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Home My WebLink AboutMiscellaneous - 1174 TURNPIKE STREET 4/30/2018o r^ Claim # Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, -MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner ov", Board of Health or Inspector of Buildings Board of Selectmen Town Hall Town Hall North Andover, MA 01845 North Andover, MA Re: Insured: Mounir Jermany Property address: 1174 Turnpike St. North Andover, MA 01845 Policy #: 5537482 Loss of: 2015/07/30 File or Claim No. AD 1856 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass._Gen._Laws,_Chapter_143,_Section_6 to be applicable. If any notice under Mass_ Gen_ Laws, _Ch. _139_Sec. _3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by first class mail. 07-31-15 Signature and date 10'1 8 3 Date..... 7.......`�.--..1.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... �T '�? Y ��.)'l- 2 ...................................................... has permission to perform J00.0/ ...J ................. wiring in the building of at ......�.7 V. /..�� -s ,North Andover, Mass. ..........f'..... ®�� . .� Fee .... ��.. Lic. No. �:?�`73l ............... 1 Y &�C RICAL INSPECTOR r / C'- 2 J J Check # J >4 ( 7-14-11; 8:14AM;G.E. Jul. 14. 20110 7: 33AM toy Commonwealth of Massachusetts ,Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS ;781+594+7323 # 1/ 2 No, 3027 P. 1 PernnitNo. Occupancy and Pec Cheoked .ev. 11071 (leave 6lanlc) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to beperfotmed in accordance with the Massachusetts ElectricR, al Code (MEC), 527 CM12.00 r` (PLEASE PRINT W NK OR ,ZTyPE ALL LVF0jUMT10A9 Date: City or Town of: NopTH ANDOVEp }3y this application the underaigued gives To notice ofhis or hII er intention to Perform thenelectrical p tc� u,0� abs below. Location (Street & Number) / U y _ Owner or Tenant s' . o x/�4ivl�oyG %I •r//yj =/ �/�•L TelephoneNo. `��' Owner's Address / �? u7Q L-',6Y)=jc� Is this permit in conjunctfon with a building permit? yes r—i Purpose of Sildiu ug f")w �Li.✓� u NO ❑ (Check Appropriate Box) H111ty Authorizatlou No, Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Neyv Service Amps / 'dolts -- — Overhead Undgrd ❑ No, of Meters Number of Feeders and.Ampacity Location and Natpre of Proposed Electrical Work: • P ®C Com lettono the olloruln 'fable to he waived b the Ins No, of lZeressed Lnruinaires No_ of CBiL-Sus o. of p. (Psddle)P'ans Transformers Tsetae o i3�iterotal No, of Luminaire Outlet& No, of Hot Tubs ISA Generators XVA No. of Luminaires Swimming pool °ve o. o tuergency g S No. of Receptacle Outlets d, end, ❑Batter Unite No. of OR Burners latter ��5 No: of fines No. of Switches No, of Cas 13urhers o..o etec en an No, of Ranges No. of Waste Disposers No. of Dishwashers tofDryer, ers KW ssageBatiitubs o, of Air Cond. Space/Area Heating IOW Heating Appliances * TCW Ballasts, of Motors Total HP of Alerting Devices - ❑ lvL'Al]tlerfiniunictpaln El —other No. No. of Devices or Batimat"ed Value ofBlectriealWork: Attach additional detail desired, or as requ(red by the hapector of Wim Work to Stark(When required by munioipal policy,) %//i-�/ Inspections to be. requested in accordance with MBC Rule 10, and upon completion. he lies ANCE COVERAGE; Unless waived by the owner, no permit for the performance of electrical work may issue unless the lieensec.provides proof of liability insurance including °`completed operation" coverage or its substantial equivalent. Tho undcraigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER [] �S w r certify, under the pales and,penalties ofpa fury, that the info r a IUM NAAU; hlvn on this application rs lens and eatnplele Licensee. .0 %,v LIC. NO,; �OeGCr� Signature ,',, LrC, NO,: 01 s (If applicable, enter exempt " in the license number line) rj/ 3 6 Address: $'alt, (-1 4frq lJ = �tBus. Tel. No,; *Per M.G.Y, c. 147, s. 57-61, security work requires D Alt. Tel. No.: OWNER'S IN5 � at ent of Public Safety "5" r.icense: Lic. No. W R: 7 am aware that the Licensee does not have the liability insurance coverage normally required by law. w, I hereby waive this r urrement. I am the (check one) EJ owner ❑ owner's agent Owner/Agent Signature Telephone No. ( p ME— $8`-2C-17 PERMI'TFEE: $ 7-14-11; 8:14AM;G.E. Jul. 14. 2011 7:33AM ;781+S94+7323 # 2/ 2 No. 3027 - P. 2 The COi MOnwealth ofMassachusegs Deptartulent oflndustrtal Accidents Off -Fee of1'nvestigalFiolss .6.00 Washington Street Boston, .MA 02111 www.rraass gov/din Workers' Compe»tsat tion Insurance Affidailt: BOders/Contrac�ors/Electricians/pX�ffibers )PBeantr hAoxmatbion 'PleasePrint T.pffmr. Name 0 City/State/Zip.- Are ity/State/Zip: 41 Phone M. Svp - -?'7 7 ,etre you an employer? Check the appropriate box. 1. ❑ I am a employer with 4. ❑ I am a genial contractor cmployeea (full aad/orpart-time).**have ni a sole proprietor or 2. LX I a and I hired the sub -contractors listed partner- on the attaebed sheet: t ship atidbaveno employees These sub=contraerorshave woirking for me in any capacity. [No workers' comp, insurance, Workers' comp. ,insurance. 5. ❑ We are it colporation and its required,] 3. ❑ I am a homeowner doing all work Officer" have exercised tb=' light of exemption per MOL myself. [No workers' comp. irtsuraoce requu ed.] t c_ 152, § 1(4), raid ate have no employaes. [No 1vorkers' comp. Type of project (required):' 6. [] Now CcnSt=tiOU 7. ❑ Remodeling 3. EJ Demolition 9.. ❑ Building addition Io.[] Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roofrapairs axother POO L `A+aY applicant that eYaecto box #1 mnst also till out tb.e section lreioty shoring ttrcir vorkeis' eotnprnas�onpohey information. t Homeovsmere who aubmlCthis affidavit indicating they aro doing a!! work=d 'thaphire outside oont,aerors must submit a new a(fing such_ tContmatore that cheek this box must attac>aed an additionaldavir indicati shoot showing the name of rile subcon6rdetors and cbeic workers` romp- potloy fufor . i�tforinatdon, ng sac I am employer that is providl tg workers' co>lepensatfore iAsarance for my employees, Below ars the policy arsd job sate rnsuratace CompinyNamc Palley # or Self -ins. lie, #: Bxpiration,,Dat., Job Site Address. Attach City/State/Zip: a copy of the workers' compensation policy declaration page (showing tote policy inuumber and e FaiIuie to secure coverage as required under Section 25A, ofMGL e. 152 can lead to the imposition o£crimina�I penalties of a iration date). fm up t$ $1,500.00 and/or one-year imprisonment, as well as civ'ilpenaltias in the farm of seSTOP WORK O12DSR and a fine Invesligafions of the DTA for ir of 'UP to $250.00 a day against the violator. B e advid that a copy of this statement may be forwarded to the Office of ieurance coverage verification, T .r hereby ereby cell& under the pains and petnak'ies ofperjuty that Me info) tttai6on provided above iS true attd cots eco . / / /% /� � %tel — 7/! -39•-7, Ojricial use only. Do not write in tltis a, ea, to be corirpleted by 010 or town offtcurL City or Tovvn' Z'ertnit/1,icense Issuing Authority (circle one): X. Board of Health 2. StWc inb Yleparfineut 3. City/Town Clerk 4. Electrical Inspector S. plumbing Inspector 6. Other Conte ct Person., Phone Date...../......f.. V.�..... ti TOWN OF NORTH ANDOVER p PERMIT FOR WIRING Ej .... / This certifies that............................................................................................. has permission to perform .... )A�. ( ...... . v'...e".................................. wiring in the building of .....N../.7 at .......%. .:l. /..........�..U..� '.. !.. .........5 ... , North Andover, Mass. Fee..................... Lic. No.............. ........................ ELECTRICAL INSPECTOR ''y f Check # 4591 ?>?fc �Zi?2d?2u/�,g1'?� d� SS�fr✓'�1.5�7'7S BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Off', ial s Permit No. Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 C R 1 :00 (Please Print in ink or type all information) Date To the lnspktol of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number ([ � Owner or Tenant iJ a� l 7�r'f! � .5 1 -?All, -r,- 7 Owner's Address 1 1 7 l ✓� A/�/�L` l Is this permit in conjunction with a buildg�;Itt it Yes LSC No ❑ (Check Appropriate Box) d3 Purpose of Building �, N t (. f �WS-1 ..0 s/iis Utility Authorization No. Existing Service Amps, Voits Overhead ❑ Undgmd ❑ No. of Meters New Serviced V c, Amps �",�Its Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Worktai Ti 'L4- t0 l"A.L / i' ,WU4/ L f INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = if you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME L ltyu LIC. NO. LkenseeG1� lint z.Q �` Signature + LIC. NO. f V vVG� 1 / '/` �J 11 4�1 Bus. Tel No. Address c/ AltTel. No. OWNER'S INSURANCE WAIVER: I am awarethat the LicenseMd—not hay- the insurance coverage or its mfksfanbal equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITfEE $ re L l , (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Sp ace/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro, Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = if you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME L ltyu LIC. NO. LkenseeG1� lint z.Q �` Signature + LIC. NO. f V vVG� 1 / '/` �J 11 4�1 Bus. Tel No. Address c/ AltTel. No. OWNER'S INSURANCE WAIVER: I am awarethat the LicenseMd—not hay- the insurance coverage or its mfksfanbal equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITfEE $ re L l , (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02 919 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City. Phone #: Insurance Co. Police # Company name: , Address City Phone# Insurance Co. Policy # Fa k e to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up. to $1,500.00 — and/or one rears' impnsorxnent-as wetl_as_c iW pienaltiesiin-lbel rn4-a-STOPYA)WDRDFR,and_afkv-0-($iDD OD)ajiay,againstzl,-- t . understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby cer6ofy m der the pains and penalties of perjury that the infornmatior► provided above is bye and correct. Signature_ Print name Official use only do not write in this area to be completed by city or town officiar City or Town Perm►tA icensing. 0 Building Dept E)Check if immediate response isregua-ed 0 Lkensing Board p Selectman's Office Contact person: Phone #. E] Health Department Other Location ^�` / ,/ " 11AI // a No. --3 Date TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ �ssuMUsE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / o S3 6 3 3 M-�-�-�- -/Al Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUELDIN43 PERMIT NUMBER: DATE ISSUED. 'SIGNATURE: Building Commissioner/Inspector of Buildings Date ^. L`!'T7l�lU 1 CiTL` TATL`lln l..f � ri�wr 1.1 Property Address: i I l H itJ C rJ to i S 1.2 Assessors Map and Parcel Number: I0-7 A 13 a Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: i Q los Sinqie—Ecky-nil*-Qw--01- _1 / 0i,non ® Yoo-f- Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required I Provided Regaired Provided 1.5. Flood Zone Information: 1.8 1.7 Water Supp M G.L.C.40. 54) Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone � Municipal ❑ On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ;n Name 9,0 IR in V 0. t Cr + _ Address for Service: ---- N�WLT1,Di-i WM 1 r—til—l�l3 Z.Z owner oI Kecord: _ C,are I 5a nn� Name Print Address for Service: nC- 0 T SECTION 3 - CONSTRUCTION SERVICES I 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: ;Addregnature Telephone 3.2 Registered Home Improvement Contractor Company Name Address Not Applicable ❑ License Number J1 1 L03 Expiration Date Not Applicable ❑ Registration Number Expiration Date 00 M z 0 ') crr,rinm e - WnRWF.Rq COMPENSATION (XG.L C 152 6 25e(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 buildipg permit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Descrivtion of Proposed Work(check all applicable) New Construction Nr Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: i n a I Fa in 1 k y Q w L 41 % o C 0, r -- SECTION 6 - ESTIMA ED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be t, OFFICIAL,USE�ONI.Y Completed b etmit applicant y Ka 1. Building(a) Building Permit Fee y o� �� ® Multiplier 2 Electrical (b) Estimated Total Cost of 0 Construction 3 Plumbing 21500 Building Permit fee (a) X (b) 6 4 Mechanical (HVAC) 1 ®O 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, J m e's F� i n e Y as Owner/Authorized Agent of subject property. Hereby authorize Willi ca m iia, rre *t B d on e5 to act on My belf, in all erosrelative to work authorized by this building penmt application. a2'�Z 7/03 f Si tahire of Owner Date SECTION 7b OWN AUTHORIZED AGENT DECLARATION 1 as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name * - Signature of Owner/A.-ent Date NO. OF STORI!S—SIZE nta BASEIAIENTOR SLAB 0.5 SIZE OF FLOOR TD,4BERS 1 �X ra 2` a )eJB - 3 30(16" rs SPAN ILA l ty DIMENSIONS OF SILLS 1{ X 6 DIMENSIONS OF POSTS H )C(,, DIMENSIONS OF GIRDERS t4 VV HEIGHT OF FOUNDATION THICKNESS 10 SIZE OF FOOTING Vwx ca 14 X MATERIAL OF CHIMNEY r i C V' IS BUILDING ON SOLID OR FILLED LAND SolitJ IS BUILDING CONNECTED TO NATURAL GAS LINE AJO ,-�0�)5''-, 'Shro/0)�' r WILLIAM J. SCOTT Director (978)688-9531 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 CHIMNEY APPLICATION AND PERMIT 'I. Fax(978)688-9542 DATE3 3 I Q PERMIT # I83 c LOCATION 1H r VrvV D ► OWNER'S NAME 3a .M S F 'l Y\ 1 - BUILDER'S NAME MASON'S NAME I n MASON'S ADDRESS 149 Lde S + ► 1 Y Q,o' S+-- 01 e, +k yC'rJ MASON'S TELEPHONE -% — Co ?to — 017 L{ 9 MATERIAL OF CHIMNEY G lGk.. INTERIOR CHIMNEY EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES THICIQTESS OF HEARTH 'a " Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: � eS L07� SIGNATURE OF MASON CONTR..LIC. # (05 ; oQ L4 EST. CONSTRUCTION COST/C TRACT PRICE Lj ()®Q . PERMIT GRANTED FEE ROBERT NICETTA, BUILDING INSPECTOR�� INSPECTED 4:1 SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 N FORM U - LOT RELEASE FORM V'V F« -c' % 3-tt-�3 INSTRUCTIONS: This form is used to verity that all necessary approvals/per ^ f.� 4 Boards and Departments having jurisdiction have been obtained. This does not rale ieve the applicant and/or landowner frcm compliance with any applic-able or require m s0 2 2003 " "*-****"*""APPLICANT FILLS OUT'TNIS NORTH ANDOVER PLANNING DEPARTMENT APPLICANT (.l *tkJi& J3arre_-* t4onnf-5 PHONEq7?-(o$9•'3L3a0 LOCATION: Assessor's iylap Number 1 (7 )7 A PARCEL e SUBDIVISION LOT (S) � STREET —FL) Y- 57h O ST. NUMBER __L-7 L/ **OFFICIAL USE ONLY R CO IMEDATIONS OF TOWN AGENTS: CONSERVATION ADMINIS TOR DATE APPROVED DATE REJECTED_ COMMENTS CCVk,! 0 APR 0 2 20Q3 TOWN PLAN R DATE APPROVED N INTH ANbOVER DATE REJECTED Pp_,4NING PEPARTM91NIT COMMENTS FOOD INSPECTOR -HEALTH SEP IC INSPECTOR -HEALTH CO DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED - 'ri) k"I 'A "_- _ -- N._-, It PUBLIC WORKS - SEWERMATER CONNECTIONS . i. DRIVEWAY PERMIT FIRE DEPARTMENT 1 & .ter V' RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 jm MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 2-27-2003 DATE OF PLANS: 2/27/03 TITLE: 1174 Turnpike St. COMPANY INFORMATION: William Barrett Homes COMPLIANCE: PASSES Required UA = 645 Your Home = 558 �83 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS 1522 30.0 0.0 54 WALLS: Wood Frame, 16" O.C. 3200 13.0 3.0 228 GLAZING: Windows or Doors 446 0.350 156 DOORS 93 0.350 33 FLOORS: Over Unconditioned Space 1536 19.0 73 BSMT: 8.0' ht/6.0' bg/2.0' insul. 88 10.0 14 HVAC EFFICIENCY: Furnace, 86.0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer 'K ►'1 o-�-'� nate `1 GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUH.DING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. Permit Applicant T Property address Map / Parcel Applicant's Phone Number 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 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 bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of 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 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens 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 part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density 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 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 and shall receive a onetime 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 represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER 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 OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS GROUNDS FOR RE ALS THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. AP ICANTS SIGNATURE DA TE Ef a 7�� 3 S FORM TO BE ATTACK TO THE BUILDING PERMIT APPLICATION Name Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity E�l am an employer providing workers' compensation for my employeesworking on this job. company name: UJ 1 i a m (2)cx, c r e,i�— H ©m ,-- _S Address J O L4CL -T Q r ftj Ike, S+. City iQ Q - A f\ Phone #: 4 7 F - 10, at 'cL O Insurance Co. ONO -C, y 1u n ok S Uco" Policy # t,U C 9 5 83 7 to Company name: Address City Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as_well_as_d34l.penattiesln-thefwnrA-aSTOP W-ORK-ORDFR.-and_afore.of..($1110M)-a day againstme. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under th_9 pains and penalties of pegury that the information provided above is true and correct. Print name t�.> .t 11 i ov m G o, f Phone.# Official use only do not write in this area to be completed by city or town official' City or Town PermitA icensing l' De t "I"',g p ❑Check if immediate response is required .n Licensing Board p Selectman's Office Contact person: Phone A- E] Health Department 1:1 Other Workers Compensation Insurance. Policy MARYLAND CASUALTY CONWANY Information Paze NCCI Company No.: 10545 and Employers Liability 0 ZURICH ACCOLNTNUVIBER: M006133531-001-00001 ` Branch Poiicv Number Producer !rode ' Previous Poiicv dumber AL U1 AUBURN' I WC 9;3,769 % 04 02090918 I TCl 95837697 03 Branch address: 15 MIDSTATE DRIVE AUBURN CdA 01501 1TE1Nl 1. Named insured anti Ntaninu .Aactress Proaucer Name ana Mail= .Address COLONIAL DEVELOPMENT CORP. DBA TARPEY INSURANCE- GROUP_ INC. WILLIAM BARRETI' HOMES PO BOX 567 1049 TURNPIKE ROAD WAKEFIELD MA 01880-1667 NOR T'ri ANDOVER MA 01845-6109 (781)'_'46-_677 This Information Page. with policy provisions and endorsements, if any, completes this policy. Insured is: CORPORATION Risk I.D. No.: F.E.I.N.: 04320t987 Other Workplaces Not Shown Above: SEE SCHEDULE OF INSUREDS .01) LOCATIONS ITEM 2. Policy Period: From: 03/24/2002 To: 03/24/2003 12:01 a.m. Standard Time at the Insured's Mailing Address ITE -NI 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Ernpiovers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits of our liabiiity under Part Two are: Bodily Injury by Accident S 1()0. ! Each Accident Bodily Injury by Disease S 500.000 Policy Limit Bodily Injury by Disease S Irk- � Each Employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: ALL STA i cS EXCEPT N D. OH. WA, WV. WY. NV .3,N D THOSE LISTED INi 3 A D. T his oolicv includes these endorsements and schedules: SEE FORMS AND E`1DORSENIENTS APPLIC.01.E LIST ITEM premium for this policy will be determined by our manuals of rules. ciassincations, rates and raring plans. All information 17he required on the foiloix ns Classification Schedules) is subject to verification and change by audit. SEE CL:aSSIFTC.�TIOti SCHEDULE Total Estimated Standard Premium S 1,660.00 If indicated below, adiustments of premium shall be made: Premium Discount S �'� Annually Expense Constant S 244.00 ❑ Semi -Annually Premium for Endorsements S ❑ Quarterly Taxes and Surcharges S 78.00 ❑ Monthly Total Estimated Annual Premium S 1, 982.00 Minimum Premium S 500.00 1 IDeposit Premium S 1.982.00 ISSUe Date: 02'19/2002 '•NC INSURED COPY t - Lr;. r_•t - u6Li] 1.Li Cduntwstgned By Authorized Z �. N 00 o F (n O 0 J � C = W C mnc to E CD Z 30 N w VO N N M \V C j D 01 O y m Z N LL O Z V o 0 0 m L) m C E r X w W 0 \\ Iv, Z 5 W to W Ju m IX Q Y maw YZW Ix> QHD J m Z J r Q O j Z Town:of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM O t�ao , 4• 6Y` C o 4 tO.wtMwtw 1' �9SSACHUsti� In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, s150a. The debris will be disposed of in /at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. i REQUIREMENTS FOR BULDING PERMIT SIGNOFFS BY BOARD OF HEALTH To be filled out by the applicant and submitted with the Building Permit application 1. What is the proposed project? Deck pool addition new house other 2. Are plans attached? (For additions and new houses on septic systems, QeJsNo complete floor plans of proposed construction and any existing house must be submitted. For pools and decks, a site plan with location of pool or deck is required. Dimensions of deck are needed.) 3. Is municipal sewer available at this location? Yes No 4. If sewer is available and a house already exists, is it tied in to the sewer? Yes No 5. Is the location served by private well? i Yes No 6. If this project is an addition and the house is served by a septic. system, has there been a Title 5 inspection done recently on the septic system? Yes No 7. If, yes, is the inspection report on file at the BOH? Yes No 1219 APPLICATION FOR WATER SERVICE CONNECTION North Andover,M� Application by the undersigned is hereby made to connect with the town water main in L t Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. or subdivision lot no. Owner Contractor .F t Address Addres pplicant's Signature 24�, 120 PERMIT TO CONNECT The Board of Public Works hereby grants permission to to make a connection with the water main at subject to the rules and regulations of the Division of Public Works. Inspected by Date 4�le �� - Ll�e- TH WATER MAI Street Street �, Board f Publi Works By See back for rules and regulations 6 Z. ¢� w w A w as G v u o w° u a V) 0 v � z z m w° U ro w o w W pq a X °z° x o a O �, u¢ a w w x H w z ,.. v, ° z w w A ", z 0 C=3 `� oo- o dC &-o a c CcCc ..: s = o m O CD c :om CD a +"' N :o =�� m c E r.0 m4 A& CD ZNma s S� =M c 1: N o 0 ✓ f6:mc m '. c m p CO V N Z :mo.� o, cc.o c r �. •N CSt A C Z CD uj C-3 CD ®� g CO) CL m C a� m 91, ca coM E I.. CLO L C O O C. _O a. H O V .CL H C O V ca ® Z 19 o z `OILI o. Z U �a 5 r: ca: a� oma.COO . M. � LL `vDd1 QLn p .• Y � � :U-0 . OO a w `• 0Q% .� t, �_ V O • , O 0 _. 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I I L-------------------------� ------------------ ---------------- 10-IN -------------------------------- 10-IN 1 .0-1171 I I I I I I I I 7, I I L I I I I I I I I I I I I I r �0/eZ/f :avd �:)NIW7Z�1=l z100:4 1SI :A1111llr;jl3AWOH 7-�Nld =10 �!tG( Ili(/ II IIS//I :TWx .0-4 .m-IZl �'Lll1. l��`Odd a �� — � 'Afl NMddQ C1NO�:GS 'del ll ld�!-IS �10N:4CISA�!!I -�A- Nld 'd'llil l��f'Odd O I :3 I LL J w ll1 I r J x J -----X ------- --� I ---------- ,�> w ------------- I �I �I F lU O LL _ N vv Q � N - O 0 I LL 0 X mi ml x z (6 I J LL x Rl Q w C, � w _ry Q� O I � I ll1 I -----X ------- --� I ---------- ------------- I I I I I I I I I I I I 'JAI -s :Aow vw SNVid IDNIWV® !4=1 �NId dO � C .I=..B/l AON�CJIG�I ! ,,E-1N1� -L1� fib` �1dQ :I-dx lulu j)TOM OL LL N IV SNOII0AG E)NIQTIng A N I d dO �!G C Wo wN�a 1 0/eZ/t „0=,I = Zai ��N�QIS�� ,1��1N1� IV% -"J �Cd-lb .01 N z �-- O z U_ Lu L`3 ��QQ Ow u 0 UE0Z� Jam— 4 4IFitw0 UU-P zzU;n X ►-XX= X`_ w r Q w B O F-- ��z 1Q�w'J� Co z IL �Opw u cn (K � A p (L (L U�`�NfY '�O/Lrr Z7 /f7 n�l///��{{ -i1 — nz/1 N z �-- O z U_ Lu L`3 ��QQ Ow u 0 UE0Z� Jam— 4 4IFitw0 UU-P zzU;n X ►-XX= X`_ w r Q w B O F-- ��z 1Q�w'J� Co z IL �Opw u cn (K � A p (L (L U�`�NfY NORTiy Town of North Andover °A tit4ac 161 - Building Department �� °` `' - ` ° °c 27 Charles Street ° North Andover, Massachusetts 01845 +� (978) 688-9545 Fax (978) 688-9542Arco w �SSACHus�� I I APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION I i ADDRESSrn)!J a lee S+ - LOT NUMBER SUBDIVISION i DATE REQUEST (FILED 9 %463 i DATE READY FO IR INSPECTION Cl I 4_03 �...�,.. ,...:...,o ,.r�•rrn� unrnn q'r% !`T ACTN!_ n,&TF. TC REnTTIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFI IAL USE ONLY ROUTING II CONSERVATION r' " i PLANNING, ! Nl�v D.P.W. — WATER ME DATE 7 lO�0QATER D.P.W. MUST INDICATE THAT METER HAS BEEN INSTALLED TO THE INSPECTI9> REQUEST DATE. SIGNATURE / DPW A ORIZATIO ,0 A 2 CL Q V Ld 0 co W q >4 0 0 w z 2 c a a i��yy A C o a0 6J�F x`An • rl x. gA��y Fra QJ u I Po 0 r o 1 z N &. A -f ` J :O 44 = 4Wo � a . o �c r r cj cc m r � 4D CD C. ..CD �- �..� : E 40o o m u OI L m = = H 01 o CD h a o�l�c 1 o � C, w U ® o `a coy m C� N m i = W co �� :� d=yt ._ m 7� cc -02 :y On C11:1 _. � :momCD c N N r ®r _ r = CA -9) W R H FL� C Z = r ®•y O U m ®®_ Vi C' ®m CIO N."2 I-- s WE= Cc 5 I O s O v CO) H .G3 L- 0 - 0 is CD CL CO) E a0 CM 0= o m m CD ® O O C" CK Cm Q C 4-0 C cv cc o � CD CLG. COD C G O 2 CO) a O a C.2 COD G O V Ca - ' A w�Se a �+ u u ti D b G G id r•a % u q G neo p W s ' N ` J :O 44 = 4Wo � a . o �c r r cj cc m r � 4D CD C. ..CD �- �..� : E 40o o m u OI L m = = H 01 o CD h a o�l�c 1 o � C, w U ® o `a coy m C� N m i = W co �� :� d=yt ._ m 7� cc -02 :y On C11:1 _. � :momCD c N N r ®r _ r = CA -9) W R H FL� C Z = r ®•y O U m ®®_ Vi C' ®m CIO N."2 I-- s WE= Cc 5 I O s O v CO) H .G3 L- 0 - 0 is CD CL CO) E a0 CM 0= o m m CD ® O O C" CK Cm Q C 4-0 C cv cc o � CD CLG. COD C G O 2 CO) a O a C.2 COD G O V Ca - 4aic4i' ENVIRONMENTAUDEMOLITION CONTRACTORS ABATEMENT CONTROL SERVICESe INC. RESIDEIV�TIATL / GOMMERC►1,4L /INDUSTRIAL JANUARY 16, 2003 NORTH ANDOVER BOARD OF HEALTH 27 Charles Street North Andover, MA. 01845 978-688-9540 DEAR SIR/MADAM ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE FOR AN ASBESTOS ABATEMENT PROJECT. THE JOB WILL TAKE PLACE ON: WEDNESDAY, FEBRUARY 5, 2003 LOCATION: 1174 TURNPIKE ST. NORTH ANDOVER, MA. 01845 ANY QUESTIONS CONCERNIG THIS MATTER SHOULD BE DIRECTED TO MY ATTENTION. SINCERLY, FRANK BALOGH PRESIDENT 2 INDUSTRIAL WAY • SALEM, NH 03079 • NH (603) 898-9472 • MA (888) 870-9292 • FAX (603) 898-1846 4 VPPA 7018/1AV, I& 01NOSSarliffses7s ASASSIVS180100,flofffax Ith the Comply w Wvt & Me *VnLQW bcd0n7AV11dhV name, -1 Why, Department of notification w , requirements of CMR 7,.15 (W71 'and the Department of tabor and, xw"trw,y yl requirements'if 453 CKR 6.12 (W AFA 4, F requftO 01AW dW4WA07t 14i 2. SulKnit Orlglnal,f1vj' Form To: Commaa weal of Asbestos Program P.9&: 20087.0087 3. This Form may be,-.., used for notifying ft. jl' Protwion Agency Region I of asbestos 1,_" operations wbjeclto�: NESHAPS (40 CFR subpart er, N is the facility ,9ccupied?.1qj i .Q, Yes p No �Asb#" orltrdCtOr PAT'gMBNV',CONTROL SVC,INC. ,A0000362..K 4�q 13 -wesles"wome Y', Inefi, age, 9 -a im 11 .1. f JAMES CAROL FINELY NQ 764540, Nam INSTI cu N ORtH VAN DOVER, MA ctyl7owl? 1. All sea" Of 0% form mug f form mug be i��,;�-EXTERIA,"J In order Ith the Comply w Wvt & Me *VnLQW bcd0n7AV11dhV name, -1 Why, Department of notification w , requirements of CMR 7,.15 (W71 'and the Department of tabor and, xw"trw,y yl requirements'if 453 CKR 6.12 (W AFA 4, F requftO 01AW dW4WA07t 14i 2. SulKnit Orlglnal,f1vj' Form To: Commaa weal of Asbestos Program P.9&: 20087.0087 3. This Form may be,-.., used for notifying ft. jl' Protwion Agency Region I of asbestos 1,_" operations wbjeclto�: NESHAPS (40 CFR subpart er, N is the facility ,9ccupied?.1qj i .Q, Yes p No �Asb#" orltrdCtOr PAT'gMBNV',CONTROL SVC,INC. ,A0000362..K 4�q 1174 -TURNPIKE ST. - Address 01845 978-688-9292 Zip code Telephone 2 INDUSTRIAL WAY AOMSF - 03079 -603-898-9472 zP code Telephone Written Contract 7)P.1 (MIUM Or YdVtdV On Site _project Supervisorjforeman: AS33772 'GOSSELIN,.- NOW"' T Ducelwcjdon .0 AMERICAN 411ENVI-RONMENTAL CONSULTANTS, INC. AA000162 .kY, 0UCe1&kd&017J# 6. Asbestos Analytical V, � S8. ME AME 3P I w-2/5/03 2/5/03 .;4 'vm (Sat. -Sun.) 7, Pro)ect start date end date specific work hours (Mon. -Fri.) 7 am What Mpe. of project is this? ownaimon repair renovation other r A ESTOS REMOVAL DGsalbe the asbestos abatemept procedures to be used: glove tag WdMre u^ arltain/npnt, deanup a-rdasulaffon &Ptudlarlly POLY DING STRUCTURE IV,4s,the job being conducted [ indoors: noutdoors? 11.". Total amount of each typ_e of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.) 0 or other ,surfaces(square fQ LU2 Fb be removed, enclosed or encapsulated: Unear Saimm feet Unear Square feet wiw&" I. 0M., O/Am QhW100) 42<Pe§Wbe the decontamination systems)to be used: SURROUNDING STRUCTURE Y 7, -'131,, Describe the /dis containerizati n 0 , posal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(9): Wet removal into 61ni1 Poly Asbestos Labeled Bags. S,X iA. f .14 For Emergency Asbestos Abatement Operations, the DEP and DLI officials who evaluated the emergency: fp.W. OrOWZ�rT&`r7AW` " ,a We T. 7'i -o Waver x DO prevailing wage rates apply as per M.G.L. c. 149, § 26, 27, or 27A -F to this project? ❑ Yes No _qz A 4, NQ 764540, 1174 -TURNPIKE ST. - Address 01845 978-688-9292 Zip code Telephone 2 INDUSTRIAL WAY AOMSF - 03079 -603-898-9472 zP code Telephone Written Contract 7)P.1 (MIUM Or YdVtdV On Site _project Supervisorjforeman: AS33772 'GOSSELIN,.- NOW"' T Ducelwcjdon .0 AMERICAN 411ENVI-RONMENTAL CONSULTANTS, INC. AA000162 .kY, 0UCe1&kd&017J# 6. Asbestos Analytical V, � S8. ME AME 3P I w-2/5/03 2/5/03 .;4 'vm (Sat. -Sun.) 7, Pro)ect start date end date specific work hours (Mon. -Fri.) 7 am What Mpe. of project is this? ownaimon repair renovation other r A ESTOS REMOVAL DGsalbe the asbestos abatemept procedures to be used: glove tag WdMre u^ arltain/npnt, deanup a-rdasulaffon &Ptudlarlly POLY DING STRUCTURE IV,4s,the job being conducted [ indoors: noutdoors? 11.". Total amount of each typ_e of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.) 0 or other ,surfaces(square fQ LU2 Fb be removed, enclosed or encapsulated: Unear Saimm feet Unear Square feet wiw&" I. 0M., O/Am QhW100) 42<Pe§Wbe the decontamination systems)to be used: SURROUNDING STRUCTURE Y 7, -'131,, Describe the /dis containerizati n 0 , posal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(9): Wet removal into 61ni1 Poly Asbestos Labeled Bags. S,X iA. f .14 For Emergency Asbestos Abatement Operations, the DEP and DLI officials who evaluated the emergency: fp.W. OrOWZ�rT&`r7AW` " ,a We T. 7'i -o Waver x DO prevailing wage rates apply as per M.G.L. c. 149, § 26, 27, or 27A -F to this project? ❑ Yes No _qz A 4, 13 faciu4voesci/ovoa C 1 Current Or prtor 45e of facility: r. u BURNED HOUSE s, 2.. Is the facility owner -occupied residential with 4 units or less? ®Yes C3 No cS r"3 ,Facility OYtrter; i:: s.'JAMES't&'CAROL FINLEY 1174 TURNPIKE ST. t Aw�ie ^ _ NORTH ANDOVER; MA. 0 845 978-688-9292 Telephone l ;4 t FaciUtys Or(!!'S On Site Manager Address' {{ i G4?P+M zo rode Te/epiare l f � +oral Contractor s a , : Address • =,� d�4'.1tf �yFr re OW Dp rode lephant + ,I •r ti,+ko , .cwpv vrsr Waters•av* IAWW _ Ptdky av Exp Date. f.t N , 6 What is the size -of the Wlity7 300 (sq ft) 2 (# floors) ` �- ,a,�6�sliaasvq�!adooapdoisoosa� Transporter of asbesWscontaiMng, waste material from site to temporary storage site (if necessary) to final disposal site? j. ABATEMENT CONTROL SERVICES,INC. 2 INDUSTRIAL WAY " owns Address SALEM. ;i. NH. h 03079 603-898-9472 GAY?awn77, Dp carie Telep l— 14, v}`Transporter of asbestoscontaining waste materials from removaVtemporary storage site to final disposal site: x:, ,kY igtY?Gran 4Prode Telephrne `'Notes 'Tidrt�er k N A 3`1 Rguse stationancl owner (if applicable): ,; StdGL1nSI/lLtsY , ti'tt � r N7(h QhC ' tfi r: I YOM Address :<Sd%d Wrists 7 C `t, n h a t,? I:. '. barts310.pN /Town, i s y. 2Mae Te/ephare t is i i , , ti A t final D I Site 'MPERIAL:.LANDFILL ya _ „+ ,LaCaypo Mame Owlws Nave Itdt`Y rF R iJ �BQGGS ROAR ""st } Anh�Ra 724-695-09.00. PAI. 151-26 rode r • Mq'S? tea,; 1 C�JIIQ� 1 iuridersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts Regulations T 9 t "i for for.the Iternoval,:Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in :.,,..;. "this notification is true and correct to the best of his/her kn Wedge and belief. 1/17/03 Y FRANK" BALOGH ' IF �'i HhtName MauedSlynature gate PRESIDENT'' ABATEMENT CONTROL VC,INC. 603-898-9472 ->r R>pGat/l/Ge.. RepresentlrYy Te/ephme r i-2 INDUSTRIAL! WAY SALEM, NH 03079 I i„ r 1 i a' Apfdresr Q1i'/r0wn Lp code '�iy � t Fee exempt (CJty,,Town,_district, municipal housing authority, owner occupied residential of four units or less)? � Yes ❑ No Y k4 i, ti5mt 1 t �v'1764540 n iEf sett tf � t ` t Stidrer # (from front of form) K ;. Sltt.�-st3«t;!? _!<. ,y',w'i+J � ,r t.�',rt�a , ? t �F�k ;,: r • ; - _ Location No. Date �ORTM TOWN OF NORTH ANDOVER 3? . OL a Certificate of Occupancy $ f i ; Building/Frame Permit Fee $ swCNus t' Foundation Permit Fee $ f Other Permit Fee �I)Pmfl $ _)DO TOTAL $ Jo y Check # 16139 Building Inspector ' TOWN OF NORTH ANDOVER 1 BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .c �yyg�D M �.. �r� y►��CttlO� �BC:1�$�� -,`"� -�`r' r-Gz�',M;.�a�r.�, �. ,��g "� i".. __ ✓Y' {err,.,..;^ dN" _... .%wbq--k`.' lyres, tt � r.w'£ 'a.'�. xi. BUILDING PERMIT NUMBER: t7,3 DATE ISSUED: a a CUD SIGNATURE: Building Commissioner/InEe2ctor of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 11-1 yL)r 5 at- t o -I A 3 Map Number Parcel Number 1.3 Zoning Information: g District Proposed Use IUILDING SETBACKS (ft) Front Yard Required I Provide 1.4 Property I Lot Area Side Yard Provided Rear Yard Provided i1.7 Water Supply M.GL.C.40. S 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ 1 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record U& :�,j & rr es e .r _ aQ {Zo v m�Crest A to 1- 'a Name (P nt uu c �— - - Address nor Service . elephone 1 2.2 Owner of Record: kName Print li Address for Service: Ji nature -1 ele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Ltd i 1 ia. rm Z a e e_ � Licensed Construction Supervisor: iOL4Q`ruirm) Pike, S* i Address 1� -787—toga-2 2Lo Signa a Telephone e 1 3.2 Registered Home Improvement Contractor Company Name I Address Not Applicable ❑ C_ 5 b5�.y► License Number rOlca `o -% Expiration Date Not Applicable ❑ Registration Number Expiration Date crrr-r>inM e _ Wn1D1W; VRq rOMPFNSATION (M.G.L. C 152 & 25e(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. affidavit Attached Yes .......❑ No ....... ❑ -Signed 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: SECTION 6 - ESTIMATED CONSTRUCTION Item COSTS Estimated Cost (Dollar) to be� Completed b pen nit a lic,ant OFFICIALUSE ONLY �.., 1. Building no (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbinE 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 as Owner/Authorized Agent of subject property. Hereby authorize f i 0.M �. d't' to act on My bel ; in all matters lative to ork authorized by this building permit application. X ,%G��3 Sia ture of Owner Date SECTION 7b OWNER/AUTHOTRUED AGENT DECLARATION 1 as Owner/Authorized Agent of subject property Herebv 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/Anent Date Ell NO. OF STORIES SIZE BASEMENT OR SLAB ST D SIZE OF FLOOR TIMBERS 1 2' 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIN ENSIONS 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 61/2,,2/2003 08:45 9787944720 BAY STATE GAS PAGE 02 01/21/2003 10:46 970GO22397 WILLIAM BARRETT HOME PAGE 02 . I41LL,YAM bARRETT HOME PAG9 02 Town of North Andover �•� �, .��.♦ HbiwiBB DepAr"eAt 27 C wIft SuvK North And&Aw, l► usachvsew 01845 ¢ (978) 688-4545 F= (973) $88.9547 B-uYldjH 2eUfit'gn Affidavit ♦ • ,K �,. 3. r. �j�.r�� Aum.•. i� �/�L`-;�I.�/,��i! 1�►�� r l I — zi-0r3 . M - a 01 42t i Vb8L 848 I U wood WbOlS mj CO:@1 0002 �,t Nar North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) ignature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector Workers Compensation Insurance Policy NIARYLAND CASUALTY CONWANY Information Paze NCC'1 Company No.: !0545 and Employers Liability ZURICH ACCOLNTtitiMBER: M006i38531-001-00001 Branch Pofic, dumber Producer Lode Previous P oiicv Number' 2E�EWAL \ .1GBli L\' I WC O583?697 04 02090918 I 'CI 05837697 03 Branch Address: t5 MIDSTATE DRIVE AUBURN MA 0150t IT ENI 1. Named Insured anti Manine address Procaucer Name ana Nlaiiing Andress COLONIAL DEVELOPMENT CORP. DBA TARPEY INSURANCE GROUP. INC. WILLIA\4 BARB 1 HOMES PO BOX 567 1049 TURNPIKE ROAD WAKEFIELD MA 01880-1667 NORTH ANDOVER MA 01845-6109 (781) 246-=677 This Information Page, with policy provisions and endorsements. if any, completes this policy. Insured is: CORPORATION Risk I.D. No.: I F.E.I.N.: 043201987 Other Workplaces Not Shown above: SEE SCHEDULE OF INSUREDS .01) LOCATIONS ITEM 2. Policy Period: From: 03/24!2002 To: 03/242003 12:01 a.m. Standard Time at the Insured's Mailing Address ITEM 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Empiovers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits of our iiabiiity under Part Two are: Bodily In by Accident S IM. 000 Each Accident Bodily Injury by Disease S 500. OW Policy Limit Bodily Injury by Disease S Ino. f 00 Each Employee C. Other States Insurance: Pan Three of the policy applies to the states. if any. listed here: ALL STAi'cS EXCEPT \D. OH. WA. %VV. WY. NV AND THOSE LISTED IN 3A D. i his oolicy includes these endorsements and schedules: SEE FORMS AND ENDO RSENIENTS APPLICABLE LIST ITEIyi 4. Tae premium for this poiicy will be determined by our manuals of rules. classifications. rates and rating plans. All information required on the foilowing Classification Schedules) is subject to verification and change by audit. SEE CLASS IFIC.\TION SCHEDULE Total Estimated Standard Premium S 1,660.00 If indicated below. adjustments of premium shall be made: Premium Discount S " Annually Expense Constant S 244.00 ❑ Semi -Annually Premium for Endorsements S ❑ Quarterly Taxes and Surcharges S 78.00 Ct Monthly Total Estimated Annual Premium S 1, 982.00 Minimum Premium S 500.00 Deposit Premium S 1.982.00 issue Date: 02/19/2002 ,e, - — C,t r tri_y�-�tc7 NSUU, D COPY Cduntersimed By authorized Representative �- 00 00 0 1 A (Ed. 1 0-U91 Convngnt. 1997 Nationni C onncti on t :omnensatinn inaumnee The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity �I am an employer providing workers' compensation for my employees working on this job. Company name: w t i ( i a. yr 8 0, r T G tt H 6M e 5 Address 10 l4 9 T' tp r r2 a i d e- 5-t J. City: t'l% A AJ o v e e- , ,n�1 Q. Phone #: i 8' - & R 'ok - a Insurance Co M ay' Y l a^ i C 0.5 L)A I+v C. o a Policy # U-) C 95 9 3 -7 to 9 7 0 ti Company name: Address Ci • Phone #: Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 andtor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) 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 verification. I do herby certify und6t7?�.pains and penalties of perjury that the information provided above is true and correct S ago Print name %(,III ax,, 8 GL r r t✓ tr— Phone # & 9 a - `QL,3 a0 Official use only do not write in this area to be completed by city or town official' ❑ Building Dept []Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION N Z a. N O o l H'onO �p g� �W Cin ui O Z Q Z _O N N '� \V 5 ~O J U N M a >> rn o LL a O Z p p cn U p p w O O g � U 'n �v) m E x +`+ W~w CO O \\ v Z W d W J m Q Y m E: Y > I= Q cot, F=- � JrnZ "T Q j Oz 01 rA rA x w A a o v a O w v a v cn o U z z z Q a o p w O w U G w w `� °�° O w cd C w" a w u °�° O w v cn G w p U w z 0 a M G w w w A a q cn o cn v O cn w- co O. OD 0 Cm C2 y y .CD L CLs c O CD C.3 CL Q) O V C42 C O C.. H r-, i CD ci CD C. CA G C CM C O •C 0 � c ca _0 /U3 LU V / w U..1 w LU U) ts �: ca vC.3 wj:CLG O C � O • t O 02 E e -lop m o Om E .cam :o m :cam CO 0 � cm E CL=- CEOL N s' cm m C N � � �t y MO 4Ce�_ C O m � : N m 1.2 L = C: : O Cf Oct Co acs o m � C.)IZ g co cm I .0 H N m C N COO LL •y m � � G mat O � LU vi o«. m"N ca 0 Z O V ® pCL m C ® H°OCD .O CL:E Gs co O. OD 0 Cm C2 y y .CD L CLs c O CD C.3 CL Q) O V C42 C O C.. H r-, i CD ci CD C. CA G C CM C O •C 0 � c ca _0 /U3 LU V / w U..1 w LU U) BAY STATE ADJUSTMENT SERVICE Ins��ettor of Buildings kbwn of North Andover Town Hall North Andover, MA 016 Re: 45 New Ocean Street, Swampscott, MA 01907 Telephone Numbers 24 Hour Emergency Number (781) 858 1075 (781) 599 9922 (800) 865-2206 FAX (781) 599 9099 Town Fire Department James and Carol Finley Property Address: 1174 Turnpike Street North Andover, MA 01845 Policy Number: File Number: HMA2032806 2126 Board of Health Town of North Andover Town Hall North Andover, MA 01845 Company: Patrons Mutual Insurance Company Date of Loss: 05/07/02 Cause of Loss: fire damage Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000.00 or cause Massachusetts General Law, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer and include a reference to the captoned insured, location, policy number, date of loss, and file number. This is not a request for a report, this is to comply with Masschusetts notification laws as set forth above. Paul R. Nestor, Jr. Adjuster On this date, I caused copied of this notice to be sent to the persons named above, at the add sses indicated by first class mail. May 7 2002 Signature Date Member of the National Association of Independent Insurance Adjusters Date. - 04 TOWN OF NORTH ANDOVER 9 PERMIT FOR PLUMBING s i _ 11 This certifies that .. .�.. . �. .. f. r /� .... ! ....!...... . has permission to perform ................ • • • • • • plumbing in the buildings of ... F..l!� .{.'/..................... at ... A............... North Andover, Mass. Fee.Lic. No.. .3.S.ci. ............ r�r.,-....... PLIV BING INSPECTOR Check # , 5247 2007 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT.TO.DO PLUMBING/ /� (Print or✓Type) �— a ® ` U V �! Mass. Date �� 19_Permit#, LJ / �r-%�� Owner's Name LeyBuilding Location 11711 Type of Occupancy New ❑ Renovation ❑ Replacement ❑ Plans Submitt Y ❑ No ❑ FEATURES_ Installing Company Name �z�G� G`� h one: Address / V <f -LZ 6 e corporation ❑ Partnership Business Telephone 7 c 7 o-2 ❑ Firm/Co. Name of Licensed Plumber�A� 7 � --f77)� Certificate 7 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes,i3f No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance polio Other type of indemnity ❑ Bond ❑ OWNERS 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: Owner ❑ Agent ❑ I hereby certify that all of the details and information i have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the chusetts �Plumblngand Chapter 142 of the General Laws. By g ureof LwAinsea Plumoer Title Type of License: Mastev Journeyman 0 v ME .. - ■■® NNNNEEENNEEMMMMMM0NMMMM .. - ■MMMMMM■MMMMMMMMMMMMMMMM■MMI Installing Company Name �z�G� G`� h one: Address / V <f -LZ 6 e corporation ❑ Partnership Business Telephone 7 c 7 o-2 ❑ Firm/Co. Name of Licensed Plumber�A� 7 � --f77)� Certificate 7 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes,i3f No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance polio Other type of indemnity ❑ Bond ❑ OWNERS 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: Owner ❑ Agent ❑ I hereby certify that all of the details and information i have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the chusetts �Plumblngand Chapter 142 of the General Laws. By g ureof LwAinsea Plumoer Title Type of License: Mastev Journeyman 0 Location Z z z No. Date N�^TM TOWN OF NORTH ANDOVER T f S • i ; , Certificate of Occupancy $ Building/Frame Permit Fee $ J�CHus Foundation Permit Fee $ _ f Other Permit Fee $ TOTAL $ Check # j b 0 / 3 1 5 5 `i 1 Buildin nspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: _� DATE ISSUED: ') SIGNATURE: Y Building C20ssioner/I for ofBuildings Date 77(r d - SECTION 1 -SITE INF TION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Servicer Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: V Licensed Construction Supervisor: Address t ature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor ,giuM "l L .s , Z11 e - Not Applicable ❑ Company Name % ?41r i�'��Cf°'�- Registration Number 7--Z3 ^ v Z Address l �/ , r_ / O eZ%'Z3Z — i iS Expiration Date S nature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify Brief Description of Proposed Work: 4-A 4U A- !Z ' K r 0 4A o-4 Vkb 10c ,La_ kCA-� r SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant {} CIAL .R USE ONLY ` s 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing - Building Permit fee (e) 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 1, . lcl J__r a 5 �4 x /44-1 as Owner/Authorized Agent of subject property Hereby authorize 4aW8 1 [ q /�� r� �/l C to act on My behalf, in all matters relative to work authorized by this building permit application. -Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, Aye%[ C pt YlI ,Al"s C- . 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 �We !f Print N 9e Si tune of Owner/A ent Date �. tn NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TWIBERS Igr 2ND 3 SPAN DINIENSIONS OF SILLS DfMENSIONS 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investiga%ons Boston, Mass. 029 91 Wor' ers' Compensation Insurance Affidavit �m� yrC e7 /De L- --i-none am a homeowier performing all work myself. LDI am a sole proprietor and have no one working in any capacity =1'am an employer providing workers' compensation for my employees working on this job. Cit.: Phone* ComRarty-name: Address ------------------- Phone* Faiture to secure coverage as required under section 25A or MGL t52 can lead to the impos ton of crinunal penalties. of a fine up to $1.500.00 and/or one years' imprisonment as well as civil penalties m 41116 form c(a, STOP MAK Ot t and a rine of (SMOo) a day against rne. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the. DIA for coverage verification. I do herby certify under pains and Signature Print name /7O -WI t� UW the information provided above is ftue and- correct Official use only do not write in this area to be completed by city or town official" ©Check if immediate response is requi►ed Building Dept Contact person: phone �M WORKMAN'S COM PFNSATfOti 5 -Y -0Z #_ 9 -33/-D X3.3 El Building Dept - p Licensing Board D Selectman's Office Q Health Department D Other 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_ _ ,Ta M PS 46 PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREETT1 7y �c q �i ,��° 5 ST. NUMBER *****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMME TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH PTIC INSPECTOR -HEALTH COMM DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTION DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILI Revised 9\97 jm C4 ,/f 1 4p� 7O H ox Cd x a o CA u u "d w° �. v u V) o � co z z z A GQ Or- -o O w° x 00 a U co w a o U 4 ►-� tmD c3: CISw x a ° uz `l U O w u cn / O w a o a C7 00 O a: —co G W. zw d A -. w v 7 W o z cn v q i 8 cn rp �g v w P4 H co E L O C O co CO2 O V H C O !O CO3 r�M-7 O v C. H C CO CM C O C G 'o W W Wo ' c o ®� o .o C H Cc C.2 �nC n m to . m C �= O O � w, m 3i�►Ea L ff. j oi co • �o o. y O 0 �0. Un c Em ��m a c0�y y © 3 rn�p = C m J c �- m W = C y C C42 W O C, E" a :mo nc.w � o y m ' z = o os oQ aCA= D , •O m y 60.1 Z O cC o n c •C o H m C = m :0 30 N LJJ C ' y=•„ •n,c w y O w CCD •d Z LLI CD E CM CA) m O 'O H $ nim > rp �g v w P4 H co E L O C O co CO2 O V H C O !O CO3 r�M-7 O v C. H C CO CM C O C G 'o W W Location i i U r ^j pt I<,e 54 i No. ) Date `� .�h cl 41 CHUSE� 13087 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ / 3� Building Inspector 08/04/99 11:26 130.00-- I} Div. Public Works x�z 11 I• • No ly N t pi' V` N i L`ti i � � a 0 O OU U x A LTJ A d a z3z cn 0 O O z U O WW O U z O U U z � o w zd __ w � m Q m Q mm N a � v� � rO On a o O zp Ll a > m u o I a a 0 z �• 5ujz m o o w d rn a ...� a ❑] U M z O F v [act w � w n a Q o U u ¢ L)z ¢ o O c Z Q o Z Q o z o : m o D � w E Z s° s U O O s ¢ m d Q E< ¢ 5 — — 5 — 3m a I• • No ly N t pi' V` N i L`ti i � � a U O OU U x ly V` � � a U O OU U x Town of North Andover OFFICE OF COMMUNI'T'Y DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director (978)688-9531 HOMEOWNER LICENSE EXEMPTION Please print. DATE �� JOB LOCATION 11747 �U L Number "HOMEOWNER I -� ,c V l fir PRESENT MAILING City Town Address 1?O i1,032 9.9, State / 9 NOFTIy 's,��O O A • o u �9SSACHUS�� Fax(978)688-9542 Section of Town - 0o -If 7 3q-3 Work Phone 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 as 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 a/she understands Town of No. Andover Building Department minimum inspection ocedures nd req ' is and that he/she will comply with said procedures and requi ents. HOMEOWNER'S SIGNA APPROVAL OF BUILDING 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 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 oA 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 andlor landowner from compliance with any' applicable or requirements. ------*-`APPLICANT FILLS OUT THIS SECTION* APPLICANT PHONE LOCATION; Assessor's Map Number - PARCEL SUBDIVISION LOT (S) STREET %��/l�J ST. NUMBER ...... .***OFFICIAL USE ONLY � �M1w� C�ia~�i� �ordh-er � 3 RECOM 17NDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED r7" _ , o , . B. COMMENTS ✓° %VOI�S�p; TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWER/WATER CONNECTIONS DRJVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE �J I rA as 0� ?" UJ z o � c N • C3, C y C-2 p, c MOON; Cp cc y c �Z O 2C 'pi / m 7, N R Ea ' C ms moa co co O m 2: {cmc _ mm O �3N m L c M m� C i . co W LELL) r1:Nmm c ha acs m o� •oNZ 'cao W C p :5 =6 A V CL. p,le 0 C = A v H O �- 0- 060. m N 4545 N N c co m CD m `o cm c C N m t F�'N% Cn O z 0 9 Vko fi O ts 0 co CD CD ■ L CD Z o„ O CO) G c ccm c ca CD ow p Z7 � � L cc o a M: v�4 ca !c zCD CD C C cc ca is 0 C( -- w w w CO o a a w C9w° w a�' a°' U w w p°G w a o°G w —coC w ra CO o cn ?" UJ z o � c N • C3, C y C-2 p, c MOON; Cp cc y c �Z O 2C 'pi / m 7, N R Ea ' C ms moa co co O m 2: {cmc _ mm O �3N m L c M m� C i . co W LELL) r1:Nmm c ha acs m o� •oNZ 'cao W C p :5 =6 A V CL. p,le 0 C = A v H O �- 0- 060. m N 4545 N N c co m CD m `o cm c C N m t F�'N% Cn O z 0 9 Vko fi O ts 0 co CD CD ■ L CD Z o„ O CO) G c ccm c ca CD ow p Z7 � � L cc o a M: v�4 ca !c zCD CD C C cc ca is 0 C( -- w w w CO No 1082 i Date .......... :...F.?... A TOWN OF NORTH ANDOVER 8 PERMIT FOR WIRING Ai O This certifies that a has permission to perform ........... .:.............................................................CU pwiring in the buildin of ....... .......................,. at ... .� �/.....:................................................. �. , North Andover, Mass. u �,` / Fee.? ............. Lic. No.........�:.........,...................................................... -EI:ECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ThFC0M10NWE4LTH0FAf4MCHUS= Office Use only DEPARi1ifEAi0FPUR1ICS4FM Permit No. llJ (p BOARD OFFNEPREYLMYONREGMTIOASS27C UR 1200 � UVd, Occupancy &Fees Checked PPLICATION EORPFRlIff TO PEPF'ORMELECMCA.L WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (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. Location (Street &Number) % / °79 TF !a) Tk#G; PiK r Owner or Tenant 9i-- C/fZ04- JLkti Z. G S/ Owner's Address TQ X411214-- Is this permit in conjunction with a building permit: Yes ® No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ..mss Amps / Volts Overhead ® Underground Q No. of Meters New Service Amps Volts Overhead ® Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipala Other No. of Dryers Heating Devices KW Connections ' No. of Water Heaters KW No. of No. of 1 Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER , Walosat S'/ y -;,9f .. InspeaicnDWeRe4owd Sigwdut dXSPdR1ficscfpajW FIRMNAME Lica•se%f/a �� A �l�� Si@== 1 arc 16 OWNER'SPgk ANC'EWAVER;I.anawvaethatthel edbmia aod@ntmy' onflaspem>�applraUmstagtmsna>t (Please eck one) Pwner ( Agent o Estimated V&eofFSecftW Wade $ F c v — Rao 0 14 C,41,& Final !✓iLL ��1� _ Lioa>,seNo Business Tel.Na A1tTeLNa 9-7 tetp�ed byMassactast�is Gaan1 Laws" Telephone No. PERMIT FEE $ --3799 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ... ...................................................... has permission to perform ..... ............................ wiring in the buil of .. ........... .............................................................. 11Vp.. at .—....... ..... ................. .North Andover, Mass. Fee -'--b ..................... Lic. No . ............ i��........................ ELECTRICAL Nspwm Check # IPY Official Use Only PermitNo. 'i,{vg aeA4-6--s "d;W& Safety Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 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 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work descriibeed below. Location (Street & Number 1 / U_ �)�2! , J Owner or Tenant 7a wte— S_r / n Owner's Address Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Vats Overhead ❑ Undgmd ❑ No. of Meters New Service Amps Voits Overhead .❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Electrical Work OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = .. (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perju FIRM NAME ef✓e 6XC` f i L T7vv4 LIC. NO. 4121 71 Lkensee jam' S� Signature_T �7 �— uc. NU. Bus. Tei No. ✓n Address �'^ ° L6 $ C� �' c'I , S / Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have a the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that mysignature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of dt fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ .Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wirin No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = .. (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perju FIRM NAME ef✓e 6XC` f i L T7vv4 LIC. NO. 4121 71 Lkensee jam' S� Signature_T �7 �— uc. NU. Bus. Tei No. ✓n Address �'^ ° L6 $ C� �' c'I , S / Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have a the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that mysignature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ (Signature of Owner or Agent) Location i -i L -f 1; r< <, n e- No. t r _ I Date L4 Z,61 ZCco 1 NORTH TOWN OF NORTH ANDOVER f � 0 AL � 9 Certificate Occupancy $ of E<t' s�cNus Building/Frame Permit Fee $ 1 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ - S^00 Check # 3� IL111 (t I 37,P)3 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICAT,I�ON TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING iry BUILDING PERMIT NUMBER: 193 1 DATE ISSUED: .,;pt aAn SIGNATURE: A YZW Building Commissioner for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: ZO Ivin1P) 1.2 Assessors Map and Parcel Number: Map Number Parcel Number ,tV o f (/ //�� U J,ev- M Q�/�� / 14 �/Zonning ,Inffoormation: 1.3 Zoning Dis1.rid Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RaIllired Provided Reqwred Provided 1.7 Water;S Oly M.G.L.C.40. 54) 1.5. Flood Zone Information: Public Private ❑ Zone Outside Flood Zone 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System S,MION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ce vvve Name rint) Address forServs— ice gnature Telephone 2.2 Owner of Record: r d z ��L� AU?11-V 4 Nam Print p Address for Service: 4 Signature Telephone ,SECTION 3 - CONSTRUCT RVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address _ t Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone Of b :4 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 buil 'ng permit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 DescHi tion of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description roposed Work: v,l —T VS v (9-rir +rofv 0 pO5 F_ All r � I� -�'V V rl 6 ,oT X; s ,o -,,e SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beN Completed by permit applicant OFk'ICI�l �._ USE O)+II.Y ,. ': 1. Building V/1-' Y�L 00 AVD1A00Vn (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 D 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 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, -3G Y-\IfS T2at%L&--Y 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 Na C �,7 S' <atmure of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMMERS INIAX r 2ND 3 iv 0 SPAN ,4 Cywk r DIMENSIONS OF SILLS DIMENSIONS OF POSTS kz DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING" lj X MATERIAL OF CHEVINEY M IS BUILDING ON SOLID OR FILLS LAND $ IS BUILDING CONNECTED TO NATURAL GAS LINE W ad FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. Ra H -ay.0 0 'APPLICANT •■`/ 3ML-S••••E/Add'/V••••••••••••••PHONE ••6��—■�a�� ASSESSORS MAP NUMBER ! d LOT NUMBER 3 oZ SUBDIVISION LOT NUMBER STREET -P I ICe— s STREET NUMBER �! / OFFICIAL USE ONLY C,,,vcS;nu C�- <3'' X 6-" /n c),D /200 14,X MEDENE RECOINEENOMMENDATIONS OF TOWN AGENTS r11v s.. Ciii....■■..................■.........■...................■ .■........... lr �- DATE APPROVED " t CO ERVATION ADMINISTRATOR DATE REJECTED L� L& kn DATE APPROVED • .I�i�iltn`i�l�l:7 DATE REJECTED • uluia�t. DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED 4Z DATE APPROVED SEP SP TO -HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE _( O-� 6 sc, z �„ 5.0., Please print �l DATE V JOB LOCATION "HOMEOWNER HOMEOWNER LICENSE EXEMPTION Number Town of North Andover Building Department cQ IAOR - '"'° p Street Address 27 Charles Street,° North Andover, MA. 01845 s,n°��g D. Robert Nicetta Name KHu Building Commissioner Home Phone Work Phone (978) 688-9545 688-9542 Fax Please print �l DATE V JOB LOCATION "HOMEOWNER HOMEOWNER LICENSE EXEMPTION Number v Street Address Map / lot Name Home Phone Work Phone PRESENT MAILING Town ke J State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/ e will comply with said procedures and requirements HOMEOWNER'S SIGNATU APPROVAL OF BUILDING OFFICIAL w O w o LE v C a U) z A c¢ o as C U w a z r4cc c�° w a u w z U W 0� cin w a w ow z C7 �° C4 m w z a w Q a ,, I= z cin v i o cn ui om y a z 0 U O w A 0 co O c O O v Z co a O y I co cm C C ca Q co .ca CO E m m CD O O CL cD O O O O a CL CMa y C O= *" C C v CID .v J G. O CD C Z Q CD CL C3 V2 O C C C _02 0 LLI 0 U) LU w W CcW W U) CA V • • C - i moi: � N O Ar O. c CO C L. CD :NSC m '� 0_ y Ec �7� m o 3 C2 s a� � L m N H C,* CD 3 t .. C e m m N m O C N O C N �� m O A A 46 c = o —� cm— O Q c" C 'O N :S C = p, vm O -CC .:LowZ Co o , CD r C O O_ cm C i m m N m C , ID 3 CO N � $ O CD Lau, LL •y O C C Z .m gym. m N O C� CL p m C O y _ c m� N �O D cz CL a z 0 U O w A 0 co O c O O v Z co a O y I co cm C C ca Q co .ca CO E m m CD O O CL cD O O O O a CL CMa y C O= *" C C v CID .v J G. O CD C Z Q CD CL C3 V2 O C C C _02 0 LLI 0 U) LU w W CcW W U) cn M N (o N M A N o) a0 h h m ki P -i t -i Mi oo ao ao ao W W i o TS �� ti U W o y o Z O O h O M I� A to to �` to va Q)�/ J Q A h 2 N (� O eF �t N O 0) to t0 0 N i W V� M p ►� Ni Ni ki ki vi ao 06 ao y .. Z Z a o h O A A A A A A A A A Z LL 2 j � � � Q o � p ` Q � ? o � J r O r �•l Q vZ�i W z Q Q JZ o Q Z;ci m m W m LA: IZZ to k Q. O O p pL.L= Q � FIti I. I. IO LL to U J to to ~ O V) z z z z i z zQ M' r 32' rn Q - 3= U tV W kPE 0 O Zz JV z 'L-4 � Q W :.-kM■ el""N LLJ Lu V) W Y Z hh. v N N O N �a I Q) Q O , O o I � O O O � � Z h � Qp M n Z �o hh. 1W � N N O N I Q) Q rn , O o I � O O O h � Qp M n Z �o p N • ` � vi n J hh. ::�(o V Ln �O --N W n 3 1W � I 1 '1 II I I O CV N O N I J J � i 31.73' -T' , O o I O O h ::�(o V Ln �O --N W n 3 0 o I 1 '1 II I I N � O � W I V ::�(o V Ln �O --N W n 3 � to I 1 '1 II I I I � ui o I � Qp M n Z p N • ` � vi n Q M �D Z 1 ::�(o V Ln �O --N W n 3 0 ,:�O 03 Date..... :-2 .... E ...-.............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0 This certifies that ... TQ.m .......... 1) ....... ...... %L ............................... has perinuission to perform ......... -f ....... .................. f ...... ring in the building o ... .. .................. 7 ...... wiring ................................ at ...... 'U * r A" /91 vc '*'**** ........... . North Andover, Mass. Fee .... ...... Lic. No. ��.00.?02 ...... C . . ...... ... .......... ELECTRICAL INSPECTOR Check # 4493 THE COMMOATWFALTHOFMASSACHUSEM Office Use only DEPA UA1EW0FPUN1CS9FETY Permit No. BOARDOFFMPREVEVHONREGULAHONS527CM12M Occupancy & Fees Checked APPLICARONFOR PEWIT TO PERFORM ELECTRICAL WORN ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 ^ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 0 Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street � Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes M,No (Check Appropriate Box) Purpose of Building Utility Authorization No. %� �� Existing Service Amps / G Volts Overhead [z] Underground =1 No.. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity' Location and Nature of Proposed Electrical Work ,ydli, -7-� % F/b /au7ty 7:7, 7-Y 7-dA.rS7Qr cie -N ,9� - /*yL f No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices.. No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local-1Municipal Other No. of Dryers Heating Devices KW EConnections i No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER lrmaanoeCov� Pta�uanttotherac}marta��M('�atatllaws IhaNeaommLiabf7dyliszmceFbky n tiftCon ice Cov'agearits eWivaiait YES NO IbaveaftnitiedvaldproofcfsmmtD ieOffice YES lyouhatedr. odYES,pbsei thetypeofco by cheddngthe box INSURANCE _ BOND GIIIER 04-16eSpecfy) F4im6mDaie EsturkdVahrofFdcWWink $ w0daoStatt hzspetfimD.MRegtresled Rough Final Signed underlie Periahies of HRMNAME '� t• `� IioerrseNo L. -rr w a ?T)r,, ris t sigtiahne1A11120 LkenseNo �a ® BusitmTelNo. _ �D / / J,�i✓ Alt Tel No. 6`9 OWNER'S INSURANCEWAIVER, lam awate that the l -mw does riot have the m armw oovmW or its substantial egwvalat as tegtmed by Massadmet s General Laws and that my sigtntttue on this pemrit applicatim waives this regmenott (Please check one) Owner r7 Agent Telephone No. PERMIT FEE $ Signature ot Uwner or Agent The Commonwealth of Massachusetts i Department of Industrial Accidents , Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Location: City Phone # 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for rry employees working on this job. Company name: City: Phone # Insurance. Co. Policv # Company name: Address City: Phone #: Failure to secure coverage as required. under Section 25A or MGL 152 can lead to the impositiarof criminal penalties of.a fine up to $1'.5oo .00 and/or one years' o prisonment-as va as_cwd oenahms-nfieinuninf-aS•TOP]MDRK9RDBRand aTine�f ($1DA DD)�rlay tme. I understated that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under the pains and penalties of perjury that the irrfww6on provided above is true and correct Signature Date Print name P.bone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing. D Building Dept E]Check if immediate response is required Licensing Board p Selectman'$ Office Contact person: Phone #. n Health Depq ' tment o Other Location I I I � (v {`ti (� t {ta No. Date amLo 3, TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 4 14 L") Foundation Permit Fee $° OMer Permit Fee $ TOTAL $ �� O Check # S 0 3 cj Building Inspector Y. \R 14 \ 5830 \5830 -FNDN- CER T. DWG 5/23/2003 1 N/F FERRAGIMO �r AL 178.79 i / — — — N/F THOMAS � I z u1 o, J�, C `� �' ro / o ./ �� N/F HANSOUR / -0- h LOT 1 mJ/ 112,000 S.F. o m CP ---1 131.5'_ FTI `3 to N/F LIGHTBURN X124.0' n`•. °•.� / ��. 122.7' 382 i 2 o ti 31.73 N/F TRUONG I HEREBY CERTIFY TO THE TOWN OF NO. ANDOVER _ v t ��T t BUILDING DEPT. THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN AND THAT IT DOES CONFORM FO UNDA TION PLAN WITH THE TOWN OF NO. ANDOVER ZONING REGULATIONS REGARDING FROM STREETS & LOT LINES." 1 174 TURNPIKE STREET _SETBACKS IN NO. ANDOVER, MA I ►? 4v o.'v p [ K DRAWN FOR WILLIAM BARRETT HOMES, INC. DATE: MAY 23, 2003 sE' ' SCALE: 1"=60' 0 30 60 90 =i46 MERRIMACK ENGINEERING SERVICES MAY 23, 2003 66 PARK STREET " ANDOVER, MASSACHUSETTS 01810 STEPHEN E. S F R.L. S. DATE Y. \R 14 \ 5830 \5830 -FNDN- CER T. DWG 5/23/2003 NORTH Date.... '.``3�...b.-8 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... 1 v n til T` [ r � .?......... .. A .............................. has permission to perform ............A. t.`Vt .................................................. wiring in the building of ..... 2 r V,�........ j ...I- r? at .....�..�. ..`!...... ........S ...... , N(oh rAndover, Mass. s ELECTRICAL NSPECTOR 'r Check # y°@c 4586 Official Use OnI� Permit No. ?W5 (�d?lZ?yld72lU�rg1'?>�f d�?yL,gS.S L'? ItSc7?S Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 5277 CMR 122:00 (Please Print in ink or type all information) Date J � �d To the Inspector of Wires: Town of North Andover The undersigned applies for a/permit to perform the electrical work described below. Location (Street & Number Owner or Tenants Owner's Address Is this permit in conjunction with a building permit Yes CZE No ❑ (Check Appropriate Box) Purpose of Building /[ei� Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgm l ❑ No. of Meters New Service Amps Voits / Overhead ElUndgmd El No. of Meters Number of Feeders and Ampacity �C�r� l f 1-1� Location and Nature of Proposed Electrical Work Ic OTHER: /P, k 4:17 la.?— INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YESI NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) G (Expiration Date) l Estimated Value of EI cal Work Work to Start U G Inspection Date Resquested Rough Final Signed under the Pe aloes of perjury: t�s FIRM NAME . /^� iW LIC. NO. r 7,0 4�- �y731 �7/ �/ Bus. Tel No. �/ Address �9t �J Aft Tel. No. QWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusett General Laws. And that my signature on this permit application waives this requirement_ Owner Agent (Please Check one) / Telephone No. PERMITfEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grad ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring 4 No. Hydro Massage Tuds No. of Motors Total HP OTHER: /P, k 4:17 la.?— INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YESI NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) G (Expiration Date) l Estimated Value of EI cal Work Work to Start U G Inspection Date Resquested Rough Final Signed under the Pe aloes of perjury: t�s FIRM NAME . /^� iW LIC. NO. r 7,0 4�- �y731 �7/ �/ Bus. Tel No. �/ Address �9t �J Aft Tel. No. QWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusett General Laws. And that my signature on this permit application waives this requirement_ Owner Agent (Please Check one) / Telephone No. PERMITfEE $ (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations` Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for rry employees working on this job. Company name: Address City: Phone # Insurance. Co. Policy # Company name: Address City Phone # Insurance Co. _ _ Policy # Failure to secure coverage as re quired.under Section 25A or MGL 152 can lead to the anpositimr of criminal penaBie of.a�fine up to $1,500:oo T and/or one years' imprisorxnernas wag_as_c wA4xnaltiesinlhelarm-da-STDPYjK) C ORDERand_afxned_($IDDM)-arlay m -le— I understand that a copy of this statement may be forwarded to the Office of Imrestigations of the DIA for overage verification. ! do hereby certify under the pains and penalties of pegury that the #Awmabw provided above is true and correct Signature_ Print name Phone.# 0 Official use only do not write in this area to be completed by city or town offic iar City or Town Permits icensing. I] Building Dept E)Check if immediate response is required .n Licensing Board E] Selectman's Office Contact person: Phone #.- E] Health Department ` El \ Other