Loading...
HomeMy WebLinkAboutMiscellaneous - 124 PHILLIPS COMMON 4/30/2018 (2) 124 PHILLIPS COMMON 210/058.0-0047-0000.0 k r j Date....... a........ .. °�t •�"° TOWN OF NORTH ANDOVER ° PERMIT FOR WIRING ACHU 'This certifies that .................................................. ......................... .......... has permission to per ... ..`! � wiring in the building of '� .2. ............................................... at........I 'c?/.A,,,/G/I/--S .... . .7y17ti,! i1 5 .North Andover,Mass. Fee...a'�R........... Lic.No..7SS j............... (�1.. .. ELECTRICA_L INSPEC�7'OR Check # - 7 Cf MrMnlU646A or///aldachadA Official Use Only t� (� Pormit No. tCq 2- 7 21aparttnant o1Jire services BOARD OF FIRE PREVENTION REGULATIONS- Occupancy and Fee Checked r cv, 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accoldenee with the Massachusdts Electrical Code(MEC),527 CMR 12.00 (PLEASE PMT IN INK OR TYPE_ALL IN.F01a"TION) Date: City or Town ofi XA,; Ane; veT- To the Inspector of Wires: By this Application the undersigns gives notice of his or her intention to-perform the electrical work described below, Location (Street dt Number) / (f.0 yyt &7 o Y1 r Owner or Tenant _ g r l�' �g r y Telephone No. Owner's Address Io2 ti Ph, Is this permit in conjunction with a building permit? .Yes No ❑ (Check Appropriate Box) Purpose ofBuilding Utility Authorization No. Existing Service WOO Amps /,�o /„hyo Volts Overhead❑ tlpd rd.may _. g Ur! No.of Meters New Service Amps / Volts Overhead❑ Und rd B ❑ No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t Com lesion o the fp1lowin table may be waived b rhe lar ector o Wires. No.of Recessed Luminaires No.of Ceil.•Snsp,(Paddle)Fans o'o ors Transformersq No.of Luminaire Outlets No.orflot Tubs Generators o WA No,ot,Luminalres - Swimming Pool ove.❑ e- o,o mergency ig Ing Ind." d. Datte Units No.of Receptacle Outlets, No..of Oil Burners a. FIREALARMS of Zones No.of Switches _ - . ..., . No.of Gas Aurners No.of wracrtion an —Initi'ating Devices No.of Ranges No.of Air Cond. Total Tuna No.of Alerting Devices No.of WasteMisposers Host Ilump um er ons K o.o Se - ontalned Detection/Atertin Devices No.of Dishwashers Space/Area Heating KW Local❑ un Gips Connection ❑ Other No.of Dryers Heating Appliances XW Security ystems: No.of waterKW o,o f o,o No.of Devices or Equivalent Heaters Signs Ballasts Data Wiring: No.Hydromassage Bathtuhs No.of Devices or E uivalent No.of Motors Total tip a ecommunica ons firingg: _� OftfER: No,of Devices or E uivalcnt.. . t �rraeh additional demi!V desired ar es revelred by the Inspector of Wirer. Estimated Value of Electrical Work:��e o, — Work to Start: (When required by municipal policy,) Inspections to be requested in accordance with MEC Rule 10,and upon complafon. i.NSURANCF COVERAGE: Unlcss waived by the owner.no permit for the performance of electrical work may issue unless the licensee provides proof of liability.insurance including"completed operatioh"coverage or its substantial equivalent. The undersigned certi.lies that such cage is in force,and has exhibited proof of same to the permit issuing office. ov CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) 1 certify,under rhepalrrs and penaltlev of perjary,that the information an ehls application is true and complete. FIRM NAME: Licensee: Le-hgrd �eauso/et'� Signature LIC.NO.: ({fanpficahle.enter exem an the Iceme namberline.) 1 LIC.NO.:Z_, Address: , d?ge_� r� �Sz1" a well .�z lS`-� ;Bus.TeL No.- `Per M.G.L.c ]47,s S7 61,sccurry work regwres Department of Public Safety"S"License;`Alt.TelLic..N.o,t7� sem, Ze OWNER'S W9U.1tANCE WAIVER: 1 o. em owae that the Licensee does not have the liability insurance coverage normally required by;.law. By my signature below,I.hereby waive this requirement�I'am the(check one owner, Owner/Agent ❑owner's a ent. Signature , Telephone No. PF.R1t11T FEE.•>T .' . .., / v � `� M . .. _... _.,.... . . �::_:..�w. .... . . .. . .. ;`� ., Date. .3 .31v.g. . . ... . . NORTH of '` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation .,;�. . .L� in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . ,� .�/. . 1.�.t %'. !.C� ` `: .```.��. . North Andover, Mass. Fee. . Lic. No:. n. . . . . . 6 9- 1 C� U GAS INSPECTOR�� Check# �( 6712 MASSACHUSETTS UNIFORM APPUCATON FOR PERNW TO DO GAS FITTIlVG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date 1- -;7: ( Z - 0 Building Locations _ �'l o Permit# Owner's Name Amount$ New Renovation Replacement ❑ Plans Submitted w u OV m N F z , °m w Q �- a v w x �, 0 r c a e d w z F w w �/ w C w > 5 r F" rA Z F W C � W J m o x LT. e a ; o o W y s SUB -BASEMENT 3 C > BASEMENT IST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR - 6TH'. FLOOR 7TH . .FLOOR 8TH .' FLOOR . (Print or typt� Name_ c/ Check one: Certificate Installing Company Corp. Address D �0 'Lvr�z ❑ e Wk . e 7o ❑ Partner. usmess I a ep one Go15 - 0-Fi/Co. Name of Licensed Plumber'or Gas Fitter IA- INSURANCE A -INSURANCE COVERAGE I have a current liability Insurance,policy or it's substantial equivalent. Check one: If you have checked yYes please indicate the type coverage by checking the appropriate box No Liability insurance policy ®�" Other type of indemnity D `-+ Bond ❑ Owner's Insurance Waiver: lam 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. e accu Signature of Owner or Owner's Agent Check one: hereby certify that all of the details and information 1 have submitted Owner to ❑ Agent 13 best o tted(or entered)in above f m knowledge e application Y . g and that all plumbing work and installations perform\eed under Permit Issued for this rappl cation will be in.and rate the compliance with all pertinent provisions of the Massachusetts State Gas ode and Ch er 142 of the General Laws. Title -Signature of Licensed Plumber Or as,Fitter ❑ Plumber 2 t C (J City/Town,, ❑ Gas Fitter icense um er ❑ Master _ APPROVED(OFFICE USE ONLY) Journeyman 4 a i Location IGT 1 l7- /-�4 No. � Date T' 4oRTFj TOWN OF NORTH ANDOVER . " p Certificate of Occupancy $ Building/Frame Permit Fee $ �►,�p',,.°''�� Foundation Permit Fee $ ►� !�� °-=- s�cMusE _ Other Permit Fee $ Pt, ewer Connection Fee $ T-o Water Connection Connection Fee $ PD- O- TOTAL $ (�O G � Building Inspector C Div. Public Works No. 7:3 Date 4 "ORT11 TOWN OF NORTH ANDOVER cp Certificate of Occupancy $41 � Building/Frame/Frame Permit Fee $ .a 9 � oundation Permit Fee $ SSAcMUSE i rmlt Fee $ N �� Sewer" tion Fee $ 4?t/V0,4� *'Connection Fee $ 'Yoker/TO 'Yoker/TOTAL $ o Building Insp4Ef0—r "' ! Div. Public Works Locution r � ��l//f '!/✓1 No. Dated a ' NORTM TOWN OF NORTH ANDOVER # » Certificate of �pancy $ + i • , Building/Frame Pel;ft e $ Foundation Periv}t�Fee y s�C usE Other Pe fit Fee ?4I $ ' j�► Sewer Co®r1 i ee #/Z Z.Water Connection P&00/001 TOTAL { Building Insp , r Lin/7 Works' Y� T NO; Z73 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /� �l I� PAGE 1 MAP K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ZONE I SUB DIV. LOT NO. LOCATION _ " Z P RPOSE OF BUILDING .: OWNER'S NAME VU, N � NO. O STORIES ? 1 SIZE T, OWNER'S ADDRESS�33ASEMEN OR SLAB ARCHITECT'S NAME Vj ! SIZE OF FLOOR TIMBERS 1ST .- M b 2ND h� 3RD BUILDER'S NAME { /n I„ ` ` SPAN �C/ DISTANCE TO NEAREST BUILDINGIJ�/� �A�r DIMENSIONSOFSILLS-A- DISTANCE FROM STREET /\ POSTS C�l J DISTANCE FROM LOT LINES-SIDES C26 ( REAR '1n� " GIRDERS S v / 2_ AREA OF LOT I C 5-bo ��2, FRONTAGE HEIGHT HEIGHT OF FOUNDATION Q t/` THICKNESS IS BUILDING NEW Ot 9✓e� too SIZE OF FOOTING 1 lC � ! ( X G� IS BUILDING ADDITION M A \O MATERIAL OF CHIMNEY IS BUILDING ALTERATION x \/V IS BUILDING O SOLID O FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY 1 1 IS BUILDING CONNECTED TO TOWN SEWER e--s �J IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS (�p�� / R 3 PROPERTY INFORMATION PERMIT FOR FOUpIFpiL�H9I{��i}A®V LAND COST 600 SEE BOTH SIDES REGULATED 9Y PARA. 114j— ► ILC% EST. BLDG. COST. 2 0 //,�-l/DO s EST. BLDG. COST PER SQ. FT. PAGE 1 FILL OUT SECTIONS 1 - 3 z,PAGE 2 FILL OUT SECTIONS 1 - 124 U� EST. BLDG. COST PER ROOM NATE °2" -�y FM PAID �00 �s SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY y ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS ' PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH SIGNATURE OF OWNER O AU $f IED AGENT FEE " OWNER TEL.# � � PLANNING BOARD PERMIT GRANTED CONTR.TEL.# — CONTR.LiC.# 9 o_o t� Sd BOARD OF SELECTMEN BLDG.FERMe'KE a 2bfs — p -r�A ►T Ana FPAWRI7T 010 LESS FDA FEE *V DUE FRAME PERMIT$ 11 b8 BUILDING INSPECTOR DATE: ?—?-9ZFEE PAID % Je, w BylLDING RECORD 1 OCCUPANCY , 12 ; , ; ' SINGLE FAMILY SPORIES �THjS SECTION MUST SHOW EXACT DIMENSIONS OF LOT.AND DISTANCE FROM s MULTI. FAMILY OFFICES,, —_ ,''LOT LINES AND EXACT'D-IMENSIONS'OF BUILDINGS. ;WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPbSED.;THIS REPLACES PLOT%PLAN.- ' CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE __ t I I ,2 I3T CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL 3 BASEMENT AREA FULL FIN. B M AREA '/. 1/2 °/, FIN. ATTIC AREA ' NO BMT FIRE PLACES HEAD ROOM _ MODERN KITCHEN `i 4 WALLS I .'9 '`. FLOORS •'i ° CLAPBOARDS t 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ �_ ASPHALT SIDING NARDVJ'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE —{I_ STUCCO ON MASONRY: VUr 901 IVij`l STUCCO ON FRAME I ' T BRICK ON MASONRY " 'ATTICSTRS. &-FLOOR I_ ,; it ARAI f.'ii'1�•.f„ T BRICK ON FRAME - CONC. OR'CINDER ILK. STONE ON,MASONRY', WIRING STONE ON FRAM SUPERIOR POOR _ - CA ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ \ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ ILE FLOOR TIE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPE LESS F ACE a; �: FORCED HOT Al URN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS NO. OF ROOMS GAS OIL s`t�r'�7J111t{.etj`J B'M'T 2ndELECTRIC wd i•+ " t!I•�T• �-t r i.r - -- Ist -37-13rdI NO HEATING r f FINA L >1 ORTpj L� L f own 0 Andover No. 2 7(3 ko 1942er, Mass ., BOARD OF HEALTH PERMIT T LD 74k; .... ............. ................ •THIS CERTIFIES THAT................ 4R.MtrtRP . 6er, BUILDING INSPECTOR has permission to erect W!M*D.F"00.EbuildinFs Rough I Chimney k-3 ...Pft.UA to be occupied as................ tlo� .. . ... ....... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the InspectipfRNN%Wt6CQff6Wction of Rough ONLY Buildings in the Town of North Andover. REGULATED BY PAU 114j.& JC, Final VIOLATION of the Zoning or Building Regulations Voids this Permit. pp M(q%a&_4 Akff F PAID& ELECTRICAL INSPECTOR PERMIT EXPIRES IN 6 Rough UNLESS CONSTRUCTIML STA TS Service:". PERMIT FOR FRAME/BUILDING L&4 Final .......... .. ... ........ .................................. DATE: FEE PAID' BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner SMEU NO. No Lathing to Be Done Until Inspected and Approved by Smoke Dot. %M Building Inspector Aso w. l r FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM .ti . SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADDRESS ASSIGNED BY D.P.W. y Z STREET no -- APPLICANT S . PHONE DATE OF APPLICATION f ) Z TOWN USE BELOW THIS LINE PLANNI G BOARD TOWN CANNER DA'L'E APPROVED ��J� DATE REJECTED CONSERVATION COMMISSION CONSE ATION ADk N. DATE APPROVED llATE REJECTED Ell BOARD OF HEALTH DATE APPROVED 6v /1/ HEALTH SANITARIAN llA1'E REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS e fut FIRE DEPT.A"n L�_.9 1 RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and health Boards, the Conservation Commission prior to the issuance of any building permits -for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. LO7-0/7 ` 0 c Col 130.3 0 �� � }�� � AN /NST.2.//MENT SveyE �� JUN 2 4 1992 B tILDIMIG, DIED R @tri' N` , I � r NE.PEBy CE.PT/FY TO TyE TITLE/,!/SU•PO.P ANO BLOT , L,4,,tl TO THE BAN.( T//qT TvE On'E[L/uG /S [OCATEO O.V T//E GOT.qS S/fOIrN A.t/O T//,yT/T/JOSS CD.t/FO.P/Y1 /N ' !Y/Tfi/ Tf/E 727G/N OFNO. An/DovS.e ZON/.vG .eE6ULAT/O.1/,S �O /I r� REGvORO/.✓G SETBAC�t'S F�O�STPESTS E ea,- M/ OTM/ Tif'E FEOE.P.4L F[000 H9Z.4P0 APE 4. /OJ�AN�/V FD,P ►S,yew�!o/t/F MM!/N/Ty P.4NGG ALI �.t/!LL/�S G.,OnJMQ.V �E rECQG.►�E�t/T LSN Of Mq zsoa 98 SSB C'ae� 6/�s183 9 N ' � ESSit✓ P T/i//S Pf ®,gt�k AGE O�ePOSES- �/OT FDP Bovvo.Psi riov_ Bo�,vo.aes�/.v.�o,P.ys- �E.P.P/�1.9GY E'.f/GidEE.P�.c/G SE.PI�/lES ,47-1041TA.t'E.y F,PO,yJ EX/STi,�/G PE-Co,PpS. 66 �q,e, - ,s'T,PEET • ,A.t/ODYE�P, �/'QSS,4�s/vSETTS o/8i0 ,i CERTIFICATE OF USE OCCUPANCY '1r r �C ' w �.., j F� 1 .�,. ! t -t oi_Ei � Building Permit Number 2 7 3 Data SEPTEMBER 2 4 , 1 9 9 2 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1 2 4 PHILLIPS COMMON ( Lot # 17 ) MAY BE OCCUPIED AS S I N G L F$ F A M I L V DWELLING ( type C ) IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. i OF 14ORTH 9ti 32h< CERTIFICATE ISSUED P h i t t i p z Common D e v . C o n p . :.. . '. _ 733 Tun.npie St. ADDRESS Nonth Andoven MA SSACHUS' j Building Inspector 4 IN PLANNIN AL A I 7 r, ' ORTIj V wn 6 0 f® -0 ' Andover 0 rn No. 27 3 p d"t b 130 0 Ir/ � Andover, Mass. A4 19 Tf. , -••! / orPAj ( - HE-ICK BOARD OF HEALTH ' PERMIT TcrB,PFL U I LD R6 LL J?'s.... ..!�bgp.................. THIS CERTIFIES THAT.....................I BUILDING INSPECTOR has permission to erect buildings onAof.*1a..7.701W.'ft" ...0.�cW-406Zll Rough eis��ial Cal Chimney .!0....... O-Z io, t6 be occupied as.................. kL�...h"R;LL/4'Q-, Final - provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in -.;2 PLUMB17GG 1�4PECTOR t9 this office,and to the provisions of the Codes and By-Laws relating to the InspectiprRMff*WWdAfijj(&ction of to 1, _9 010 Buildings in the Town of North Andover. REGULATED BY PAPA 114A& JL& a 4, VIOLATION of the Zoning or Building Regulations Voids this Permit. 00 60�� PAI INSPECTOR PERMIT EXPIRES IN 6 M `� L,-N j �j (J.- _F_SS CONSTRUCTION STAFTI-; ServicRoughe) PERMIT FOR FRAMUBUILDING Final 00 .......... ............... .................................. I DATE: �_ VFEE PAID-AHOK6 !'7' BUILDING INSPECTOR GA INSPECTOR Occupancy Permit Required to Occupy Build'ItIg Rough q in Display in a Conspicuous Place on the Premises Do Not Remove Burner STREET NO. No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building inspector 'Co •Location /--9�71 1� - --Y - No. 13/j Date NOR, TOWN OF NORTH ANDOVER f 0 F - ., A * ; : Certificate of Occupancy $ Building/Frame Permit Fee $ j .. s�cHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 C 5 9 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING ft L wy BUILDING PERMIT NUMBER: C2 Y60, DATE ISSUED: ���® CM®� M SIGNATURE: M g Building Commissioner for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O icy I7h; 11 cGYnwon y Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning DisU c­t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RecIttired Provided Reqtiired. Provided I d Z 1.5. Flood nformation: 1.8 1.7 Water Supply 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 �� t 7 e 0-�cnR.\ JA4 -�11�1 ��I1OS �rl�c rQ o (Print) Address for Service: c G , Signature- r lephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ o 11, Licensed onstruction Supervisor: (37 5 6 3 3 0 License Number Address 1 0 Expiration Date Si e gna re Telephone �.. 3.2 Registered Home Improvement Contractor Not Applicable ❑ i ] ' � >b2 t S' M Company Name I I A9 10R Registration Number rM Address Expiration Date Signature Telephone y♦ Kr l 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 rmit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Desch tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 1 Set, Yllktu'��a S kcrc SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to bex s � OFFICLAL"USEQNLY Completed by permit applicant rte, 1. Building / 06 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of /A Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC 5 Fire Protection 14 6 Total 1+2+3+4+5 of Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OW GENT OR CONTRACTOR APPIAES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize L,jG'r G 9 of to act on My behalf,in all matters relative to work h1horized by this building permit application. Signature of Owner Date SECTION 7b OWNER//AAUTHORIZED AGENT DECLARATION I, %Tf' L L , 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 ° v Print e 19 5 - 16- 00 Si ature of wner/A e Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL,OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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. APPLICANT �1A(��C � L —�C, R� PHONE(a ���_ 6 I ASSESSORS MAP NUMBER �J LOT NUMBER q SUBDIVISION LOT NUMBER STREET ?�I; I i P S &ny-vo n STREET NUMBER I��1 ............................................■.............................■ OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTSJ2�nj v� y(s i--�G rc /L �100 00028T140-2,000 mom DATE APPROVED fo C01491ERVATION ADMINISTRATOR DATE REJECTED COMMENTS I DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-ETH DATE REJECTED DATE APPROVED SEP E R-HEAL DATE REJECTED CONOAENNTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED CONMMNTS RECEIVED BY BUILDING INSPECTOR DATE CAMERON BROS. INC. 567 P02 SEP 17 '92 07:52 REGISTRY: L35I-?C NOKFH TITLE REFERENCE: PLAN REFERENCE: PI-A W µa . l l 9 9 8 AF •rrl r 7�CPO S � I b t'�oposEA T o Y 0 n i4 0 p' s o m y �42,,-z 00 COMMON 2 4 96 This plan was not prepared from an instrument survey. MORTGAGE pip Y p L A N Offsets and distances shown should not be used to establish property lines. LOCATION This pian iS intended for mortgage purposes only. N©Kr" AWOOVER, NIA I certify that the structure shown on this Plan '"_ r in conformance with zoning setbacks SCALk� DATE: 9"f Z -`�Z in effect at the time of construction. CERTIFItL)TO: I certify that the parcel shown is-YQT located within 1 t�1N N6 R? a flood hazard area as depicted on HUD FIood Insurance Rate Maps for Community No:a-9'00 2<8 _ C0 o CAMERON BROS., INC. Job No. MALDEN, MAsMCIHUS=TTS _ 1� ----------* J ��* co"ZI -- --- - -- Ar- C i , Nz- Im. iffs"Now"m mum"Sopupwom Ir - - --- - -- - - - - --- -- - - - -- -- - - -- -'-- --- - -- - - - _ - -- 1 1 i ---- - - -- _ .._ - - - . ------ - - - -_ --- - ---- ----- ----- -- -- .. _.---------------------- - ---- - - - i - 1 - 1 �it.4LQQL�j �5 SG li i�. .� '7�oq (CM) S21 - 9a . �� -Cam�� I I rd of Building Regulations and Standards I One Ashburton Place - Room 1301 I' Boston , Massachusetts 02108 I Home Improvement Contractor Registration I I Registration: 129109 Expiration: 7/7/01 Type: Individual I OME IMPROVEMENT CONTRACTOR Registration: 129109 STEPHEN R . CAPPELLA j Expiration: 1/1/01 STEPHEN CAPPELLA I ,. Type: Individual 31 ELEVENTH HAVERHILL MA 01830 STEPHEN R. CAPPELLA STE�P�HE�N CAPPELLA VLEVENTH AVE. ADMINISTRATOR HAVERHILL MA 01830 91tei Board of Building Regulations One Ashburton Place Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 09/28/1952 Number: CS 075633 Expires:09/28/2003 Restricted To: 00 STEPHEN R CAPPELLA 31 ELEVENTH AVE HAVERHILL, MA 01830 Tr.no: 75633 Keep top for receipt and change of address notification. 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations , Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: fa'Z� i l 1 S C�fJYf'11MGY'1 City 1IT)&VLf -- Phone(919-) 01-6.0Zy`Z 71 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity aI am an employer providing workers' compensation for my 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 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 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 under the pains an a !ties of perjury that the information provided above is true and correct. Signature Date 5-la-00 Print name e-y*tn uA Phone# % — 1 (q0P0__ Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check d immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Town of North Andover o� TAO RTW qti • 1 61 Building Department h 27 Charles Street North Andover, Massachusetts 01845 . mX �► (978) 688-9545 Fax (978) 688-9542Two �9SSgc►+u5���y DEBRIS DISPOSAL FORM r i 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 cl.1, s150a. The debris will be disposed of in/at: i�Z e,hi moo d n 1 RuCI 0 V, Vc,cA111 Facility location S 6n� Signature Y 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. Steve Cappella Property Care services Estimate 31 Eleventh Ave Det fsmat�# Haverhill Ma 01830 (978)521-9992 5/14/00 14 Mass HIC 129109 75Ctl;� Doti marx&Deiare O-Leary Customer htfor�ation Mark&Deidre O-Leary 124 Phillips Common North Andover Ma (978)681-6242 Description - Qty Rate /#rrocmt Demolish&Remove Existing Deck Labor, per 1 150.00 150.00 Equipment,per 1 250.00 250.00 Replace with New Deck(Appx 350sgft.) Material,per 1 1,965.34 1,965.34 Labor,per 1 3,288.00 3,288.00 *Project subtotal 5,653.34 Total 5,653 3�1 NORTH ONM Of _ Aindover ro o2 fry o L AD dover, Mass., .� 3 COCMICMEWICK �� AD RATED P'P��,�Gj S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT... M X. ... BUILDING INSPECTOR IQ .,�r7 / rC............ , .�r ........................................... Foundation has permission to .... . bmldings on 1 a I/....0 Rough to be occupied as..)..Q...........� DeC.I. .+.4..0.w.....`,...�..�....�. / ���� ..�.......... Chimney.. . .. ..... ... ...... ....... .................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M Ora #p Ay7 $J ? - PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STAR S ELECTRICAL INSPECTOR • Rough ........ .... .... ... ...................... ............................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wale To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det.