HomeMy WebLinkAboutMiscellaneous - 110 SUTTON HILL ROAD 4/30/2018 (2) 110 SUTTON HILL ROAD
210/097-0-0064-0000.0
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.CN Commonwealth of Massachusetts Official Use only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Map&Parcel
I
Y.
C� 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 INFORMAT70119 Date:
City or Town of: A;c)Q,rrH .Alu:>0 v. 2 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)1�(� S'o77o- N -�;,
Owner or TenantCTelephone No.
Owner's Address
lis this permit in conjunction with a building permit? Yes ❑ No ❑ Building Permit#
Purpose of Building Y,14, Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Servic Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
0V* - 97�,�' 0VFi!Z CCrilli T/---/Z
Completion of the rollowin table ma be waived by the lns eetor of Wires.
No.of Recessed Fixtures No.of Cell.-Susp.(Paddle)Fanso.of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators. .. KVA
Moven- o.o mergency g ng
0
No.of Lighting Fixtures Swimming Pool rnd. rnd. Batts Unita j
No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners o.o e on an
Initiating Devices
No.of Ranies No.of Air Cond. Toone tal No.of Alerting Devices
No.of Waste Disposers ea Pump um er_ ons ___ o.oSelf-Contained
p Totals: "`" Detection/Alerting Devices.
No.of Dishwashers Space/Area Heating KW Local ❑ Connection al Other
ITeleNo.of Dryers Heating Appliances KW ecur tySystems:
No.of Devices or Equivalent
No.of Water l o.o o.o Data Wiring: U 1j5
Heaters Signs Ballasts No.of Devices or Equivalent
No.hydromassage Bathtubs No.of Motors Total HP
communications g: .0)1 i
No.of Devices or Equivalent
OTHER:
Attach additional detail if destred,or as required by the Inspector of N'uw.
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 0 (Specify:) 9/1 7/n
(Expiration Date)
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.
I eet4&,under the palns and penalties of perjury,that the Information on this application It true and complete:
FIRM NAME: LIC.NO.:A 1 19 8 3
Licensee: LOU I S CONT I NO Signature LIC.NO.:E 2 8 7 8 8
lieable enter"'exempt"in the license number line.
RlaaP _ ) Bus.Tel.No�78-363-5420
Address. Alt.Tel.No.;
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement I am the(check one)C]owner owner's agent.
Owner/Agent vL
PERMIT FEE.
Signature Telephone No. a
O
O '
�� o
Location Zza -sON S f
No. 7` Date
HORTI� TOWN OF NORTH ANDOVER
f � s
9
Certificate of Occupancy $
Building/Frame Permit Fee
MU $ a�
s,k
Foundation Permit Fee $
Other Permit Fee $ _
TOTAL $ O>S
Check #
13735
/ Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER. a DATE ISSUED: ow
SIGNATURE: ,
Building Commissioner/I for of Buildings Date
SECTION 1-SITE INFORMATION Iz
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
86 S444-oYv 2.Lo 017 , 0
�DUa
Map Number Parcel Number
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 R red Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M
2.1 Owner of Record
630 Cc bepL 1 /0 Sk i s4-
Name(Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
z
M
Si nature Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
1
Licensed Construction Ssp rvissor: 06002-
I6'?_ License Number
Address �t
w ✓ �"Y ' Expiration Date ic
Signature Telephone F
3.2 Registered Home Improvement Contractor Not Applicable //0
Company IF
,G s— Registration Number
Address
O /
Expiration Date ^
Signature Telephone G)
N �
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.......2' No.......❑
SECTION 5 Descri tion of Proposed Work check all a lIcable
New Construction ❑_ Existing Bjailding K Repair(s) ❑ Alterations(s) Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other . ❑ Specify
Brief Description of Proposed Work:
Zia�ra 1.,. Q -e n �-v� F
, �
b i
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be
oftc, USE(3NLY
Completed by permit applicam
1. Building (a) Building Permit Fee
Q�
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
' Hereby authorize to act on
40 - 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 r
and belief 1
17C M (9 S IJ 6
Print Name
Signature of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR T VIBERS OT 2ND 3
RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS 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
CERTIFICATE OF L IAB I L I T Y INSURANCE DATE 07/30/99 (MM/DD/YY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
PELHAM INSURANCE SVCS INC THEENCOVERAGECERTIFICATE
AFFORDED BYYHOLDER.
THE POLICIESBELOW.CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER
122 BRIDGE STREET
PELHAMNH 03076-
I N S U R E R S AFFORD I N G COVERAGE
INSURER A: Liberty Mutual
INSURED INSURER B: The Maryland
Thomas Doyle DBA INSURER C:
Thompsons Construction & Roofing
8 West St. INSURER D:
Salem NH 03079
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
THE .TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
B [X] COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 300,000
[ ] CLAIMS MADE [X] OCCUR SCP 34865353 04/15/99 04/15/00 MED EXP (Any one person) $ 10,000
[ ] PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE . $2,000,000
[ ]POLICY [ ]PROJECT [ ]LOC PRODUCTS - COMP/OP AGG $2,000,000
AUTOMOBILE LIABILITY
[ ] ANY AUTO: COMBINED SINGLE LIMIT
[ ] ALL OWNED AUTOS (Each accident) $
[ ] SCHEDULED AUTOS BODILY INJURY
[ ] HIRED AUTOS (Per person) $
NON-OWNED AUTOS BODILY INJURY
(Per accident) $
[ ] PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY
[ ] ANY AUTO AUTO ONLY - EA ACCIDENT $
[ ] OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
[ ] OCCUR [ ] CLAIMS MADE AGGREGATE $
[ ] DEDUCTIBLE $
[ ] RETENTION $ $
WORKER'S COMPENSATION AND [ ] WC STATUTORY [ ] OTHER
A EMPLOYER'S LIABILITY WC2.31S-314995-019 04/21/99 04/21/00 E.L. EACH ACCIDENT $100,000
E.L. DISEASE-EA EMPLOYEE $100,000
E.L. DISEASE-POLICY LIMIT $500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Garage Repair at 82 No. Policy St. Salem, NH
CERTIFICATE HOLDER [ ]ADDITIONAL INSURED; INSURED LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR
Anthony Mottolo TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED
PO Box 504 TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION
OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Andover's MA 01810 REPRESENTATIVES.
AUTHrO'RfIZED REPRESENTATIVE
W
(7/97) Page 1 of 2
I
S
NORTH
Town of Aindover
No. All)
0�A COCNICMEwICK dover, Mass.,
CRATE D PPS\ �Cl
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
THIS CERTIFIES THAT.....,-�...& BUILDING INSPECTOR... � � MIA
.................................................................... Foundation
tohas permission to erect . r buildings on ..! 5 ............. Rough
........ v..... .........
to be occupied as...... 0..�. .........'. .......Sf.r� ........ ... � Chimney
.................................................. .
provided that the per on 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 onstructio_n of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Rough
Cp
PERMIT EXPIRES IN
6 MONTH S Final
UNLESS CONSTRUCTI S 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 RoughFinal
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.
rr ff'' ,�� y "t Office Use Cnty / �I, Cc
V1J� LQTIIIIIIIi111IP � 1 a �4it 55 11-Rtt5 Permit Na.
_ Bepartman Qf �uhlk ---afEtg
Occupancy & Fee Checked
(leave blank)
SOARO OF FIRE PREVENTION REGULATIONS .527 CdIR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR?12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(X)� or Town of NO M ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical w,crrk described below.
Location (Street & Number)
Owner or Tenant e/I�t,/
Owner's Address If 7 Sf�A/8aCXA11 E-A2>iAll&
Is this permit in conjunction with a building permit: Yes 1 Na 1_ (Check Appropriate Box)���
Purpose of Suiidincrl �L ' 1 Utility .authorization No.
Existing SerJice Amps _J VCits Cverhead Unagrnd No. of Meters
NeI.v ni
Ser./ice _co Ap, /
s • "01 Its Cverneae _ Unccrna No. of Meters �
Numaer of Feeders ana Amcacity
Location and Nature of Proposed E`ec i 'vcrc
To tai
No. of Ligr,ang Outlets i No. a. ��s I No. of Transformers K,A
I Above~— ;n-
No. of Licttttng Fixtures i Swimming ?cat grna. — crna. Generators KVA
No. at Emergency Lighting
No. of R_cectacie Outlets No. of Oil Surners 3ar.ery Units
No. of Swrccn Outlets No. or Gas Surners I FIFE REARMS No, of manes
No. of Cetection and
No. --tf Ranges No. cTotal f Air Conc• tans I initialing Oavices
Heat Total Total
No. of Oiscosais I No.of Pu--=s Tons KWNo. of Bouncing Cevices
No. of Sed Contained
No. of Cisnwasners ScaceiArea Heating KW OeiecaonrSounaing Devices
— Mun cicat —Othar
No. at Or/ere Heaanc Oev^cos Cvv I `Local Oonnecaon
No,
Or No. of I Low Voltage
No. of 'Nater Heaters KW i Sicns 9adasts Nir.nC
No. Hycro Massage Tubs No. of Motors Tatai HP
OTHER:
INSURANCE CCVEFAGE: Pursuant :a the reeuirements at %iassacnusa-s general 'Laws � _
I have a current Liaotiity Insurance Paiicy including C:,mo:ecee Oeerauenc
s Ccverae or 'is sucstantial eeuivaient. YES NO _ I
nave suomineo valid proof at same to the Office. YES I NO _ If ycu nave cnecxec YES. -lease ineicale :he :yce at coverage Cy
cnecx ng the d0proariate Cox.
INSURANCE I,1 3CNO = OTHER = (Pease Scec:'.y) tEXotration Datel
Estimated Value of E!ecncal Work S
Insaect:cn Oate RaCuestec: Rough -_
:nal
Worx :o Start _
Signed under a ie of perjury:
i' LIC. NO.
FIRM NAME v
�2 Signature
L!C. NO. J
Licensee
�. 014 Sus. 'e. No. 5. - 0 ` Alt. Tei. .^l0.
Address
OWNER'S INSURANCE WAIVER: I am aware that the _:ce.n.sea noes lot nave ne ns ;ari. w coverage or rts suent- Ow ecurvaier� e^l
cu rea ov Massacnusetts General Laws. and :nal my signature on :ns aermu aacucauon waives chis reawrement. Owner 9
(Please cnecx one) 3 � rd
Tetecnene No. PERMIT 'roc 3
(Signature of Cwner ar Agenn Gr .Z�4 71,�x
<j"`'
I
t9
` \ {}� Office Use Only
r G tr Lfam=nluraft 1 of gnsar4imitt Permit No.
3partrunt taf f uhlic $afetg Occupancy& Fee Checked
3194 (leave blank)
BOARD OF FIRE PREVENTION REGULATIONS 527 C`.IR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CM . 12: 0
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(XX or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perfor/m/the electrical work described below.
Location (Street & Number)
Owner or Tenant G'l-Py, AV /-
Owner's Address /
Is this permit in conjunction with a building permit: Yes V No r (Check Appropriate pox)
Purccse of 9uildina_ 'Fes i ellPh fi Utility Authorization No.
Existing Service Amos _J Vcits Overhead _ Unacrnd No. of Meters
New Service Amps _J Vcits Overrteac _ Uncyrrta r No. of Meters
Numcer of Feeders aria Ampacity /
Lccaticn arc Nature of Proposed Elec:r.cal Ncrx
Total
No. of gn;ing Outlets i No. of Hct 7_-=Si No. at Transformers KVA
L
I Above.— In-
No. at Lignting Fixtures i Swimming =act grno — crud. _ I Generators KVA
I I No. at Emergency Lighting
No. at F�ecectacie Outlets No. at Cil Burners j Bacery units
No. of Swttcn Cutlets No. w Gas =urners I FIRE ALARMS No. of Zones
Total No. at 'election ana
No. at Ranges No. at Air Cana. tens Initiating Oevtces _
No. of Ciscosals No.at Heat Total Total
um= Tans K'VV Na. at Sounding Devices
li No. of Sart Contained
No. of Cisnwasners - ScaceiArea Heating KW Oe:ectioniSouncing Oevtces
Muntcioat Other
No. of Orrers Heat:ne Cev:ces KW
Local Connect:an
No. at No. at - LJw Vottage
No. of '.Vater Heaters KW I Sicns Ballasts Wir:nc
No. Hydro .Massage Tubs No. of Motors Total HP
OTHER: -Si°LfJji-� �rrM
INSURANCE COVERAGE: Pursuant to the recutrements at massac-user:s general Laws _
I have a current Liamitty Insurance Potic•/ inducing C_-mc:etee Ocerations Coverage or is sues;antral ecuivatent. YES ✓NO
have suamtrtea valid proof at same to the Office. YES ANO _ If you nave cnecxea YES. ;tease inaicate the Clpe at coverage cy
checxtng the aopre nate cox.
INSURANCE BONO = OTHER = (Pease Scec:fy) (Exetration Date)
sumarea Value of)Vecticai Work 5
Worx :o Start Inscec;:en Oate Racuestec: Rougn Final
Signed under the
F UPf7 perjury, ILIC. 1140.
iRM NAN
/u`!/n ,t gure
LIC. NO.
Sinati
Licensee a a
/�// Bus. Tet. No;
Address 27 17/" r Q� Alt. ;et. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee aces not 'lave the insurance coverage or its sulat, Ow eaurvalenAgentt o
dutrect ov Massacnuserts Genera) Laws. ana that my signature an :n:s �ermir aepitcatton waives this reautrementOwner
(Pease cnecx one)
–eteanone Na. PERMIT FEE 5
(Signature of Cwner or Agenti `�"`'
Date....... qq
677
O1 NO DTM,h '
3? •6th ••.i,��6 OOL TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
�Ss�cwusE�
This certifies that ........... .... .. ........... .... . ... .. .��:---`.............
has permission to perform ........... . .. . ......... "................
wiring i e ildin of.......8 0........Sr. ..................................
at .. . ,North Andover,Mass.
Fee.. .... Lic.No. ............. ...............................................................
4112,611:47
ELECTRICAL INSPECTOR
35.40 PAID
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
Location -au ,4)
No. Date7449i4a
N°"TN TOWN OF NORTH ANDOVER
O�
Certificate of Occupancy $
* Building/Frame Permit Fee
�7S++no'Et� Foundation Permit Fee $
�. SACHUS
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
!i. TOTAL $ft-
L l Building Inspec or
15:59 19227.00 PAID
! Div, Public Works
Location flo A
No. Date' 6
NORTH , TOWN OF NORTH ANDOVER
r pt 4t a° ,eti0
3? e * OG
p Certificate of Occupancy $
Building/Frame Permit Fee $
r CMustt Foundation Permit Fee $ _T
Other Permit Fee $
- � Sewer Connection Fee $
/00 Water Connection Fee $
TOTAL $
I'.
41v.
In ctor �
9' '5 7 is Works
Location I/6fi!
No. `1, Date
A
oORTM TOWN O.F NORTH ANDOVER
„ Certificate of Occupancy $ 0 4
Building/Frame Permit Fee $
u �ss�cMusEt Foundation Permit Fee $
i
Other Permit Fee $
Sewer Connection Fee $ _�
Water Connection Fee $ , �
� —
iTOTAL $
Building Inspector
} 1fl , ' Div. Public Works
PERMIT NO. -� T APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. � `� �tPAGE'rc:
.: MAP 440. ( LOT NO. / l .. -— --_— --
LPURPOSE
ECORD OF OWNERSHIP DATE BOOK iPAGE
ZONE SiJf3 DIV. LOT NO. —� -
-- -- uLOCATIO OF B ILDING[R'8 NAME / l ' / - STORIESZ- 81ZE
2
1 . OWNER'S ADDRESS ._��_ —_- G S�
3BASEMENT OR SLAB ••�� .
ARCHITECT'S NAME U SIZE OF FLOOR TIMBERS IST 2N0 3RD
_
BUILDER'S NAME /,,� /-^� /���T SPAN r 2%a.�,�D
DISTANCE TO NEAREST FIJI.LDING �{Q DIMENSIONS OF SILLS
DISTANCE FROM STREET. 2-✓ p) s - '� --
V POSTS
DISTANCE FROM LOT LINES'-'SIDES :3,57 - REAR i fi'Ji GIRDERS O .
AREA OF LOT - �,4'� y�f FIRRONTAGEHEIGHT OF FOUNDATION (y r THICKNESS /O 1/
..
�n`��. IS BUILDItAG NEW L(,/�vi7 - ----� SIZE OF FOGTING z D X
'V IB BUILDING AppITIONL - MATERIAL OF CHIMNEY
IS BUILDING ALTERATICiN IS BUILDING ON SOLID OR FILLED LAND d
WILL BUILDING CONFOR•MIT.OPEgUTAEMi:NT9 OF CODE 18 BUILDING CONNECTED TO TOWN WATER (_
_ _ _—Y,L-�� -- - �✓L-'s'
BOARD OF APPEALS ACT„ON.'F ANY tS BUILDING CONNECTED TO TOWN &EWER /nk
IS BUILDING CONNECTED TO NATURAL
GAS LSI/NE
INSTRUCTIONS J PROPERTY INFORMATION
---------------
LAND COST 'Z 2-
SEE BOTH SIDES ^ 1
EST. BLDG. COST
PAGE I FILL OUT SECTiC2NS 1;- 1 EST. BLDG. COST PC Sq. PLI
PAGE 2 FILL OUT &ECTiONS 1 - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST,BE,ON OUTSIDE OF BUILDING
4 APPROVED 13y` ATTACHED GARAGES MUST,CONFORM TO STATE FIFIE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING_ INSPECTOR
DATE FILED •�/�. �..
,,�-^ ■UILDiNG IN&YiCT01
&IG- TUR OF N OR-AUYNORIZED AGENT
F E E ry OWNER TEL I Z`: l �/2- -2.Z Gd
PERMIT GRANTED KK PERmIi ,. �`�' CONTR.TEL.r 7 5�
.� DUE FRAME PERMIT CONTR.LIC.r ��1 42' 7
H.I.c.r
A
J.
f
L BUILDING RECORD
T OCCUPANCY T2
INGtE FAMILY S'Ol S 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 I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION B INTERIOR FINISH
CONCRETE _ {b— 1 7 (3
CONCRETE BL K. PINE _�E7 _
BRICK OR STONE HAROW D
PIERS PLASTER Jee
_ DRY V/Ati
UNFIN.
3 BASEMENT ( -
AREA FULL FIN. B-M'T_ ARA
_Q
FIN. ATTIC'AREA
NO B M'T FIRE PLACES2-
HEAD ROOM MODERN KITCHEN
4 WALtS I 9 FLOORS S
CLAPBOARDS B I 7 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH _
ASPHAIT SIDING HARDVI _
ASBESTOS SIDING COMMtJN _
VERT. SIDING ASPH. IILE-
STUCCO ON MASONRY —
STUCCO ON FRAME '
ATTIC $TRS, 6,FLOOR
BRICK ON FRAME I—
CONC. OR CINDER BIK.
STONE ON MASONRY {rI WIRING
STONE ON FRAME 1
SUPER16R_I_j POOR _
ADEQUATE NONE
5 ROOF 10 PLUMBING
CABLE I HIP fBATH a.flX'1
GAMBRELMANSARD TOILE_`RM. 12.FIX.1
FLAT-11SHED WATE7,CLOSET _
ASPHALT SHINGLES LAVA'u'ORY
WOOD $HINGES KITCIIE'N SINK
SLATE NO F_FJMBING
TAR b GRAVEL $TAIt_`.HOWER
ROIL ROOFING MODEPN FIXTURES
TILE FI,OCR
TILE OAOO
g FRAMING 1 T I. HEATING
WOOD JOIST JooO PIPELESS FURNArE
FORCED HOT,AIR FURN.
TIMBER BMS. A COLS. STEAM
STEEL BMS. & COLS. HOT W-T-R OR VAPOR .,
WOOD RAFTERS Y AIR CONDITIONING
RADIANT H'T`G
UNIT HEATERS
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No. 324 ►- .. f.
rti dover, Mass. �/ 19 6
coc M'CN WICK ��
ADRATED F'?9`�' (5
5 BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
o ��� BUILDING INSPECTOR
THIS CERTIFIES THAT...........................C....�/,... G� .................. ...............................��^......................................
Foundation
has permission to erect.......... ` .... ....:.. ........ buildings on ........./..L.0.........4744.ff. U?! .... ....... ;D,....... Rough
to be occupied as .......................................................01,4')...(?.1 - ............... "1��. ./........................................... Chimney
provided that the person accepting this permit shall in every respect conform to the terms o 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. !ERMITPLUMBING INSPECTOR
REGULATED R E4RA. g
VIOLATION of the Zoning or Building Regulations Voids this Permit. B ATION NL Rough
Y PAS• 114.8-S g •
PERMIT EXPIRES IN 6 MON�TE_ �� 9� inal
UNLESS CONSTRUCTION STAR Ste~'FEE PAii) 1 c� ELECTRICAL INSPECTOR
-RQugh
.............................. ...... ... .�.. ... .... .............................................., 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.
LI) �' "" �� Smoke Det.
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FORM U - VkRIFICATION FORM
• I
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: Phone
LOCATION: Assessor's Map Number `�7 Parcel r--� - -
Subdivision r 2m Lot(s) AE2@0P 3a2 fl
Street )vj/ Rx St. Number 1 //7a
************************Off - cial Use Only************************
RECOMMENDATIONS OF A S: Date Approved 71ZI$
Conservation Admi i slVator Date Rejected
Comments
CQ41 Date Approved
Town Planner Date Rejected
Comments '1t YY) C0CftA,,t&l 1wC� /(Q 1 ,L��['
Date Approved
Food Inspector-Health Date Rejected
Date Approved l�
SS„eplE Inspector-Health Date Rejected
Comments
Public Works - sewer/water connections4�
- drivewpy permit —I TL,)
Fire Department
Received by Building Inspector Date
Growth Management Bylaw Exemption Statement
Town of North Andover Building Department
This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as requested below.
Name of Applicant on Building Permit(below) Address of Property for Permit(below)
tt'o
Map and Parcel : - /Purpose of Application (check below)
Phone Number of Applicant: _Single Family _Two Family
I the undersigned applicant for the above property attest that the attached building permit for which this
form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth
Management Bylaw. I also understand providing this form does not absolve me or any party to this permit
from the requirements of obtaining other permits required prior to the issuance of the Building Permit.
Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building
Department and is only officially accepted when the Building Permit is issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the
above lot, in the building permit application and associated attachments, complies with one or more of the
following sections as indicated by a check mark.
This is an application for a building permit for the enlargement,restoration,or reconstruction of a dwelling in
existence as of the effective date of this by-law,provided that no additional residential unit is created.
t/ The lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
Bylaw.
This application is for dwelling units for low and/or moderate income families or individuals,where all of the
conditions of 8.7.6.c are met and/or represents Dwelling units`or senior residents,where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
purposes of this Section"senior"shall mean persons over the age of 55.
This application is a part of a development project which voluntarily agreed to a minimum 40%permanent
reduction in density, (buildable lots),below the density,(buildable lots), permitted under zoning and feasible given the
environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently
designated as open space and/or farmland.The land to be preserved shall be protected from development by an
Agricultural Preservation Restriction, Conservation Restriction,dedication to the Town,or other similar mechanism
approved by the Planning Board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an
adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth
Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the
parcel.
This application represPnis a lot which is ready for building permits,(i.e.all other permits from all other boards and
- _ commissions have been received and the..prcject is in compli,ice with-those permits), and the Development Schedule
does not accommodate iss ;nq a bui!.1;ng permit in that Year,one building permii will.be issued per Year per
Development until such time as the Development Schedule accommodates issuing building ptnwir.;. hpolic: n must
supply approved form U with this EXEMPTION.
Please provide any and all information that would assist the Building Department in making a determination
that your application is allowed one or more of the above EXEMPTIONS.
By signing below I attest to the accuracy of the information provided and that the attached building permit is
allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or
inaccurate information, or the checking off of an above item which does not comply,whether done to my
knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit.
Sig t r of Ow r or A thonz Agent who signed the Attached Building Permit Dasa "
This form mus be attached to the Building Permit upon application for such permit.
CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number Date (S4 e T oZ 6o _ q q 7
THIS CERTIFIES THAT n
THE BUILDING LOCATED ON
�, I
MAY BE OCCUPIED AS S, I IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
RT /
MO M n
O' •'+e CERTIFICATE ISSUED TO C1' l e./1 K . TA uS r
ADDRESS 33 Wg I kee 'T- �V
rr.h
.
b
+J "°'� Building Inspector
r
t10RTIy
/6
too
Y r i
IL
0 LAKE -'
COCMICHEWICK
DRATED Pl?, y
Sqc Use
APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
ADDRESS/LOCATION OF PROPERTY: L�
DATE REQUEST FILED/READY FOR INSPECTION:
CLOS ING DATE ON PROPERTY: - 2-
S ' 9
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REOIIIRED
ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME.
A RE-INSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF
THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES.
SIGNED: L l �y �• 2' 2"
t -
1 G
Town,.*Of over f
-t- rt dover, Mass. 19 Pr,
I� COC MIC MEwICN �
%9 ARRA r D P'P�,`�C�
5 BOARD OF HEALTH
RMIT T D Food/Kitchen
Septic System t��'.-dim
BUILDING INSPECTOR
1 fy
THISCERTIFIES THAT........................... ... .. ......................................................a...G........................................... Foundation
has permission to erect..........L,. .....�?........ buildings on .........f..l..0......... (7 G? ?.....f- c�1.........t4 ......... Rou
tobe occupied as.......................................................� ............... ./y........................................ y.
s' c .
provided that the person accepting this permit shall in every respect conform to the term of the application on file in i
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in Ve Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit.
PERMIT EXPIRES IN 6 MONTHS
ELEC RICAL SP CT
UNLESS CONSTRUCTION STARTS '
- - - Ro lc
.............................. ...... ... .... ......................................................... Se ce
BUILDING INSPECTOR —/
x
Occupancy Permit Required to Occupy Building
GAS INSPECTOR
� C s > -�--�
Display in a Conspicuous Place on the Premises Do Not Remove ►nay �j/J c .
No Lathing or Dry Wall To Be Done
*}
DEPARTMENT Ins ected and Approved b t Building Inspector. - o �
V Burner
P�,'J AJI Af 6 X40 aN
street No.
SAW Smoke Det.
WOW