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Home My WebLink AboutMiscellaneous - 121 WEYLAND CIRCLE 4/30/2018I I Date. 2 //- G:) ...... TOWN OF NORTH ANDOVER 9 PERMIT FOR GAS INSTALLATION This certifies that .. )11-7....../�........... has permission for gas installation . �� rte. �..4 . in the buildings of ...!............. . at ... �. �.. �'.`y !.!�? n... c «..... , North Andover, Mass. c Fee.C.-2 Lic. No.. :_, . - —....... 4 aS INSPECTOR %� Check # /O 3 Z U 5,172 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING (Print or Typel GC Mass. Date 0� =to— Permit Building Location &i -Owner's Name -:2L-,,, Type of Occupancy New p Renovation p Replacement p Ptans Submitted: Yes❑ NOR Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET M Corporation 103C MIDDLETON, MA 01949 p. Partnership Business Telephone 9 7 8- 7 7 4- 2 7 6 0 Frrm/Co. Njum of Ueensed Plumber or Gas Fitter WILLIA R HARRIS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ®I No O If you have.checked yes. please Indicate the type coverage by checking the appropriate box A liability Insurance policy 13 Other type of indemnity O Bond D OWNER'S INSURANCE WAIVER:( 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 O signature o1 owner or Owner's 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 of my • knowledge and that all plumbing work and installations performed under the permit' for this application 41 be in comp with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge gy T of Ucense: 6�r Plumber Signature of Ucensed Plumber or Gas Fitter Tule Gasritter Baster License Number 3 7 8 5 City/Town Journeyman L h N yWj r! r tll v = a: = A N Of � ra ti Z O i Q e 0 Z 2 0 a; r S V1 t m &U W h al W O a. G < �< 6 W W dc s V N = W Q r 10 r 111 s r 0: car Z M Z tl h tW W J. < C~ W 0 s O= O 6 pp r N i C S O O S W iR o 0 V rC Y G h O Sus—BSMT, FA BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STN FLOOR 6TK FLOOR 7TH FLOOR BTH FLOOR Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET M Corporation 103C MIDDLETON, MA 01949 p. Partnership Business Telephone 9 7 8- 7 7 4- 2 7 6 0 Frrm/Co. Njum of Ueensed Plumber or Gas Fitter WILLIA R HARRIS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ®I No O If you have.checked yes. please Indicate the type coverage by checking the appropriate box A liability Insurance policy 13 Other type of indemnity O Bond D OWNER'S INSURANCE WAIVER:( 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 O signature o1 owner or Owner's 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 of my • knowledge and that all plumbing work and installations performed under the permit' for this application 41 be in comp with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge gy T of Ucense: 6�r Plumber Signature of Ucensed Plumber or Gas Fitter Tule Gasritter Baster License Number 3 7 8 5 City/Town Journeyman L Date. . 4/// ..... r 4) ,ORTk r TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that1` `.....`. .L' C.. .. . has permission for gas installati 6o in the buildings of 7/, // at//./.�� !./�-f �1':�. , North Andover, Mass. fLic. No... ........................... , ,✓ GAS INSPECTOR Check # �� J 4910 MASS APPROVAL # MASSACHUSETTS UNIFORM A 21111111101 VFW ar Typed G� e WIMI Naw O P&MA bolt (z iGASFITTING Perm, # 410 - 3 0, owner: r>ante 10-, —%I rYAe d —EQ 5; �oni-. � p Mu Sul matted: Yes(] No In"kV Company Name YANKEE GAS Check one: Cedfficate Address 140 SOUTH MAIN STREET I$ Corporation 1030 MIDDLETON F MA 01949 0. Partnership Business Telephone 9 7 8- 7 7 4 -2 7 6 0 L Firm/Co. Name o1 Ucensed Plumber or Gas Fater WILLIAM R . -HARRIS INSURANCE COVERAGE: 1 hake a etment Kabilty incur nce, policy or Its substantial equivalent which rheas the requirements of MGL C1r. 142- yes 42Yes C No O it you have checked Ye j. please indicate the type coverage by checking the appropriate box A liability insurance policy G Other type of indemnity ❑ Bond 0 OWNER'S INSURANCE WAIVER: t am aware acct the licensee does nct have the insurance coverage required by Chapter 142 of the Mass. Geral Laws. and that my signature on this permit application. waives this requirement. Check one: Owne{ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and irdorrmbon 1 have submitted (pr entmedf in ab7n aappkation we true VW aavrate to Vo best of my - knowledge and that all plumbing work and ir"lations pertained under the permit' for hS Wb all pwbwt provWona of am Massachusetts State Cas Code and Chapter 142 of the taws lay T of License: 'Title Pl Plumber gna r or er muster License Nunbw 3785 Otyfrown Joumeyman L b a a � . a p � a v = a ei W IS m � O C tll p F W Q e. C C >� t cc a all J F W C VA (� = 0 �. ? 6i Qi s. Q sue—esrT. OAseMeRT 1ST FLOOR I LI 2ND FLOOR *RD FLOOR 4TH FLOOR 61% FLOOR aTH FLOOR 7TK FLOOR tag `TH FLOOR In"kV Company Name YANKEE GAS Check one: Cedfficate Address 140 SOUTH MAIN STREET I$ Corporation 1030 MIDDLETON F MA 01949 0. Partnership Business Telephone 9 7 8- 7 7 4 -2 7 6 0 L Firm/Co. Name o1 Ucensed Plumber or Gas Fater WILLIAM R . -HARRIS INSURANCE COVERAGE: 1 hake a etment Kabilty incur nce, policy or Its substantial equivalent which rheas the requirements of MGL C1r. 142- yes 42Yes C No O it you have checked Ye j. please indicate the type coverage by checking the appropriate box A liability insurance policy G Other type of indemnity ❑ Bond 0 OWNER'S INSURANCE WAIVER: t am aware acct the licensee does nct have the insurance coverage required by Chapter 142 of the Mass. Geral Laws. and that my signature on this permit application. waives this requirement. Check one: Owne{ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and irdorrmbon 1 have submitted (pr entmedf in ab7n aappkation we true VW aavrate to Vo best of my - knowledge and that all plumbing work and ir"lations pertained under the permit' for hS Wb all pwbwt provWona of am Massachusetts State Cas Code and Chapter 142 of the taws lay T of License: 'Title Pl Plumber gna r or er muster License Nunbw 3785 Otyfrown Joumeyman L tf t Location % % (.,J No. Date ,SJACHU y TOWN OF NORTH ANDOVER Certificate of Occupancy $ V� v Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL i $ 7 U .: Mt &:59 150.40 PAID Milding Inspector Div. Public Works Z3 1 Location No. �� I� Date 745-9(01 �pRT1y TOWN OF NORTH ANDOVER • . pL « ; p Certificate of Occupancy $ Building/Frame Permit Fee $ JACMUS � Foundation Permit Fee $ Other Permit Fee $ 0. Sewer Connection Fee $ p, 633 Water Connection Fee $ TOTAL $ )71221%; 04 04110�? 9 161 2b,� 07 Buil ' g Insp for ' """'00RAID Div,,is u c Works •i Location /Zt /4aiD No. Date � q3� M57 TOWN OF NORTH ANDOVER Certificate of Occupancy, $ Building/Frame Permit Fee $� Fo tion Permit Fee $ Other Perr'a n $ Sewer iinf oJiVe $ V 99S,ny ction Fee $ TOTAL �R 0( ECTOR $ Building Inspector Div. Public Works 3 500, PER.IfIT NO. APPLICATION FOR PERMIT TO BUILD - PAGE 1 NORTH ANDOVER, MASS. MAP 4,10. LOT NC 2 RECORD OF OWNERSHIP (DATE BOOK iPAGE ZONEI SUB DIV. LOT NO. 15 1996 # ± m i LOCATION Lid of c e c be— PURPOSE OF BUILDING OWNER'S OWNER'S NAMEo X woo / OWNER'S ADDRESS • / J J / it r� �f' a J�v !% or yo S'7- NO. OF STORIES SIZE it BASEMENT OR SLAB 'WLoS-et-X e"7- o - ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST /�X�O 2ND ^1 X v 3RD f7 BUILDER'S NAME D OC Q `. �D v SPAN ! DISTANCE TO NEAR ST BUILDING/[� i DIMENSIONS OF SILLS /_ DISTANCE FROM STREETfl 0�l POSTS -- DISTANCE FROM LOT LINES - SIDES REAR GIRDERS f I� AREA OF LOT h n / FRONTAGE (1 V HEIGHT OF FOUNDATION 91 THICKNESS Jv i � IS BUILDING NEW v e V SIZE OF FOOTING / !� X A, IS BUILDING ADDITION A'� 0 MATERIAL OF CHIMNEY d SON r IS BUILDING ALTERATION I'v IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE y _ 77 IS BUILDING CONNECTED TO TOWN WATER YY s BOARD OF APPEALS ACTION, IF ANY ,y'/A '`� IS BUILDING CONNECTED TO TOWN SEWER Yl. s IS BUILDING CONNECTED TO NATURAL GAS LINE 11'e S INSTRUCTIONS- SEE NSTRUCTIONS- SEE BOTH SIDES iT PAGE 1 FILL OUT SECTIONS 1 3 PAGE 2 FILL OUT SECTIONS 1 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS t PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OFNER qJt AUTH IZ A NT ill //0. FEE PERMIT GRANTED 7-/719 3 PROPERTY INFORMATION LAND COST -rV EST. BLDG. COST?�IBLDG. COST / VV ((JJ !lJfIII EST. BLDG. COST PER SQ. FT. x/71 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BYYf�ff77 WILDING INSPUC'TOR OWNER TEL. # (o b `r" 3.` 7 y CONTR. TEL. # 6 6 �� 31 , 7 CONTR. LIC. # ) 6 Q b H.I.C. # 1 15 1996 # ± m 3 PROPERTY INFORMATION LAND COST -rV EST. BLDG. COST?�IBLDG. COST / VV ((JJ !lJfIII EST. BLDG. COST PER SQ. FT. x/71 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BYYf�ff77 WILDING INSPUC'TOR OWNER TEL. # (o b `r" 3.` 7 y CONTR. TEL. # 6 6 �� 31 , 7 CONTR. LIC. # ) 6 Q b H.I.C. # SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER 6 FRAMING WOOD JOIST aL FORCED HOT AIR FUI BUILDING RECORD 1 OCCUPANCY STEEL BMS. & COLS. 12 = HOT W'T'R OR VAPO WOOD RAFTERS _ THIS SECTION MUST SHOW EXACT -DFMENSIONS bFLOT•AND DISTANCE FROM ` SINGLE FAMILY PIES-- - MULTI. -FAMILY UNIT HEATERS GAS OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS a — -RAGES, ETC. SUPERIMPOSED. THISREPLACES PLOT PLAN.•' - CONSTRUCTION' : 2 FOUNDATION -' .I '8 • INTERIOR' FINISH' CONCRETE dt -- 2 I3 ` + �•. f mac. CONCRETE BL'K. PINE BRICK OR STONE HARDW'D PIERS PLASTER _ DRY WALL — � UNFIN. 3 BASEMENT I s AREA FULLFIN. B M'T' AREA NO B M T `FIN. ATTIC AREA FIRE PLACES - + HEAD ROOM MODERN' KITCHEN L _ 4 WALLS CLAPBOARDS I 9 FLOORS DROP SIDING I CONCRETE B 1 22 J —I— 3 •' WOOD SHINGLES EARTH ,�� ASPHALT SIDING • HARDIN'D _ _ _ ASBESTOS SIDING _ COMMGN 7�— VERT. SIDING ASPH. TILE STUCCO ON MASONRY 1�_ STUCCO ON FRAME` BRICK ON MAS NRY- ATTIC STIRS. & FLOOR BRICK ON FRAME ' I— CONC. OR CINDER.BLK. STONE ON MASONRY WIRING STONE ON FRAME, ., SUPERIOR POOR I ADEQUATE e NONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET — ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER 6 FRAMING WOOD JOIST I 11 HEATING PIPELESS FURNACE FORCED HOT AIR FUI TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPO WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B- 'T 12nd I Ist 3rd ® ELECTRIC NO HEATING PER11IT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP d40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK .'PAGE ZONE SUB DIV. LOT NO. �— LOCATION j f t /^ r u e— PURPOSE OF BUILDING )% /_ ! f„S. „/. OWNER'S NAME NO. OF STORIES /I1 SIZE OWNER'S ADDRESS/ s BASEMENT OR SLAB ;has ew letAT ARCHITECT'S NAME .t Q 2ND Xi o 3RD SIZE OF FLOOR TIMBERS IST P-XfD t7 BUILDER'S NAME .re, X (A )oa elAN ;t Coro ,• .� I^ 1 T.i DISTANCE TO NEAR ST BUILDING �j� I DIMENSIONS OF SILLS -- / DISTANCE FROM STREET Y �"7 " POSTS ��SQ --_ DISTANCE FROM LOT LINES - SIDES /i.,.... REAR I'^!. J1 + 1jj " GIRDERS II AREA OF LOT. }� Jf J FRONTAGE �,.y..�- HEIGHT OF FOUNDATION y THICKNESS IS BUILDING NE - SIZE OF FOOTING s�•S X A, IS BUILDING ADDITION fV ,� 'j 0 MATERIAL OF CHIMNEY IS BUILDING ALTERATION Ii) I V IS BUILDING ON SOLID OR FILLED LAND 3 o � WILL BUILDING CONFORM TO REQUIREMENTS OF CODE !1 vp Y IS BUILDING CONNECTED TO TOWN WATER Y BOARD OF APPEALS ACTION. IF ANY A IS BUILDING CONNECTED TO TOWN SEWER (f Y S IS BUILDING CONNECTED TO NATURAL GAS LINE r t r S INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST :AGE EST. BLDG. COST PER SQ.EE BOTH SIDES EST. BLDG. COST E 1 FILL OUT SECTIONS 1 - 3 ALJ PAGE 2 FILL OUT SECTIONS 1 - 12 EBT. BLDG. COST PER ROOM SEPTIC PERMIT NO. A40ELECTRIC METEP6 MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY -'r ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS ' PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED NUILDINO INSP[C` * SIGNATURE OFW�NE�R �t�4UTHOJIiIZEp ANT F E E OWNER TEL. ✓<J PERMIT GRANTE CONTR. TEL. # 6 Cn � • � ! % 7/ 19 CONTR. LIC. J1 H.I.C. # BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYSiOkIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION I 8 INTERIOR FINISH CONCRETE PINE B 1 2 13 CONCRETE BL'K. BRICK OR STONE HARDW'D PIERS PLASTER ORY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA _ 1/1 1/1 % FIN. ATTIC AREA N8 M'T FIRE PLACES T _O HEAD ROOM MODERN KITCHEN ?7 L 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE B _ 1 T 2 �_ 3 _ DROP SIDING WOOD SHINGLES EARTH ASPHALT SIDING HARMU'D ASBESTOS SIDING COMMCN ASPH. TILE VERT. SIDING _ STUCCO ON MASONRY STUCCO ON FRAME _ BRITK ON MASONRY BRICK ON FRAME ATTIC STRS. 8 FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I_;�POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd 0 ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 0 z W o Q O c� aG cn r., z z a PG v U m w a w � z � w z C V) a v � U) w p U cz w w w Qa c;, G E CL N O N R cm co Ql C OD O O7 C .F O N m O Z 0 Q J 0 W 0 CD O CD O O V Z CL CD O W D � W cm C y p 'C CD co) CL O •g m m co 0 CD co O i C? Q) ® L CC 00- 136. y C C) R 0 J W "FL o W C cc •C C _c d CO) m m L L 0 C m J L C y W co E m :mo : CL y m m N d C t m O V Z A O � Q m C i mCD CD W_ C 'O CD L1. co U m C O- C A y H = Z Q- E CL N O N R cm co Ql C OD O O7 C .F O N m O Z 0 Q J 0 W 0 CD O CD O O V Z CL CD O W D � W cm C y p 'C CD co) CL O •g m m co 0 CD co O i C? Q) ® L CC 00- 136. y C C) R 0 J W "FL o W C cc •C C _c d CO) Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name"of Applicant on Building Permit (below) Address of Property for Permit (below) _%2Z GvP- v L d d (« c- /e Map and Parcel: Purp se of p ication (check below) Ph9n1yTpe of Applicant: Single Family _ Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning yla . This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This app!ication represents a lot which is ready for building permits,(i.e. all other permits from all other boards and c,)rnmissions have teen received and the -project is :n compliance with those permits), and the Development Schedule uoes not accommodate issuing a building permit in that Year, one building permit will be iszu3d per Year per Development until such time as the Development Schudicile accomn ac.ates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowle a or not is grounds for ref al by a Building Department to issue a Building Permit. S#wAr6'of_OT4ner or Auth rized Agent who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit. wE yGA,�/D C i,e C L� �,eaPpSEO ,yovs�'. Goco Tac/ A.S/D PLAT �°GA.t/ /N i(/a. �.vva✓E.e �•4 ss . OZ4,/KV ,cMe 7 9G OAT(; �E��/�AG� E.t/G�•dEE.P/.[/G 9E•PY/lES 6G P-4.P.E� ,ST.PEE"T A.t/OOYET �1.4S.S.4G%l/SETTS O/8/O 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: ;7ezLc,�� '�C z7y "o Phone LOCATION: Assessor's Map Number / Subdivision T6,Y 6 Street'�- Parcel Lots) ( v St. Number ************************Official Use Only************************ OF TOWN AGENTS: Com ervati4n Administrator omments 11 1� MW Town Planner' - Comments Date Approved z Date Rejected Date Approved Date Rejected Date Approved Food Inspector -Health Date Rejected Septic Inspector -Health Comments Date Approved Date Rejected Public Works - sewer/water connections L N ) 7-15-q6 - driveway permit Fire Department ' LV Received by Building Inspector t f 1 (� �l W1 tDate JUL 15 I k v 0 b 4) M M O z m S`. v C � mm N C ;C O Q c t v o 0 aI c 1 N'C m 13C.3 a C. N co 0-4 u O v O C a 0 a W 0 G v E w cn as c nn�y�L cn cn v 0 W CD O OC �- O o � Z °D O. O y G C CD cm C ca CA O �O -FE m m CD ow CL — *-0 CD o L CC O 0. CL CMQ o Cc vCc J-0 O CA C Z CD 0 CL L) CO) C !C — C cc C � mm N C ;C O Q c t i o 0 IS 1 N'C m 13C.3 C. N co N E CD (� as E a as c nn�y�L y E_ EM'S Q ��II Q,CL tv: \ 1�j.[ V r2+ �/`s•�' v 01 0 W CD O OC �- O o � Z °D O. O y G C CD cm C ca CA O �O -FE m m CD ow CL — *-0 CD o L CC O 0. CL CMQ o Cc vCc J-0 O CA C Z CD 0 CL L) CO) C !C — C cc mm N Q cm m i. IS N'C m N co N E CD 6e` na N N N EM'S Q ��II Q,CL � 2 cc =0C2 n o. D _-- •N C ~ oc E C.t C=3oco,N LU m En m U C_ p y C. G3 o C =ZZaZm OL y C 0 W CD O OC �- O o � Z °D O. O y G C CD cm C ca CA O �O -FE m m CD ow CL — *-0 CD o L CC O 0. CL CMQ o Cc vCc J-0 O CA C Z CD 0 CL L) CO) C !C — C cc CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 335 Date NOVEMBER 1, 1996 THIS CERTIFIES THAT THE BUILDING LOCATED ON 121 WEYLAND CIRCLE MAY BE OCCUPIED AS SINGLE FAMILY DWELLING IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO ADDRESS 733 Turnpike St. Nor i clover, MA Building Inspector ---N BUTTERWORTH & O'TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY claimsAbutterworthotoole. com SALEM, MA OFFICE P.O. Box 8294 SALEM, MA 01971-8294 A 7CEIVED TEL: (978) 741-5731 FAX: (978) 740-9109 JAN 0 5 2009 REPLY TO: TOWN OF NORTH ANDOVER HEALTH DEPARTMENT January 2, 2009 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAW, CH. 139, SEC. 3B TO: Building Commissioner or Inspector of Buildings ADDRESSES SALEM, MA OFFICE P.O. Box 8294 SALEM, MA 01971-8294 Board or Health or Board of Selectman TEL: (978) 741-5731 FAX: (978) 740-9109 REPLY TO: El City/Town Hall City/Town Hall North Andover, MA 01845 North Andover, MA 01845 RE: INSURED: Anthony and Aricia Makkinje ADDRESS: 121 Weyland Circle North Andover, MA 01845 POLICY NO: BHH10001771129 LOSS OF: December 29, 2008 FILE NO: 083-1465 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 Law Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen Law Chapter 139, Sec. 3B is appropriate, please direct it to the attention of the writer below and include a reference to the captioned insured, location, policy number, date of loss and file/claim number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Paul Trainor Adjuster BUTTERWORTH & O ' TOOLE, INC. SALEM, MA OFFICE P.O. Box 8294 SALEM, MA 01971-8294 TEL: (978) 741-5731 FAX: (978) 740-9109 REPLY TO: Fx January 2, 2009 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY claims(&butterworthotool e. com RE IC VL:LJ JAN 0 5 2009 SALEM, MA OFFICE P.O. Box 8294 SALEM, MA 01971-8294 TEL: (978) 741-5731 FAX: (978) 740-9109 REPLY TO: TOWN OF NORTH ER HEALTH DEPARTMENT FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAW, CH. 139, SEC. 3B TO: Building Commissioner or Inspector of Buildings ADDRESSES City/Town Hall North Andover, MA 01845 RE: INSURED: Anthony and Aricia Makkinje ADDRESS: 121 Weyland Circle North Andover, MA 01845 POLICY NO: BHH10001771129 LOSS OF: December 29, 2008 FILE NO: 083-1465 Board or Health or Board of Selectman City/Town Hall North Andover, MA 01845 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 Law Chanter 143, Section 6 to be applicable. If any notice under Mass. Gen Law Chapter 139, Sec. 3B is appropriate, please direct it to the attention of the writer below and include a reference to the captioned insured, location, policy number, date of loss and file/claim number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Paul Trainor Adjuster