HomeMy WebLinkAboutMiscellaneous - 120 BERKELEY ROAD 4/30/2018 f 120 BERKELEY ROAD !per/
1
2101047.0-0081-0000. /
L-3cation ��� t?� /( E'/p`/ J?d
No. ` Date da
NOR7iy TOWN OF NORTH ANDOVER
AL
0. A Certificate of Occupancy $
41
Building/Frame Permit Fee $
Foundation Permit Fee $
s�cHust
e Other Permit Fee $
Sewer Connection Fee $
c Water Connection Fee $
TOTAL $
'] Building Inspector
136
3U 6$/17/99 13:28 32.00 PAI"
Div. Public Works
PERMIT NO. /OZ APPLICATION FOR PERMIT TO BUILD********N RTII ANDOVER, MA
M%$,ND. 0 „� 7� .1.0F.N0. 2. KECORBOFOWnLI1SLlll' DATE BOOK PACE
ulnei
St. R1)1V. LOT ND. /a560
t1 `c
j:i)f:Aii(IN PliftlOS6llFBlllll)ING A- �Q `act o� OPC1� Dmc_1 3
NA”" NO.OFSFORIEs SIZE
.J�.r+es a{ .�atiree- ��ss ��r -l�a oX/d� t�PPE�
'AYNER'S ADDRESS '2.V BASEMENr OR SLAB 1 1 q x /s-, /"p w t r-
ND RD
e e HvtiJf
AR('i 111"E(.'1''S NAME ! y. C r I_C� SII OF FI.(Y)(i TIMBERS �y" Id>- / 2 3
BUII DL•K'S NAME (� Yej C e, I,• SPAN
�
I)II"ANCE TO NEAREST BUILDING ?_ DINIENSI(NYS(1F SILLS
DISI"ANCE FROM S I RLE r ��•� /.'.�. DIMENSIONS Of I'OsI s �k
DISTANCE FROM LOT LINES-SIDES t.7 Iii REAR DIMENSIONS OF GIRDERS
ARTA OF Lor fR(NJTAGE °��7✓ ` 1IEICiI R OF F(x1NDATl(NI TI SICKNESS
ISOI)ILDIN(iNEW �� =SI%J=OF'IIX.)IING - ;�f .�JK a R U X
IS BUILDING ADDI"FION Nil NIAI"ERIALOFCIIIMNEY
1�4BMLDINGALTERATION /a0-CE!`��✓� - IS BUILDING ON SOLID OITTILLED LAND
WILL BUILDING CONFORM TO REQX IIREMENrl_S OF CODE ys 15 BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY ` IS BUILDING C(NNNEC-I".ED TO"[OWN SEWER
IS BUILDING CONNECT"ED TO Nn I'URAL GAS LINE
INS7li(-TIONS 3. PROPERTI'INFORMATION LANDCOST
ESI. BI-FX;.COS F o 00
PAGE 1 FII.I.OIrrSECTI(N1S 1-3 lSq/J qK EST. BLDG.COS[I'ERSo.FT.
ES 1. BLDG.COS PLA ROOM
iEl ELTRIC METERS MUST BE ON(XrrSll)E of:BUILDING S61'1'IC PERMIT No-
-%1-IACIIEI)GAKA(.ES.NIUSTCONFORE ,I'(()STATEFIRERE(iULA[IONS =. - 4., API'il1�KEDBY: C
PLANS MUST BE FILED AND APPROVED BYBI111.DINGIIJSPE(:ron BUILDINGINSPECTOR S� X39`j
DA'fL•111.1:1) OWNERS IE111. '[f t. 71
C(N'I R.I L•I.N
f � A -
C(N 1,R. 7 r►0 10 APR 1 51^ 1 1
SI/A]I IRE OI:UWNIJ?(It A01110RIIED AG1:N1"
I I.I.CA
i
111; S 3a (III HIIIII.GRAN 11.1)
I' `moi
19
r FORM U - LOT RELJfASE 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 SEs d- /4e sStd.v PHONE q7�`'6�r � '3 i
LOCATION: Assessors Map Number PARCEL
SUBDIVISION LOT (S)
STREET i3,er�$L44 aG ST. NUMBER %1-U
*****�OFFICIAL USE ONLY"*"
RECOM TIONS OF TOWN AGENTS: -
CONSERVATI&rADMINISTRATOII DATE APPROVED 14
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
Ili DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
ADD I
PUBLIC WORKS-SEWER/WATER CONNECTIONS I f kl E1vC L, 4',• sl:Ni
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
The Commonwealth of Massachusetts
( Department of Industrial Accidents
Office of fnyestlgaUens
? 600 Washington Street
Boston, Mass. 0 111
Workers' Compensation Insurance Affidavit
name: t G In a N J Q e Q k,4 t L -
location_ O r3 -c✓ K t y
city
phone#
C] I am a homeowner performing all work myself.
�am a sole proprietor and have no one working in any capacity
C] I am an employer providing workers' compensation for my employees working on this job.
Company name:
address...
city _
phone a-
msaranec co: policy#
I am a ole proprietor general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers' compensation polices: d`
company name:
address:
city:- nhone+f^
insurance Co.
Policy#
company-name:
address.
city: phone#,-
--7:
7777
insurance>co. pa�icy#
Failure to secure coverage as required under Section 25A of MCL 152 can lead to the imposition of criminal penalties of a fine up to 51400.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties
yof perjury that
Qthe information provided above is true and correc
Signature .�1= -_ (ee� Date yr / Q 9
Print name fi t c G ,ev d 12 e of ✓ C Phone# 9 IF b S-6— C 3
:-chcck
do not write in this area to be completed by city or town official
permit/license# 11Building DJ
C]Licensing ediate response is required c3Selectmen'C]Health Dep
phone#: 00ther
(r"ued 3195 PIA)
NORTH
Town of over
is
70` * -_ -� _- �� h
...... ...........
No.
;L Not
c� dover, Mass.,
ORATED P'? C,
BOARD OF HEALTH
Food/Kitcheno�Food/Kitchenitcitche_en
PERMIT T Septic System
THIS CERTIFIES THAT-14.1WO...16 e&J' BUILDING INSPECTOR
.................................... Foundation
tt
has permission to erect...R*.-MR..q.!....... buildings on.......tay..!p......a ........1�... ...... Rough
to be occupied as... * " ' * ........ 4, 14 V OV....... . v%K& Chimney
provided that the person accepting this permit shall in every respect conform to the..terms..of.the application.. . ..o.n..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. 1 #j 5 4) "% e 6 49 ^A PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
2 e C +� PERMIT EXPIRES IN 6 MONTHS Final
30 r? UNLESS CONSTRU CA'TI N ST4,RT ELECTRICAL INSPECTOR
6 C Rough
.......... ... ...................................... . ..... .......
........ (.....�-7 Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
No Lathing or Dry Wall To Be Done Final
Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENTBurner
Street No_
SEEREVERSE SIDE Smoke Det.
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VHS BANK rMr rnr DWZWjTc IS ,r.MTSD OM IN
MW LOT AS SH01N AMD nUr it DOGS CONFpIW
t ..vvcber.�'.BOalilVc REG11LErtoa/S �
=GLRDING ssra4cxs I'AOY SrAcrrs ! Lor LMS.'
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jou FBO x nOOD HAX"M ARU AS DRA XN FOR
�iO►N p 1rY PAJVrL i r S a Of
000�
S
1�IS P OR PURPOSE'S - NOT FOR "SER
99B
>OUNAARY p MINATION. BOUNDARY INFORYmom ME`RRrMACK ENGINEERING SERVICE'S
IAXVM FROM rXlSrla►G RXCORDS. 198 PARK STREET
,G,y,9 ANDOVRR, MASSACHUSETTS 01810
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