HomeMy WebLinkAboutMiscellaneous - 106 MIFFLIN DRIVE 4/30/2018 106 MIFFLIN DRIVE
210/032.0-0004-0000.0
t
........0.y~..
NORT►,
°f�"";•�40 TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
,SSACMus�
This certifies thatab
..! .�.........�'i........1.......�.G.. ..1 ........................ ..........
has permission to perform ..10 ��.L:.........' /����,�
............... .............................
wiring in the building of . ................r.. .. ..............................................
a '� —.. •�-..... -.1./G ..`.......... ,North Andover,Mass.
Fee.' . Lic.No.G�.. 5f *!
............. ..............................................
{ ELECTRICAL INSPECTOR
.��
Check #
J -
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Rev 1//07cy and Fee Checked
� ] 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 TYPE ALL INFORMATION) Date:_ 7.— /,3 — p 7
City or Town of: NORTH ANDOVER 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) AyidDe— r
Owner or Tenant J Telephone No.91-g
(46
Owner's Address ��yt �t-
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building_. ]q !q p )01 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: a� P J CM
4,
Completion of the ollowin table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above In- ❑rno.o mergency Lighting
rnd. d. Batter Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices
No.of Waste Disposers Heat Pump I Number TonsKW No.of Self-Contained
Totals:
Detection/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent
No.o Water
KW No.of No.of Data Wiring:
Signs Ballasts No.of Devices or Equivalent
{ No.Hydromassage 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 Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 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 cov age is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: LIC.NO.:
Licensee: e' - Signatur LIC.NO.:E4'/9
(/f applicable, rater exQmpt"in the nse number line.) Bus.Tel. No.: I
Address: � t.Z tt� t 1�4 Alt.Tel. No.:
*Per M.G.L c. 147,t. 57-61,security work requires Departm nt of Public Safety"S" License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required b a By myT signature be ow,I hereby,waive this requirement. I am the(check one)❑ owner ❑ owner's agent.
Owner/ gent
Signatu a Telephone No. PERMIT FEE: $
j`
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of In vestigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information
Please Print Legibly
Name(BusinesslOrganizatioMndividualy ( ��v
Address: r c
City/State/Zip: ���L/p,��n� /j'f f� �1�-3'� Phone.#: 6/7 —a.53��1
Are you an employer?Check the appropriate box:
1.❑ I am a employer with 4. ❑ I am a general contractor and I Type of project(required):.
2.(�employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g
working for me in any capacity. employees and have workers' g' ❑Demolition
[No workers'comp,insurance comp.insurance.#� 9• ❑Building addition
3.❑ required.] 5. ❑ We are a corporation and its 10.❑Electrical r
I am a homeowner doing all work officers have exercised their repairs or additions
myself.[No workers'comp. right of exemption per MGL 11.❑Plumbing repairs or additions
insurance required.]t c. 152,§1(4),and we have no 12•❑Roof repairs
employees.[No workers' 13.❑Other
comp.insurance required.]
Any applicant that checks box#1 moat also fill out the section below showing their worker'� sation policy information.
t Homeowners who submit this affidavit indicatingthey
tContractors that check this box must attached an add banal sheet showing the name ofhirthe outside
b�ocontractors
and state submit a new affidavit indicating such.
employees. If the sub-contmctors have employees,they must provide their workermp.Policy number.
'co whether or not those entities have
I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: f
Policy#or Self-ins.Lic.M$s o,P
Expiration Date: a Q
Job Site Address:
Attach a copy of the workers'compensation policy declaration page(showing policipn-----
{ Y and expiration date).
Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the
fine up to$1,500.00 and/or one- eaz ' imposition of criminal penalties of a
Y imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for msuran a Covera a verification.
I do hereby certify under the pains and penalties ofperjuiy that the information provided above is true and correct.
Si tune:
Date:
Phone#: —
Official use only. Do not write in this area,to be completed y city or town gf)4ciaL
City or Town: Permit/License#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: -
Phone#:
No Date.....71, a...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
4N
'IS CHUS
This certifies that ....... ........ .............................................................
has permission to perform ........ ................ .........r I..................
wiring in the building of.....Zi (' ' Lj' �-
'..—....t.... . ..........................................
at... ...... ........................... .North Andover,Mass.
Fee.. ......... Lic.No,!:,.L.V.7............................................................
ELECTRICAL INSPECTOR
07/2�-%' .�I i ', ' i 7 5
N 56 25.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
The Commonwealth of Massachusetts 01
Eice Use °"]
` Pe l t No.
Department of Public Safety
cupancy $ fee Checked
BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 (tent blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to.be performed In accordance with the Massachusetts FJeetrlal Code. S27 CMR 12:00
(PLEASE PRINT IN INK 0E ALL INFORMATION) � Date__
City or Towh ofIT4 Anjoave r To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street b Number) 1p M is 1 i n r�U
Omer or Tenant Anja _1�01,omom
Owner's Address
Is this permit in conjunction with a building permit: Yes ❑ No J . (Check Appropriate Box)
Purpose of Building Utility Authorization NO.
ExL-ting Service Jon Amps / V0lt3 Overhead ® Undgrd❑ No. of Meters_
NevService Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
N®ber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work &J Mm
No. of Lighting Outlets p� No. of Hot Tubs No. of Transformers Total
KVA
No. of Lighting Fixtures .5 Swimming Pool Above in-
rnd. ❑grnd. ❑ Generators , KVA
No. of Receptacle Outlets a 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 No. of Detection and
tons Initiating Devices
No. of Disposals No. of Heat Total Total
Pumps s KW No. of Sounding Devices
No. of Dishwashers Space/Area Heating IW No. of Sel� Contained
Detection Sounding Devices
§6. of Dryers Heating Devices KW Local❑Muniection❑Other
ConnNo. of Water Heaters KW Si, of No. of Ballasts Low Voltage
Wirin
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liabili Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES® NO U I have submitted valid proof of same to this office. YES❑ .NO ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate. box.
INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify)
Estimated Value of Electrical Work $500. (Expiration, at
Work to Start Inspection Date Requestedt Rough Final t � 9 b
Signed iL.Aer the penalties of perjurv-
FIRM NAME LIC. N0.A
Licensee Signature LIC. N0:
Address Bus. Tel. No. q`1$ y$L{-Ion 11
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware--that the Licensee does not have the insutahce coverage or ts, su -
stantial equivalent as required by Massachusetts General Laws, as that my signature on this peicmit
application waives this requirement. Owner Agent (Please check one) '
Telephone No. PERMIT FEE S
Signature of Owner or gent
/ n
Location /GL l] r Ile
//- 1 o�
No. �� 3 t Date
MGRTN TOWN OF NORTH ANDOVER
O�O•,t`•o I•,MO A
' Certificate of Occupancy $
r�ssACHU Building/Frame Permit Fee $
! Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # -�
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
3k021I fO> �1lTii5C
BUILDING PERMIT NUMBER: /� 2� DATE ISSUED:
C
SIGNATURE:
Building Commis oner/In for of Buildings Date cz
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
/d6
q /I Map Number �— Parcel Number
f
1.3 Zoning Ino formation: 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 Required Provided Required Provided
1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M
2.1 Owner of Record
Name(Print) Address for Service
d �At
Signature �' Telephone 1
2.2 Owner of Record:
Name Print Address for Service:
rI t
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address
Expiration Date
aa®
Signature Telephone �•
3.2 Registered Home Improvement Contractor Not Applicable ❑
log
Company Name M
Registration Number
Address
Expiration Date
Signature Telephone
SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes.......0 No.......0
SECTION 5 Description of Proposed Work(check all applicable)
New Construction ❑ Existing Building Repair(s) 6", Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of / g
Construction D
3 Plumbing Building Permit fee(a)X (b) �y
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
L VN BeR6 as Owner/Authorized Agent of subject property
Hereby authorize M tl 'R :L /JNC7-/ L 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 AGENT DECLARATION
1, p/3 E2G' ,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
C°fI 100Z yN C9oLD 6E72G
Print Name
Si nate e of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
1r ND RD
SIZE OF FLOOR TINIBERS is 2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DtIW-,NSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Town of North Andover f NORTH 9
-(Uro 6! �O
h..:1, .. '.• •6 Q
Building Department o
27 Charles Street * `
North Andover Massachusetts 01845 Z
(978) 688-9545 Fax (978) 688-9542 �' `°` 'K• ,0
gcHus���y
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit# the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a.
The debris will be disposed of in/at:
L L
Facility location
Signature of Applicant
// - z 7-
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this f
project through the Office of the Building Inspector.
f NORT{�
Town of North Andover ° ""'•�"
Building Department p
27 Charles Street
• North Andover, MA. 01845 �;'°•�•.�'�;�
D. Robert Nicetta SS"�H„Se` I
Building Commissioner
(978) 688-9545
(978) 688-9542 Fax
HOMEOWNER LICENSE EXEMPTION
Please print
4
DATE 7- llV N
JOB LOCATION /Q 6
Number Street Address Map/lot
"HOMEOWNER A-tA-AJ >. CA11, V•6op-U�a 9 7�-
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner-occupied dwellings
of two 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 108.3.5.1)
DEFINITION OF HOMEWOWNER:
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 or two family dwelling, attached or detached structures ac-
cessory 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.
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 No.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
� NORTIy
Town of ..-.: 4« over
0 .,63 $ _
Q)
a1) _ oo
�D� COC L MEWI0 - dover, Mass.,
A
ORATED
S H E
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System '
I BUILDING INSPECTOR
THIS CERTIFIES THAT... ... .. P.^0�.. ...............
'� N"""""' r� Foundation
has permission to wwt..*`,� ........4A buildin on At.......... N
. ...... .. ...............................l...... Rough
b�
to be occupied as...... .................... ............................................................................................................................................N C V Chimne y
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. 3 ' I PLUMBING INSPECTOR
VIOLATION of the Zoningor Building Regulations Voids this Permit. Rough
9 9 g
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTIO S TS ELECTRICAL INSPECTOR
Rough
.. ................... ............................. .... Service
. .. .. .. ............... ..............
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
Location
No. Date
NORTN TOWN OF NORTH ANDOVER
f?O•,,`•O I•,�OOS --T
Certificate of Occupancy $
' Building/Frame Permit Fee $
Foundation Permit Fee $
SsAcNust
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
Div. Public Works
Location
�6
No. � Date I
TOWN OF NORTH ANDOVER
3? �` .• 0
IL
p Certificate of Occupancy $
' Permit Fee $
Building/Frame �g
40 Foundation Permit Fee $
SSACHust
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
.n
TOTAL $
Building Inspector
,' ' Div. Public Works
a
PERMIT NO. 000e APPLICATION FOR PERMIT TO BUILD*****�**NORT11 ANDOVER, MA
nI u'NO. Z I �� LO i.NI). 16
2. RECORD OF OWNLRS11111 DATE BOOK PAGE
ZONL SUB DIV. LOT NO.
pe'er e eT Qvc;� Nyco e) ut3�vrrt��J
1.Ol A I ION � �� If ti PIIR!'(76E(A 1)Uil UIN(i ..
� ( jko 7�iNc iJ ZlK� (�
()\\'NEB's 1J Al IE L/- 17 M 5G j Q NO.(X S TORIES SIZE
OWNER'S ADDRESS 1 /V �'r�f 1 e 7 ( BASENIENf OB SLAB
ND RD
i .AR('IIIIECI'SNA10E „ Sol/0rylo�Aj SIZE OF FI(-X)R IINIBERS 1 2 3
ltll DER'S NAME / twZ( ( ^2r STAN
/ DIS I ANCF 70 NEAREST BUILDING DIMENSIONS OF SILLS
DIS FANCE 1'Rom STREET DIMENSIONS OF POS Is
DIS I"ANCE FROM LOT LINES- IDES REAR DIMENSIONS OF GIRDERS
AREA OF LOT FR(NJIACE IIEIGIIT(O:F(AINDAII(NJ THICKNESS
IS BUILDINGNEW SIZL'OF F(X7lINC, X
IS BUILDING ADDITI(NJ MA FE RI A1.OF C111NINE Y
IS BUILDING ALTERATION IS BUILDING(NJ 501.1DOR FII LED LAND
Wil 1.BUILDING CONFORM TO REQI)IREMENI S OF CODE IS BUILDING CONJNECI ED 1 O l OWN WAFER
BOARD OF APPEALS ACT ION, IF ANY IS DIIILDING CCNJNECI ED 10 10"SEWER
IS BUILDING CONNEC-1 ED TO NAI URAL GAS LINE
INSLUCLIONS 1 PROPERTY INFOR11LATION LAND COST
ES 1. BI(X:. COST O
PAGE I FILI.CX)f SECTIONS 1-3 ES f. 131 DG. COSI PLR So . FT.
ES I BI DG. COS I PER ROOM
ELECTRIC METERS MUST BE ON(RfTSIDE OF BIM DING SEPTIC PERMI f NO. le Ile,
AFIACUEDGARAGES MUST C(NJFORM'fOSfATEFIRE RE(i1ILA TIONS 4. API'11O1'Eb Bl"
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR 1J11ILDING 1 , F.CTO11
DA I E FII ED OWNERS 11:1
CO IR.IELH l . :2Cr�
SIGN.AIIIRF&OWNER OR AtIIIIORIZEDAGEFTT CON1R.1.1(fl 063106
PI:RA11I GRANTED
19
a
r
i
DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Nutber, Expires: Birthdate:
CS 063100 09/27/1999 09/27/1967
Restricted�To: 00
MAURICE"0 FORTIER JR
X �;�l109S BROADiIAY RD
DRACUT, MA 01826
\re
__ `�� ;lfa� �arira-r�aayuuecr��� 4��il��;i�IC��Eldes��3 r
'7 fJ
UJ
>- t C PIE rt;� c VEMENT CONTRACTORS
- N
" Board of Bu'ildim-� and
a r 3 t t l
One As �bu�tc�n 1"' 1 "�
r�
l0 c-. IMPROVEMENT CONTRACTOR �
vagistration 117589 Expivation 10/23/98
rype 08P.
1095 BROADWAY RD
OF
01'326
�;ffl��CIJT HA
�r.%�+T✓.•:.<,n r,Yi 7,i�3J U:'t��l1�a♦�'IQ"�
Acf,im':sfP�:ti� f �
N M
O
cz
O
N 11
O R:
T
OD h 'GD
Q
[11
[
-4. fri
0
r
■ 'i
■
��.�"' ✓�Q �Q'/�?!f�?��i2f.UCQf D�e1['��3C�C�.(d�J> m
47 LL
LL NOME IMPROVEMENT CONTRACTORS REGISTRATION � o
-. Board of Building Regulation--- and cndards � 0.
�u
One Ashburton Place -- Room 1301
Boston , hfassacbusetts— o'2108
Li
Ri
CID
o3 l',OMF=. IMPROVEMENT CONTRACTORS �
117589 Expiration 10/13/08 O
� `r�7 f.�' _• D1:3>^FIV
04
r, =3
1095 BROADWAY RU
DR`ACU E MA 01826 if 11taTEr i:`i� �
MAUI HE 0. f�FNC
l G`c rn;ei i� �3J BRUHAY !tiy
APIliAatri+TCr: u O
00
4yr �
EL
00
r4 N
N
� - O
LL
ci
LL
�I r
m - -
,1j; ' .
i
Q.
CJ �.
I
I :
:z
rr:
.��. J�� �I}p'yi7/IYLC'3LCL�l1'�f�f2• ��v�G`�C1F1dCG��2C�3f.Lt"1
lI
i
,k
rl£dM1iT n�a CORNT�RAtCaT�OR�SnR=GI. T�t_ATcFlO
01,1E ncJ
o�ace - ROOM 1.:0-1
One ,aah ��sto 0210S �n
Qn1
�{ il ca l JCS . 10/23, 93
1-J , bB9 C {} ami
}vim UIJI ii1�,0f_•:ti'r ir�?i.11'
DBA
C-CjtjT
R,, i-k'jt.lfs `
�0 P rER
Q
1;tT(f� ':] . r J , i`. r_ ":F '7J��'nnl'-r!•''� -h
r1()95 'SOT BR(�ADU YRl? UnlCE ..
^ r
DRACUT MA
Q a;rrsls a.;o� O�13Glki MA
N
O � �
CD -_
O
O
CO
t..3 v.
•� s
O "9
i' 10
C.0 co
N
m
O =-X
Q m
-[I F
Q
rAOR
T
— V oNNm
o Andover
No. 2o,9
LAICE CX dower, Mass.,— '7 2,-8 197(f,
CHICHEW1
ATE P
BOARD OF HEALTH
SS
Food/Kitchen
PERMIT T 1j Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.......................................................... . . . ..................... Foundation
A
.......... Rough
..4.(A.1.
has permission to OF66t.......ftP
A.tg........ buildings on ......./.«..-..................". -A....r
tobe Occupied as.......................................................Ir 7 411. ...4 ....... Chimney
provided that the person accepting this permit shall in every respect conform-to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION S S Rough
LDING INSPECTOR Final
T TS<6ii Service
....... ...
........................:4.... ...................................................
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove
Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
s
Date. .. .'. . .
C,3-f rfl
NORTH TOWN OF NORTH ANDOVER
' PERMIT FOR PLUMBING
CHUS
This certifies that .�! �': ✓. . . . . . . . .. . . . . . . . . . . . . . . . . . . . .
has permission to perform--
. . . . . . . . . . . . .
plumbing in the buildings of . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 11
at.. . . . . . . .'. . . . .:, . .�... .. . .`. ..'`�. ., North Andover, Mass.
Fe . . . . . . . . .Lic. No.
PLUMBING INSPECTOR
07/2879811:11
35.00 PAID
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
uv (
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
Type or print)NORTH ANDDvER,MASSACHUSETTS Date
Building Locations /06 FF//1 Permit # G
Amount �-
Owner's Name
New E] Renovation Er Replacement 0 Plans Submitted 11
FIXTURES
w a
Ln
a x a Q Ln A x A w w w
Q F
a
d
SUB-Bm
l��v>avr
Ise ROCR I 1
ern R M
M RDQ2
4M FIDCR
sup FLOOR
6Ui FL"
7M FL"
M FLOCK
(Print or type) r Check one: Certificate
'A Installing Company Namey , CfY �� Corp.
Address CY Partner.
VA Gt �o
Business Telephone — ❑ Firm/Co.
Name of Licensed Plumber: DC7✓I ti J A-rgy4
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: a
Liability insurance policy Other type of indemnity ❑ Bond
Insurance Waiver: 1,the undersigned,have been mdde aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner F1 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 Massachusetts State Plumb' Code and Chapter 142 of the General Laws.
By: Signa reo cense um er
Type of Plumbing License
Title
City/Town Licensemer Master Journeyman ❑
APPROVED(OFFICE USE ONLY
Location G�f<'— .f—+�
J
No. Date
NORTH TOWN OF NORTH ANDOVER
O:• � o �,�G 111
Certificate of Occupancy $
Building/Frame Permit Fee $ �
ACHUS Foundation Permit Fee $
Other Permit Fee $
r-
t Sewer Connection Fee $
CU
Water Connection Fee $
TOTAL $
Building Inspector
-E
Div. Public Works
PERMIT NO. ` V '
APPLICATION FOR PERMIT TO BUILD — NORTH AN MASS. PACE ;
MAP 140. s LOT NO. p 2 RECORD OF OWNERSHIP (DATE BOOK :PAGE
` ZONE l SiB DIV. LOT NO. -
D -I I
LOCATION 6G ju / PURPOSE OF BUILDING
.. ... .. __. _ _ OWNER'S NAME l�l/ NO. OF STORIES �( SIZE
IC O O _
--1 OWNER'S ADDRESS o6
_ BASEMENT OR SLAB
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST 2ND 3RD
BUILDER'S NAME SPAN
DISTANCE TO NEAREST WJILDING DIMENSIONS OF SILLS
DISTANCE FROM STREET POgTS
DISTANCE FROM LOT LINES - SIDES S`REAR 3 GIRDERS
AREA OF LOT - F✓RONTAGE JJ HEIGHT OF FOUNDATION HICKNESS
IS BUILDIfjG NEW SIZE NG OF FOl;TIV x
IS BUILDI ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERl TION ( n G` IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IB 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 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES
.._ _ .• .. EST. BLDG. COST
PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO.
r 4 APPROVED 8Y
5 ATTACHED GARAGES MUIiT CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
' ■ ILOIN' INSPILCTOI
I ATUR O O R DR AUTHORIZED AGENT
E E `OWNER TEL# o 0 �z-
PERMIT GRANTED
CONTR.TEL N
19
CONTR.LIC.I
- • _ - � N.LC.
BUILDING RECORD
1 OCCUPANCY 1 2 •t
SINGLE FAMILYscoulEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY ' OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION g INTERIOR FINISH
CONCRETE a' 1 2 13
CONCRETE BL K. PINE _
BRICK OR STONE HAROW D
PIERS PLASTER
_ DRY WALL
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M"T' AREA _
FIN. ATTIC AREA _
N_O am T FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WAtls I 9 FLOORS S
CLAPBOARDS B 1 2 J
DROP SIDING CONCRETE —
WOOD SHINGLES EARTH
ASPHALT SIDING HARD'/"D
ASBESTOS SIDING _ COMIAGN
VERT. SIDING _ ASPH. III( _
STUCCO ON MASONRY _
STUCCO ON FRAME
- MASONRY ATTIC SIRS. 6 FLOOR I_
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME SUPERIOR ,
POR
ADEQUATE I-1 NNE
rj ROOF 10 PLUMBING
t
GABLEHIP BATH IJ FIX.I _
GAMBREL MANSARD TOILET RM. 12 Fix.)
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
t
WOOD $HINGES KITCHEN SINK
SLATE NO PLUMBING
TAR d GRAVEL STALL SHOWER
ROLL ROOFING MODERN FIXTURES
TILE FLOCR
TILE DADO
g FRAMING 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. 6 COLS. STEAM
STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR
WOOD RAFTERS _ AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
GAS
.. 7 NO. OF ROOMS OIL
6'M'T 2 d _ ELECTRIC
Ill I 3,d I NO HEATING
{�10RT/y r
Town o _ _ over
No. 306
dover, Mass.,— ,a/
9-COCM CKEItlICK
.qsoq E
'�TE D 1► .�
E BOARD OF HEALTH
PERM. IT T Food/Kitchen `
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT..................................... .............0064'Lt.dtj........................................... Foundation
has permission to erect......... —<�-.,........ n ........./Q..C..........�M..l.FF.z—. .r. .......1.r'�,(.1> � Rough
ugh .
to be occupied as
.
.....................................
.�.!�?...�..�a.............. .�.nL:......���:.�C............................................:... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations.Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION ST Ts- ELECTRICAL INSPECTOR
Rough
...................... ....... .. ..... Service
.... . . ... ... ... . ..........................................
DING INSPECTOR
' Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove FinalRough
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
Street No.
Smoke Det.
t
rAoU6-E
SPac.� 1FCR ORy�R �lE'NT -
f
Lit .7r
. b, ���----�---.------mac---_-- . z .�► � �
fit
• 0 O''F C-,iZC►.1ND) �rrV CA( 1►4��r�
�\ a
E v
/k i
6 j4eA
j ,
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*****************
_ U?� S
APPLICANT: t a ou?o,.� � Phone (5-0X-
LOCATION: Assessor's Map Number S Parcel ll0(
Subdivision Lot(s)
Stree /t �Vl �(en lrm, St. Number D �
***********************. Official Use Only************************
RECOMMEN TIO F AGENTS:
Date Approved
onservation Administrator !
Date Rejected
Comments
Date Approved . ,
Town Planner Date Rejected
Comments
Date Approved
Food Inspector-Health Date Rejected
Date Approved ' r
Septic Inspector-Health Date Rejected
Comments
i
Public Works - sewer/water connections
- driveway permit
• Fire Department
Received by Building Inspector Date
BUYER: Steven and Amy Solomon
'This 1nslp-"ttan Oxaludes the coafon tM 01
MOMbk sheds as t4 ronlng & tbsrk
tort
3D
N \\N
L�
I
±
I�L_o cls ll� i
-LaT 1"
` ..L=T l
l-,20 too ft
IIc. O '
TTo e.cterior acId-Ition.8 by permit, duri.nf, the. pasf, ten years.
M TME ( Interate National Mortgage Corp. i
AND ITS TITLE INSURERS. MORTGAGE INSPECTION PLAN
! IN
I CERTIFY THAT THE BUILDINGS SHOWN DO ( CONFORM TO SETBACK REQUIREMENTS N 0 R TAHA�A N D 0 V E R
I.E. (Ff1oNr. SIDE, & REAR SE19ACIC 0IILY) OF o r t h Andover
AMEN bONSTRUOTED. OR ARE EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. G.L.
ftF1imi. CHAPTER 4oA, sEOTION T. UNLESS OTHERWISE NOTED. MASSACHUSMS
I FURTHER CERT
IFY THA rTIIIS PROPERTY IS YR&r LIPI� IM89A9USIIED FLOOD
14AZARo ''OOMMUNITY PANEL NO.: 250098 O003dDATE' 6/2/ BOOK
93 DEED 3082
THIS COMPANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT T E RECORDED
DATE OF THE LATEST DEED OF RECORD. PAGE 167
WHENEVER BUILDINGS ARE SHOWN LESS THAN ONE FOOT FROM THE PROPERTY LINE IT IS ADVISED CERT. NO.
THAT A MORE PRECISE SURVEY BE MADE TO VERIFY-1HESE.MEASUREMENTS.
THISCERIIFICIITION IS BASED ON THE LOCATION OF' t1RV�,4b1AYBAA�OTHERS, JWD DOES NOT PLAN BK. PACE
REPRESENT A PROPERTY SURVEY. VERIFICATION OF'•'SUR 4j(�RK, R ...y AND OFFSETS, AS SHOWN, 1657
MAY BE ACOOMPUSHED ONLY BY AN ACCURATE. INS dl�iEtlT'.SU IVR�•!r�'.i? PLAN DRIED
THIS CERTIFICATION TO BE USED FOR,.M,6�GAGE PURW ,S ONLY. November 16 995
OFFSETS AS SHOWN Mt Ov'T0.13Er kr: SCALE: 1'- 20
USED FOR THE FSTABUSHMEN _ EPROPERT`j�;jItUESr�
- 1 Gu j BRADFORD
ENGINEERING CO.
P.O. BOX 1244
HAVERHILL MA. 01831
JAMES W. BOUGIOUKAS R.L.S. #9529 TEL (508) 373-2398
Location
No. .�� C� Date v/�b,
• 40RTq TOWN OF NORTH ANDOVER
09 Certificate of Occupancy $ _
• ; ; Building/Frame Permit Fee $
Foundation Permit Fee $
ss�cMust
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ S '
Building Inspector
�. 08/10/99 14:37 25.00 PATTI
Div. Public Works
PERMIT NO. ��j (�j p� APPLICATION FOR PERMIT TO BUILD********NORTII ANDOVER, MA
D
N1:\PNo.�� I.oFNO. 2. REcoRDoFowNERsiiw DATE ROOK PNCE
7ONF SIIBDIV. LOT NO.
LOCA I[ON /%� j p �/Ji PURPOSE OF BUILDING
O\VNLR'S N."iM t: �IGQ� ` NO.OF STORIES Sl"[_E
owNF:it,S.0R
)1) ESS (�1BASENIEN'I OilSLAB
ARC IIII-ECi''S NAME SIZE OP FLOOR TIMBERS j 1 ')ND 3RD
BUILDER'S NAME'� U�����£- � SPAN
DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS
DISTANCE FROM S"IREET 1)INIENS IONS OF POSTS
DIS"1'INCF FROM LOTLINES-SIDES REAR DINIENS IONS 0FG[it DERS
\It EA OF LOT FRONTAGE IIEIcuT0F Fo[IN DATION TIIICICNESS
IS 111111 DING NEW SIZE OP FOOTING x
IS BUILDING ADDITION MATERIAL.OF CII1NINF.Y
IS BUILDING ALTFRATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OI'CODE IS BUILDING CONNECTED TO TOWN)VATER
BOARD OF APPEALS ACTION, IF ANY 1S BUILDING CONNECTED TO TOWN SEWER
1S BUILDING CONNECTED TO NATURAL GAS LINE
INSTIICFIONS 3. PROPERTY INFO11N1ATION LAND COST - - -
EST. BLDG. COST s�
PALL 1,1'1LL OI IT SEC"f1ONS 1-3 EST.BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
VI.FCTRIC ME f ERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMITNO.
A-1-I'ACIIED GARAGES NIUSTCONFORNI TO STATE FIRE REGULATIONS 4. APPROVED BY:
PLANS MUSTBE FILED AND APPROVED BY BUILDING INSPECTOR [IILDI INSPF '01
i
DAI'LFILED OWNERS TELIV
CONTR.TELN
SI(:NAIHiRF: OF OWNER OR:111"IIIORIZt:D AGENT
PERM f1 GRAN"IIiD �Ar
^,^,
19 !17
Revised 1/5/99 .)NI -- - - - -- ---- ----- --- -- - - — - --- - --- - -
NORTH
•
Town O . OL dover
No. -
%O 91L
, .,aC:,
ORATED p �C�
S 5`
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
® � /
THIS CERTIFIES THAT........ BUILDING INSPECTOR
.................. .................... .............................'.1..�..........................^............................................ Foundation
has permission to erect... ................... buildings on ........ . . ........��,,.`" ��,/ ....�. ..... Rough
t0 be OCCUpled aS......®. e. ...... ......4.o4..( Chimney e dwo4 `a ��0'VC Chimney
. . ..... ....................................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUC N S T ELECTRICAL INSPECTOR
P �-4Rough
........ ..... ... ......... .... .................... ...A.................................... Service
�c 13300 BUILDING INSPECTORRFinal
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Null To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
j 4
TIM
ll lblZl(/G'(.I GU1G �'�✓I�LCUI�C7�1G�.(/.lPGW i h �'4 f N
I' DEPARTMENT OF PUBLIC SAFETY ,
,x CONSTRUCTION SUPERVISOR LICENSE
-Number: Expires: Birthdate: `
CS:-- 034200= 091301999 0913011945
_.:
00
.. --- '..Restricted To:=
�f
Ldn.,�v�Stit'd NORMAN SAY-, .
70 JEFFERSON ST
1" NA 01845
N ANDOVER, � r R
67 (Policy Provisions: WC 00 00 00 (NM ONLY) , WC 00 00 00 A)
29 •
VM INFORMATION PAGE-WCIP
wz WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY
INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY
HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115
NCC!Company Number. 1 '�
compwq Code: 6 THE
HARTFORD
CIDr
v
a
0
o lufTht
o LM MWWAL
h POLICY NuMM: ��„y4Z �'—'
Pre tw Pocky Number.
1. Named hound and Okfling Addivess; NORMAN GAY DBA ALL UNDER ONE
(Nta., Street,Town,State,dip Cods) ROOF/PEST IN PEACE
N
d
O
M FEMI NurOW: 028349269 NORTH ANDOVER, MA 01845
SkIs Ids%M08tlon Nun*er(s):
s
i 'It M Nettled het"h: INDIVIDUAL
LM'MN of NE- h*Ured: ROOFING
ND 01her trot 0110we Above: 70 JEFFERSON ST. , NORTH ANDOVER, MA 01845
Nam 2= Poky P" From 11/09/98 To 11/09/99
no 12:01 a.m.,Standard time at the insureds mailing address.
i PMdUOW S Nene: MASS WORK COMP A R DIRECT
LENNOX INSURANCE AGENCY
t� PO BOX 462
esu,
sera LYNNFIELD, MA 01940
r Produosr's Code: 083477
® ORke: THE HARTFORD
4801 NORTH WEST LOOP 410, SUITE 20C
mom" SAN ANTONIO TX 78229
B52-7991
mom _
atttr
r
® t ne policy is not o+nang w-,."s countwsianed Gy ow authonzod representative.
r
~ 7�?
17,Auftwb*d Rep seettfatMe
Form WC 00 00 01 A Printed in U.S.A. Pop 1 (Continued on next paps)
Ptooese tits: 10/0 9/9 8 Pollsy EAMatlon Hate: 1.11 a 9/9 9
ORIGINAL
R�
I ,aent�al & Com►nerC1a�R - �.
Licensed&Insured aOI�
• Roof Leak Experts •
(508)794-3883. 1-800-WAIT-4-US
PROPOSAL SUBMITTED TO a PHONE DATE
11'15*1A CP
STREET
JOB NAME
CITY, STATE&ZIP CODE JOB LOCATION
ARCHITECT DATE OF PLANS JOB PHONE
rWe Propose hereby to furnish material and labor in accordance with specifications below, for the sum of:
Dollars ($
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from specifications Authorized
-_below involving extra costs will be executed only upon written orders,and will become an Signature
extra charge over.and above the estimate. All agreements`contingent upon strikes,
accidents or delays beyond our control.Owner to carry fire,tornado and other necessary NOTE: This proposal may be
insurance.Our workers are fully covered by Workmen's Compensation Insurance.
withdrawn by us if not accepted within days.
EWeereby submit specifications and estimates for:.��i'/� �1. ;.
rr i Tc�
.�sd%�� r�l�' �'' L'��l ._r; moi' Get` �i °���`-• _ _
T a V'£;<
i
/:7�/ i"=��.5-<��%�:r::!" CG/%� �'l,�.r9i1 r,;'y�l'� �'�/ c-��.•r�..�.,,. _ ..� moi_-,. _,,.. ,,.. --,r•��, �
•
Location
No. / Date 1
MORTq TOWN OF NORTH ANDOVER
3j ° • OL
0 p
Certificate of Occupancy S
�' b'•••°'stn 9
�ssBuildin /Frame Permit Fee $,�cNust
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
i
Check #
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER. I DATE ISSUED: rnM
.50 q SIGNATURE:
lfaWl'171f4ow.—
BuildingCommissioner/Inspector of Buildings Date G/'Kz r 1s
SECTION 1-SITE INFORMATION = O
LI Property Address: 1.2 Assessors Map and Parcel Number:
'Al0 3910
A.,G re a) . Map Number Parcel Nurdher
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
. 0
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D
Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ J
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m
2.1 Owner of Record
Ac,
% rr/i 41A,
Name(Print) Address for Service
Signature Telephone
27.2 Owner of Record:
Name Print Address for Service: O
Z
M
Signature Telephone 90
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: O
! 4 i1 License Number
Address
Expiration Date
'Signa re Telephone r
3.2 Registered Home Improvement Contractor Not Applicable 0
Company Name
Registration Number r
Address V /r r
Expiration to /�
Si "r Telephone G)
F-tJX ,�t- 9.7d'- �! 2-
SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and s bmitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit. .
Signed affidavit Attached Yes.......❑ No.......❑
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑ Existing Building Repair(s) ❑ Alterations(f� ❑ Addition ❑
■■
Accessory Bldg. ❑ Demolition ❑ Other • ❑ Specify
Brief Description of Proposed Work: .
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building01
(a) Building Permit Fee
U V 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 TO BE COMPLETED WHEN
OWNERS AGENT ORXONTRAQQR APPLIES FOR BUILDING PERMIT
I, L as Owner/Authorized Agent of subject property
Herebv authorize to act on
My behalf,in 1 t rs rglativ ork authorized by this building permit application.
Si na ure olrO,%vner 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
SI/.E OF FLOOR TIMBERS 1 2 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
f[EIGHT OF FOUNDATION THICKNESS
SV'..F.OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
,ale f!�onanat.�w�eal� ct. 6jauu��ru !1J
BOARD OF BUILDING REGULATIONS
3 •_ License: CONSTRUCTION SUPERVISOR
- Number. CS 035152
Birthdate: 08/31/1948
Expires: 08/31/2003 Tr.no: 2254
Restricted: 00
GLENN C COTE
11 KOPER LN
PEL.HAM, NH 03076 Administrator
T� t`aoar�moma+ral!/. a� !lam/ y
y
i.3 Board or Building Regulations and Standartis
• I HOME IMPROVEMENT CONTRACTOR -ii
Registration: 114134
.i.y ,
Expiration: 08/06/2003
Type: DBA
Salem Vinyl,Siding,&Windows
GLENN COTE
11 KOPER LN C 1..-�...
PELHAM,NH 03076 Adminiwalor
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)
ti
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
NORT�y
0 0Eover
O 10
No. Sto
o� L A dover, Mass., '
OOATED
v H E
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
ABUILDING INSPECTOR
THISCERTIFIES THAT.............�......�...... .................. ............. ................ ....................................I............. Foundation
744
has permission to erect .... ........ buildings on ..... �,�,/ g
e Rou h
................
i
t0 be OCCUp18d as. Chimney
... .. . . ........... .......................................................................................
provided that the person acce this permit shall in every r eft conform to the terms of the application on file in Final
this office, and to the provision of the Codes and By-Laws r ting to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION TM,, ELECTRICAL INSPECTOR
Rough
......................................................... ...................................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
Location � i i`r � ' /Z
No. 531 y Date
MORTq TOWN OF NORTH ANDOVER
OSO°,•`•O .0 . R
F P
y
• ; , Certificate of Occupancy $
E BuildinglFrame Permit Fee $ 3
MUb
gCS
J Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 30
Check # 13
,- i I i
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
TIS�.f+ec t3ffiCl�1 ase fl�
BUILDING PERMIT NUMBER: DATE ISSUED: a O
SIGNATURE: At�jo
Com--`-
Building Commissioner/It r of Buildings Date Z
SECTION 1-SITE INFORMATION O
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
13a
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: (�
Zoning District Proposed Use Lot Areas Frontage ft V�
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M
2.1 Owner of Record
6'41KOtlid C,6b64RC, /69 /n 1;1FZ-I'AJ'
Name(Print) Address for Service:
1
c
Signature Telephone O
W
2.2 Owner of Record:
Name Print Address for Service: O
Z
M
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: O
License Number
wna
Address
Expiration Date
Signature Telephone r
3.2 Registered Home Improvement Contractor Not Applicable ❑ v
Company Name M
Registration Number r
Address r
^
z
Expiration Date
Signature Telephone G)
SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6) r
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes.......❑ No.......❑
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
X e as U Dt°r-7
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building (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 TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
ereby 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 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 '
Si ature of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
IFFJGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHHvINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BMDING CONNECTED TO NATURAL GAS LINE
FORM U - LOT RELEASE FORM ..S 6 -o3
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits
Boards and Departments having jurisdiction have been obtained. This does not relieve
e
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION
,(
APPLICANT-A(� Lyh/ �Q LfJ6 'RG PHONE97_
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION
LOT(S)
STREET ST. NUMBER
_/t
USE ONLY
RECO ENDATIO S WN AGENTS:
CONSERVATION ADMINISTRA OR DATE APPROVED
DATE REJECTED
COMMENTS sz
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR—HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR—HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS—SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE_
Revised 9197 jm
BUYER: Steven and Amy Solomon
'This InOPp"Uan Oxcludes the contonnmW 01
MOls shleds as to ronln� s�tbsrlc
t��3311<s��ntl��.
g�
} ( i01
C'Q
� I
y N
c:'T
.. c=T t o T
110, 4
No e.c.teri.or additions by permit, durinf* the pass; ten years.
MTHE ( Interate National Mortgage Corp.
AND ITS TITLE INSURERS. MORTGAGE INSPECTION PLAN
41 tACATO IN
I CERTIFY THAT THE BUILDINGS SHOWN DO ( CONFORM IT) SETBACK REQUIREMENTS
I.E. (FRONT, SIDE, & REAR SEIBACIC ONLY) OF Z o r t h Andover N 0 R T H A N D O V E R
WHEN �ONSTRUOTED, OR ARE EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. O.L
�TiE,MI. 04APTER 40A, MOTION 7, WIEESSS OTHERWISE fNO1TED. MASSACHUSETTS
I FURTHER CERout; � PROPERTY (8 ypr LQ I&A TVAWbuSHED FLOOD
HAZARD AREA'OOMMUNITY PANEL NO.: ATE; DEED
250098 0003GD6d293 BOOK 3082
THIS COMPANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT T E RECORDED
DATE: OF THE LATEST DEED OF RECORD. PAGE 167
WHENEVER BUILDINGS ARE SHOWN LESS THAN ONE FOOT FROM THE PROPERTY UNE IT IS ADVISED CERT. N0.
THAT A MORE PRECISE SURVEY BE MADE TO VERIF.Y�INESE•MEASUREMENTS
IS CER11F1CA1TON'IS BASED ON THE LOCATION qF,,W 2V A 11 F 8A OTHERS. AND DOES NOT PLAN BK. PAGE
RF?RESE?JT A PROPERLY SURVEY. VERtFlCAT10N OE'•SIJR>8 1"�RI(gR$},l��t� AND OFFSETS, AS SNOWN, 1657
►TAY BE ACCOMPLISHED ONLY BY AN ACCURATE. INSMd1�Et�i,':SURVG;•��•!;..r :? PLAN DATED
THIS CERTIFlCATION TO BE USED FO •�Mb GAGE PURf'bS ONLY. November 16 , 1995
OFFSETS AS SHOWN At.' OuTQ:sBE.'. SCAM- t•� 20'
USED FOR THE E_STABLISHMEN EPF�QPRTy�;�If�IESI;
BRADFORD
A ENGINEERING CO.
l Zy , `, }r P.O. BOX 1244
.....�_ ___ ;�_ f�a'k.y HAVERHILL IIA. 01831
NORT#y
E
Town 0 ...: Andover
O ti"4
No. _
O dover, Mass.,
T /��)
COC MIC C w C7C �t
ADRATED P? C7
S 4
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT..... � .N..... ..... ... .. ......C.04 M r. ............................ Foundation
has permission to erect....S�. ..IS!............ buildings on ..It &. 0AW 0!J.....�7 R ,
Rough
ja!
to be occupied as......� .............1 .. . .. ........ .. ..... .....................
M � r Chimney
....................... ...............................................
provided that the person accepting thirpermit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. 3 a / Li 430
coop PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION TARTS ELECTRICAL INSPECTOR
C Rough
........... ....................... ....... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
a SEE REVERSE SIDE Smoke Det.