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Miscellaneous - 111 AUTRAN AVENUE 4/30/2018
f 111 AUTRAN AVENUE 21M045-D-0005-0000.0 R 955;` Date.......7- ........................... NORTp TOWN OF NORTH ANDOVER _ o p PERMIT FOR WIRING ,SSACMUSE� This certifies that "U........... has permission to perform 10QOL �/� ..) ............. .................. ......... ................... wiring in the building of.............................. .f� 5.............................. at................ ........'T C...... North Andover,Mass. Fee....'?:. -70—.O... . ... Lic.No. afjy .. ..,� .. . ��ll /... E'/CT L' Check # r Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. �5 3 7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: lac, U City or Town of. NORTH ANDOVER To the Inspector o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ' Lf wne or Tenant ��/a—�j r ZZ aA O Ui J Telephone No. �2k F 7� 5 Owner's Address Is this permit in conjunction with a building permit? Yes Rr No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: pori �U M P Z LQ A V2a(l I ACS 0urri—t—r i v [ Completion of the followingtable mav be waived bv the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of ota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA ' ove - .omergency oi mg No.of Luminaires Swimming Pool rnd rnd. ❑ Battery Units No.of Receptacle Outlets ` No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an Tota Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat Pump Number ons o.oSelf-Contained Totals: "— ""' """"""""""' Detection/Alertiniz Devices No.of Dishwashers Space/Area Heating KW Local❑ umcipa ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems,* No.of Devices or E uivalent No.o KW o.o °•o Data Wir � Heaters Si s Ballasts m* g' No.of Devices or E uivalent No.Hydromassage Bathtubs No.of MotorsTotal HP Telecommunications Wiring: OTHER: 1 No.of Devices or E uivalent 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: /Q 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 c age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND E] OTHER E] (Specify:) �?j(o QO O 30�j� �XP, 9/02?//U I certify,under the ains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: f LIC.NO.: oZ O�70 r9 Licensee: a �!): t / Signature LIC.NO.: /09 V, (If applicable, enter "exempt"m a lice se number line.) 1111_ AAA Bus.Tel.No.--LU4--71L--CP-7 a6 Address: t{!l A'gkta(ld AV',. Mf✓` \0CA IAA di yq� Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department 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 by law. By my signature below,I hereby waive this requirement. I am the(check Owner/Agent g one) ❑owner ❑owner's agent. Signature re � Telephone No. PERMIT FEE: r e N2 1924 DateZU..-./a......9 .. � NORT1i� ° �"'° '• "° TOWN OF NORTH ANDOVER PERMIT FOR WIRING �Ss�cMusE� This certifies that -- has permission to perform ... .. .................. . .................. wiring in the building of.......................�.J'...t ... . -*'............................ ......... ,North Andover,Mass. � - (� dee. ).............. Lic.No...........,.. ........ .................................................... (/' ELECTRICAL INSPECTOR 10/15/99 13:37 40.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer / THE CO11NMONWF.4LTHOFMMMUMS= Office Use y DF�39RTf�V'lOFPUBlICSAFElY Permit No. BOARD OFFIREPREYEMONREGE MT70NS527CWI Z-1Xl U Occupancy&Fees Checked APPLICATIONFORPRRAlffT TOPERFORM==CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 /� T /�_ Q (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. A- 2,lzk� PARCEL f� r m Location(Street&Number) 1114y TR1q ,1 Owner or Tenant 3 /meq /q J IV2,�9, ,f-17 Owner's Address Z Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building ,� l Utility Authorization No. Existing Service o2O D Amps/ad /97�Volts Overhead Underground No.of Meters ! New Service Amps / Volts Overhead = Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work D/ h?e ey4T� H No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above p Below Generator KVA ground ground No.of Receptacle Outlets -2 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Bumcr No.of Ranges 'No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals ..No.of. Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwasher Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Hearin Devices KW Local Municipal Other Cormcctiom No.of Water Heater KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.:ofMotor Total HP OTHEk 1 Ina>ranoeCoveage.Asstrn�ttot6eze�tana�.sda�elLsC�alLaws Ihawaama1Lia1*) Pc3Llird C C wragearitsa alec}nvakrjt YES NO Ilnxstbnttedm dgoofcfsametod-rCft e YESIf}aulr�e YES eit thetypeofoacaa�b�d�adangthe SCE F-1 BOND r7 MIER F-1 (Please Sp=fy) EslimatdVahaedElxbcal We k$ —?.o 0 a WakIDSbIt O '/� '9 1> IDaL-Rmpcsted Ra,gh -90 Final sg.rdundfftTiePt:i�s ofpejuy FIRMNAN E /� - Lica]seNo. ` Sb, LiamseNo /34 � F/� O l�'S�O Alt Td Na OWNER'SR4SURANCEWAIVEP,IamawmetAltrL=)sedoes not lravetfieit xawecu�a critsbtntialecltrivalartasiegmedbyNGassa±�Cen=1Laws andt(mm4==t (Please the k e) er �� Agent Telephone No. �`/— 3-3'SZ;5 �, �f PERMET FEES D . narure of ne or gent I'1-1ZM1T NO. YA1 APPLICATION FOR PERMIT TO BUILD /*"**"*NOIZ'1'11 ANDOVER, NIA Al 11 No . LOf.Nl). 2. IIECURUOFO\PlvL1Islill. DATE 1300K 11AGE /lit,E SIIU 11111. 1 I NII. r I0( AIION PURPOSE(A:131)11DINT; } � ©a/Ln-„ OWNER'SNAME P1 AM 0})4�/M nie 110. OFSF(N1IES „I � SIZE: s ()WNIVS ADDRESS W/ ul- ��f //,5 RASE ILN r(Nt SLAB tv"S® hlg-K 7- 1 eS AR(I III ECI'S NAMI _ ,/ //(" SIO:CA:I I CXNI I IM131:ItS Q Y/6 of ST 2 111) 3 RD Ill III DER'S NARIS , T I,l /� Q SPAN (-r(� DIS-IANCEIONEARI:S-I 31111.DING rJ®�1 DIHENSI(N!S(1:Sit.LSV�-- - DIS I ANCE I R(N.I STREIi r DII.ILNSI(NJS 01 1 NIS IANCE FROR1 LOr LILIES-SII)E REAR DIMENSI(NJS OF GIRDERS X e AREA OF LOr ©Q o rROHI AGE IIEI GI rr 01 O �� THICKNESS IS 131HIDING NEWtfO/ s17I:011(xnING �� NJ \/ � X IS BUILDING AUDI I I � MAMMAL OF CI IItiRJLY�►---�� IS BUILDING ALILRATI(Nl 1 0 IS BUILDING ON SOLID CVTIIIEOLAND \YII.1.BUILDING CCNJFCAIM TO REQ)O1REMENIS OF CODE IS BUILDING COJNECI ED 10 IOW14 WATER Ye,5 BOARD OF APPEALS ACI ION, IF ANY 0 A16 IS BUILDING)CCNJNECI LI)TO rOWrl SEWER � li: ts C._ IS BUILDING CONNECI EI)TO FIA FURAL GAS LiN- 4 INSI N('TI(lNS 3. PROPER TI' INFORNI:\IION 11 13 40 40 LANUCOS T EST. ut Lx;.COSr P461--- I FI I.l.Ol I r SECTIONS 1-3 EST. BLDG. COS I PLR SII. FT. ESI. L31DCi.COSI PERR(XN.E � EIECTRICNit:I LRS MUSTF 13EONOil ISIDE(N BUILDING SEPI ICmnwlI AIlACI IED GARA61::S MUST CONFORM f0SFAIEFIRE REGULA"IIONS 4. .A.1'PIIOYEI) l31': PLANS MUS"r BE FII EU AND APPROVED 13Y 13t IILDING RJSPECrO R BI II I.DING INSPECTOR DA IF I II ED E7�. ' 57 OWNERS TEL N C()?J I it. Sl(;NAIIIRI[(N O WNl.lt( It Atli 110RIZIA)Ali[I41 8 / II.LC.I/ III b � I'('RL.11I (i1tAtli I1) a - 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 or requirements. *****************************APPLICANT fiLLS OUT THIS SECTION*********************** APPLICANT MOM &J AJO PHONE LOCATION: Assessor's Map Number -7S ✓ PARCEL p SUBDIVISION LOT (S)=70 STREET 1 1z9 ST. NUMBER USE ONLY***''****** ** **** * *** 00 .ot ECOMMENDATIONS OF TOWN AGENTS: y S �07 � t') 1 s CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED ` COMMENTS W,,el W5 l TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERlWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT i RECEIVED BY BU1LDtNG 4NSPECTOR DATE Revised 9197 jm NORTH ONNM 4 � o Of (fiver 1- -)3No. A14.9q `roc- E dover, Mass., o? �Q RATED P'P�\ '`J 7L BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR Foundation THIS CERTIFIES THAT....... . rid ........AA.44. .................................................................................... t has permission to erect.15.k•x.�r..... buildings on ..... 1/.....Ao r oo.......Avt............... Rough to be occupied as...4 iF M.,../ .....R�........�......�4.ovtie......o.l�j.N.......��.��............................ Chimney provided that the person acceptin 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 S• Final PERMrF EXPIRES 1 6 MONTHS i HS N P S UNLESS CONSTRUCT10N TZAR� S ELECTRICAL INSPECTOR e � Rough At �3 S G ..................... 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. S s�� U3 7-od I aw a P s VC CP�� �o� -X?,Y3�9 r7d� 117 i I ' � I 1 �yS� v �SnoH NiIS ,� S fSic� � opo o� oaa� 8XI 01,L-,o oSf aP I tel, �U i S�h51� �� �� ��L Tn,P fI�Tc )213 W ALL �n Sul�.►�+ory o \O vj i .,..�, �. .: , r.'Ir'i A' ;A-'�f d �:j. I. ..t:. .7.t,p�S.l.i� stEI .„�.. tt v± -kt...t E 1! :- :t, r..y.,.: {. /• .,.,: 1, r r 4 sr ar ', fts.:„t. E t'. s }: „3 f i S ,:v :. ,lt a 1. rr.. r. ..i{si.e :ff ,.:11::•.r', ,}.r.,f ,:Ft.u. -.. .,'9. ..yt.Y ,{'.,.�',Tr,, r-5{..s-' .' -i{' , a '�.tN.. -"f, � x .resffd illr:,;fF ,.t.,ii, t,N ,l; t rR: ;4�, I,ti, S.t� F t ;.,7«�.a�;.!~'. ,Y.' i� ap .L.. stf t E_:tc.,.liti}i^7 r{a t,� j,E ri. , i n i!- �' '. l t. ; c?t f ;4,.<J j.,ti. a! E �t;: a s: .,�. .t't 1.;.'a..y, ,r tt .xr,r Pl y- .'d.. a,i .}.i:..!. ...4.. !t.:, -e a.3 ... :;f d 7 . J�x as!',. i t.:I .. ,. '�i'er�, ^'„�,.M7:`. t .._.a. ,n r ....t i..{ .Ft... ..�c dr , '.f• s: a ? °ttlt'fir. 4 t s ..9? ,a., } ..rt e. --q$i .;? }I. .r e t t. .f[...->i. 7.. 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S{s.: y.. •U.r,..Ai0i r.F. j + f xt - r Y'?r .�i:?> }i._ * i. r,,r { ' i c r ?a.. t ti fr:§ a Y r �}} ! i r r t r� % z” i i '� C4f uE ftf.:• :.1 t N'T", , t r t r _ ..t,,.E- I'll -`z'yJi' ":3` i r 3f'7 i r� }k•fcF11— Sry39a rc:•y 1!r # r.. utT '`t�}F t. t-.' tjt �' :�..:5 JZI�I { ttE -- .:t.:.,} c er cr f '.t e fss„x as�`.>;i _ ,t 9 - - . _ t 9k 1 r t f11 t3 J x r t S , f 9 1 ,.P ."'A .T iE�' '3+.'• 'iG Ft L A : 9 S e. Y p t I�II t .. a i1 of ,' j,'-,�-- , r t Sr.tii •t iJT S!t s" x - s i-- .,,c...,. "•."' a ' r t- x. i . T-, F_t•l' - i _ r,.1i }.13" i d t r{',tIt,`. -r3 t>�r t.'F `x' "'z^'[' -r'.k t e�"s t ,k{ 9 �_ _. " LEs, d t tt t t - itr' '�e"'rs71§yr yr' f 1 [ a hF s?`�5 r" i. r S 1 -.� r t Y,I c-- •fr F z„ s.,.r,. '' r ° s - , i4 - _, i z : �t 3},r s t x t _ k Y.� i 14., 1 .14 .k5.t`- - k ... - �' a r y r x-"a „„- '£' s ate..J K. r Y.. 11 . 7 �t .. 11 , : t - s 7' 'dam 1 4 I.- -,. r xn .. r - I'l J ,rc r .. , . t t Y 0. CO �. , 5 ; 7 'd r It V1. - a� W p t e t� a i W 4 a Slt d' fq 'O t+ { Z o o. Q 5 ki _ too F- ,, m I} }} t J rJ I' > > �x e<� ., ' s - o1 r� q .11 •+e t" I Ind c31�i� i�� Jrf t !Q � i I � (/j .'0.. {'ti �yi., (f � x �,b o r, I a l u 2 ,•.m �W _ fU, W W } r. O t f` -fit _ -. a y C O.i O jf ',��,. J C� ✓ C It f3 Uri "} l 1 " a+ 1�1 } W € (( �Lj t �s F Y r1 Q ,i +' F-stn: i� �' s t f ) 3 - - r l ��. i n 4 s.:. s; F 4 _ . . ..-�..- - - .. i :.. h { �! t ' �. , x _ m. - F �r - Jit - r - f } F t t ,, s _ i , r � ' j i t l i{ it it} t` ::i F t d M,r tr°t a•f;'4sy^' 1. -. ,. 7 a a t r _ -_. D -"� ... - .. i. _;x - kt . t v _. .: - - - .: y i Y - t .. .. .. .. Y +_ .- - - - t z The Commonwealth of Massachusetts ( Department of Industrial Accidents - — Omen a//ayesUgat/vns �I - 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit name: location: / re4 City AM �s��P!P�P phone# —41I fy I arn.a homeowner performing all work myself. a sole proprietor and have no one working in any capacity r7 I = an employer providing workers' compensation for my employees work-in o compariv a ool • v# I am a sole proprietor, general contractor, or homeowner(circle one) and ired the contractors listed below who have the following workers' compensation polices: company name- .... ..... inaurxnce co Doli # company. • addmn- inavrnnce co. c-ru Failure to secure covers a as required under Section 25A ol'i�IGL 152 can lead t the eim imposition g 9 on of criminal naltia aC a fine u t p o S1SOU.00 and/or Pc P one years' imprisonment as well as civil penalties in the form of:t STOP WORK ORDER and a fine of 5100.04 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage vcrificanon. 1 do hereby ce ify u der�pains�and aiti of perthat the information provided above is true and co M Signature l ) / J� ��/ Date `M 1J Print name ,fl/ —D 4x Phoned ��Vj— 2; Cchcck ly do not write in this area to be completed by city or town official permidiicense p f lBuilding DeDn( Licensing Bo mediate response is required C]Selectmen's❑Health Depa n: phone ; r—Other (r-+ 7195 PIA) Town of North Andover NoRTh OFFICE OF oa '"`° '°1�0 e COMMUNITY DEVELOPMENT AND SERVICES A 27 Charles Street North Andover,Massachusetts 01845 �,9`'�,• ""'`5 WILLIAM J. SCOTT SS4CHUS Director (978)688-9531 Fax (978) 688-9542 in accordance with the provisions 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 c 11, S 150 A. The debris will be disposed of in: (Location of Facility) 71 Signature of Perrrtit-Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through-the-Office of the-Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 • ' Town of North Andover � HORTh i OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES - p 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT 9SSACHUSE� Director (978)688-9531 Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION R NStreet Address -�j�/ Section of Town „HOMEOWNER / 7 68 �L1s/T Number /j Home Phone Work Phone PRESENT MAILING ADDRESS r " /V pa ©lg%5' 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 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 to six family dwelling, attached or detached structures ac, cessory to such use and 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, a form acceptable to the Building 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 No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirement . 1! HOMEOWNER'S SIGNATUR V l U APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVAIION 683-9530 HEALTIi 688-9540 PLANNING 688-9535 _;�. v\ .� �- t_ I i L T 97 LOT 96 LOT 95 LOT 94 • 90 i TOTAL AREA -- 19,000 S.F. Rea c- I I 3o'sINiACk I " LOT 46 2 ' r' / 1 LOT 49 2�z'` ./�- ;/ , /,. {� •'EXI5TINO tTORY/ r r• WOOD i / / 'l r// _ I I I I _ I LOT 47 r° I MI LOT 48 lei � I 2 OEED) I FND F •� AUTRAN AVE , UE � 1oN Adoidloj�-j Y-- K t1� rv�� 3 � A� m lr i I Znnk Rh I PLAN OF LAND IN N RTH AN DOVER , MA . „i'b,rAoI.. : __ .L a4- NO. 1 11 AUTRAN AVENUE JAMES W. I ASS R.L.S. DATE OWNER/AF WCANT! HOUSE LOCATION -- ANo BRA©FORD ENGINEERING CO. sHEET Of DOWN! A.H.O.o. 3 W A S H I N G T O N S Q - REVISIONS BY lost£ ED: W,1B HAVERHILL— MA_ 01 B30 AHO .IWB P" "£'(978) 373- 396 ` (976) 573-8021 � AHO 20' FU Ho, DATE! AUGkJ5T 4, 1999 "'MO NA80499.DWG 63641 i I i I s � ni�r;.• :v. ly Commonwealth of Massachusetts Departmint of Public Safety • Dicuptnty t (44 Chaeked ' HOARD 01F;FIRE-PREVENTION REGULATIONS 527 CMR 12:00` 3/90 11.;.. kt .akl APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK NI Work to M pertorroed In accordance with the Mauachusetts Eleettical Code. $27 CMFI 11:00. (PLEASE FRUIT III UIK OR PE ALL/I11FORII&TI0N) Date City or Toon of Dyz?7!� �it/J�DcJ6� To the Inspector of Wlrest The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Number) f// Owner or Tenant erz/101) C t_r's Address_ I /VA161__ Is this permit In conjunction with a building permits Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization 110. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Haters New Service Amps / Volts Overhead ❑ Undgrd❑ Ila. of Haters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Nock No. of Transformers Tota No. of Lighting Outlets Ito. of Ilot Tubs KVA No. of Lighting Fixtures Swimming Pool A��d. ❑grnd. ❑ Generators Kl►A No. of Receptacle Outlets Ito. of oil Burners No. of EmerIency.Light ng p Battery UnisT_ No. of Switch Outlets No. -of Gas Burners FIRE AI.ARHS No. of Zones Total No. of Detection and No. of Ranges Ito. of Air Cond. tons Initiating Devices Ilett Total Total No. of Sounding Devices No. of Disposals No. of Pum s .1T KN tlo. of Sel(( Contained Ila. of Dishwashers Space/Area heating , KU Detection/Sounding Devices Local❑ Municipal (Other No. of Dryers heating Devices Connection Not of Ito. of Low VoltageSecurity System No. of Nater heaters Signs Ballasts Wiring llo. Ilydro Hassage Iubs No. of Hotors TOM IIP OTHER: INSURANCE COVERAGEt Pursuant to the requirements of t:aesschusetts Geners LENS I have a current LabLllInsurance Policy Including Completed Operations Coverage oc is substantial I have submitted valid proof of same to this office. equivalent. YESP? NOt YES NO ❑ IE you have checked YES, please indicate the type of coverage by checking the appropriate box. I11SURAIICE (A BOND [A OTIIER ❑ (Please Specify) xp rat on ate Estimated Value of E ectrlCal Work S_ � Work to Start-, Inspection Date Requestedi Rough F[nal Signed under tits Densities of perluryt 1154C FIRM NAHE Smart Proteclion of Massachusetts WestinghousfSecurity 5 slem.s LTC. Ito• 154 Licensee • John Costa Signature LIC. NO , 5 Hedr I till Road, _WallharTtAA 0 154 • Aadre»_ Alt'. Tet..oto. OWNER'S INSURANCE NAIVERt I ars aware that the Licensee does not have the insurance o erage o dtantial equivalent as required by tiassachusetts General' wq_t an Chat my atgnsture on this permit application waives this requirement. Owner Agent (Please check one) DD Telephone Ila, PERMIT FEES ^—(Slgnature of Owner or Agent X� Date...... ........ 2767 N°RTM 4, TOWN OF NORTH ANDOVER o PERMIT FOR WIRING ,SSACNUS� J �r This certifies that ... .. �..c�. 2. ...... .......`.....``.........� ... t.Q..... � ,I has permission to perform .........- . .(.s.:.a.::. .:........ ..[.�.S.L. ............. ��.f` wiring in the building of /..K. .� .......... .. .f.�.�ca.�.............................. at....... ......... .. ..... ..... ,North Andover, Fee.... Lic.No. ............. ....... //. . ... . ............. ELECTRICAL INS EC 12/15/95 14,og'r 15.00� �>°i? f PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File Location /// u rA^.) A u-, ' No. 19 Cl Date 1 ' q 03 TOWN OF NORTH ANDOVER � w S Certificate of Occupancy $ s�CNust�� Building/Frame Permit Fee $ 3 Foundation Permit Fee $ Other Permit Fee $ F TOTAL $ •y Check # a()Or-/ 6730 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING mw BUILDING PERMIT NUMBER. - DATE ISSUED. ic SIGNATURE- Building Commissioner/I or of Buildings Date Y—es–A Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: U n'( � �„_ Map Number Parcel Number P-771 rn Y U&R t M A 1.3 Zoning Information: V �— 1.4 Property Dimensions. Zoning Dist ct Proposed Use Lot Areas Frontage(ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard 11 Provide 'red Provided Required Provided v 1.7 Water Supply M.G.L.C.40.11 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 ` SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes Pdt) M 2.1 Owner of Record e(Print7 , Address'for Service 1z - iz `7 - 275 ature Telephone 2.2 Owner of Record: Name Print Address for Service: O M Signature Telephone 90 SECT40N 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicabl Licensed Construction Supervisor: O License Number Address Expiration Date ic Signature Telephone rM s 3.2 Rt,,s stered Home Improvement Contractor Not Applicable ❑ a Company Name m Registration Number Address rM Z Expiration Date Signature Tel hone YI r 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.......❑ No.......0 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: 1 ` V� 50 c o GI ul g ZP S DW M4-;A_1 J-P e TIUIl d� Q r. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFJH'ICIAL'USl � ,y { Completed b rmit a licant 1. Building i l/O C)o ` b� (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC �,-e- 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 • 1, t L �1 as Owner/Authorized Agent of subject property to act on y be alf,in all tters relat' to work authorized by this building permit application: ~Si a ier Date Ll SE ION 7b OWNER/AU ORIZED 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 i Signature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TD/MERS iST2ND 3RD r SPAN DUVIENSIONS OF SILLS DMIENSIONS OF POSTS DMIENSIONS 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 JL W VV JLA %JA. T%.r AL ..'sor A. J%J&ALNbOVL Nk-OF V MWOW A16 No. , 0 dover, MasS*P loRATED ? H BOARD.OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.. ............ ... . ........... "RUN..................... ...................................................... Foundation ....... ............... has permission to erec .............. buildings on ../././........ .........C4.0------------ Rough Chimney to be occupied as en, --4-m~dre . ........ 'e ��il in every respect c Final provided that the person accepting this.-perml hall in every respect c rm to th�terms 6 application on file in By-Laws this office, and to the provisions of the Code and By-Laws relating to 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 CONSTRUCTION4W)g.... 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. Smoke Det. SEE REVERSE SIDE r10Rrh OF St neo ,6'q i Town of North Andover _ Building Department 27 Charles Street cousE� North Andover MA 01845 Tel: 978-688=9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE 93 JOB LOCATION Number Street Address Section "HOMEOWNER �7�-�7� ( 17-71 g 7-7/ /'Oyd'-2 Number Home Phone Work PRESENT MAILING ADDRESS f l 1 it 'IRI� 4izc_=- 1,la R-7-f /21Cf--X City Town State Zip C4 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 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 to six family dwelling,attached or detached structures ac- cessory to such use and 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, a form acceptable to the Building 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, caner"certifie t he/she understands a Town o The undersigned"homeowner" f No.Andover Building Department mini7es spection proc ures and req ments and that helshe will comply with said procedu and requirement . HOMEOWNER'S SIGNATURE OMEO S APPROVAL OF BUILDING OFFICIAL Note:Three familydwelling 35 000 cubic feet, or larger, will be required to comply with 9 9 q pY State Building Code Section 127.0 Construction Control.