Loading...
HomeMy WebLinkAboutMiscellaneous - 1030 JOHNSON STREET 4/30/2018N O O v b 0 0 0 0 0 Date . /-/- C9.5? �.6. `.. t ;•t;:"_:"�o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... _ �-� has permission to perform ....... .................................................................. y ✓ wiring in the building of .. *' k' ........................................................ at ......'j........ :...tea--- ........... ....... , North Andover, Mass. i Fee 45... ....... Lic. No !�.`?�� ..........::.... �.�.�-�'-�.:� �................. ELECTRICA*'] INSP46T0R Check # Commonwealth of Massachusetts t Department of Fire Services S BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked r [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYRE A L INNF ATI N) Date: City or Town of: To the Inspector of Wires: By this application the undersign d gives notice of hi lie intention to per Itelectric I work described below. Location (Street & ber Owner or Tena Telephone No. Owner's Address Is this permit in conjunction with a building permit? ,.. Yes.. ❑:. No.; (Check Appropriate Box) Purpose of Building Utility fitithorization 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: _ Installation of Security system a Completion ofthe followin v tahlp nrwv ho ,vaivorl h„ the In cnectnr of w;—v No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above rnd. ❑ In- rnd. ❑o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump I Totals: Number TonsKW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances,, K KW Security Systems: No. of Devices or Equivalent No. of WaterKW Heaters No. of No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail ifdesired, or as required by the Inspector oJ'Wires. 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 ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Elect ical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under thepains andpenalties ofpeijuiy, that the information on this application is true and complete. FIRM NAME:ecugtyQr�.Acas- LIC. NO.: 1 Cqq( Licensee: John S. Bassett Signature LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 603 594 5928 Address: 9 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licl9hsee 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. PERMIT FEE: $ �, This certifies that has permission to pt Date ..... ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ............................. .. ..... ...... ........ ..... .. ........... wiring in the building of ....� ..... .. ......... ..... . .. .. ... i�� . .................. . .................................. .North Andover, Mass. at ./.� ... .......... A, ........... Fee.7.. Lic. No./ ............................................................ ELECTRICAL INSPECTOR Check # %45116 Commonwealth of Massachusetts Department of Fire SeTces BOARD OF FIRE PREVENTION 11 GULATIONS APPLICATION FOR PERM fi All work to be performed in accordance. itl (PLEASE PRINT IN INK OR AL FO A City or Town of: ho By this application the undersigned gives ne f h's or Location (Street &ber) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Official Use Only Permit No. .116 Occupancy and Fee Checked �4 . [Rev. 11/991 leave blank TO PERFORM ELECTRICAL WORK i the Massachusetts Electrical Code (MW1179, 0 TION) Date:_ To the Inspe for f Wires: ier intent' ,to perform the electrical work described below. Telephone No. Yes ❑ No g (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps New Service Amps Number of Feeders and Ampacity Volts Overhead ❑ Undgrd ❑ Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Installation of Security system Completion qf the Lblloiiin table maybe waived by the Ins ector o Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o mergency ig ing Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kit Security Systems: No. of Devices or E uivalent No. of Water KW Heaters i No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail ifdesired, or as required by the Inspector of Wires. 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 ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of E ctrical Work: " � (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: John S. Bassett Signature LIC. NO.: 15330 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 603 594 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lic see 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. PERMIT FEE: $ , a 3 '14 Date ..../ 0 g NorrrH TOWN OF NORTH ANDOVER pb`4,.ao ,e 16 1tipL � g PERMIT FOR GAS INSTALLATIONra al This certifies that ...- ..... .... has permission for gas installation . ' �• in the buildings of,._.2:Z.^.... .. ......••••••••••••••••••• at,�n`3° `�O `�`" a'^• .• • • • • • • North Andover, Mass. Fee . Lic. No Z/G '. ... ..... Z. / GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ✓IASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING or print) ixvnI H^1'4 DOVER, MASSACHUSETTS Date 3 19 ,cF:2 � Building Locations j cArNsQ n S�. Permit # �&I�,1 ,Q Amount S �pn PC'grS 0,-NOwner's Name New ❑ Renovation ® Replacement ❑ Plans Submitted ❑ c (Print or type Address Check one: Certificate Installing Company ❑ Corp. UiPartner. Business Telephone 7.f / 2 y S % 77 0 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter /` Qv�h lech91'� f INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No F-1 If you have checked ves, please indicate the type coverage by checking the appropriate box. 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. 2//oti-+- By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber . ��6 2--1 City/Town ❑ Gas Fitter License Number ® Master APPROVED (OFFICE USE ONLY) ❑ Journeyman co jj — ;� )j ' 4 n � U U z E- C z rn C n L = n z w Z -I z W — %� z� r 't 'r _ •! w i W Z — � — �C C C w — — C w i-' SUB - BA SEMI EN"r B A S E M E N T I S T. F L O O R 2N D. FLOG R 3RD. FLOOR 4 T H. F L O O R Tr H F L O O R 6 T 11 . F L O O R 7T 11 FLOOR ST H. F L O O R (Print or type Address Check one: Certificate Installing Company ❑ Corp. UiPartner. Business Telephone 7.f / 2 y S % 77 0 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter /` Qv�h lech91'� f INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No F-1 If you have checked ves, please indicate the type coverage by checking the appropriate box. 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. 2//oti-+- By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber . ��6 2--1 City/Town ❑ Gas Fitter License Number ® Master APPROVED (OFFICE USE ONLY) ❑ Journeyman Locution No. Date f ` �O"T" TOWN OF NORTH ANDOVER jwiafimA]kp Certificate of Occupancy $ "- } Building/Frame Permit Fee $ �M„sE� FoundatiPmit Fee $ 1` 4_ Other POO t FeW q $ 'YAR . . S re Conn ec p eVa�$ Water ection %?e `$ TOTAL Building Inspector ' Div. Public Works i APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. V PAGE 1 MAP d-40. LOT NO. 2 RECORD OF OWNERSHIP (DATE (BOOK 'PAGE ZONE SUB DIV. LOT NO. F- LOCATION`` 0-30 TD4ry ��� ���, PURPOSE OF BUILDING OWNER'S NAME�An� w NO. OF STORIES SIZE OWNER'S ADDRESS S -tet A"F BASEMENT OR SLAB SL It ✓jXg, ARCHITECT'S NAME �vW » SIZE OF FLOOR TIMBERS IST 3RD BUILDER'S NAME J 44f!Q / S 0� SPAN za/��� DIMENSIONS OF SILLS •' " POSTS / ti/e`�,� DISTANCE TO NEAREST BUILDING `00 I -3 1 DISTANCE FROM STREET -[- DISTANCE FROM LOT LINES - SIDES *•2� d-�V REAR n 2 30 GIRDERS AREA OF LOT "/ �� 4 0 FRONTAGE // •�� /b HEIGHT OF FOUNDATION THICKNESS /p //' IS BUILDING NEW SIZE OF FOOTING X r 19 BUILDING ADDITION ` L e MATERIAL OF CHIMNEY &I IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND Q WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �� 1 / IS BUILDING CONNECTED TO TOWN WATER ! of BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER /✓ U IS BUILDING CONNECTED TO NATURAL GAS LINE tj e f INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS I - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELEr-M�'C.METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS P'(ANS MUST BE FILED AND APPROVED BY BUILDING DATE FILED / / L ) Z. SIGNATURE OF OWNER OR AUTHORIZED AGENT 162 FEE o G. PERMIT GRANTED / 19 OWNER TEL p CONTR. TEL. CONTR. LIC. N o" 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST2 Q (� EBT. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN w�w.nv ■n�r6G�VR 1 OCCUPANCY iNGLE FAMILY SiORIES ,ULT1. FAMILY OFFICES PARTMENTS CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH ONCRETE n V 3 1 2 IERS I PLASTER DRY WALL UNFIN. 3 1BASEMENT II REA FULL FIN. B M'TAREA _ 1/2 % FIN. ATTIC AREA _ O BMT FIRE PLACES _ EAD ROOM MODERN KITCHEN 4 WAILS 9 FLOORS SBESTOS SIDING ERT. SIDING FUCCO ON MASOF IUCCO ON FRAME 5 ROOF ABLEHIP AMBREL MANSARD .AT SHED B 1 2 3 CONCRETE �_ EARTH HARDW D COMMCN _ ASPH. TILE ATTIC STRS.-G FLOOR I_ WIRING SUPERIORI� POOR ADEQUATE I NONE 10 PLUMBING BATH I3 FIX.I _ TOILET RM. 12 FIX.) WATER CLOSET _ OLL _ROOFING �_J� MODERN FIXTURES 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. 6 FRAMING 1 1 HEATING ------- ,,,,,..—-+°FORCED i �' 'OOD JOIST PIPELESS FURNACE FORCEDHOT AIR FURN. IMBER BMS. & COLS. STEAM FEEL BMS. & COLS. HOT W'T'R OR VAPOR FOOD RAFTERS _ _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL 'M'T 2nd _ st 13rd I ELECTRIC NO HEATING MORTGAGE INSPECTION PLOT PLAN 1 NORTHERN ASSOCIATES, INC. ' 65 SALEM STREET, LAWRENCE. MA 01843 • Tel. 508-975.7117 MRTSAS01t DONALD A. 6 CHARLENE PEAR90H LOCAT AL' 1090 JOHNSON STREET try, STATE' NORTH ANDOVER MA DA ILa'' 11/1/90 DEED REF. 2174 / 66 PLAN FIEF. PL05080 SCALE: S- d0' JO46 A• 90/ 4020 CERTIFIEU TM CrrrCORP NORTSASE INC. NOTE: This mortgage inspection was prepared specikWly for mongagg purposes and is not to be relied upon as a survey. Northern Associates, Inc. accepts no respontibill for damages resulting from said reliance by anyone other than the said mongagee and its assigns in connection with its proposed mortgage financing to said monga W. This mortgage inspection was prepared in ec4ordance with the echnk- f Standards for Mongage Loan Inipechons as adopted by tha Massachusens Association of L&W fi vwyoa s ud C44 Engineer, Mc. JOHNSON STf+=F I FURTHER STATE THAT IN MY PROFESSIONAL OPINION the principle structure/s and accessory outbuildings. CONFORM with the setback requirements of the local zoning ordinances, and that there are no encroachments of major improvements either way across property linos except as shown. ALSO: 1. Property is not in a Flood Hazard Area. 2. Property is in a Flood Hazard Area. . 0 3. Information is insufficient to determine Flood hazard. Flood Hazard determined Iron latest Federal Flood Inwrvsa Rata Map Par I w.. i� 0 i• i_ A a a Ma ma a a - W m 0 co m T (A m T m T o m C ? m C T N C y C o (Dn m n c O - W ° „' > Z ° m Z n O •� z T Z -4 M M T m ^' D 70 -4 4 O 00 _ 7X0 m m O • 9 0 c c� 9 FORM - U - LOT RELEASE FORM aJAO-A) Aho L)Q G ,A IN INSTRUCTIONS: This form is used to verify that allnecessary 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 j� o ✓� �P'� ,�svvl� PHONE �.2- _ 909 ASSESSORS MAP NUMBER /19'))4 LOTNUMBER SUBDIVISION LOT NUMBER STREET i Irl <a� STREET NUMBER /0 3 OFFICIAL USE ONLY ........................■r..■....■.........■•.r......r....r.r.............■ RE DATIONS OF TOWN AGENTS ,. ... .............................................i.... .......... DATE APPROVED CO SERVATION ADMINISTRATOR wDATE REJECTED Cotes s,r V o r - DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS FOOD INSP TO 1� / SEPTI CTOR -HEALTH PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE E G uvH:LI MAR 12001, BUILDING DEPT I \� Q) J, L�fl o I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMrpOYLISH AaONE OR TWO FAMILY DWELLING £ ._. _.. ... _....... .._. ........ . .. ... r ., _ .. .. .......,- BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: / v 3 jvti� rvy Sz ap Num Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Repired Provided Re aired Provided t 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 0 SECTION 2 - PROPERTY OWNERSIIIP/AUTIIORIZED AGENT 2.1 Owner of Record ame (Print) Address for Service Srgnature �. Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Supervisor. Licensed Constntcti no d,S / License Number Address //,,, Ll---- / • Expiration Date Signature a ephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 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. Si ned affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description ofP-roposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Conipleted by permit applicant _ OiCIAi. USE:O1�'L�' .•' , 1. Building 2 [J J (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION T40 BE COMPLETED WHEN OWNER GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters rely i to wor iz ho ed by this building pennit application. Signature of Owner Date SECTION 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 Signature of Owner/A e Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST 2 ND 3 RD SPAN DIIb1ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIv4NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ' ✓iie toamimarturP o���:saciucae%�a . BOARD OF BUILDING REGULATIONS i i License: CONSTRUCTION SUPERVISOR Number: CS 050929 Birthdate: 10/10/1958 I Expires: 10/10/2002 Tr. no: 2703 Restricted To: 00 DONALD A PEARSON _ 1030 JOHNSON ST�.,� N ANDOVER, MA 01845 Administrator - MOM NONE IMPROVEMENT CONTRACTOR j Registration:' i 100215 Expiration: 6/15/02 i Type: Private Corporatio r PEARSON RENOVATIONS, INC._ Donald Pearson p 1030 Johnson St ADMINISTRATOR N. Andover MA 01845 �lk Emil s Y i i � hi j �l S eG it4 Ja'Alga4 !4G &vc Xk :S Gi912 r�-G . o. MAScheck"COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 3-7-2001 DATE OF PLANS: 03-07-01 PROJECT -INFORMATION-- 1030 NFORMATION:1030 JOHNSON ST COMPANY INFORMATION: PEARSON ST COMPLIANCE: PASSES Required UA = 148 Your Home = 123 I I I I I Permit # I I I I I I Checked by/Date I I I Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 480 30.0 0.0 17 TELLS: Wood Frame, 16" O.C. 857 13.0 0.0 71 GLAZING: Windows or Doors 5.6 0.330 18 FLOORS: Over Unconditioned Space 352 19.0 0.0 17 HVAC EQUIPMENT: Furnace, 82.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 131-0 and J4_4_ Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2..01 DATE: 3-7-2001 Bldg.1 Dept.I Use I I CEILINGS: [ l I 1. R-30 I Comments/Location I I WALLS: [ ) I 1. Wood Frame, 16" O.C., R-13 I Comments/Location I I WINDOWS AND GLASS DOORS: [ l I 1. U -value: 0.33 For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes I Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location [ ] No I HVAC EQUIPMENT: I 1. Furnace, 82.0 AFUE or higher I Make and Model Number i I AIR LEAKAGE: I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. 1 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R -values, glazing U -values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. I I DUCT INSULATION: 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 located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 1250 of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant I below 40 1.0 1.0 1.5 1.5 ( ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I PIPE SIZES (in.) I NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" I 170-180 0.5 1 1.0 1.5 2.0 I 140-160 0.5 1 0.5 1.0 1.5 100-130 I 0.5 1 0.5 0.5 1_0 ----NOTES TO FIELD (Building Department Use Only)------------------------- Location No. T Date %Z N°RT" TOWN OF NORTH ANDOVER p Certificate of Occupancy $ * Building/Frame Permit. Fee $ •+,,s'""°'�X' + 1 undation Permit Fee dU $�11719/ Other Permit Fee $ 199? -Sewer Connection Fee$ ! )12 7r►, Water Connection Fee $ i J'`41' Building Inspector _ 7 Div. Public Works Location No. Date ,40RT1y O•`.�o TOWN OF NORTH ANDOVER "�ti0o Certificate of Occupancy $ Building/Frame Permit Fee $ qi •O��no ,ssACMUSE� Foundation Permit Fee $ Other Permit Fee $ / -O 0 0 Sewer Connection Fee $ Water Connection Fee $ TOTAL DED 2 7 1991 Building Inspector Div. Public Works PERMIT NCS. �c�S APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. • JPAGE 1 MAP 4-40. �/ LOT NO. 12 RECORD OF OWNERSHIP iDATE BOOK PAGE i!ONF_ SUB DIV. L T NO. FI LOgATl N Q 3 4 A�O° � PURPOSE OF BUILDINGAwz C OWNER'S NAME n� � �, A+v n NO. OF STORIES �%�t% j SIZE rv^ W / OWNER'S ADDRESS �p --q-v /„S.©� !'Ji' !1 BASEMENT OR SLAB SC P-te( ARCHITECT'S NAME f)J) (� �c^J _ SIZE OF FLOOR TIMBERS IST .2,2ND '� ;v 3RD G` O BUILDER'S NAME SPAN DISTANCE TO tjEAREST BUILDING^2 04, �L�'7" DIMENSIONS OF SILLS L. / (' DISTANCE FROM STREET S`� J � �T 11 POSTS DISTANCE FROM LOT LINES — SIDES �V REAR 0 �_r GIRDERS i AREA OF LOT 41 / FRONTAGE Es ] ,�� HEIGHT OF FOUNDATION �j THICKNESS IS BUILDING NEW �� SIZE OF FOOTINGc� f X IS BUILDING ADDITION f S MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE(�t-- `7 l ! IS BUILDING CONNECTED TO TOWN WATER �L,5 BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE 4/0 INSTRUCTIONS SEE BOTH SIDES "+ L� '! \Y► 12 Utl Ly U lJ L7 y PAGE 1 FILL OUT SECTIONS 1 - 3 k{k PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES GARAGES MUST CONFORM TO STATE FIRE REGULATIONS—""' PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTO DATE FILED SIGNATURE OF OWNER OR AUTHORIZED AGENT k F E E PE MIIGRATtD: t9 f 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 0. 0-&V� EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD bn BOARD OF SELECTMEN J 'NV -1d10 -Id S3OV1d3M SIHl 'a3S0dWia3dflS '013 'S3ovu -V°J 'S3HOMOd H11M 'S9N1a11f19 d0 SNOISN3WIa 10VX3 aNV S3N11 101 WOUA 3ONV1SIa ONV 101dOSNOISN3W1a 1OVX3 MOHSiSf1W NO1103S SIHl M ZL I AONVdf1000 L aa0D3b JNIa11ns E)NIIV3H ON JIm1J313 P'E j9I —I PSI . 1.W.9 110 SWO m i0 'ON L SVJ Sm31V3H 11Nn 'J.1.H 1NVIOVm ONIN01110NOJ ill _ s831iV8 OOOM mOdVA 80 b.1.M IOH 'S10J B 'SW9 1331S WV31S _ 'S10J V 'SW9 83SW11 'Nlni 81V IOH 03J10i 3:1VN8ni SS313dId _ ISIOf OOOM ONIIV3H I.l I ONIWVmi 9 OOVO 3111 8001d 3111 S38n1X1d N8300W ONI3008 1108 _ d3MOHS 11V1S ON19Wnld ON 13AVdO B 8V1 31V1S y NNIS N3HJ11JI S30NIHS 000M ),dOIVAVI S310NIHS 11VHdSV 13SOIJ 831VM 03H 1Vli I'XId 61W8 131101 08VS W I 1389WVJ r. XI3 E) H1V9 dIH I 319VO ONiownld O L �_3NoNJ I 31VnO30V 800d dOI83dns loom 5 If N ONImIM 3WV8i NO 9NO1S k8NOSVW NO 3NOIS X19 830NIJ 80 'JNOJ (Z, 3WV8i NO )131"— T?800Ii 8 'Sdis JI11V 0NOSVW NO ADM —� E I 9 3WV8i NO OJJn1S ABNOSVW NO OJJn1S ONIOIS '183A 9111 'HdSV NOYIWOJ ONIOIS SOIS39SV ON101S 11VHdSV O.Pi\08VH H18V3 S3IONIHS DOOM 3138JNOJ S08V09dV1J SHOW 6 S11VM v N3HJIDI N8300W T_ WOdd OV3H S3JVld 3813 I.W.9 ON V38V JIIIV'NH 1A °/i '/i V38V .1. W.9 'NH ilnd V38V II 1N3W3SV9 £ NNW I1VM 1,80 _ 831SV1d O.M08VH 3NId £ Z I 9 " S831d 3NO1S 80 )IJI89 X.19 3138DNOD 3138JNOJ HSINIi 11OI713INI 8 NOI1VONf10i Z NO110nN-LSNO0 S1N3WISVdV _— s3JI3jO AIIWVj 'I11nW 53180!S AIIWVi 31!5NIS ZL I AONVdf1000 L aa0D3b JNIa11ns OFFICES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING OF NORrN Town of m n .� NORTH ANDOVER �SS�cRue��t DIVISION Or - PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 120 Main Street' North An(lover, MHSS;]CIMSettS U 18473, ((i 1 7) 685-4775 In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number S c3�' is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: cation of Facility) Signature of PermitVApplicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Ni < cl* CD l a T fu I m pop m C O m O .O p `t O °° m °—' < ao T v M � p O m ivy �n 'p n O o C c o POO O A t A at pPoo C a S o- -v v W• � v fl. Ni < cl* CD W T 11 iA 31 m m C O m O O °° m °—' < ao T °—' M 3 m �n n o c o v � v W% O Z Z T � 7 NO H M _ -4 > :i M O O O _ A 'A 70 § e .:D § x, �® \ nr . \ { 2 k a 6 2 $■ . cIc 0� R 1 § owo /o In 2#0 0� nr §2. \ { 2 k § 2 z cIc 9 owo /o =@ § mkt ƒ� @�§.. C ® ( 2 ( $ » \? cf) 7 0 r q . 9 � .' in N I FORti U TOWN OF NORTH ANDOVER LOT RELEASE FOR11 SUBDIVISION .SSESSORS MAP 17 UBDIVISION LOT(S) 40 7 PERMANENT ADDRESS (ASSIGNED BY D.P.W. ;TREET 030 �i H S O .PPLICANT / /o n a �t� rSG n PHONEo�"G�a' ya )ATE OF APPLICATION TOWN USE BELOW THIS LINE ' LANN TOW :ONSERVATION CODIRISSION------ CONSERVATION ADMIN. BOARD OF HEALTH�� Z ,, DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED 11 ANITARIANDATE REJECTED ly OF DEPARTMENT OF PUBLIC WORKS f2 of DRIVEWAY. PERMIT SEWER/WATER CONNECTIONS e/ 02 AO F rt* E DEPT deT�TJi��,d�ro IR a � — RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and ilealtli Boards, the Conservation Commission prior to the issuance of any building permit for the subject lot. This form shall not releeSthe applicant from tl►e compliance of any applicable Town quior MORTGAGE INSPECTION PLOT PLAN NORTHERN ASSOCIATES, INC. 65 SALEM STREET, LAWRENCE MA 01843 • Tel, 508-975.7117 IORTSAGOR DONALD A. 6 CHARLENE PEARSON LOCA rMT 5090 ✓OMVSON STREET try, STATE' NORTH AAvovfiR MA DA TE: 11/1/90 DEW REP. 2174 / 66 PLAN REF. PLOW080 SCALE` s- a0' I.. JOB IF. SO/ 45RU CERrrFrED Tion CrrrCDRP NORMASE• MC. NOTE: This mortgage inspection was prepared specifically for mortgagg purposes and is not to be relied upon as a survey. Northam Associates, Inc. accepts no responsibiiq for damages resulting from said reliance by anyone other than the said mortgagee and its assigns in connection with its proposed mortgage financing to said mong&W• This mortgage inspection was prepared in ,acSordance with the Technical Standards for Mortgage Loan InsWticris as adopted by the Massachusetts Association Of Lana kirrtyoce and C A Engirwrs, lnc. JOHNSON S7 Hr-,. . I FURTHER STATE THAT IN MY PROFESSIONAL OPINION the principle structures and accessory outbuildings, CONFORM with the setback requirements ofthe local zoning ordinances, and that there are no encroachments of major improvements either way across property lines except as shown. ALSO: t. Property is not in a Flood Hazard Area. 2. Property is in a Flood Hazard Area. 0 3. Information is insufficient to determine Flood Wazard. Flood Hazard determined from latest Federal Flood ' Inwrvice Rate Map Parsnll Location No. �C z Date OF NORTH ANDOVER Df Occupancy $ ame Permit Fee $ Permit Fee $ it Fee $ lection Fee $ Water Connection Fee $ Za, $ Building Inspector Div. Public Works URV,71T JV01 0� m APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. vPAGE 1 MAP K40. LOT NO. 12 RECORD OF OWNERSHIP jDATE BOOK PAGE : ZONE SUB DIV. LOT NO. FI LOCATION ;7 POSE OF BUILDING f OWNER'S NAME VG.1r`i f ea /'-9 C? il NO. OF STORIES SIZE OWNER'S ADDRESS �C�C'i OtiNS 1 S/ BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME - v '� ,�� t' SPAN DISTANCE TO NEAREST BUILDING ko) DIMENSIONS OF SILLS '" POSTS DISTANCE FROM STREET �� r DISTANCE FROM LOT LINES — SIDES .J REAR >g '" GIRDERS AREA OF LOT / L� FRONTAGE �� HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE SEE BOTH SIDES INSTRUCTIONS PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 f ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 1 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PL S MUST BE FILED AND APPROVED BY BUILDING I CTO / DATE FILED L/ r SIGNATURE OF OWNER OR AUTHORIZED AGEN FEEln.S�. GI V PERMIT GRANTED covTR. rFl. c) �S 19 COWR. LIC. 0aLo ,:) P` " DING DEPARTiVIENT I 3 PROPERTY INFORMATION LAND COST EST. CDG. COST / Q Cp 3 ST. BLDG. COST flER SQ. Fr. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD WARD OF SELECTMEN BUILDI d INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K.PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M TAREA Y. 1/2 1/. FIN. ATTIC AREA _ NO BMT FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE B _ 1 2 �_ —{I_ �— 3 _ DROP SIDING WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING HARDVJ'D COMMCN ASPH. TILE VERT. SIDING STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY _ ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBQEL _ FLAT MANSARD TOILET RM. )2 FIX.) _ SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ _ ROLL ROOFING MODERN FIXTURES TILE FLOOR _ TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ to 13rd ELECTRIC NO HEATING 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: Ilk// Z� 01Q ✓'rO Yk Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street St. Number ************************Official Use Only************************ RECOMIfENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Town Planner Comments Food Inspector -Health f f4 Septic Inspector -Health Date Approved Date Rejected Date Approved Date Rejected Date Approved Z� Date Rejected Comments 1)),547-6 SET ,Civ !=G'iE' 55,60 --/- Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date J 7#, ot5 • Cf) C/) n 0 z C/o N O Go 0 CD 10 CO) = CD m 0 CD Cl) C'3 C- C) C-3 CL = D CO) CD Z =r.0 'A .. SMq Ca — -Pa. a- M 0 CL -0 CL m =r CD =r to 'co) r -O CD CD --1CO3 CD O =r CD CD CD -1 -1 CO3 C2CD 0 z cl S HC -3 t CD CO) CL =5 0 CD < CD Co C-),= 0 CD CL CD CO3 03 CO2 CO) CL Cl) CL CO) pct t c /^ .... CO3 CD CD 0 o =r CD oC4 CO) CD =r 7. c I • CO3 CD @ CD 03 EL no ACo C, , Cl) —41b •cn C/) 7r::3 (D u CD cn rnm CD � 0 :1 O C) -n n rD Po ro In 0 rb 0 tz C/) M n l< C/) al 0 CL ;�* n :.T- rD o > 0 1-n Cl) 0 > CD a z CA �-n r- CD =. 7-1 CL 0 > = C* CD9 CD CL =r cr CD CD 0 CD CD w E3 m cf) m CD vi, CD > Cl M CD ZZ 0 < CO) m CD 7t -n CD a 0 > CD Cf) C/) n 0 z C/o N O Go 0 CD 10 CO) = CD m 0 CD Cl) C'3 C- C) C-3 CL = D CO) CD Z =r.0 'A .. SMq Ca — -Pa. a- M 0 CL -0 CL m =r CD =r to 'co) r -O CD CD --1CO3 CD O =r CD CD CD -1 -1 CO3 C2CD 0 z cl S HC -3 t CD CO) CL =5 0 CD < CD Co C-),= 0 CD CL CD CO3 03 CO2 CO) CL Cl) CL CO) pct t c /^ .... CO3 CD CD 0 o =r CD oC4 CO) CD =r 7. c I • CO3 CD @ CD 03 EL no ACo C, , Cl) —41b •cn C/) 7r::3 (D u CD cn rnm CD � 0 :1 O C) 0 n rD Po ro In 0 rb 0 tz C/) M n l< C/) al 0 CL ;�* n :.T- rD o > 0 I I_jocation �i fro. ! y v Date Y3 "CRT" TOWN OF NORTH ANDOVER p Certificate of Occupancy $ —` * Building/Frame Permit Fee $ �+s 4CHU i�h Foundation Permit Fee s�cHus $ i 7O0iiq Permit '' Fee <� $ Sewer Connection Fee $ MCI�. "T �' c W ter Connection Fee $ _ L - , 4 AY 1993 /6 Building Inspector `:�1 643 Div. Public Works 2<M811KIN0. I X- APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. I LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK PAGE ; ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING C//� % �JfK 'V /-(/�? OWNER'S NAME ! /'A, fsO� NO. OF STORIES SIZE OWNER'S ADDRESS / sem- BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME yG Trv� C SPAN DISTANCE TO NEAREST BUILDI G DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES `7 J REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 a ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED v SIGNATURE OF OWNERA HO .ZED A j*T FEE PERMIT GRANTED OWNER TEL. #__ z_/90,49 -���o/ 19 CONTR. TEL. # -' CONTR. LIQ. # t 3 PROPERTY INFORMATION LAND COST T. BLDG. COST ® •�' EST. BLDG. COST PER SO. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD WARD OF SELECTMEN �Y�W�AY �n�r6V�VR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH d 1 2 13 PINE CONCRETE CONCRETE BL K. BRICK OR STONE HARDw D _ PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING B 1 2 �_ 3 _ CONCRETE EARTH HARD"✓'D COMI.AGN VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. d FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR I- ADEO ATE I NONE 10 PLUMBING 5 ROOF GABLE MIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR d GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. d COLS. STEAM STEEL BMS. d COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL Ll.M'T 2nd _ t 13rd ELECTRIC I NO HEATING 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. Z7 ?gip � x po n o -• a, pC co) d O C O .p C/J ri z -� _=mp m Cl) vCoCO2 CD CL_ CAc � Im to N T >` -a ==—= Mn n C •C CD �� CD y O p _ --ICD m -o NCDo p� O to o Ocoo G H' n CD Cl)o CO)CD 7 fl. r C7 �o W O y D .dCD am. O C�%1 �--� o CD 5C '� d CD 0-5 y n .. Nom. O O70 d N 'C Od cr C V.� CD Cn o 5 : a V C v H '''� C% t0 Q o.CD CD ti . cn H , .� .-� -t ®� �p 'v m �CD ^ cD m N _ l J - D CD CDpo: CD C) o0 00 C CD cn CD CD N .••� D D CZ O co) CCD rn �p CD I z z CO) O (n C N '�- CO:10 CD : m d dam: ilk CCD n'a Cl) a T z c v� D CD �' n n ; .• • y: o = O€ � C cn 0T D n cn rn rD (Dm a ^rD may �n cn �' 04 tz tz �n p= d oa ►� fir5" H �? N n D x, oCn ^ 0• y � CD " c -n f1 x r1rD O '� �o w n H 0 9 0 c / $ ">C' � �(,�'/' S�c� S G/ - Jv�i�LSo�I S7I�G` � `d Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessm nts JAN 241015 M , 1030 Johnson Street TO' Property Address n Adrian Luz Owner Owner's Name information is required for North Andover MA 01845 1/12/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all compc:ients, date installed (if known) and source of information: 12 years old, 4/11/2003, Certificate Of Compliance Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan) Depth below grade: 1.6 feet Material of construction: ® cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" Cast iron through wall, 4" PVC & 3" Cast iron in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal J feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10'x5'x4' Sludge depth: 011 ❑ Yes ❑ No l5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17