREA FULL 11 FIN. B M'T' AREA _ 1/1 1/2 l/. FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN (/ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 22 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH ASPHALT SIDING HARDNId'D ASBESTOS SIDING _ COMMCN _ VERT. SIDING ASPH. TILE STUCCO ON FRAME RY I_II WIRING 5 ROOF 10 PLUMBING GABLE HIP GAMBREL MANSARD 6 FRAMING II BATH 13 FIX.) TOILET RM. 12 FIX.I 41 FLAT SHED PIPELESS FURNACE WATER CLOSET ASPHALT SHINGLES AV LAVATORY STEAM WOOD SHINGES KITCHEN SINK _ SLATE AIR CONDITIONING NO PLUMBING _ TAR & GRAVEL STALL SHOWER UNIT HEATERS ROLL ROOFING GAS I MODERN FIXTURES _ BUILDING RECORD �I TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST f t � PIPELESS FURNACE 7 FORCED HOT AIR FUI TIMBER BMS. d COLS. STEAM STEEL BMS. 3 COLS. HOT W'T'R OR VAPO WOOD RAFTERS AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M2nd I _ 1st 3rd ELECTRIC NO HEATING BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. I? � T f t � 7 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. I? FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: (>re z22m,6&/ Phone LOCATION: Assessor's Map Number .D Parcel Subdivision Lots) Street A/ St. Number ************************Official Use Only************************ RECO TIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved 22 11 Z Town lanner Date Rejected Comments Food Inspector -health Sept' Inspector -Health Comments Date Approved Date Rejected j l Date Approved Date Rejected Public Works - sewer/water connect ions &V R-27-�5 - driveway permit Fire Department t �e, d" Received by Building Inspector Date AUG SM f i � 3 V k1.1�;; I SEP 1 5 1993 CERT/F/ED FOUNDA T/ON PLAN LOCATED IN No. ANDOVER,MA. SCALE d /"= 4DATE: 10 - l3 93 Scott L. Gi/es RL. S. I 50 Deer Meadow Road 0 0 I North Andover, Moss. LOT 36, i --LDT SI,GSG SQ.FT, m EXISTI N FC.ap, L0 -r 3Z, / CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE Of THE OFFSETS OF THE SU/L DING /NSPEC TOR ONLY SHOWN COMPLY AND SUCH USE /S FOR THE- WITH HEWITH THEZON/NG DETERMINATION OF ZON/NG BYLAWS OF CONFORM/ T Y OR NON- CONFORMITY -L10•WHEN CONSTRUCTED. WHEN BUIL T. ._ _ w A c aG o w U a cn a z z `~O ] co -� w °�° u: c U w a z a X � w itW w a a .c a cn m ii U .c cG w a w v q w z v cn v as O cn A. 5 0_ C3 C c�0 C* C W � % EqU� �m oE� C', o f C•� a N R m m N co 0 m N R N CD f aU ,FLzo os O C 4 aCr � Ci ci y O cc C H C y R = O W G -0, ,� •ty C= '° c Z 'i V v .N Q LU m o m c COD C' G7 'G O 'a 2 eyv �Ly'= C = . m.0- m i D� tZ 1 O n. V1 ,^ V ) N o � N C _ o w v CD A fj r • as 0 Q1 ui J o r z A. 5 0_ C3 C c�0 C* C W � % EqU� �m oE� C', o f C•� a N R m m N co 0 m N R N CD f aU ,FLzo os O C 4 aCr � Ci ci y O cc C H C y R = O W G -0, ,� •ty C= '° c Z 'i V v .N Q LU m o m c COD C' G7 'G O 'a 2 eyv �Ly'= C = . m.0- m i D� tZ 1 O n. V1 ,^ V ) N o � N C _ o w v CD A fj r • as 0 Q1 J o z LL. co i O o s Z co CL O D y � — z Co Om O o CD o_ cc .� co'� W mm z o CL ♦..� CD co 0 Q m oa �Q Ca C 'O A ea -0 Z � z_ cm .. C Q_ Q d y O _Z Z Z ( 's OF: WFICI. ."lil'111.1)INU (:..()NSIl (VATION 1'1.ANNIM, UA TE LOCATION Town of VI'l J A N 1) 0 Vr El t 111 VVill IN III Pl,ANNING& KAHEN I I.P. NI :i l)II l:Cl()H M; lit I 1 7) (;)i!).1 7 f C111AINLY APPLICA11014 ANO I'L13111' PERMIT, # -7 f-9' )WNER'S NAME: L> 'UILVERIS NAME: L (ASON'S NAME: 'A4 rl �i1 ) N,.-' AS OWS ADDRESS: a C��ry k I I �%� /rt�C�.. ASOWS TELEPI[ONE:---- ATERIAL OF CHIMNEY: NFERIOR CHIMNEY: EXIERIOR CHIMNEY: W.IBER AND SIZE OF FLUES: PV01-- HICKNESS OF HEARTH: jo 1 iii CUL11"Iney 0/1. ()�Aepcacc con(jollill to 4ILe. U() tllcCode and flavc "m[C'.5 mid egutatiow been /Lece-;lled: ATE: IGNATURE OF MASON: ER.MIT GRANTED: FEE c) )BERT NICETTA :GILDING INSPECTOR— VSPECTEO: FMARKS: I SOLID BLOCK It QUIRED (1117f THIS PERMIT MCISF BE VISI'LAVLO 014 ME PRLNISIS qj CERTIFIED FOUNDA TION PLAN 1 LOCATED /N NO. ANDOVER,Kk SCALE /1'f= _ 40= DATE: lo -1-5-53o Scott L. Gi/es R. L. S. 50 Deer Meadow Rood I North Andover, Moss. I , W� E 1p LOT 34- w w LOT ExzSTtN mr � w \\ •Z7 P -PAD Lo -r 3Z, / CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE of THE OFFSETS OF THE BUIL DING /NSPEC TOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE- WITH HEW/TH THE ZON/NG DETERMINATION OF ZON/NG SY LAWS OF CONFORMITY OR NON- CONFORM/TY � --�O-AN WHEN CONSTRUCTED. WHEN SU/L T. _ _ V z 4 0. 0 Oour o w Cl) ria I 03W LL O w V r dll A D', am 0 y MOl H � `n d am 0 y MOl A Ix 0 r9 ci •o cJ CD " �� O •ate � : z CFO A - a 014. - NI ---if ) �iE � • �.•� �,J rte, E SU � :`CL. O N .. 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