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HomeMy WebLinkAboutMiscellaneous - 111 HICKORY HILL ROAD 4/30/2018 111 HICKORY HILL ROAD J 210/062.0-0115-0000.0 i I I Date. ,L"�� ':�+o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that . . . . . . ... . . . '. . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform � '../:. .-_. -!�-- -- . . . plumbing in the buildings of . . . : at. M. . . . !:--� .. . %�!. . . . . . . ., North Andover, Mass. Fee. . . !. . '. . Lic. No.. ./`:1 . . . . . . . . . . . . . . ! . . . . . . . . . . . PLUMBING INSPECTOR Check # 667 ,5 s�, s �• �. . .fir 1 1_ WATER OLOSSIPSZIP 3 NITOHEN ;INK; o AVATONINS C R tATHTUNI O SNOWEN ;TALL$ comm OI;MWAtHER� 13 LAUNORU TRAYS W g, WASN,MA411. 44NN oil 'g NST NATE* TANK; y ` r gs13 YANKEE;; WI SLOP SINKS \ trL04M ORAIIIS N 4At TRAPS cl O URINALS ONINKINA � o FOUNTAIN h � ' ONAIN 11 �. • �� � 13AA� •� N►ATRN ;IPINO N04N DRAINS 6441tIpL 4Mt;ARr. O - *TURN FIXTURES; CY Date. . . /! . . .`�... .. r - OF tN0°TM 1'b 3j fTOWN OF NORTH ANDOVER O � 9 • PERMIT FOR GAS INSTALLATION s ,'• °•'� qh SACHUSE� This certifies that ..A�I'-'!;;---- M�,,fir/ . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . in the buildings of . . - �! ° '�'- . . . . . . . . . . . . . . . . . . . at !'��� '� �. . . . . . . .,. orth Andover, Mass. Fee�<� . . Lic. No.. . . . . . . . . . . . . . . . .� . . . . . . . . . . d GAS INSPKTOR Check# 53 '1 7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO OO GASFITTING (Print or Type) A6&j • dA226 042L Mass. Date 19 GS Permit# Building Location�lt��/L f Fic%CrstQ R I� Owner's Name k�o zG r Type of Occupancy New ❑ Renovation ❑ Replacement Pians Submitted: Yes❑ No❑ VON �a • y w vi N N V N GC N Q O > W j 01. W } O ¢ F t r Z Z O 0 Us 0 Ur > < CA x to d o W 2 K � < W O a U1W __ W Ix W i- S C Cc )- N p� 2 0 2 o O q S t w O 2 < x < C O O w �- OC > G d !- O sus-8sMT. BASEMENT IST FLOOR ' 2HO FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTH FLOOR STH FLOOR Installing Company Name bI Check one: Certificate Address ✓ O Corporation ❑- Pa ership Business Telephone Firm/Co. Name of Licensed Plumber or Gas Fitter IlhQ j$ INSURANCE COVER I have a current l tty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ar No ❑ If you have checked yes. please indicate the type coverage by checking the appropriate box. A Liability insurance policy LaJ' Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ 1 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 the permit issued for this application will be in compliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the ral taws. T -- Title Wster gn ure of licensed umber or fitter /fir City/Town License Number /- 5 t7O APP VVED i i NL eyman M 6227 Date.................................. i gORT11 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ;,SSACHUS� This certifies that +BRI MA ..................Td�t� <p .......................................... ............. has permission to perform ...... 1 e&. ...................... wiring in the building of41....NTA i'� /?.. �'.1......................... at........ A4.AAA ,<Y...,1-&—.4....e�0........ ,North Andover,Mass. 3 Fee........:5.•®."".�... Lic.No.P.e.5.7./�............ ._ ...... ...�...�. ......, ......... ELECTRICAL INSPECTOR I Check # 7 DEFAR1IMEWOMBUCSOM Permit No. /9 2- 2- 7 BGNIRDO�FF'BeEPR> VF1V/IfO�NRBOULA7ff0M527aMiZ� Occupancy&Fees Checked �•• U A.PPUCATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,327 CMK 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMAMON) Da Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) ( ( C.l�-� l,-�L L.(, Owner or Tenant �tl✓. — - owner's Address ►^'l ' is this permit in conjunction with a building permit: Yea No (Check Appropriate Bolt) Purpose of Building NAL,, Iv 11vt'Ci Utility Authorization No. Existing Service AmpsVolts Overhead Underground No.of Meters New Serves Amps Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Q Location and Nature of Proposed Electrical Work -r ��. GA br {r u� 1 �c LT. No,of ushft oetim No.of Hot Tubs No.of Teedbrne Total Na of lighting Fixte,e. Swtmtaing Pcol AboveKVA Below KVA Oateratwa No.of Receptacle OutWs No.of Oil Buroen No.of Emeraeory IJghting Battery Uoiti No.of Switch Outku No.of an Bentms No.of Ranges No.of Air Coed. Tota FME ALARMS No.of Zana Tar No.of Dispoub No.of Had Total No.of DdK-dm and Pon" TOM Kw Iatlad No.of Dishwasher Space Ana Haft KW Na of a d� Devices No.of Self C=ubced No.of Dryer Heating Devices KW LoDM= Other No.of Won Heater KW Na d Na of Camncdoea sum Boil" No.Hydro Masnge Tuba No.of Mown Told HP OTHER- 14 hLnrXe Al MlDft0jimrmtbdMasdlrrefkGemlTA: ]hrneaasrerliet hastaeR�icyirduCfr;(7m�i� ormakawma"VAmt YES ©/Np Itrnesubrrilredvafdpoddsfaebfle�m Yl� ]r}etrhstedredoedYB4,pkai dt4ddr� OTa o waarbstat s 0 s=_ D"� �l i mrabava�dEkcftV ar S 9#zdwdkrdpew. Ani r§tMNAME 5��ch c,�S LitaseNa J'�l l��7 (o I.iom�rro l�2.� �o S— Li-c�P�O est G t�t�Lim Ilta =TaL Na �.�,J �t 2.-3Adkm 6 s (gs r� e.��(,/ AtTel,Na Ce A,Z GWT, 'SM RAN EWANFRIam anttzLiw sddm !nd arelheirelmtoe=.V rhraWyye�iva�Y���b1+ snelbGmailIavrt arddWffVsign*zonllis'drdtappicsdmW'Iliraq*=ft (Please check one) Owner Age '` Telephone No. pBRMt1'FBB 1 SII MT0FPURIKW;g/]► BOARDOFFDMPREVM Q(yR GVLCM5s7(a,a,,o LPenn*it1N1o. _ ;9 GFew Checked �...�..�. APPUCA77ONFOR PERMITTO PERFORMELECTR IM O ALL WORK TO BE PERFORMED LN ACCORDANCE WrM THB MASSACHUSSTS BL MICAL CWORK _(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) ODE,52�CMB 12:00 Town of North Andover DAIJ fj Z l a To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant L--77-777 71 A-77 p Owner's Address _ A-V-1 Is this permit in conjunction with a building permit: Yes No Purpose of Building N (Check APPrDP Box) wmm� � - vwt-tr- Utility Authorization No. Foisting Service Amps / Volta Overhead erhed Undergrmnd No.of Meter New Service Amps Volts Ovedwd UndeqPund of Meters Number of Feeders and Ampacity No. Location and Nature of Proposed Electrical Wort K-�' - _ L-yt c.-e' �Z- Na of Lighting Ondo Na Of Hot TWO No.of Tnrtobrmors TOW Na of Ughting Rugm Swig Pool' Above Belo�r OaA wt..Na o(Receptsey OutWs Na o(011 Burnpa KVA Na of Switch Ontyb No.of dory Upang Battery Units NO.of am Banton, No.of Bongo Na of ALF Con. Totd Taos F7R8 AUARM' Na of Zones Na of Dispooy Na of Hest ToW TaW Nn of ing Dasa and No.o(Dishwuhen Space Mp Nesting Ton w <oitlN�g a� Ngo.of Smmlq DeNoes dnw No.of Dryen Nesting DeHeao KwDatecties o' s Devic roa -� C*d No.of wooer Heumn Kw Na of Na of Coon tectiorts Other S Bonny No.Hydro Moatse Tabs Na of Molom Told HP i O'IM, 1n9uaneCov�Ptuntdfieretpiert>� Gereoill� lhoneauatsYLit�liy�Friry�(� oribstt����ygbE � Itsnesutrridbdveid d�eddr�tte ltyouftsrednioedYEt4,Ph11ek**#1e B= rypedoort by WcdcbSA15 0 S ( l "LIr� AlRac��d R.0 �VAzd�IW*S S�redurtder Pts ofP�i' F#W F�tMNAIVffi tiaseNo ,,L (. z 'I�iNn (;. OWI�RSB`IAJRANCBWAIVFR;Iam drrtttLeL;amee��,k;� Aft'MNa �__� 7S-r�sir.:r t anddtrtrr0'�ondibptaritappic�utsi�arirrequirsrr� °D`er�°r� a9�taea+�ambYMa�acht�lbGcr�Ilaa. (Please check one) Owner Agent SqRalum or Uw 13 Telephone No. pBt:Mrr FEE 11 Location 1-71, No. . ?c1/ Date ?�le5 NOR,h TOWN OF NORTH ANDOVER • � , . Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ �6 sAcHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /fl 180u0 �$uilding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT RLP RKNOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING a BUILDING PERMIT NUMBER: DATE ISSUED/.� 2� U� SIGNATURE: Building Commissioner/I r uildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number Aln/�T-K �dnv�o\/ /` � 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dii;d Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided sa e v 1.3. Flood Zone Information: 1.8 1.7 water supply M.G.L.c.4o. sa> Sewerage Disposal system: Public 0 pie 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHMAUTHORIZED AGENT -:District: Yes_ No_ rn 2.1 Owner of Record PiOrej IC, cM JA t4t t 4,419 Name(Print) t Address for Service — — Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone m SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ 1�ge)2[c.<_ 4773)o L)<,�� Licensed Construction Supervisor. 65 Oo S os5�— O License Number Mn Addre " a Z6 Zero Z— /oa Expira on Date lure elephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 M,Z M1,ct5vi&C TZv� Company Name m L� bit A/IQ G Z Registration Number '... Addre /_ r d--� 2�l�� Expiration Date Z SiJW4 Telephone ��,� �1 J 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.......❑ SECTION 5 Description of Proposed Work check a0 applicable) New Construction ❑ Existing Building 1( Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bl dg. Demolition ❑ Other ❑ Specify 1�fy Brief Description of Proposed Work: E T) x moi) IDouLy 649A6,0- M 5104C.6' A-&L/j�— SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be w (#FFICUSE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee 7 O O 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 c�J OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on , My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2ND 3RD 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 I rUKM U - LU 1 KCLCA.7C rvRm 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. APPLICANTFILLS OUT THIS SECTION APPLICANT A-_1_M- c ogl r z q7 7f> p430 PHONE q 76 6 V p 63 v LOCATION: Assessor's Map Number PARCEL //S SUBDMSIO,N LOT(S) STREET t &IZ(7 /h�L i Af) ST. NUMBER OFFICIAL USE ONL E0MMEjW1qtMF TOWN NTS: CO SERVATION ATWINISTRATOR DATE APPROVED DATE REJECTED COMMENTS V PaZIBW� 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 .7ECEIVED BY BUILDING INSPECTOR DATE ROVIOW 9197I �oT�TI-d A �JflovE � � MASS. ---------- _ -'l oo.00ToT_ 17.rq. y i N + I � F4� � 2S � oT 7 r r � a N tT fltZ R i Ei A 5 Ei—ice!CJ�- w irf{ iZe,SPE.c-T-ro \ SEr gAcK.. �E�c7, Py THAT low�.1 AiZ-E. X02 THE FSETS USE, o� T4-FE, �UIVDI►�A � C.vMIP(..y O►�1L.y A�D S��.H VSE. l S �'a i� ,\r ,zo�yllJG DE.TE�2�l�w.1 ATto�...J oF' Z..or..� r�C, -'sr•, 1.�`:a; +rdµ � o P Cou�o2.M Ty o2, i.1o►�.1 COn.I F-o2�'1(TY '� �'� '` I�'s�'1'a �,, t'. W N G- } . ►.1 Co►..,15T 2.UGT�D. �'i.; ' 'l-G�fi4����`f� 1' 5(Z9•�42 ?� The Commonwealth of Massachusetts • tall Department of Industrial Accidents • �;:; ��;J:. '1 Office of Investigations 600 Washington Street Boston, ,VA 02111 `"•t ;' www.mass.gov1dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name 113usincss/lhganiration/Individual): AAA, KyA5uez!� Address: 1,4<. City/State/Zip: AltA Phone #: 97v 372- _3 f t g Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ 1 ata a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. + Remodeling YNip and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp, insurance. q• ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' 13.Wther , {tk2n 47MrRi comp. insurance required.] *,My applicant that checks box#I must also till out the section below showing their workers'compensation policy information. ,.Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy ,4 or Self-ins. Lic. ##: Expiration Date: Job Site Address: City/State/Zip:________ __ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NIGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 insurance coverage verification. I do liec i rr. r tklpwns a l ties oj'perjiny that the information provided above is true and correct Si mature: Date: Ph. e_t: (JI ic•ial ase only. Do nal write in this are(r, to be coitipleted hp city or town olli"curl. City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other _ Contact Person: Phone#: ✓� �GOwl~ BOARD OF BUILDING RE t, owk License: CONSTRUCTION GU SUPEI Number: CS y.� 085055 Birthdate: 06/26/1969 Expires: 06/26/2007 Tr.no: Restricted: 00 .FREDERICK A DOUCETTE 5 PETERS LN HAVERHILL, MA 01832 v NpRTij o Twn of tAndover O 39/ - - �►►`(( Z dover, Mass., 0 Z-- A E �. A- COC NIC ME WICK V S RATED BOARD OF HEALTH Food/Kitchen PER D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... .....0............. .... � .. .... ...... ......• •• folu ndation 1 has permission to erect......... . ............ buildings on ............................. ... .. ... .. gh A to be occupied as........ Chimney to r 14. 5..........�'. e h ersekc)tinis ermd shall in eve re Gt conform to the ter of the application on file in Final provided that t e pg p ry 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 THS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TS Rough Service LDING IN Final Occupancy Permit Required to Occzipy 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 G t , No. 4 Date N01tTly TOWN OF NORTH ANDOVER F 9 . i , Certificate of Occupancy $ cHusEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ ''�r�z TOTAL $ Check # 6`7— /Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP ff.SOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERmrr NUMBER DATE ISSUED: w SIGNATURE: 'Building Commiisioner/InVecWr of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: rr a.1 0-(–�03 3-000b Dv--� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonis Distrid Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Regiured Provide Reqtured 'n— Rapred Provided 1.7 Water Supply M.GI.C.40.§34) 1.5. blood Zone Infomntion: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes_ No_ rn 2.1 Owner of Record n LL S t D€, ►2,� Name Print) Address for Service: Signature n Telephone 2.,,Owner of Recorrd: 146c - A . 195 H 1 LLS I DJ -, 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 Address Mn Signature Telephone Expiration Date r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number rn r Address r Expiration Date z Signature Telephone Z. SECTION 4-WORKERS COMPENSATION(KG.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 811 applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: w6 2�0� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be p}±f+ e y USE"' Completed by pennit a licant i""' y. I. 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 O 8 5 Fire Protection 6 Total 1+2+3+4+5 6 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,k/ � w`�— fjJ �t (:FS 15"V s as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf in all njatterative to work authorized by this building permit application. Sr attire of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ,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 w 1 g g PP my knowledge and belief Print Name Signature of er/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR THVIBERS 1 ST 2Nu 3RD SPAN DM ENSIONS OF SILLS DIMENSIONS OF POSTS DIIv1ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY ISBUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r�tcit7ry TOWN OF NORTH ANDOVER • a Vat�ce � ,'�"r9 ,. � OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 sSAcH+,�r Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: 11 �� t10S� JOB LOCATION:—_) to Lc Number Street Address Map/Lot HOMEOWNER7'�2 ') e Name Home Phon Work Phone PRESENT MAILING ADDRESS 1 ,7 5' V� c { 1 U c- P City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to 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 HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws, rules and regulations. The undersigned homeowner certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOME OWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption F e.. f c . r 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 at: 1 a5 S1,i lsio r 0-0 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by NIGL 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: EE (Location of Facility) Signature of Permit Applicant Fire Department Sign off: ,Y -- Dumpster Permit Date F AORTii Town of 4Andover O 'fid M�� •4• �f,V No. 3 80 = A� _ dover, Mass., �! COCKICKEWICK �^ °Ramo PPS\ (C7 `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT......... ...... ...... ..Q .tir ....................................... . .....OF/ . ............................. Foundation has permission to ore cti.... Q�. ..... buildings g on ..............� .... dC........... Rough .. tobe occupied as........................................................................................................................................................................ 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 IOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS 3v•OQ ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service UIL ING INSPECT 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. PERMIT NO. _ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 �I AP KJO. i LOT NO. i17> 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE ZONE _' I SUB DIV. LOT NO. f1rS f — LOCATION I'/ f/Lc a / PURPOSE OF BUILDING OWNER'S NAME ; , NO. OF STORIES '7 l� slik OWNER'S ADDRESS t t4DC/ l / I I BASEMENT OR SLAB ARCHITECT'S NAME d, reu Le✓ i ev. w SIZE OF FLOOR TIMBERS 1ST ZX 1{� 2ND 3RD BUILDER'S NAME Le SPAN I C{ lG� �y l C/'0 DISTANCE TO NEAREST BUILDING� DIMENSIONS DISTANCE FROM STREET ` -3e)r POSTS V _ DISTANCE FROM LOT LINES-SIDES-�- O> REAR 4-ZW> GIRDERS y U i�++ T AREA OF LOT "� ,p�® FRONTAGE lee J HEIGHT OF FOUNDATION / THICKNESS 16'7 IS BUILDING NEW yQ_! SIZE OF FOOTING II X 1> IS BUILDING ADDITION ,V A /o MATER:AL OF CHIMNEY IS/J ICK IS BUILDING ALTERATION y IS BUILDING ON SOLID OR FAIL{LEED LAND c57 tS' !\ WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �/� IS BUILDING CONNECTED TO TOWN WATER L�4,p•7!✓� BOARD OF APPEALS ACTION. IF ANY (VEL IS BUILDING CONNECTED TO TOWN SEWER IV '-' IS BUILDING CONNECTED TO NATURAL GAS LINES INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST A I SEE BOTH SIDES �V EST. BLDG. COST 1( I Soo - 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 SEPTIC PERMIT NO. A BOJ ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDIN NSPECTOR DATE FILED BOARD OF HEALTH AFAWATUF OWNER AUTHORIZED AG om 2u Aorue �r F E E PERMIT GRANTED PLANNING BOARD 19 OWNER TEL.# CONTR.TEL.# S 7'v 3� BOARD OF SELECTMEN CONTR.LIC.# 4 J-.0 /-7 G 2 0 M7 WILDING JINSPECTOR B.UILDI`N'G RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES TH-IS SECTION MUST SHOW EXACT DIMENSIONS,OF LOT AND DISTANCE FROM MULTI FAMILY OFFICE$ _ 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 _ 3 1 2 I,_ CONCRETE BL K. I PINE BRICK OR STONE HARDW D PIERS PLASTER DRY VJAII UNFIN. 3 BASEMENT, AREA FULL IN. B M T AREA _ 14 '/2 '/ FIN. ATTIC AREA NO B M T FIRE PLACES ' HEAD ROOM MODERN KITCHEN 4 WALLS II 9 FLOORS CLAPBOARDS B 1 22 f 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMfACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRYATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T G { UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st -3IdI NO HEATING F NORT Town of Andover No.65 * z LAKE dover, Mass., 19 97 t D - - '9A_C OCHICHEWICK iY'�` SCC t S V BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D , BUILDING INSPECTOR THIS CERTIFIES THAT}, ..51 ./................................................... ............ Foundation has permission to-ereet........�,�7fi.L�......... buildings on .....1J.(......... .Y...... ...�...1.......�:b?, Rough ' to be occupied-as....................................................... ........................................... Chimney } z� 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 Y; E Final PERMIT EXPIRES IN 6 MONTHS x UNLESS CONSTRUCTIONS ART ELECTRICAL INSPECTOR .,t . Rough 4"i7 ... ........ Service BUILDING INSPECTOR $ Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y P Final ` No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. , i HOME IMPROVEMENT CONTRACTOR cVIEW Registration 107679 s Type - INDIVIDRIAL Expiration 08/05/98 THOMAS DAVID ZAHORUIKO Thomas D. Zahoruiko i f�Eli� Hickory Hill Road "°MI"isrw+MR North Andover MA 01845 -- -- _----------,•_-- � ✓/ze -(�oman�zoouuea,�C/z o��/f/fciaaaclivae�a � - DEPARTMENT 07 PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE I Suber: Expires: 3ir-L1da.e: I CS 055417 04/051:993 34/3:1.969 Restricted To; 00 TRONAS D ZARORUIKO t 185 MICRO n HICKORY HIT RD N ANDOVER, NA 0.84; J . .d{ 1 Aut). G436 $- 8 , ks OFFtslubY � FEB 2 D M97 �� Q CR�hTlou RcbN\ Ct Y B01leR NEW lywN i I I I, � S T N SoRCBtZ„ I� I;I t s�PPc,�x�rrrLgiRsdPPlyf i Z40 y E I i — 3 YC LnLLY j ----�� ---- -o —�---j— I � �3r�sE�.•�ui' ,�rA+ti►} l�tvoLVBS'• i i ______-- { E�SZ,uS II I I STuo F I Nis t}rD +- STo R X169- A R6A5 w t Re -----i ` 1 PLi ktt� N0,LO SIn+KIPuMP I Lrusut,h S7-0RA6€ s I � I I T(Z O(koP cE(Ll TJG { O' L>uzrraLL(FI j.,;SH QR2 i � ..l 4--up 3 i T�,STNGL CARPET• o � 1 „I�ec�rct^ r��i; sc,D� To aoi�sR/re•w�+ ` i N i C 6 t L N6 NT, 7 1 3" o r cbred.Ur E�gCzetc N AL F juli� smcf3: S ro9 .8o 3-0 OT i I ToT AL 6LAZI IJG P Ropos6.p 6XC 6® 8- � 2 3 i I 7CTAL UBT4TlN6-ARB'A PGC c t21G43b OS.t 30 20 s-F • t t;�)q-LCSCQ20.0� c j I*- PLUS sN�oAcgai' A 1R S�PPtY SYrTgM T4 (ZF(�l Rt�D 4 N�ARAL� L1447 SUPRO-At-KM BY (8)7SWATT L16acM _ r Location No. Date NORT1y TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ �ssAcMustt Foundation Permit Fee $ U Other Permit Fee $ RECEIVE p P sewer Connection Fee $ AYM .1 er Connection Fee $ TOTAL $ JUN 05 &1AP N0,An - Building Inspector lover Collector Div. Public Works PElk-1*1IT NO.. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. a PAGE 1 W4AP d-4Ot LOT NO. 7 2 RECORD OF OWNERSHIP DATES Q� OK� PAGE (ZONE QZ I SUB DIV. LOT NO. 7 OunR 1 LOCATION Wekof1/ kill oa J:r I1I PURPOSE OF BUILDING Ing PURPOSE OWNER'S NAME AoNlas D Z �rJt>,At .O l NO. OF STORIES 2 SIZE I-7M1�✓ OWNER'S ADDRESSA4 „�-ea PMI/ Dp. L__G /1�•I'I , ��l BASEMENT OR SLAB ba j �l. ARCHITECT'S NAME16 .5 r Rola KI, Ifh SIZE OF FLOOR TIMBERS IST 2y1O 2N0 2x�O 3RD BUILDER'S NAME ''j�Ac 'D• Z_&kor t%( SPAN 'III m" 7L DISTANCE TO NEAREST BUILDING y q ., DIMENSIONS/ OF SILLS ^L, Zz/ DISTANCE FROM STREET t 25 1 " POSTS 3 il`sf/2 tAl y DISTANCE FROM LOT LINES-SIDES 201+ REAR t ,sv1 " GIRDERS (y) 2X/0 AREA OF LOT 26)a60 s l FRONTAGE 1W/ HEIGHT OF FOUNDATION D�/ THICKNESS /oil IS BUILDING NEW �S T W SIZE OF FOOTING 8 2-q` x i011 IS BUILDING ADDITION NO MATERIAL OF CHIMNEY brICK 7 IS BUILDING ALTERATION NO IS BUILDING ON SOLID OR FILLED LAND SO WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yes IS BUILDING CONNECTED TO TOWN WATER YL09 BOARD OF APPEALS ACTION. IF ANY AIA /W IS BUILDING CONNECTED TO TOWN SEWER /yes 1� IS BUILDING CONNECTED TO NATURAL GAS LINE es INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST r_�'O pO SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY EST. BLDG. COST l9 Q�* LDCV- PAGE I FILL OUT SECTIONS I - 3 REGULATED BY PARA. 114.8-S. L.ly, EST. BLDG. COST PER SQ. FT. So EST. BLDG. COST PER ROOM 1 L I i L3 PAGE 2 FILL OUT SECTIONS 1 - I2 _ 1 � GATEFEE PAID 10V =` SEPTIC PERMIT NO. 1 A ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED,AN APPROVEDBY B LDING INSPECTOR DATE FILED BOARD OF HEALTH SIGWA-TUIrE OF OW R OR AUTHORIZED AGENT FEE PLANNING BOARD PERMIT GRA OLD I PERMIT FEE LESS FDA FEE .. i o 0 , 02 BOARD OF SELECTMEN DUE FRAME PERMIT $ :7-5T, &a (JP ac lrs lone# s.'k-M- 0169 PERMIT FOR FRAME/BUHL . . su1LDl NSPEcroR bvjncrs f 6mt # Sad-3)3 - 17(7 DATE: ,'FEE PAID: $.�(10 ` BUILDING RECORD 1 666UPAN6d, X12 , SINGLE FAMILY I !. S"- RIES t �.THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT! LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTFRIOR FINISH CONCRETE d 1 2 13 CONCRETE BL'K. JJINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ 1/1 1/2 V4 FIN. ATTIC AREA _ N_O B M FIRE PLACES I HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD1"✓'D ASBESTOS SIDING _ COMMON n6� VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 9FLOOR _ ~r y T , -T - BRICK ON FRAME �� � �� -' CONC. OR CINDER BLK. • STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR ADEQUAATE I NOONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) J_ FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING t '' TAR & GRAVEL STALLSHOWER ROOFING MODERN FIXTURES `-TILE'iFLOIOR 10 , •i TILE DADO r 1 , 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBE B & 5. STEAM: t STEEL BMS. 8 COLS HOT W'T'R OR,VAPOR I ' WOOD RAFTER AIR CONDITIONING RADIANT .H'T'G?,. UNIT HEATERS ! 7 NO. OF ROOMS GAS; O,11L E'M'T 2nELECTRIC t ; rrr 1st 13r��' Nb HEATING t Folin U TOWN OF NORTH ANDOVER s LOT RELEASE FUM + SUBDIVISION � �CXUP-`/ 44 LL ES4&4S ASSESSORS MAP p�Cth q I SUBDIVISION LOT(S) Loo # PERMANENT ADDRESS (ASSIGN BY D.P.W. STREET lC C J1�d• rn APPLICANT 110MGtS .D, -za.kp('ul Kt7 PHONE ,90$ — 393- 1A7 DATE OF APPLICATION ql 17I9a TOWN USE BELOW THIS LINE PLANNI B AR DATE APPROVED TOWN PLANNER DATE REJECTED CONSERVATION COklkIISSION • DATE APPROVED CONSERVATION AD IN. DA REJECTED BOARD OF HEALTH oe DATE APPROVED W _Z/ 7_ HEA THS 'TAR AN70 DATE REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT 0A, U)41n �- SEWER/WATER CONNECTIONS11 L r� L TIRE DEPT. .��'he� RECEIVED BY BUILDING INSPECTION DATE .'; 1,5 7 �� r MAV This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the ; compliance of any applicable Town requirement or Bylaw. oFz- A o �jc.aL.E � 1"=dro' Ap2.�L 28, 19RQ, 5o Q r��c�2 Pmt c--4�)ocw Z.o F�10. Au oovE'e,�MA. e „ H I L� T f l 1 22• Iters Peep Kse., � -oT �o IG8 12' e} I It 28' i Irk 1 I F � oT 7 or 26,46o U U 1 [N Am LES C " LES 13872 h- i Location No. `6 Date NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �' b •'�� Foundation Permit Fee $ ,SSACMUSEt Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ P'0-4 00 TOTAL $ 10e2D B qg In p ctor Div. Public Works I Location )41 LL No. /6 Date S//_2 NORTH TOWN OF NORTH ANDOVER F p Certificate of Occupancy $ ` Building/Frame Permit Fee $ ACHU Foundation Permit Fee $ ZM SJACNUSE Other Permit Fee $ Sewer Connection Fee $ Water Connection F $ TOTAL $ �� U Building Inspector 5178 Div. Public Works i JUN 51992 SGA.t.r�:1`�= QA-r'E.: 5(ZR (g� o " �"4' C C - Uo2T1-i A ��ovE.� � MAc�,s. t i 4• 20 N t� cp tF-x�SrV,II 4= � ZS 1 L, U u r r o- o- N CSs.1 w�rt-! 1�e5PEJc.T-ro j i S C-�Q-TIF' TH ©F'FSET� SHaw t.J A1�.,� rT—oTr:. THE 8c)t�.ntt..►6 �uSFaE TFI� aF'F'SETS \ - S 22 W rrH THF—-Fc k J lu G SET Ertp_ I-. C:k-T' ..i c�F' �.o a.a !►v Cy u E$ Sy l.,A�c.iS o F CouFo2.M Ty oQ, i.1ct..1 13972 ^ �c[ N E✓t..l CouS-t2.uGT�D. �iS� C1$TEa 5(2q+�QZ �v Ze Sok ",n + ��I���e�� � � Y�/Yv�r� - .. .. .� `��� 1��� `� ®_ ®�'n��i�� ������•����� FICA AORTH own of 6 ndover to 4 DRIVEWAY ENTRY PENT o ® .Z f - H� er, Mass.,l��1�. 1 IOR ? PERMIT T 0� SS BOARD OF HEALTH THIS CERTIFIES THAT..)jW10./.N .....Z.6....WzQ A10 PICO ....... 47 NYC r ��.�.. • .. BUILDING INSPECTOR has permission to ere�f-..^........ .. i.... ldings on 0W A/A .•...... � Rough � CLE.4. to be occupied as. ./ . ..� AI& ................. ChimneyFinal provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY Final VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. PERMIT EXPIRES 1 1 6 MONTHS �3 AID ELECTRICAL INSPECTOR , .ESS C®NST U 6 N STAB �� P Rough PERMIT FOR FRAME/BUlLl Service Final .DATE: FEE PACU:7 BUILDING INSPE GAS INSPECTOR Occupancy Permit Required to Occupy Buildl*RG. PERMIT FEE 0-0 Rough LESS FDA FEE o. 00 DUE FRAME PERMIT$ `7 incl Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. 5252 Building Inspector t Location No. Date r ' HORTN TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ # Building/Frame Permit Fee $ �+s CH tFoundation Permit Fee $ s� E Other Permit Fee $ ` 1-I-� _� L'Sewer Connection Fee $ �)i 06; Water Connection Fee $ } '~��' 'r•.,�y. �r �r _�� Building Inspector Div. Public Works Town of, w'I'I:,\t.ti 3�::-r�: iyUit�"t',tl �1..N1 � r ����lt► .�►i�I � �•►. .. Iit111.1)IN(i )U�'1�1 nl;i ;�:;i� l►i► ,� II :�.►r►t.i!� Il;1 i r Wl!i-17 75 I Il:i\1:1'11 I'iLANNIM; P1,ANNING & (A)INDILINITY DEN'1:LOPA11? WAIL ��% " �L � AL FI NA 1�`�1 `�G � _ I �ORTI6'�A 1� own of w: n over 0 DRIVEWAY ENTRY PER -LC► Iec�. ,- o EAS over, Mass.,h!1 •� /�l � F �• BOARD OF HEALTH PERMIT TO 001 LD J••r . P111;24'�2. THIS CERTIFIES THAT.. ;q ..vzQtq&?ujjC0b� .....�!. .. ... "l— Rough B,U,�jLL).�NG INSPECTOR has permission to ereCT.=O..FIF)Wildings.. on���..��� � Rough`s' ��%% . ...... 4o be occupied as. L�....� � y �. �... Final ... .... .............. Final Ztl•C•QY'� ��l y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in L PU IN I PECTOfli this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of � 1 Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY i REWTEO BY PARA. 114.8-S. B.C. ' a i VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES 1 6 MONTI I vz ELECT ICA INSP C O�R /3-qFEE PAID /00 Rough �� Ir ESS CONST fIJ N STT service PERMIT FOR FRAME/BUILDING- Aga A Final DATE: (o"°T FEE PAID: 7-59- BUILDING 1NSPE GAS INSPECTOR Occupancy Permit Required to Occupy Build RM PERMIT FEE . vo Rough LESS FDA FEE 400. 0 DUE FRAME PERMIT Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEP No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector ,,� I y • CERTIFICATE OF USE & OCCUPANCY 7 IN Building Permit Number 1 6 8 Date AUGUST 19 , 1 9 9 2 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1 1 1 H I C K O R Y HILL ( L o t #Z ) MAY BE OCCUPIED AS SINGLE f A M I L V DWELLING IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. ND DrH 9 CERTIFICATE ISSUED TO T h o m a.6 D . Z a h o x u i k o A 185 HickoAy Hitt Road ADDRESSNan h A r d o v e& . MA ��QSSACEH USE��y Y ' Bu ing Inspector I i Location No. d Date, ' MORTIy TOWN OF NORTH ANDOVER sFEWs • + • . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ .1 Jr Check # 18583 J-� /''building Inspec& TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT,& ORDEMOLISH A ONE OR TWO FAMILY DWELLING r�..7,77-7 'U. rn BUILDING PERMIT NUMBER: DATE ISSUED. X SIGNATURE: f Building Commissionern r of Buildings Date _Q z SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O i!l All 4QAO 062 . 0 ®//S Alg ttrk k i, a1g. 16A Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: zming Disirid Proposed Use Lot Area Fronts 11 1.6 WELDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide red Provided Re4qWred Provided v 1.7 Water Supply AG LC.40. 34) 1.5. Hood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes_ No_ M 2.1 Owner of Record Name(Print) Address for Service: T— Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z —Signature Telephone m SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 2E��IZ+GK A LO UG&-7—re— Licensed Construction Supervisor. 65; .0 ?)So- - ) o S' O License Number Address 7y^3�Z�a0#- (o ZG� Zvu Expiration Date store Telephone r � 3.2 Registered Home Improvement Contractor Not Applicable ❑ v lel M1 i,C Company Name Registration Number M rpt--rex-5c r Addre r" ` 7 nature TeLe hone Z Expiration Date SECTION 4-WORKERS COMPENSATION(M:G.L C 152 § 25c(6) s 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 Pro osed Work check all applicable) New Construction ❑ Existing Building Repair(s) Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition '! Other ❑ Specify -1 Brief Description of Proposed Work: DEMO 0 L D V_ I A,S-f-�4 i l NUJ C tt S`-) /'el:.ti7-&x— Tor SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be (fFFICIAL USE{jNyy Completed b permit applicant =z 1. Building E/ (a) Building Permit Fee - Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin Building Permit fee(8)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 as er/Authorized Agen of subject property Hereby autI rize to act on My.. rized by this building permit applicati _ S' e of Owner - �r Date SE TION 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 Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TAMERS iST2ND 3RD SPAN DIN ENSIONS OF SILLS DIN ENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ✓f e �i�ote nu»uuea�/� a�"���lt+�,urr�u�Aa.IYQ BOARD OF BUILDING REGULATIONS r.. License: CONSTRUCTION SUPERVISOR Number: CS 085055 Birthdate: 06126/1969 ` Expires: 06/26/2007 Tr.no: 85055 Restricted: 00 FREDERICK A DOUCETTE �, / 9 5 PETERS LN HAVERHILL, MA 01832 Administrator ` 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 at: /11 PlcKc4y 4,a f eg. 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section l OA. The debris will be disposed of in: Com, Al tla 7iSPOSAC- cd?F'. 9735'2- (Location 5'2(Location of Facili Signature of Permit Applicant 1-2��rs Fire Department Sign off Dumpster Permit Date The Commonwealth of Massachusetts Department of Industrial Accidents "; ;"���",1• r Office of Investigations 61,, d � - �,�•'-' 600 Washington Street Boston,MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): M 2, /!/i CW Address: r /reT��S 44A/6— City/State/Zip: f-f,4VEA/ J,11 c4A- Phone #: f 7,oAre you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2X 1 am a sole proprietor or partner- listed on the attached sheet. + 7• ZRemodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year 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 insurance coverage verification. I do hereby ce u er the pain penalties of perjury that the information provided above is true and correct. Si nature: Date: - Z!_ 0,47 Phone#: 7 72 lode-- Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling.house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax 4 617-727-7749 www.mass.gov/dia I I I =1 l it i LID TL moi, • Nute:This drawing is an artistic ""'; '? :: Designed:9/10/05 interpretation of the general appearance of printed:9/10/05 the design.1t is not meant to he an exact • t< rendition. ,''zg;,\ ;,. •;, __ ___ 1300debe.kit FD -,ng#: 1 `?J 1 -------- 118;= I 43" k— 44" f- 31 r" �I I 94"' 24" I SCI 3B W X36 50,839 � �— �111� VIJ AS ✓� BD12 SE133 EZ WSS m = = N '--------._.............-------------------------------------- w O I N �� C -� O - - N �\ N �.. i N 1 A G) I j. ' U) � I I �......... fn � w w w o � ccm8 i I A A W ............ j - 1290 ` i I 114—24" :E 38 z, I I All dimensions-size designavions Liven are :h :'' ''%;.'< This is an original design and must not be Designed:9/10/oi� subject to verification onjob site ands tt released or copied unless applicable fee has Printed:9/10/05 adjustment to fit job conditions. ` been paid or job order placed. a. a 7 300debe.kit _ Fp 1 Drawing:#: I i I I I I i 1�a344 JF • 91; x+44 �. 15" -1 F44- 18" - � 46 ��4 � 2444 1 / 94 94 / 224" / I I � � I I \ I c) WW1830 FRO, (Y') LW1536 8 / �� / / SW WA2436 , SDC18 r rn v %''' '/%' �'� TSA2418 4) LO EZR36L.WSS BD12 ! SB33 EZR36L.WSS .3 I j \ i 361412" � 3399 �� 3641 i 4M rJ2 log j 4 7a1 { ! All dimensions_size designations iven are :"}`'`' " This is an original design and must not be Designed:9/1 0/0 j subject to verification on job site and y,.., ;: t;;. -.;; released or copied unless applicable fee has Printed:9/10/05 adjustment to fit job conditions. J I sQ fa> been paid or job order placed. _ 1300debe.kit __ _ El 1 Drawing#: 1 NORTH ovm Of Andover L.. . ........ I No. 0 0 A E dover, Mass., L COCHICHEWIC 77 BOARD OF HEALTH Food/Kitchen PERM !TT D Septic System 0 BUILDING INSPECTOR THIS CERTIFIES THAT........G. . .......... ........... ....... .... ................................ ................. .............................. Foundation has permission to erect........................................ buildings on .... ....... .. ....... ... ... .......... ......... Rough to be occupied as.�- ....... ...................... ...... 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 4 S Rough W ................................................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Oca, 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. •• ....^(Print a Typal ('Vr-•••••�• •• ..�.�rvnM Mf"r LJVI�1 iV1`e n rnml l 644 V IJr'Lu���uu�v �• •. nt fn NORTH ANDOVER, Maas. ()ateCk Bullding �, Permit *_ �J 2 7�� l�7 Z 2 Locatlon Owner' ' ^-�- k1 it Name e re. k,v� �.1>9r.�J o K'S • New t Renovation ❑ Replacement p Plans Submitted: Yes❑ No.❑ FIXTURES s{ w ~ J M O Is = r y J M s O D .1 ~ « Z s ~ M It s w s s M L ar r. i < i S w a t~ s p $ ell s F O V st 1 • rs a o 3 On N La i e o i t 0 aua—st IMT. tAt[MtNT / 16T FLOOR 3N0FL000 SAO FLOOR 4TH FLOOR aTH FLOOR STH FLOOR. >ITH FLOOR aTNI FL0011 Check one: Certificate Installln0 Company Name ���32�/�e._. �� � C)Corp. Address 67 L�yiJ Ge C,v jeo( 0 Partnership ❑Firm/Co. Business Telephone 6 3 3 .Name of Lkensed Plumber dUd1/1 i9x- ice, 'EcW—U to INSURANCE COVERAGE: ece 1 have a current Ilabilty Insurance policy or Re substantial equNalenL Yea 0 No ❑ 11 you have checked y". please Indicate the type coverage by checking the appropriate box A liability Insurance policy ®/ , Other type of Indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licenies does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Ownu or Ownef s AGeni Owner ❑ Agent ❑ 1,=certify that aN of the details and Information I have submitted W entered)In above appfkatlon are true and amurate to the best of my ►novttedpa and that all plumbing work and Install lions performed under the permit I for this application will be in compliance with an perilnen provisions of a Massachusetts Stale Ptumbing Code and Chapter 112 l3enerat Hy . Title Signature of sod Plumber eft UcsnnNumber )/S7?,? CttylTown AfITMED(OFlICE USE ONLY) Type of Plumbing License: Master Journeyman 0 • Date. . . . . . . Wt4 "0`R°7 :otic TOWN OF NORTH ANDOVER a • PERMIT FOR PLUMBING a SA mus � This certifies that . . . . . . . . . . . . . . . . . .�. . . . . . . . . . . . has permission to perform . . . . . . G? .�(!?? plumbing in the buildings of . . . . .(. Gww IJ�,�/ .... . . . . . . . . . . . . . . . . . . .. North Andover, Mass. 4 Fee.,;Z57. No.. .1,/.�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR 14:36 25.04 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Office Use Only Gibe Cramm umal#h of 5adm� emit No. � atprtmrw of Ptllilu $afttq O=pancy&Fee Checked �5 BOARD OF FIRE PREVENTION REGIJUTIONS 527 CS1R 12:00 3190 peave blank) 57 47 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 7=2-V-5::2 (X* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) L G`'c— OI `J Owner or Tenant P [Z�l_. �t 4't-y0 5 K. Owner's AddressIs this permit in conjunction with a building permit: Yes _ No ❑ (Check Appropriate Box) Purpose of Buiidino �� �� ��' — Utility Authorization No. Existing Service Amps —J Volts Overhead Undgrnd L-1 No. of Meters New Service Amps Volts Overhead _ Undgrne (` No. of Meters Number of Feecers aha Ampacity Location and Nature of Proposed Electrical Work n/(5-(A /5 No. of Lighting Outlets ,� No. of Hct '.bs I No. of transformers ota, KVA No. of Lighting Fixtures i Swimming Poo, Abcve.— in 7-. to grr.e. _ grr.c. _ Generators KVA No. of Emergency Lighting No. of Recec[ac:e Outlets c7 I No. of Oil stirrers I Battery Units No. of Switch Outlets Q�l I No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. at Air Ccrc. Total No. of Detection and :ens Initiating Devices No. of Disposals No.of Heat Tctat Total Pur.:cs :chs K'.'J No. of Bouncing Devices No. of Se,f Contained No. of Dishwashers I SoaceiArea i-+eatira K`.Y De[ec:toniSounding Devices No. of Dryers Hearing Devices KVV Loca, ' Mun,cio- n ^Other _ Connectio _ No. at 140. at Low Vcttage No. of Water Heaters KW I Signs Satiasts Wirinc No. Hvaro Massace Tubs I No. of Motors Totat HP OTHER: INSURANCE CCVERAGE. Pursuant to the reou,rements of Massacr.L;serts ;eneral Laws I have a current Liao,iity Insurance Policy incluc,ngCor..^:e[e ceranpns Coverage or its substantial eauivaient. YES I have suomittea valid orcof of same to the Office. YES yVO = If you nave checxea YES. please indicate the type at coverage by cnecx,ng the appr0 to box. INSURANCE ' BOND = OTHER = (Please Scec:��) 03 (Expiration Date, Esumatea Value of Electrical Work s /,�Q, (fit `Li Worx to Start Z-iv _1 7 Insoecuon Date Recuestec: Rough l'_V411A_ Final Signed unser ti;Ie Penalties of perlury: ^ FIRM NAME �-�I" M C �`C UC. NO./ /n el Licensee Cwt t "C- �its4 c'i i��� ig^azure LIC. NO. 1&?7) <- - i �ot�� Bus. Tel. No. Address � I SCJ � �� Alt. Tel. No. OWNERS INSU ANCc'NAIVER: t am aware that t'he Licensee sees not nave the insurance coverage or its supstantiat eautvalent as re- awred by Massachusetts General laws. and that my signature on ^:s cermit app,tcation waives this reawrement. Owner Agent (Please checx ones 7eiecrone No. PERMIT FEE S iSignature of Owner or Agents - - +c-oho= . ' • Date... L ' T' 793 ....9-7 f/ a � fI NORTH *�. TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� This certifies that ......... (.c..........i 5............. 1 has permission to perform ... ���� ....... wiring in the buildi g of.... ...... ... . .................. at..... �.�........ .... . . .. .. ... ........ ,. . ... . ,North An rr, S. ../`�i ........................................... e6o�-7&2 ELECTRICAL INSPECTOR T/25/9714:33 75.00 RAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer