Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 129 FOREST STREET 4/30/2018 (2)
129 FUKt51 51 Ktt I / 210/106.A-01740000.0 - � Massachusetts Fire 1i MASSACHUSETTS FIRE INCIDENT REPORT 1011111"Incident /� DEPARTMENT OF PUBLIC SAFETY OFFICE OF THE STATE FIRE MARSHAL Reporting 1010 Commonwealth Avenue Boston,Massachusetts 02215 ®�®®,System Department Revised FORM 10 FDID# ►/ ' p ��D41jE f�7 Report FP-32 y / If Exposure MATE Day 0f 1 Sun 2 Mon 3 TUB Alarm Tkme Arrival Time Back in Service Incident# �� �` Fire only, jZ� t1/ Week 4Wed 5Thu 6Fri 7Sat O Q 11 Cl Structure fire 17❑Outside spill with fire SEE MANUAL Z Z 6ACTOR,xtingu' nt 5❑Stand by MUTUAL AID 13❑Vehicle fire 18 71 Other fires not classified FOR OTHER O W sista e 6❑SalvageQ= CALLS 1 Read 14❑ Brush,grass,leaves 47(]Chemical spill F-Yanon only 7 ❑Ambulance 2 I , Given O O 15❑Trash,rubbish44❑Power line down -Q V rd 8❑Fill in.Move up NA H V" 16[-1 Explosion.No after fire 45❑Arcing electric equipmentFIXED PROPERTY USE(Occupancy) CORRECT ADDRESS(Up to Im, rn-um of 21 characters) ZIP CODE CENSUS TRACT OCCUPANT NAME (LAST FIRST,:Ml) HANE ROOM or APT.. OWNER NAME RASTFIRST MI) ADDRESS TELEPWONE O .12 s METHOD OF ALARM co INSPECTION NO FIRE SERVICE PERSONNEL NO.ENGINES NO.AERIAL APPARATUS GO 13 1 Telephone direct f DISTRICT� O RESPONDED RESPONDED � RESPONDED 2 Municipal alarm system 3 Private alarm system NO.TANKERS NO.OTHER VEHICLES 4 Radio SHIFT HAZARDOUS MATERIAL PRESENT? 5 verbal YES El NO C-1 RESPONDED `' RESPONDED r.j 6 No alarm reed. 1 7 Tie4ine(911) SUBSTANCE 8 Voice signal municipal alarm NO.ALARMS :[FOR SE FP 33 signal ALL 9Not classified above ASUALTIES 0 Undetermined or not reported Special Equipment Used? O 20 FIRE NUMBER OF NUMBER OF NUMBER OF NUMBER OF RESCUES SERVICE INJURIES FATALITIES � INJURIES FATALITIES _ OTHER O MOBILE PROPERTY TYPE VEHICLE STOLEN? Yes❑ No❑ I t AUTO,VAN 22 TRUCK UNDER 1 TON ESTIMATED TOTAL Insurance Co. 12 BUS 41 BOAT,UNDER 65' DOLLAR LOSS 13 MOTORCYCLE Total Insurance $ Claim Paid $ 21 TRUCK OVER 1 TON 08 NONE ' YEAR MAKE MODEL COLOR LICENSE NO. VIN# 30 IF EQUIPMENT INVOLVED YEAR , MAKE MODELS SERIAL NO. 40 IN IGNITION �f y-/- T` �i4!/. �1CD - �d / / Df, OCOMPLEX AREA OF EQUIPMENT INVOLVED IN IGNITION — ORIGINJK L FORM OF HEAT IGNITION MATERIAL IGNITED FORM TYPE METHOD OF LEVEL OF FIRE ORIGIN Number of Stories CONSTRUCTION TYPE O EXTINGUISHMENT 1 ❑Grade level to 9 ft. 1 F7 1 story 1 [.l Fire resistive 1 '1 Self extingwshed 2 F7 10 to 19 feet 2 n 2 story 2 I 1 Heavy timber 2 [7 Make shift aids 3❑20 to 29 feet 3 F1 3 to 4 stories 3 I I Protected noncombustible 3(-1 Portable extinguisher 4 FI 30 to 49 feet 4 0 5 to 6 stories 4 F I Unprotected noncombustible 4(-1 Automatic ext.system 5 C1 50 to 70 feet 5❑7 to 12 stories 5 1.1 Protected ordinary 11 Pre-connect hose tank only 6[-7 Over 70 feet 6 IJ 13 to 24 stories 6 C1 Unprotected ordinary 6 I 1Pre-connect hosehydrant draft standpipe 7 L-1 Objects i,flight 7❑25 to 49 stories 7 (1 Protected wood frame 7 [1 Hand-laid hoses hydrant draft standpipe 8 F7 Below ground level 8 Cl 50 stories or more 8 n Unprotected wood frame 8 1 1 Master stream device 9❑Not classified above 9 F1 Not classified above 0❑Undetermined 0[I Undetermined or not reported OEXTENT OF DAMAGE Flame Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE 1 Confined to the object of origin 1 n Det.in room or space of fire origin—oper. 1 R Equipment operated 2 Confined to part of room or area of origin 2 C7 Det.not in rm.or space of fire origin—oper. 2 (1 Equipment should have operated- 3 Confined to room of origin 3❑ Det.in rm.or space of origin—no oper. did not 4 Confined to the fire-rated comp.of origin © 4❑ Del.not in rm.or spate of origin—no oper. 3 1!Equipment pre.but fire too small O 5 Confined to floor of origin 5[l Det. in rm.or space of fire origin but _ to oper. l 6 Confined to structure of origin fire too small to opec 9[1 Not classified above f 7 Extended beyond structure of origin 9 0 Not classified above 0 FI Undetermined or not reported 0❑Undetermined or not reported 8 rl No equipment present IN A) 9 No damage of this type(WA) 8❑ No detectors present(NrA) 00 —IF IF SMOKE SPREAD MATERIAL GENERATING MOST SMOKE FORM TYPE BEYOND ROOM OF ORIGIN ----- --I --- O 1 / AVENUE OF SMOKE TRAVEL 7 I 1 Utility opening in floor R f�oL ! 1 ❑Air handling duct 4 F1 Stairwell 9 I 1 Not classified above 2❑Corridor 5 F1 Opening in construction 0 F l Undetermined or not reported WEATHER /1 3❑Elevator shaft 6 n Utility opening in wall 8 I , No avenue of smoke travel(N A) CONDITIONS Entries contained in this report are intended for the sole use of the State Fire Marshal.Estimations and evah nouns made herein represent"most likely"and"most probabin" cause and effect.Any representation as to the validity or MEMBER MAKING REPORT DATE accuracy of reported conditions outside.the State Fire T Marshal's office,is neither intended nor implied. — Ai�, ��/� �.,'� ! S"' FIRE MARSHAL -- J i v' /Z Z�'�✓ F.M._1 Yes 2 - No ORIGI AL:FIREJWPARTMENT CARBON COPY:STATE FIRE MARSHAL r rage 3- SOP CHECKLIST FOR CARBON MONOXIDE ' �- Z–ZY—y�" Location of Incident! / T 0'e6 5 r S� Date of incident �UIICK CHECKLIST OF OCCUPANTS Headache yes no k--" Fatigue yes no Nausea yes no ✓ Dizziness yes no Confusion yes no Are any members of the household feeling ill? yes no?� Do the residents feel better away from the house?yes no Since the detectofs alarm went off,what have you done? Shut-off carbon monoxide sources yes no If yes which sources Let in fresh air? yes no If yes how did you let the air in _ How long did you let the air in PPM reading ambient outside the dwelling Highest PPM reading in the dwelling "--2 0 F Pm Carbon monoxide detector present? yes --- no If yes list the number of detetors locations and make, and serial number of each below. 1. - 2. 3. v 4. CW L 7W I ch:'0 rY 6F2 - i 715 Which detector(s)by number above activated? SOURCE CHECKLIST LOCATION PPM READING Chimney clogged flue,blocked opening Fireplace(s) Natural gas LPG,Wood(indicate type for each fireplace) I. /5% r1,V,' (c,v C_,_75 Ig f'P�Lt 3. 2. 4. Gas Appliance (if Gas Company on Scene they can perform this check) (IF MORE THAN 1 OF THE FOLLOWING APPLIANCES LIST EACH ADDITIONAL ON THE COMMENTS PAGE WITH ITS LOCATION; AND PPM READING) refrigerator stove vent over stove clothes dryer water heater (chimney pipe) furnace (gas,oil;leaking flue/chimney pipe barbacue grill (in eclosed or semi enclosed area Oil burner c•� t I a �_ i car garage WOW 0- Entranceway Entranceway from garage to house Name of individual operating the CO monitor Person completing the Checklist_ Location /---79 Na Date �� V I/ -;� MORTM TOWN OF NORTH ANDOVER � s . � Certificate of Occupancy $ �ss�cNusBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # C59 = ', / Building In2p for TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. "ac SIGNATURE: i Building Commissioner for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: z� "aL Map Number ParcelNumber 1.31.3 ZonZoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard_ Required Provide Recgired Provided Re red Provided 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Infomration: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT M 2.1 Owner of Rcord ,y I Name(Print Address for Service Tgtr`atiireTelephone 2.2 Owner of Record: Name Print Address for Service: O z Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor:ZI T 3 License Number Address 75�UGkJ V Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address r � Expiration Date p� Signature Telephone V SECTION 4-WORKERS COMPENSATION(NLG.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) ❑ TAddition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: is .►�f� s>aie ��_,P/eN�" , ,o.P 6f /?Loa �ii7.yi.� ,�r'roroe..� er6��.�•s �.� � /�>'G.•ovwdey �.^b C!�'��d� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit a licant O>ECIALS �S� 1. Building :>24,00 ti (a) Building Permit Fee 3a roY�a +iad a = yo,oa Multiplier 2 Electrical dt0 s (b) Estimated Total Cost of ode d Construction/ 3 Plumbing dd 50C'O, Building Permit fee(a)X (b) 4 Mechanical HVAC 0 0 5 Fire Protection 6 Total 1+2+3+4+5 0 0 V, Check Number SECTION 7a OWNER AUTHORIZATION TO E COMPLETED WHEN OWNERS AGENT OR C 0N_ _- CTnR —FS FOP,RETr;,nYNn P WHIT � nu..i a � I> _ as Owner/Authorized Agent of subject property Hereby author' Li0 L° �/ to act on My behalf; ill m e to rk ed h' permit application. �- is •a o , o-� i Ire of Owne Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, z�wao �/�J�yjD 1✓ C�4l�/E�C�GC� 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 c`=fJGt/A•�� ir/G1Z/�AJt/ �3�Pc vb Print Name Signature of O er ent Date NO.OF STORIES SIZE BASEMENT OR SLAB IV14 T KD SIZE OF FLOOR TMMERS / i s 6 2 3 SPAN /Bj' - DEVIENSIONS OF SILLS Ar /—e DIMENSIONS OF POSTS C►4e DIMENSIONS OF GIRDERS /V/ DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY NA IS BUILDING ON SOLID OR FILLED LAND 50"9 IS BUILDING CONNECTED TO NATURAL GAS LINE IU I 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 /��/�� C ,�� PHONE S/i= i1z,6 LOCATION: Assessor's Map Number PARCEL SUBDIVISION - -- `� � LOT(S) STREET S ,- : ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** R4RVE C E ATIO OF TOWN AGENTS: ATION ADMINISTRATOR DATE APPROVED zea Z DATE REJECTED COMMENTS &Oke� U�91,ht G�s� l� TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm BOARD OF BUILDING REGULATIONS EE� License: CONSTRUCTION SUPERVISOR l Number: CS 078341 Birthdate: 09!07/1959 } I Expires:09/07/2004 Tr.no: 78341 Restriated To: 00 EDWARD NIABRECQUE r, , � 12 VISTA DR Com- -v ' Administrator � j DANVERS, MA 01923 Board of Building Regulations and Standards q HOME IMPROVEMENT CONTRACTOR E. Registration: 132840 Expiration:-=04109/2003 - z Type_:1_ndividua1 EDWARDN..LABRECQUE rt EDWARD LABRECCQl1E , ` 12 VISTA DR. GGA� 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) j ignatu 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 i jai . 1ji) 16 y f UfST)6 NS izply CIO ,Z 146 L' �, I pA04t 64 i P kso -L eeyy f PT uAF i 'r3 �l OC - ..._ F c�9 J�1i�'Pi�f S� E�14��"`j IVtvs� L /JJbN10�/ R60 AL � WINhnJ 16 ' I 40 N� 1 1 NAScnacR�LIANCE RFFC3lr 1 1 aa.rachaAw[[.En.rgY coag I ra:.le r 1 t Iheek Soltwaro Veraioo 2.01 i 1 t ' 1 m.Ci[ed byAete I I 1 CM:North Aodawr SI'Are:Naeaachusetts W: 6322 021MUC—TRE: I or 2 Paoi1V.Datached YS1Df TRE HP tTItL 5 :O[her INS.-Elactrla A.ei.tmt+l Wre: le-zo-200. O]IP6IANCE:PASSES Required uA=98 Your Nona r 6J Area or 1bw1tVCont. Glaxi ng/3bOi Parl-- R-Valve R-Vel0e U-Value W ___---------—----------- CEILINGS 6a0 ]5.0 30.0 10 NA1SS:NOOd tYafe. 36.O.C. Sr6 15.0 13.0 26 GIA2lw0 Wad—of Door. to 0.350 lT D3R15 i0 0.260 5 1''ll30R5:Over Oataide Air 160 35.0 10.0 5 NVAC EOUIPP@NI:Furoaee. MD AFM O}(pLlA STATIg61rr: The proposed beildlp d.eiga describedhere la Con,iut.nt with the building plana,opeciticatl—and otbaz WWI- -- lWI iane a.bat ttad_t,it.parol,applicetl.n. Th.pr.po..d building hen h.en dealgn d to.vat in.rpuiresanta of the ita—Chueatts Ea—W Code. The—licg load for ehi.building.a1M the cooling load if rpprapriate. ha.bean do emined us inq the applicable Stallard Deaign Condt[ions(Duna I.". Code. The WN aq.fpa.o[—1-2-d to beat or cool the bul lain .hall ba w greater then 125%of the duiga load a.apecitt.d In SecttdM 380Oet 1310 lad]a.a. D.Il der/p.aigwr m[ i I I I I I I I S S . Toho - ^ a '8tg � g 5P83 0 � �r.. �� �s�i��¢��4� Bg�Ss °��gB ��s ;• eke ks ��.o" ," �U---- Qo$1 s8 �;v "�xogs 's Egg ?g a� 08 y evo ' se �`II � it --------------------------------------------------------------------------------------------- -------- NORTH • E Town of And 0 No. 2..2. <0 o dover, Mass., A0"A 18 40 COCMIC � A=DRATE D P'?O\ �C1 '9S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT..... av/ 0IN t � BUILDING INSPECTOR Foundation r , 9' �o�'+fir has permission to erect..... . ...`.......... buildings on .............. ......... .... . ........ �... ...S ......... Rough to be occupied as...�....,5 /'t !tr r.....4 a�!A;*^' 0090 i/' �itY�+t/Ny.. W.ell s�� Chimney .......... . .......... . . .. ......... provided that the person accepting 3his 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-Lawslating to the Inspectio , Alteration and Construction of Buildings in the Town of North Andover. '0 6 Aj r /7 � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI ST TS ELECTRICAL INSPECTOR ob 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 Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Dec. 4228 } , Date...................... .......... NORTF/ °`,�``°;•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACMUS� This certifies that 1� / has permission to perform ............ wiring in the building of.............. .......................................... L,.-2.7 ............................... .North Andover,Mass. Fe .......N..... Lic.No.............. ...... <_ r........................ k/LLECrRICAL INSPECCOR Check # � �j-y Official Use r0 THE COMMONWEALTH OF MASSACHUSETTS Permit No.__�9,a r —_ --- Department of Public Safety e22 Z-11) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy&Fee CheckedM --_ 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 performtheelectrical work described below. Location(Street&Number_—tp- 7—_ -------- ----------------------- Owner or Tenant_--pa v' 7—r- C4 ----- --------------------------- ------------------- Owner's Address__—Q�rf_ Is this permit in conjunction with a building permit Yes No • (Check Appropriate Box) Purpose of Building__C_6__e_U le,5 _ _ _----_—______Utility Authorization No. Existing Service--�?--9©----_Amps_—_I(O/a,3�®Voits Overhead Undgrnd No.of Meters New Service -----Amps-— —_—Voits Overhead Undgrnd No.of Meters___-- Number of Feeders and Ampacity_— -------- ---------------------------- p _jL✓ ��_4 _ GlordS�— �''- Location and Nature of Pro osed lectrical Work_ Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA ^� Above In No.of Lighting Fixtures Swimming Pool qrnd gmd Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets J No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and 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 _Iao.of Dishwashers Space/Area Heating KW Detection/Sounding Devices • Municipal • Other No.of Dryers Heatinq Devices KW Local Connection t+ No.of No.of Low Voltage Q i e ` No.of Water Heaters KW Signs Bailases Wiringb? 1 No.Hydro Massage Tuds No.of Motors Total HP OTHER: r if tQC C` kl' d r- L e INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivant YES NO = have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the 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 theP naltie peq FIRM NAME_ cstnqPCT/s]^,i.,,C LIC.NO. License {;cC 3 ��f``Gi Td �l!. — SignatuQ ISM LIC.NO.tt C7y Bus.Tel Nov V. Address �f1 r_'n vfC Ave OL Alt Tel.No. 19 — OWNER'S l NCE WAIVER: I am ware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. nd that Ty-stgnatur&bn this permit application waives this requirement. Owner Agent (Please Check one) Telephone No�G S/_4 PERMIT FEE $_ (Signature of Owner' Agent) ' ?/ b 5 Location �� 9 --� No. /7 2 Date MORTM TOWN OF NORTH ANDOVER f � 3?'�,t••o ••�0 F41 w 9 4 - ; ; Certificate of Occupancy $ CHUs<� Building/Frame Permit Fee $ 4 Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 15897Building Inspecto I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: ic a d voL SIC NATURE: '/ <<--?" Building Commissioner/InEeEtor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft _ Front Yard Side Yard Rear Yard R 'red Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of//Record // f - 11 Name(Print) Address for Service: gnatu Telephon 2.2 Owner of Record: Name Print Address for Service: �z Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Yensed Construction Supervisor: License Number Address Expiration Date MC Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ / ��. Company Name M Registration Number Address q 07 ' S O.11v—4�12 Expiration Date L Si nature Tele hone _- lei 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 builoing permit. Signed affidavit Attached Yes......Z No.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition Accessory Bldg. ❑ Demolition ❑ , Other ❑ Specify Brief Description of Proposed Work: .K �/� E�i��J� GtJ.,o� .o h.✓/T���✓ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be = ,�: CALSE Og gas Completed by permit applicant ,' 1. Building (a) Building Permit Fee a q/ D rJD,OD Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical(HVAC) 11-114 � 5 Fire Protection 6 Total 1+2+3+4+5) ® grafi&' ael Check Number SECTION 7a OWNER AUTHORIZATfON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> /'amu L as caner Authorized Agent of subject property Hereby authorize c� a to act on My beh&f;", I tt tive o k authorized by this building permit application. e of er Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I> as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief G i_e Print Name �G� l Si ature caner/A e Date NO. OF STORIES SIZE BASEMENT OR SLAB -13,s���✓� SIZE OF FLOOR TIMBERS { v 1 ? 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS a " 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 P-oq 3 y d o`er'"A' INSTRUCTIONS: This form is used to verify that all nec essary approvals/permits Boards and Departments having jurisdiction have been obtain d. Th s does not from elie the applicant and/or landowner from compliance with any applicable or requi ements.Ve ******************APPLICANT FILLS OUT THIS SECTION APPLICANT P16ul �R( LL�� PHONE LOCATION: Assessor's Map Number—i D PARCEL % SUBDIVISION LOT(S)a A STREET ST. NUMBER_1�21 USE RECOMM D ,TIONS TOWN AGENTS: C011(SEI*iV TION ADM ISTRATOR DATE APPROVED DATE REJECTED COMMENTS01 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED Q DATE REJECTED COMMENTS u PUBLIC WORKS- SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9\97 jm Board of Building Regulations and Standards HOME.IMPROVEMENT CONTRACTOR . t Registratiorit 132840 ' Exp rat on:.:p4/09/2003 - FType individual i EDWARD N.LABRECQUE \ EDWARD LABRECQUE 12 VISTA DR. C G--•' L"" YdARb 60 WILIAM;'f;GE TCONS 1 ii License CON STRUCTION'SUPERI/.ISOR N-__ C's 078341 ' � Bi�t�slate:`09/07/19'89 r � Expmt09/07/2004 Tr.no: 78341 'W66idWd To 00 l( EDWARD N LABRECQUE _ 12_VISTA DR — / DANVERS,�MA 01923 Administrator j Sent -By: H&K INS; 517 926 0912; Mar-4-Ue a:vIrsI . DATE as,�t �►� CERTIFICAT IABILITY INS E l PRODUCEa THIS CERTIFICATE IS ISSUED AS A MATTER. 0.' INFORMATION H 3 K ineuranca Agency Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P. 0. Box 344 L!OLCER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 182 Main Street ALTER THE OVERAGE AFFORDED 9Y THE POLICIES BELOW. WatarGnm MA 02471-0344 NSURERS .AFFORDING C01rERAGE I INSJFED INSURER A vemant Mutual Labramue RemOdeNng INSURER 6: 12 VIM DfW INSURER C: Damm MA 019M INSURER C. INSURER E. COMAM THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSLED TO THE N,&RED t•IAMED ABOVE FOR THE :CLICY FERICC 'NOICATEC. NOTWiTHSTANOING AH) REQUIREMENT,TERM OR CONDITION OF ANY CGNTRAC7 OR 0TH=P DOCUKJIEMT VV17'H FESPECT TO WHICH T-16 0:i.11:10ATe MAY BE 13SUED OP, NIA" =ERTAIN,THE INSJRANCE AFFORDED BY THE Fo-l CIES DESCPISEC HEREIN IS SUS.IECT TO ALL 7.1E TERh1S, EXCLUSIONS AND CONDITII?NS OF SU�rI POLICIES,AIGG?ELATE LIMITS SHOWN MAY HAVE EEEI REDUCED BY PAID CLAd�1S. IN . tr 'TP: ° EKP A` N JMiTS TYPE OF INSUP.ANOE POLICY NUMBER A, r I;. ;YYI ATE f n' EACH ENGE A G:NERAL L149IL17Y 8P170392a5 t 1'Cw-Ct i 1 r03:02 I 1,0C' 0'QO x COb1MERCIAL GENERAL LIABILI'V °I?E DAMAGE MAGE iAn�'dna Ira) S 00,QQ0 CLAIMS MAGE FRI OCCUR. MED EXP'Arlt'we�eI5 nj S 5,000 PERSONAL A ADV IN.JRY $ 1,000,00C GENERAL AGGREG47E r 2,000,000 GEML AGGREGATE LIMIT A:PL!ES PER: PRODUCTS•C051F�CP AGG s 2.n0a QDO POLICY? LOC AUTOM061LE LIABILITY COMBl'SIN(iLE LNIT S ,Ea 1.4,1 kkt° AUTO ALL GANEG AUTOS BODILY INJJRY c fNel oerso-) SCHEDULED AUTOS HIRED AUTOS I, I BODI'_ INJURY $ (Fer ecclden:) NONC`NNED AUTOS :ROPERTI DAMAGE $ ;Pe(mWeni) i I AUTO ONLY•EA ACOCErIT 5 GARAGE LIABILITY +—T ANY AUTO OTHER T 4N EA ACC .S AUTO ONLY: AGG $ 'x ES5 LlAEiiY EACH OCCURRENCE S t .1 ( I A00RE3ATE $ :7CCUR i ;JL.MS MADE OA)JC.TIBLE ' S LRETENTION S $ Vr E KERS COMPENSATION All!) T on,Tv 'Ei.��,I;C _.. I E.L EACH AOf DENT $ t I I E.L DGEAS -EA EMPLOYEE j$. fl E'.L OISc4';E•POLICY U611T ulEp 1 �' 11 PCh 0' OPERATIONSAOCAT!CNS°JEhIC ES'eCC!U810\1S ADOEC SY CADORSEMEEN%PECIA L PROVISIONS M ( � t , r y TiF 'j Fity 0.DD!?OVAL INSURED;INSURER :ITER: CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED @EPORE THE E%PIRATION 5,ei ^A✓TfiOVB" DA-E'HERc+:F,THE ISSUING INSURER WILL ENC'EAVOF.TO MAIL 10 DAYS'APP ZN NOTICE TO THE CERIINCATE HOLDER NAMEO TO THE LEFT, BUT FAILURE PO 00 SO&TALL IMPOSE NO OELIGATION OR LIA51LITY OF ANY KIND UPDN THE INSURZP.RS A3ENTS CR REPRESENTATIVES. AUTHORIZED P PP_SENTk!VE ti John R. Hedlhy DRU i" 0. ACORD CORPWA71ON 7988 JRH + _ li (� ' i � I � �� f U �� � ��� ��i���"� ,���'1���' VSs= �� � --INN PLY thio r - V0,51",ri2x or � A &A e P* i l2 e 12co ! ' 30 o mg it 40ee -14 doe _Fit -21 f F-I-APtVA7 OA) alONA 131,9 ; 1 / r,,4 `J S j t � to M/ F)RST K# ---------- #sic ......... yr -"Woo - lAhTfii+1'i'eiiltllif`I .{ Mom,., � t 11 - ��,': � jglyJrf(:t�n•w,�....J -?- ;!+MY'f ;•G„;.- 1 , J • ..(' i ,� _ ..:... ..av;�.N•wh:e..,a:.v.-- ..x:�I.`vi.�., 'yitr.,y,:�� , i `t,� r ,;' _.t 4 •moi, - ....... �.: r� ..ry ��+ : } P.. .'L,. {yii�lvv�,. 4tr ?s �i by -• , _ 6 .� , N•;r'ri>o.r,w,,,,_ •r ':Algl -..1+Ik t� k n I MAScheck C LIANCE REPORT Messachusetta En,igy Code Permit a —heck SO[txare Version 2.01 I I Checked byiDate I I I CTTV:North Andover STATE:M achusat is HDD: 6322es CIXJSIRUC[W TYPE: 1 0[2 Family.Detached HEATING SVS[EM TYPE:Other[Non-E le ctzlc Resistance) GATE: 3-3-2002 LOMP...:PASSES Required UA=55 Your Home=42 A[ea 0 Levity Cont. Gle¢ing-o— Perlmeter R-Value R-Value U-Value UA ---__________________________________________________________________________ CEILINGS 100 30.0 30.0 WALLS:Wood Irame, II O.C. 352 15.0 15.0 15 GLAZING:WintlOve or Doo[a 30 0.4)0 ld DOORS 35 0.260 9 FLOORS:Ove[UncOntliti0natl Space 50 30.0 30.0 3 _____________________________________________________________ CCl[1PLIANCE SIATEMENI: The proposed building do ig0 described here i ith the building plena.ep,,ifi cat ions, and other calcola t ions eubmittedtwith the permit application. The proposed building has been designed to meet the r,q,i remen to of the M, it. Energy Coda. The heating load[o[this bvilding.end the cooling load if appropriate. hoe been determined a ing the applicable Standard Design Condition,flood n the Coda. The HVAC equipment selected to heat or cool the building shell be no greeter than 125%of the design I,od ae specif rad in Sections 780Q 1310 end 34.4. BuilderiDesign er Da[e f - MAScheck(Tr@LZANCE REFGR]' I I Msssachasetta Energy Code Permit a I MAS check Softva[e Version 2.01 I I Checked byNaxe I CITY:NorthMd— ee i SIATE:Ma .......ts lOD: 6322 WN UCIION TYPE: 1 0[2 Family.De[ached HEATING SYSTEM TYPE:Other(Non-Electric ROsiatencel ➢ATE: ]-3-2002 (L!@LIANCE: Invalltl Area(sl All,oCevlty Cont. 01-ingN o[ Perimeter R-Vele,R-Value U-Value VA ___------------------------------------------------____________________________ CEILINGS 0 0.0 CEILINGS 100 35.0 35.0 1 WALLS:Hood P[ame. 1"O.C. 35215.0 15.0 IS GLAZING:Window.o[Wora 30 0.170 ld OWRS 35 0.260 9 FLOORS:Ovec th,—ditionetl Space 50 30.0 30.0 2 The heating load for this building,end the cooling load if appropriate. ha.been de[er.inOd using the eppliceb 1.Standard➢.sign Condition.found the Code. The HVAC equlpmenL eelec[etl Co heat or cool the building 1h1 11 be no greater than 125%of the tleaign toad ea apecif i.tl in Section,780 CMR 1310 and Id.<. Boilda—,igner Date MAScheck INSPECTION CHECKLIST ' • M.....h...ti,Energy Code MAScheck Software Version 2.01 BATE: 3-3-2002 Bldg.l Dept. Use 1 CEILINGS: [ 7 1.R-30♦R-30 I commante2ocation I I wALLs. [ ] 1.Wood Frame. 16"O.C..R-15 t R-15 I comments/Location I WINDOYfS AND GLASS DOORS: [ ] 1.U-value: 0.42 For window.without labeled U-values. describe features 0 Panes_Frame Type Thermal Break? [ ]Yea[ ]No Comments/....tion I DOORS: [ ] 1 1.U-value: 0.26 I Coimnente/Location I FLDORS: [ ] 1 1.Over Unt-ditionea Space.R-30 I commante/Locati.n I I AIR LEAKAGE: [ ] Joints. penetrations. and ell other such openings Sn the building velope[bat a of air leak.g.m [be sealed. When natalled in the.building a velope. r sed lighting future¢ shell meet o of the following requirements: I 1. Type IC rated.manufactured with nd pen.tratione between the i:id.of the r sed fixture antl ceiling cavity antl sealed or gin keted to prevent air leakage into the u onditioned space. 2. Type IC ratetl, i ordance wIEb Standard.-E 203.with no m than 2.0 cfm IOCe44 Ls)a t from the the onditioned space to the ceilingrc 1ity.n The lighting fixture shall have been tescetl at 15 PA or 1.57 lbs/ft2 pressure difference antl she 11 be la lis d I 1 vaeoR RerARDEa: ' f ] 11ilretl o [hex m-ln-winter side of all non-vented framed I ceiings,walls, and[bora. MATERIALS IDENTIFIGTIIXq: [ ] Materlals and equipment must be identified so that compliance can be determ lned. Manu fell.........ls for all inetelletl hea[lnq I and cooling equipt ends v ter heating equipment moat be , provitled. Insulatmenion R-valuesiand waglazing U-values must be clearly marked on the building plena or specifications. I DUCT INSULATION: [ ] Ducts shell be inaulat.d par Table 14.4.7.1. I WGT CNISIRUMM: [ ] All a ssible Joints. ...... n . end c ..tions of supply and r urn I ductwork located outside pond itlonedspace. including stud bays or joist levities/spaces used to[....port air hall besealed anacking tape installed according to I using...tit d fibra..bthe o nuf"turer'e installation i rlions. Mesh tape may beitted where gaps or. e les.than 1/8 Bu ct tape le not permitted. The WVACays[em must provide a means tar balancing air ens wac.r systems. I 1 TEMPERATURE-ROLS [ ] Thermostats are raqulied for each sepal a MVAC system. A m ..I I .mats.m o par sally r s o shut off the heating and,,,cooling input co each zone orr f loorreh.I be provided. 1 HVAC E[11IPMNI SIZING l [ 7 I Rated output....city of the heating/cooling system i t... than 125%of the deeign load ae specified in Sections?aIW 1310 and]4.4. I [ ] SWIMMING POOLS: I Aheated imming pool.must ha /off heater-itch and I rellquire a rswunave lose o r 20%of the heating a.,W le from non-d.pletabl.sourcea.vPool pumps require a time clock. 17 MVAC PIPING SNSUGTIW: I HVACpiping.I-yiag fluid.above 120 F or chill-d fluids blow 55 F must be insulated to the following levels Iin.1: I I 'I' ' SIZES Iin.1 I lEATING SYSTEMS: TEMP(F) 2"RUNQJT1 o-1" 1.25-2" 2.5-4" I LoLow..assure/temp. 201-250 1.0 1.5 1.5 2.0 1 x temperature 120-200 0.5 1 . .0 10 1.5 I Steam condense to any 1.0 1.0 1.5 2.0 I ¢IDLING SYSTEMS: Gilled water or 10-55 0.5 0.5 0.25 1.0 I refrigerant below 10 1.0 1.0 1.5 1.5 [ ] I CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pi pea to the folloxing levels in 1: I PIPE SIZES(in.) tKLI-CIRCULATING I CIRWLATSNG MAINS 6 RUtWTS HEATED WATER TEM3(P): RUtKWfS 0-I" 0-1.25" 1.5-2 S 0'. 170-180 0.5 1.0 1.5 2.0 140-1601.0 1.5 100-130 0.5 1 0.5 0.5 1.0 I ----NCIIES TO FIELD(Building Department Use Only)---------------------- North Andover Building Department i 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) Sign 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 NORTH E Town of Andover No. /7? °SA 000H,' � dower, Mass., a -vat ORATED S PP� C M H BOARD OF HEALTH PER IT TO ILD Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... ...... .�..C .... .....................: . Foundation has permission to erect....S.,.K�.�. .......... buildings on ... .. ..... o.00.0.6.4 Rough t0 be occupied as......FI"ON ' Fo �t r V M •v t r S/V /� R �OV�C Chimney P .............. .. . ..... .................. �............................. 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 9f Buildings in the Town of North Andover. � .,. fr•p/��s�r+� PLUMBING INSPECTOR � j*/ f VIOLATION of the Zoning or Building Regulations Voids this Permit. &*,*,V00&Wkough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough . ........ ......... ........................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. t v s+r•r 4 W ' N Z_o of r b1 .o 0 2- 9- y 23 Q • s•rY, w•e'. 39, P✓�j P SCOPE /c' QU//c'oEu4mr o x/50) X 150 -- ... .. ... ..... ....... ....... ° o-T' z�. v ° DESI N G FV- 10N 4T.. TOP Of � � 4T ..( STONES = EX15TIM� ELEWriON 4r.. ..:,.. . . ....... ...................... Elr/o/v - DSS/QN CJS!3U/CT �S �iUI /N!/. G/PE OUT' Of 110C/,5.�' '• �� Lqi.ao � I/VY. PIR-c INTO TANK 144. 3o /-f-7,6 5' sUB de- /NV PIPE OUT OF 74NK Ji-4. /I !49.55 � e INV. PIPE INTO .0 ,60Y 1-60, 06 /52. 7 Z- /NV. eo/PE OUT OF D. BOX / • 70 1 Z .Szs� lVeZ7;5/ o �5v, ieo Z 8 Z- Z— INV END OF RIPE /so.so /5 z. s N� vE� Y p • F02 � �bn�• „ n 61C 7-rY GV�1Tf-2 E'L E'Y,4T/DN - .4 VE2.4CE 5TONE SC.4G E': / ,}o ' D4TE: DLc7P7W QT PROBE NOTE: 7-1115 P4,4N 15 NOT 4 91..4e�..4NTY C148I5 TIA NSEN s SER L7/, INC OF T1/E SYSTEM BUT Q !/Ek'IFI"TION /60 SUMMER STREET YA!/ERNI�,�SS' 1 OF T#4F 4OC.4RON OF XqF EX1.571N6 57R LICT NeE5. Location .� l ��/� S T S230 �Lo'� No. Date roRTh TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ cNusE _ VFp Other Permit Fee $ Z `�RgY Connection Fee $ MA? j Water Connection Fee $ 0,L r r `Building Inspector 1 Div. Public Works Location /��•� �� , �� � I No. Date ,f,N�aT.,ti Z TOWN OF NORTH ANDOVER azLmaifftp Certificate of Occupancy $ Building/Frame Permit Fee $ a ��s'ne•'"�� �'� '`' rt Permit Fee �Q #Other Permit Fee $ , mer Connection Fee $ Witterr�Gennection Fee $ .N t ,C Building Inspector Div. Public Works { Location �� ��'� � `ST No. = ' Date °RTM TOWN OF NORTH ANDOVER •. O� Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ /00 , 06' YAMrmit Fee $ CLEC 2 U jnewer Connection Fee $ - '� ater Connection Fee $ No.Andover l`0jj T&L $ /00 - 00 r� & C), Building Inspector" l U ti / � Div. Public Works PERMH NO. `�7 L� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.. L)Ohl >3 6 J PAGE 1 MAP .1 . I LOT NO. Z� 2 RECORD OF OWNERSHIP �DAT� BOOK PAGE — iONE SUB DIV. LOT NO. LOCATION Ct3T PURPOSE OF BUILDING r' / V _ OWNER'S NAME NO. OF STORIES Z SIZE d� S OWNER'S ADDRESS2 U ��y �. .'`� ��2Ll��i� BASEMENT OR SLAB d A_4e,64 ARCHITECT'S NAME _ SIZE OF FLOOR TIMBERS 1ST zy//-v' 2NDZ�(/o 3RD � A BUILDER'S NAME SPAN DISTANCE TO NEAREST•BUILDING DIMENSIONS OF SILLS ^f y/ --- DISTANCE FROM STREET vibo POSTS G•_4 b DISTANCE FROM LOT LINES-ASIDEES �/DI REAR y_�1 GIRDERS AREA OF LOT 'D . ` /1�{C, 77 FRONTAGE /�/ HEIGHT OF FOUNDATION r� THICKNESS /O / IS BUILDING NEW V /l.G� SIZE OF FOOTING o/�} /� X 42 je IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND id WILL BUILDING CONFORM TO REQUIREMENTS OF CODE -�J� � IS BUILDING CONNECTED TO TOWN WATER NJt, BOARD OF APPEALS ACTION, IF ANY \ -�' — IS BUILDING CONNECTED TO TOWN SEWER .41b IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST V O0-0 SEE BOTH SIDESEST. BLDG. COST J �GE 1 FILL OUT SECTIONS 1 - 3 PERMIT FOR FOUNDATION ONLY EST. BLDG. COST PER SQ. FT. r EST. BLDG. COST PER ROOM r GE 2 FILL OUT SECTIONS I - 12 REGULATED BY PARA: 112.7 S.B.C. SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING DATE:124 '� '1L FEE PAID:-I.Qa ,_ 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FIICED AND APPROVED BY BUILDING INSPECTOR DATE FILED r /2a BOARD OF HEALTH SIGNA OF WNER OR AUTHORIZED AGENT OWNER TEI !!/17 2 /'.�'S 6 F E E 43 CONTR,TEL.#636 V Sb CONTR.LIC.# PLANNING BOARD PERMIT GRANT D 1919Y-- !� J CC77 ..Ste, fPU BOARD OF SELECTMEN PERMIT FOR FRAME/BUILDING 3 LESS Fm r r �v DUE FRAME PERMITI-6-3�VIP DATE: b FEE PAID.__.._,_...... ��, f �� surow INSPE R _ ._--,BJJI-LDING RECORD 1 OCCUPANCY 12 , ,~ .,.,. •, SINGLE FAMILY s. RIES THIS SECTION MUST SHOW EX&CJ D MEp4jQA1S OF LOT AND DISTANCE FROM MULTI, FAMILY OFFICES LOT LINES l*AND',.EXACTs;DIW4E'NSIONS OF BUILDINGS, WITH PORCHES, GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ a I I3 CONCRETE BL K. PINE , BRICK OR STONE HARDWD — PIERS PLASTER ... _ DRY WALL UNFIN. 3 BASEMENT I ' AREA FULL FIN. B TAREA _ y, 1/1 1/1 _ FIN. ATTIC AREA NO BMT FIRE PLACES, HEAD ROOM _ MOQERN KITCHEN 4 WALLS I FLOORS CLAPBOARDS s000, B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW D _ "jING COMMON _ •\ .V ASPH. TILE - STUCC MASONRY STUCCOON ON RAME BRICK M SONRY ATTIC STRS. & FLOOR I , BRICK ON FRAME I CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR ADEQUATE NONE ` 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) ' —LA—T SHED TER—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 GAS 7 NO. OF ROOMS OIL B'M'T 2n �'� ELECTRIC 1st 13rd NO HEATING i 1 i s , Town of North Andover - r BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE JOB LOCATION C�2,3 A3- Number Street Address Section of town ."HOMEOWNER" ��4c�L /�• �K�LLL�' ' G/>Ja��'3I7� (�0/1/ -2.145` 1 Name Home bone Wofk Phone PRESENT MAILING ADDRESS -47 A co&.A✓ City Town State 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 HOMEOWNER: Person(s ) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be, a one to six family dwell- ing , attached or detached structures accessory 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 . Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding 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 he/she understands the Town of ', .North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and ,requirements . HOMEOWNER' S SIGNATURE G� APPROVAL OF BUILDING C X 'Note : Three family dwellings 35 , 000 cubic feet , or larger, will be required to comply with State Building Code Section 127 . 0, Construction Control . BUILDING DEPARTMiiEN r ' FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) 0 PERMANENT ADDRE (ASSIGNED BY D.P.W. t STREET `L JJJ APPLICANT }; ?,g.&Z /1Z/��%� PHONE DATE OF APPLICATION ,* v— I Q TOWN USE BELOW THIS LINE PLAN �N+ BOAt RD + DATE APPROVED TOWN CANNER DATE REJECTED CONSERVATION C01it1 ION �.p DATE APPROVED PO 3 e( NSERVA N ADMIN. � t DATE REJECTED BOARD OF HEALTH DATE APPKOVEDe Al ' •AL'1'H SANITARIAN _y f3�r� vn1'L' REJECTED V' DEPARTMENT OF PUBLIC WORKS v �S6UU O �1 i DRIVEWAY PERMIT SEWER/WATER CONNECTIONS No 0 40w 6 Ar- Dy '--FIRE DEPT. r _� RECEIVED BY BUILDING INSPECTIO DAT l6 a �» This form shall be signed by the agents of the Planning and Health Boards, 6= the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the ilT , compliance of any applicable Town requirement or Bylaw. iYr 4 ry Post-It'"brand fax transmittal memo 7671 #01P80080 re Co. e P one N !� Fa 0-3 —8/.;2-1 e N Department of Environmental Management/Division of Water Resources t WATER WELL COMPLETION REPORT WELL LOCATION GEOGRAPHIC DESCRIPTION Address ar Iii N S E W of (leer) (circle) City/Town Well owner (road) Address 0. N S E W of lmi.in tent a (circle) Board of Health permit: yes no 0 intersect. w/ 0001 WELL USE WELL DATA Domestic epublic 0 Industrial 0Total well depth_ !f6f ft. Monitoring C] Other Depth to bedrock_ft. Water-bearing rock/unconsolldated material: Method drilled � Date drllled / Description CASING Water-bearing zones: Type r, 1) From_.W To 90 2) From- To_ 00 Length,7- _ft. Dia(•I.D.)__J0_rin.. 3)From To Length Into bedrock it. Gravel pack well: die. Protective well seal: Scroon: dia. Grout.❑ Other Slot$' length from—to PUMP TESTley A r Static water level below land surface�ft. Date A Igoe 1Drawdovvn4&,;C�ftafter umping/hr. "'—min, at _gpin How measured ` Recovery OO ft. afterZhr, ff min. LOEFORMATIONS COMMENTS From I To Driller Mass. Registration+ Firm / Address— City/Town ddress City/Town aEL ery s n print mry DRILLER COPY LIj � t �"`►S$<r41�H ! it ��+ a, 1" �T AS. 'Z froId. y ti'';irk fit °I COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY OF 1010 COMMONWEALTH AVE. a ' MASSACHUSETTS BOSTON,MASS.02215 �r ENCLOSE CHECK OR MONEY ORDER LICtN;r: EXPIRATION DATE, L l')N 1.If . °U P k ii V 1 S O R FOR REQUIRED FEE, 09/30/ 1993 RESTRICTIONS 6 EFFECTIVE DATE LIC-NO. g MADE PAYABLE TO I{"U I�I` o `%C Mo /1991 9444835 "COMMISSIONER OF PUBLIC SAFETY" n mGLEN A GETTY IINQ CASH). 5 S h 027-48-1251 1 5 A ;T PHOTO(BUSTING OPR ONLYI FEE: AUG 1 ,3- 1991 1UG. 00 HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY SIGN NANE-WE SIGNATURE LINE STAMPED -OR -SIGNATURE OF THE COMMISSIONER N li DOB tj..ruba�7R 02/04 /1959 4 !>r. NUI Df-.TACH LICENSE STUB{ THIS DOCUMENT MUST BE PRINT HOLDER WHEN ENGAG CARRIED ON THE PERSON OF ( SIGN URE OF LICENSEE SIGN NAME IN FULL-ABOVE SIGNATURE LINE F OTHERS RIGHT THUMB PR T ED IN THIS OCCUPATION, COMMISSIONER ,uu PLANNING FINAL NORTH__TC WA L'wn oAndover No. 529 DRIVEWAY Eaj-ji�y PERMIT A y EWiCK er, Mass.,DFM�a 19A OR pP SSA � PERMIT T LD BOARD OF HEALTH . . T...V/C.K.-CT..r" THIS CERTIFIES THAT. ...09.0-AW ...... ,,,,,,,,,,,,,,,,,,,,,,,,,,,, ;.esssr . BUILDING INSPECTOR has permission to�.V... � ildings on/2%. ... .6 .....t4na dough �S.(e ..499.0 �4-s/ .IFL'A&. Chimney to be occupied as. .... ••••• •••••••••••••••••• Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY Final VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULAT D BY PARA: 112.7 S.B.C. _._. PERMIT EXPIRES I N MONTHS DATE;G)' FEE PAID:/r ELECTRICAL INSPECTOR Rough PERMIT FOR FRAME/BUILY 11 bESS CONST C , START Service ..•' Final DATE: EE PAID' I� -�'2- . .. .................. :.. ........ .. .... ...... . ----,.� BUILDING I CI'OR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough LW}U /DO."TO Final Display in a Conspicuous Place on the Pr >r P Y P e .,.. Do Not Remove FIRE DEPT. k� Burner .. No Lathing to Be Done Until inspected and Approved by sEEr140. Smoke Det. Building Inspector NDO Llt .'I;� II ) Nti -r .. • i I' (fIIII `:Illi( r- i♦'PION I 1IV1':If IN��I. II;I r-I f�t1!�•I ;,-(;- I I1:,\1:1'11 I'I.,\NNINt� i'1,ANN1NG Y� (;O�1I1111N1"1'1' I)1;V1:[,O1'I111 N'1' I:Y'\I;I:fd CHIMNEY APDL 1 CA 11 O1J ANU ITKA11 1- DATE PERMIT LOCATION re; J OWNER'S NAME: BUILDER'S NAME: 2c;.wA('c - - - - v1ASON'S NAME: yq MASON'S ADDRESS: -1ASON'S TELEPHONE: IATERIAL OF CHIMNEY: WERIOR CHIMNEY: LXILRIOR CHIMNLY: _Sldrr� IUI,WER AND SIZE OF FLUES: j Z -HICKNESS OF HEARTH: ' lift chim)-ley an. OilepCace conoo4nl to .tlte �ce.(lu,i�cer►►e►I.t:3 uO .t.11e cu(/e aI11I have nu1e.3 and :egu,eati.olvs been neeeZveci: y.�� ------------- TATE: Z 7 L 'IGNATURE OF MASON: - 'ERM IT GRANTED: FEE ' OBERT NICETTA ' UILDING INSPEC -ORgn NSPECTEO: EMARKS: SULID FLOCK REQU11t1:U THIS PERMIT MUST GE DISPLAYED 014 111E I'RL1(II SLS r i Location ' � 9 .��S"T- No. C S Z Date A3D �Z NpRT11 TOWN OF NORTH ANDOVER O< «ae ,a,hp p Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $CHO -------- Other Permit Fee $ i Sewer Connection Fee $ Water Connection F $ TOTAL //4 *Bull*lng 5065 Div.Public Works 1 CERTIFICATE OF USE OCCUPANCY I Building Permit Number 5 2 9 ( 1 9 9 1 ) Date JUNE 1 , 1 9 9 2 THIS CERTIFIES THAT THE BUILDING LOCATED ON 129 FOREST STRFFT ( LOT # 23A) MAY BE OCCUPIED AS S i n g t e F a m i t y D w e t t i n g IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. F NoR,TM CERTIFICATE ISSUED TO P a u t T n i c k e t t 20-Post 066 ice Ave. ADDRESS 'Li,9S SACFH t15E , 1 01 Building Inspector i PLA.NNI N GFINAL �. C� C ��K0 O R T.11 own of � ndover No. < 1 .rr113 u,,..ir '�'''t1 11;r.:y. to s 9 est K neo, er, Mass.,_. CUC'ti�hE WICK NA BO BOARD OF HEALTH PERMIT SRF ILD rr THIS CERTIFIES THAT. .. . ......r77PQ1C. .K ............................ S has permission to# ... � . f uildings on/V Op... .R:�.I , nnR B 1 to be occupied as .143 ®.. .... � JRX/'P ................... C im i provided that the person accepting this permit shall in every respect conform to the terms of the application on file in TNS vy� T qL PL7�0 SPEOR, this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of R u � - Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY VIOLATION of the Zoning or Building Regulations Voids this Permit. P E REGULAT D BY PARA: 112.7 S.B.C. I M I T E 1�'11?,E' I Q N/10�] T F1 S DATE: FEE PAID:C0-� ELECTRI AL INSPECTO r �7 Rough �C • PERMIT FOR I I -.1 I�{.)�.� , service� R FRAME/BUILDA Final '----- DATE: EE PAID I-- y--�L . .. ........... . ........ ..UILDING.. I.... . ..., BNG i CTOR GAS INSPECTOR 0o_`t1P017.ci, i'E.n:iil 1?cquired f« (hwupy RuddillILKPOMIT fat Rough WS foo.' �• Finn al Display in a Conspicuous Place on the PrenNOWME PERMIT&9�, 05 FIRE DEPT. Do Not Remove Burner d 11--�#- No Lathing to Be Done Until Inspected and Approved by Smoke TREET Net.'" �- `L W Building Inspector Date. .C.".1.? -� ".O RT:'�a TOWN OF NORTH ANDOVER 0 ° PERMIT FOR PLUMBING 'SSACHUS This certifies that . ' c.z has permission to perform . . .1 ���.��.<'. �. . . . .l.'!j�. . . . . . . . . . plumbing in the buildings of .—(7... . . . . . . . . . . . . . . . . . . at . . ?.`.T. . . . .<_: �. . . . . . . . . . . . . .. North Andover, Mass. Fee. . ... . . .Lic. No.). . . . . . . . . . . . . . . �- . . ����L._�. . . . . . PLUMBING INSPECTOR Check # 5639 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) .- NORTH ANDOVER,MASSACHUSETTS Date Building Location a fvreSl S� Owners Name �Q✓� i e P Permit# r F Amount 3 0, Type of Occupancy ( t 't°� 9 New d Renovation ® Replacement ❑ Plans Submitted Yes ❑ No ❑ FIXTURES C P4 16 a SLI3IEW B4SffvENT IST 11fm 2ND PIDQ2 3RDHDQ2 41H H DM SII3 HDM 6M FU= 7M HIM gm imm (Printor type) �j ' n Check one: Certificate Installing Company NamcaOl,/�"-eQS--� I/Q�P J VS C �orp. A dressSm 1 q-i` &ve— ElPartner. Iykf- v-ePk o e��r-v Business Telephone f— 1. 7 ❑ Firm/Co. Name of Licensed Plumber: 7;6 k4 QS f✓ yCTQ�"�C Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature 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 Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusettsAstate Plumb' Code Chap 142 of the General Laws. By igna o �cens um r Type of Plumbing License Title j City/Town icense rqumDer Master Dt /roumeyman ®- APPROVED(OFFICE USE ONLY O � Date..6. ... 3 ..40 3 HORT!{• °f<"`° •'"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING •D•�i�D��'``1' �,SSACHUSEt This certifies that ....... has permission to perform ......� .4f 4. wel....... *i..................... wiring in the building of......... a .[....... . ?.�.... !`.. .... ....................... at.....f. .. P ... 5 ........ ........ .North Andove S. 1 .� �. f........... Lic.No./f/711v ..... �. -0-L,.... .... .c....�.... ELECTRICALINSPECTOR Check # r,✓, �� is. 5U0 Official Use Only ` Permit No. S ?�f�ed7�27?Zd?2lf/c�fl'�f d�7yL,g.SS�C�ZLS�77S 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: 0 (Please Print in ink or type all information) Date � O To the In pector Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Numberj� r rs� Owner or Tenant ��V l ly-( CA< " Owner's Address `1l Is this permit in conjunction with a building permit Yes 9,-' No ❑ (Check Appropriate Box) Purpose of Building [/ "C l If S Utility Authorization No. Existing Service P 6 o Amps 0 Voits Overhead i� Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of FeWers and Ampacity Location and Nature of Proposed Electrical Work ,�/ (f/Ivi� ✓ �Avh r� {'rCW S'� H� arca S 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 / 2 No.of Emergency Lighting No.of Receptacles Outlets ( cJ No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and 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 WaterWeaters KW Si ns 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 Pen ies of rjury: Q FIRM NAME 6(i e� QQ--,-� F'�d�C {/S LIC.NO. �S Licensee am GLS d yr Signature LIC.No. Bus.Tel No. Address Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) �Xt, 1 Telephone No. PERMITTEE $ :3� (Signature of Owner or Agent) The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 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# R Insurance.Co. Policy# Company name: Address City. Phone#: Insurance Co. Policy# MEMMOM Failure to secure coverage as required under Section 25A or MGL 152 care lead to the imposition of criminal penalties of,alfine up to$1,500.00 and/or one years'irrprisorrriern_aswelLas_civil.penaltmAnSheSrrmjof-a STOPY40W—ORDf3lmd_afioe-ot.($1110-OD)-ajiay--igainstme I understand that a copy of this statement may be forwarded to the Office of Investigations of the DW for coverage verification. I do hereby certify undar the pains and penalties of perjury that the rrformabon provided above is true and correct Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town Pem>it/Lic:ensing Building Dept ❑Check I immediate response is required [] Licensing Board E) Selectman's Office Contact person_ Phone# D Health Department Ei Other