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HomeMy WebLinkAboutMiscellaneous - 1044 JOHNSON STREET 4/30/2018 (2)o m f-� 'Location/­ No. ocation/•No. 1 < heck # Date l,7 '' 2*1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Building Inspector/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ;Se1666616r ii+Ci&1-iikollii :.. BUILDING PERMIT NUMBER: . - DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1.2 Assessors Map and Parcel Map Number Number: Parcel Number Address for Service c)/i�xJ S(JA) 0 1.3 Zoning Information: Zoning Distnd Proposed Use Telephone 1.4 Property Dimensions: Lot Area (so Frontage (ft) 1.6 BUILDING SETBACKS ft Signature Front Yard Side Yard SECTION 3 - CONSTRUCTION SERVICES Rear Yard Required Provide Required Provided Required Expiration Date Provided Not Applicable 0 Company Name Registration Number Address 1 7 Water Suppty M.G.L.C.40. 5 34) Public 0 Private 0 1.3. Flood Zone Iafomutioo: Zone ' Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal. System: 0 On Site Disposal System V M X z O `s SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service c)/i�xJ S(JA) 0 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Aq,dress Sigo4ture t Telephone Not Applicable 0 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone V M X z O `s SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .:..:..0 No ....... 0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition ❑ Other 0 Specify Brief Description of Proposed Work: o ✓ c "_IA ,�CX� v,�C ' G.i% � �. TIC 633 c SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit a pplicant,_,_;;: ZQFC iCIA�L 'USEONi.Y «. .. 1. Building $. roo•do 00 • epi SF/E7� (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) C3S i / 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS ALCENT 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 OwZler 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 ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1ST 2ND 3RD SPAN DIMENSIONS OF SILLS DDAENSIONS OF POSTS DUAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH]NMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE F; 10 /tea Ig�(3 �o,) Wf D,. C- K • FORM - U - LOT RELEASE FORM a OI 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. Y/ APPLICANT_s ji//1�� L O Al U PHONE L ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISIONN LOT NUMBER � STREET � / 1hW S0^1 Lr� STREET NUMBER l OZ ............................................................................ OFFICIAL USE ONLY ............................................................................ RECOMMENDATIONS OF TOWN AGENTS ............................................................. ... ..mann... �7 K- DATE APPROVED 6 ZG p� CON ERVATIONADMINISTRATOR DATE REJECTED -640 COMMENTS C-.r/�^+ 1pG.���ON i) (r•k'�.�1 1®ti✓ �`'� DATEAPPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD, INSPECTOR - HEALTH DATE REJECTED DATE PRO / SEPTIC INSPECTOR - HEALTHY DATE REJECTED COMMENTS _ PUBLIC WORKS - SEWER / WATER CONNECTIONS DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR }y�, Ct71 5�]lt t e 20'La-gv.cR `°cam Oc baudm L V O C CZ Er .' n Z B az V (3 � Ui m p n v „ ! - J-1 ¢ o L co j]4�C Z W V W W z\. Y C N C LL �. at TMJ �3n r a S1 0- Z� �' cc O itl ii. y. F C .� Zuj fL lL a Q o f `� c c��� E E z'n !.lU OO W(11 Z 2`C N' N U NL v'1J7 U%N NC>L mQ�EP yLUJJJZ �� 11.w H-0Optl.NY ) MNytl fi L... ��N>Z GaL N Z(!1W S O -> Cot oo F c ulZc HviCL oQo=c WWa W NwEQ f o�jO� �p�LSiEt. Daa�x cc oZ W va 2 o �Z� c� Kiri Q Qp W 1- F-•-mcc�'3_ 11�' �ciir-aL�,Qy�' J U g Q �a O z u i L._ o� o �a o =._ x ["iii C F ;C•- _OosaEm QIiOO od y, fl ti � Qas 4' 0 v 0 C/) m m m 0 a: cm cc o CA 10 co 0 �W� CO! d 0 COO) n' O C CA -v 0 Cl) CD 0 Cts y� CD CO) 0 CD 0 G CD -03 =y O Q y • Q = 3 Z a m Co ma m m o N CL m . C = � Z s N :-j .rt r a O Fn aac-E► m m � C N C y r N O ?m mCD k4t�j, C91 = OO tC -r• O O . Ero4 p r a ara cogCL c A ,, ^^ tC O � VJ m co m N cc =CO m N r'f • O �JC� iA d d � cr c C/) a Z H c J ^� m y V CO) N ¢- sm o *4 p • ZCD CO) a mo o .O r.tv=�� 3 �' CA >H r :ate os CD r a� O y, _ 4� o � o O = cn 4 I ej y 0 O C � n C/)� o d o w z p? o GQ Mw n p o a�n9LmrD r cn _o- ` o o � r ca T^ ` rs o S O > 4 I ej y 0 O C I Location / I / -No. i . _ Date ,,So TOWN OF NORTH ANDOVER o ainwdkp Certificate of Occupancy $ Building/Frame Permit Fee $ ,sSACK USEt Foundation Permit Fee $ Other Permit Feed $ /.5 • D r Sewer Connection Fee $ :Watfr Connection Fee $---"—"" TOTAL $ 4�/ r Building Inspector RAY 6 1993 Div. Public Works PFRJIIT NO. 163 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. //PAGE 1 MAP d40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK PAGE ZONE SUB DIV. LOT NO. F-1-1 LOCATION PURPOSE OF BUILDING Cjt� AE / )_ q mz?L L/T/�-SIIZZE �K. t7f /S,r OWNER'S NAME n}� v O I.w f ,���1 ��,/�^ J ,7 I�l)5V; NO. OF STORIES OWNER'S ADDRESS —` �6i 101_j �Wh_�•lNSON BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 104 KL -T C0� !� SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS DISTANCE FROM LOT LINES — SIDES 10 REAR 2W GIRDERS AREA OF LOT , -loo Sic FRONTAGE /,69 q6 (�Ll 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 t WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER A p� BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER My IS BUILDING CONNECTED TO NATURAL GAS LINE IVO INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 i ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BEF17 AN, PROVED BY BUILDING INSPECTOR DANS FILED SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED t 1s e o 4z i DING DEPARTMENT OWNER TEL. #5()t _(OH'030 CONTR. TEL. #-(aL7- (o CONTR. LIC. #--050 b 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST ZY& Zy8,ys, EST. BLDG. COST PER SQ. FT. mM y EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN a/am, t Mw-amw inar6GtVR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION J� 8 INTERIOR FINISH CONCRETE PINE 3 1 2 13 CONCRETE BL K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/, 1/2 '/, FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE B 1 2 3 _ _ _ DROP SIDING WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING HARDW D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK N MASONRY BRICK ON FRAME ATTIC STRS. S FLOOR _ CONC. OR CINDER BILK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 10 PLUMBING 5 ROOF GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD A TOILET RM. 12 FIX.) FLAT 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 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. d COLS. Pqt 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 _ 3rd 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. 1st it FORM U - IAT 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 'fi^lls out this section***************** APPLICANT: _1 /�-� (� �I� 1.�-�M� o�,r ClD Phone a� LOCATION: Assessor's Map Number Parcel Subdivision Lot (s) Street C_JG IV �d/V St. Number o( L ************************Official Use Only************************ COM14FNDATIONS OF TOWN AGENTS: V7,��* /aij Date Approved Conservation Administrator Date Rejected Comments t/2 Date Approved (A Town PlannerTy Date Rejected Comments Food Inspector -Health Septic Inspector -Health Date Approved Date Rejected Date Approved c Date Rejected Comments _/1/�? d t -Ay'/ eaoi A'. G P,eh Public Works - sewer/water connections - driveway permit Fire Department .Received by Building Inspector Date _C a I C') 0 z cn m D 0 z T z D r C �F _ CA 10 C Z CD CL r d m a n� v CLCD Q CD o S. _ _ CO CD CO) 10 CD a 0 CO) 10 CD _ CD Cl) _ CO) c 0 c CO) CD 0 _ r•* CD CD a y. CD CO2 0 O CD 0 C CD O •HOQ H SCECD'fl y G O0CD Ci H e7 CL 7 � m Z -4 CD Mn �t =r CL cL CD so CA CD O CD Ca O �_ ON .E =r CD CD > > C, O IC -w O n y' C, c ay =1 r' r�r o.� T: VI t0 C CDCD . k CLH ` 0 CD J c CD _ o O to O p� N CL tD c: N C� N :� CD C H CD n N7CD O C2 A C O � C � O �z CD o a a -C. o o =y CD r �CD d dd -a So.'o mss: ow Z d z M w oc°p m t�r z w p- c c to z "oma C/)75 °o a tz d lEz z GJ y 0 0 c • f Location No. a 9 Date / TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ NUW& i; $ r Building Inspector i Div. Public Works PER31IT Ni--' : = ' APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. I/ PAGE 1 MAP K40. LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE SUB DIV. LOT NO. �I LOCATION PURPOSE OF BUILDING .+ CN �k>Si �•�G / CSR G,�2r�� OWNER'S NAME pA��D}"S �►NtaE Lc�M RAo NO. OF STORIES / SIZE 69WL-E 1(,.'* %ACX OWNER'S ADDRESS 1®44 SCi-fNSUM C'T, 1 �1V1 J JJ 77 BASEMENT OR SLAB 5LR� m 4Koi a.o x -3 ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME \/ I KL 'T �X �1 ' ` SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET / " POSTS DISTANCE FROM LOT LINES - SIDES --40- REAR z1®� " GIRDERS AREA OF LOT �J'S,F FRONTAGE f6�+� 9� HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW oc N� SIZE OF FOOTING X ` IS BUILDIN ADDITIO ADOI'1IDO 'TO 6�k A WAACi MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND 50(.I0 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER NO BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER NQ IS BUILDING CONNECTED TO NATURAL GAS LINE N® INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 4 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECT DAT ILED IGNATURE OF OWNER OR AUTHORIZED AGENT F E E .l 7 7, ,r �.f�"57'1.041 p PERMIT GRANTED / OWNER TEL. #668-A 30 C--CONTR. TEL. 617- 335- 3 Z� S 19 /CONTR. LIC. N_P r C� 1(- 3 ��L 3 PROPERTY INFORMATION LPD COST EST. BLDG. COST %OGO EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF NEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY Isc STORIES MULTI. FAMILY _I OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH d 2 13 PINE HARDW D PLASTER CONCRETE CONCRETE BL K. BRICK OR STONE PIERS DRY V✓All _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T AREA _ 1/1 '/t '/ FIN. ATTIC AREA NO 8 M T HEAD ROOM FIRE PLACES MODERN KITCHEN _ _ 4 WAILS I 9 FLOORS CLAPBOARDS B 1 2 �_ 3 _ _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING HARDW'D COMMON VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. d FLOOR I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR I- I POOR ADEQUATE NONE 10 PLUMBING 5 ROOF GABLE I HIP BATH 13 FIX.) _ GAMBRELMANSARD A TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 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. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS SIAL B'M'T 2nd _ tat 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. NK w IM R r.1 lk , CD Gb Pt Z w 77 rl IT T) x b Z =1 cr r -I C- 3 -Z 72 �77 50 � 3 � 3 s lQ � X } J LU p O 9L X 50 � 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: �\) IIS Irl , l.om RA�2i Q Phone LOCATION: Assessor's Map Number Parcel Subdivision Lots) Street 4114 St. Number ************************Official Use only************************ RECO ATIONS OF TOWN AGENTS: Date Approved Id X9 Conservation Administrator Date Rejected Comments Town Planner Comments Health Agent Comments Public Works - sewer/water connections driveway permit Fire Department lv Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date r] 4 7.1 C)%" l�,�z . 6 A- rov1r'f Tv fS ol C ✓ I '17 �� l�� Wit' �� ' r1� �/ 4�• � I -yor r i MICHAEL J. COX CARPENTRY/REMODELING 31 0 MIDDLE STREET WE:YMOUI'H, MA 02189 (fill) 335-5326 /A no ol C ✓ I '17 �� l�� Wit' �� -yor i MICHAEL J. COX CARPENTRY/REMODELING 3 1() MIDDLE STREET WEYMOUTH, MA 02189 (617)335-5326 2x6 2X� /6 �G 2 2 A5,oNA zT Xy ST i MICHAEL J. COX CARPENTRY/REMODELING 31() MIDDLE STREET WL:YMO(1TH, MA 02189 (617)335-5326 L C 2U I C cc C5*0 O d 2 cm —. y O Q co O. O CD CA CL O a Cl) y CD dp Z CD =r -p H --1 �.�wrD=r CL CL c CD O ® co, O �..� O=r CD 1 > >C� n -0 —1 p O ZC•CO! p N� n 4 -Op C. 3 N � ' C; k a O CD O N O CD CD m 0 N .Z O CV CO) V N a tV cr C 1•� .-► CN rr ^^ CD V J N CD O CD -� CDch 0 CD 7 m 1-� p z N N � CD C'= �y ;W C* w CD • o CD m m cl CD -o C O C O_ = �_. �q Cn d CB o -G_ Z CA ytTl v C C7) n y I 1 r C — G x G a o. G1 C CoOrt� r C O a ?C o T 10 o D C�'� Z CO) i r CCD O 'C CL 0. C.� y o CD CD CL Q CD D c) CD o CD 13 n z Cf) C CD y < M M c; v y rlo COC i < CO) o 10 p CD a Z C..D* O CCD T z D CCD I C cc C5*0 O d 2 cm —. y O Q co O. 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G1 C CoOrt� r C O a ?C o �.v 0 c CD04 Town of North Andover BUILDING DEPARTMENT Homeowner License.Exemption (Please print) tt DATE �''�„ t�, �, � , JOB LOCATION 1014 J Ot" I s0 ( v 'Sfi • Number Street Address Section of town ,n "HOMEOWNER" DAN 1,0 Lo enGA Loo 5o —6U S — i a-2, Q Name /-� Home Phone Work Phone l; PRESENT MAILING ADDRESS ` J0 AJ 1 � A7 00UG-2_ ma City Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code, Section 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwell- ing, attached or detached structures accessory to such use and/or farm „ structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Bulding Official, that he/she shall be responsible for all such work performed under the ',,,building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of -North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE .APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. 4 N2 3 Date.... 79 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... R. .q. 1(f.� ...................................................... ✓has permission to perform ..... ...... ............................... wiring in the building of .... Lr.wa&4e ... .......................................... at ...... .... Td.f ................... . Aorth AndoverrNft'ss` Fee ... 3VA-12)... Lic. No. 3 ...... /ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TJ&C011"0Nff LTHtl FAJAM(7JJj.'SEM Office Use only . DEPARTAMWOFPUBLICSAFETY Permit No. BOARDOFFIREPREYEWONREGIMTIONS527CM]Z'•(1W Occupancy & Fees Checked IVAPPLICATION FOR PEPJff TO PERFORM ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat O/ Town of North Andover To the Inspector of Wire The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) D $ ©,J Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes M No fZ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ��� Amps 10012 OVolts Overhead [79—Underground a No. of Meters New Service Amps /� Volts Overhead [::] Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work SGI R ZftJe ��'O�I /.ti 5,Rc No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. ofLighting Fixtures Swimming Pool Above Below Generators KVA and around No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of*vitch 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 Municipala Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Si Bailasis _ N Hydro Massage Tubs No. of Motors Total HP l� 'J OTHER' Inw a xeGaaagra RaswttD Mm4we n rtsdMwmdiEftGffoWLaws Iha%ea=atLnWhum=PcbcymdxkgCm-#*Opa&m CotaagecritsabfttaleWvalat YES NO a Iha%esthmwdvalidpoofofsamebthe0ffi= YES M NO If)whaeedxdcedYES,pi=eUk*thetypecfo�dWbydxckrgt6e Cil: FIRMNAME hgiecdmD*ReWe9Wd (P1em*effS') EVirzicn Dale — UE V"cfEkcftix1Wotk$� / Frol d .rte •_ _ I kml•b BushssTd.Na AIL TdNa 3d735�t 38?3.-C �X 3:73 owZo 9W 9190 OWNER'SlNSLIRANCEWAIVFR;I.amawat dA1heLdmnrt Lam aadthatmysignattreontispm*wr,As smRa,wwrt (Please check one) Owner M Agent L.:1 �--r+ Telephone No. PERMIT FEE $ (O