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HomeMy WebLinkAboutMiscellaneous - 135 HICKORY HILL ROAD 4/30/2018 135 HICKORY HILL ROAD 210/062.0-0118-0000.0 a)lv'11.5................ Date. NORTH 'o " �, TOWN OF NORTH ANDOVER r- 9 * � PERMIT FOR GAS INSTALLATION S�CHUS� This certifies that.�?=i. .�- �AP cam- ................. has permission for gas installation ............... . .t R-...................... in the buildings of..........p..... c1v.:evrD..fj..................................................... at.......1. �..........................�. ................. �....'Q;�"NoA Andover, Mass. Fee..... ,�... Lic. No. 2........... !...!. ................................................. GASINSPECTOR Check# -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK cj"CITY MA DATE - 14- Is PERMIT# l� JOBSITE ADDRESS . 13�5� _ Ic zOma[ OWNER'S NAME GOWNER ADDRESS T� TEbz.S- 11FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:[ RENOVATION:91 REPLACEMENT:El PLANS SUBMITTED: YES FJ-1 NO® APPLIANCES'l FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 � BOILER l��..—r_1.�._ �� _ _.. _ I. 1_ _.. 1 . . . BOOSTER .- CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE (_. _1i l- -�-.. GENERATOR GRILLE INFRARED HEATER __ ^! _—I _ r _ [ .((_ �T► _ j LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOFTOP UNIT TEST UGIT HEATER UNVENTED ROOM HEATER L WATE OTHE HEATER ........... . ........ .. .. . - `___J L �I r I f I �(. OTHER L_______ sl.... I INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com ' ce wi all Pe ' nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �k � LICENSE# J SIGNATURE MP I MGF EjI JP [A JGF LPGI 0 CORPORATION Q# PARTNERSHIP 0#=LLC E]#= COMPANY NAME:I-.-.! J^b--1 ADDRESS i�l ISN. to �-��a•� CITY STATE Nle ZIP TEL FAXf2� CELL �.� IaEMAILcaK��� 7 �s �� t`�C-� ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPEC11OR&OTES Yes No 3 I Sll THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): o-C �,_%,Ap r Address: 1? `r���-•��r� (Z City/State/Zip: P�;�. e�l�, o.?F15 Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. El am a general contractor and I � have hired the sub-contractors 6. EJ New construction employees(full and/or part-time). 2. I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g E]Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy anal job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby a un ;a thepains andpenaldes ofperjury that the information provided above is true and correct. Si afore: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions a Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more Of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license oz permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of ridustdal Accidents Office of I lVestiga tion' 690 Washington Street Boston,MA 02111 Tel,#617-727-4900 ort 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 _.WWW-Mass.goV1Xa t COMMONWEALTH OF MASSACHUSETTS famel mu nol 2 WRI Lai ><�,; �N� GASFJTTfR:5 r" PLUMBER ,. ISSUES... TIHE F0LLOWIN ' L:tENS:iJE;<::.;> L I CEFISE> AS A JOURNEYMAN�PLUMSE H M PAGEAU 17 TIMBE RLAE RD<;>; <"` ;<`'' _.: ,,1s�,:-�_�,��,•�,, � .S p:LAisTow BJH 03865 2543 225' 257714> >:; 0` a:: ..;;1:6;';_>;" 8 Date. �./. ... ... .. HORTM Of.�``O TOWN OF NORTH ANDOVER ° F ' PERMIT FOR GAS INSTALLATION . y 'fffSSAC MUSE�< This certifies that .!.�j -. . �f�, � -�,. �� . . . . . . .,. has permission for gas installations- -w in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at !�. .'... `�"�/� �. . ` , North Andover, Mass. Fee. . . . . . . . . Lic. Noce'`/�. . � � . . . . . . . . . . . . f 1�aAS INSF. CTOF v v Check# 5779 MASSACHUSEI'IS UNIFORM APPUCATON FOR PERMPr TO DO GAS FITTING (Type or print) Date /a 1Z `J/06 NORTH ANDOVER,MASSACHUSETTS Building Locations 135- i C�fo�'�f �� f 40• Permit# Q5-17 71P SIwda Q Amount$Owner's Name NewElRenovation ❑ Replacement ® Plans Submitted x C4 F z w w w p x x rA O W F aU w x v, F a q P 6Q H z E x W a W H w U �, a o 3 a o U °x SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Check one: Certificate Installing Company Name >♦--1 A C C D 2 A AJ P C v M a r ry S Corp. Address PO 3 vX Partner. 1,gWR-1"Ce— 0 / kY2— Business Telephone G 11'S- 9 S"O y Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No O If you have checked}_es,please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity ❑ Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent 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 Massachusetts State Gas Code and Cha ter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber a 2zu City/Town ❑ Gas Fitter License lNumoer rl Master APPROVED(OFFICE USE ONLY) M Journeyman 2, rf) Date. /r TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING w , This certifies that . . . .� a -'�•". . . . _. . . . . . . . . . . . . . . . . . . . has permission to perform V-', plumbing in the buildings of .�.. . .V-', . . . . . . . . . . . . at .�~3-`. . . . .f. ... .f -�r�- -�� . . . . . North Andover, Mass. Fee . . . . . .Lic. No.`-/.Vli3 .. r/ . . . . . . . . . . . PLUMBIN,C,INSPECTOR Check # _ 7166 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS _ Date /�y�© Building Location f 3 �Ji 6yo'? /t/�%/ /j1) Owners Name.,7_44 �J/57AIoty,9 Permit Amount Type of Occupancy ©eye J/bAj NewRenovation Replacement M Plans Submitted Yes ❑ No FIXTURES a � x d � A SUB-FRa BA EVE*iT ISL HIM M FIfM 4M ROOK 5M HIM 6IH)HID(gt 7M HDM SM Imm 4t (Print or type) Check one: Certificate Installing Company Name NA f f Ot?A n1 etyl/�,�ca Corp. Address PO 13 01( 5 72- LA W q eovC-C 'q- 0i y Z Partner. usiness Telephone 61T ' 9 -p yrFirm/Co. Name of Licensed Plumber: 0 4 4iV L-tsurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity D . 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 0 Agent D 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 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By: igna ure vi Eicenseuum er Title Type of Plumbing License �v y Ir3 City/Town License um er Master ❑ Journeyman 12 APPROVED(OFFICE USE ONLY ZIT � Date. N° 47rJ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACHUS� This certifies thatZ�.: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . plumbing in the buildings of . :r.�� ... . . at. :. . . . . . . . �:.".: %� . .�` - . ., North Andover, Mass. Fee t r. . . .Lic. No.�� f . . �t-f-? ✓PLUMBINGJNSPE(&R Check # '.% C) !/t WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date ? Building Location /3 /'�/c �/_cert MIZ Owners Name {�S-r4xJ6 PPermit# 7,?7 41 Amount Type of Occupancy l New Renovation Replacement 1:1 Plans Submitted Yes No FIXTURES z z o w H F gi mill d !-� SCBM H�4�1VII�IT lS]C FIDQ2 M RUR 3MRfm 4IH FLOQZ 5RI FLOQ2 61H HJOCR '7II3 FIOQt gm FLOCK (Pfint or type) Check one: Certificate Installing Company Name •C 1e.� L B Cji 'v- 1 t Q E] Corp. Xddress ' L `/--C) C-6 �w I<C n Partner. C w Td rCJ '-'U 3 F Business Telephone 3 rA -2777- Firm/Co. Name of Licensed Plumber: 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' tallations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the M etts State Plumbi ode ciaha 142 of General Laws. By IgAaRlre 01 Licensectum eType of Plumbing License Title City/Town License Number— Master Journeyman ❑ APPROVED(OFFICE USE ONLY u No 3 6 Date... NORTI I 3?°.t�`'°:'�"°°� TOWN OF NORTH ANDOVER ` p PERMIT FOR WIRING ,SSACMus� a< This certifies that ../a:.�J ...�.: ....................................................... has permission to perform ......... ....' `'... �. .. .................................... wiring in the building of.............. ................................... at....j�...............:��:' !r� ................ ,North Andover,Mass. Fee. l'..�"..... Lic.No......�... ............... ..:....... .:.. ............. `-ELECTRICAL INSPECTOR fi Check # 2 `7� WHITE:Applicant CANARY: Building Dept. PINK:Treasurer -� THEC0A1M0AWE4L7H0F1VI9M4CMSE77S Office Use-only Useonly DEPARTMENT OFPUBLICS4FM Permit No. J66 6 & BOARDOFFIREPREYEW0NREGUL4TIOMS527CMR 120 ;75'UVAA Occupancy&Fees Checked �,��� PPLICATIONFOR PERMITTO MFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date '11 I- I 01 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant I IZA- `A57wL�O Owner's Address SAy-1(7 Is this permit in conjunction with a building permit: Yes t No (Check Appropriate Box) Purpose of Building jt&�S b Utility Authorization No. Existing Service Amps Volts Overhead M Underground No.of Meters New Service Amps / Volts Overhead M Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Wt A-6; l 7-) o'�f No of Lighting Outlets I No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA l� groundg1:1round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal Other • Connections No.of Water Heaters KW No.of No.of 1I Signs Bailasis r No.Hydro Massage Tubs No.of Motors Total HP OTHER fi-a =Coved Rasuat>rbthetegt�ar �Ga�a�alLaws ialait Iha\eaauartLiabdtyhtstr&=PbkymdudmgC�on� .GamdWcritsskgartia oWYES � NO vasa . IlmesubmOddproofofsamelotheObice YES r-J-IvO r IfjcuhaxdudWYES piMemdc*thp-tA ecfwmaWby&dmgthe INSURANCE [D' BOND OTiim ftmspecdy) Equation Date EslimEkd Value l Wak$ Wodcl+oShart 1 o htspaMionDweRe pWad Rc# -- �l r 1 c0 11 Fatal Sigttedutxfaie ofpajtey FIRM NAME t vtil... li �A � —5� Q lioetn�seNa VAI fZ SL (o Lioanee_!�( � �t �iy.va�� SigraEtue v" ✓�--'� Lioer>SeNo 1� Z.? Vb`�— Ai TeL% OWNER'S WAIVER;I.amawarethattheUr== nut theit�srrdnx iritssubdartial does Mme oaaage eastagtmedbyMGateralLaws andthatmysigrE t anthispemffi thisreclttasne{t. (Please check one) Owner Agent Telephone No. PERMIT FEE$_ �' Location /3S ' r tc�or )/f I l 1? No. Date NORTH TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ • i � Ss^n. Building/Frame Permit Fee $MI ` +• Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /� ' Building Inspector ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 7,y7, s> t .. .',- ,.. .^.,. ,.,. .. _ .. . r.. ...,� .... ... .. ...,r... rn BUILDING PERMIT NUMBER: �� DATE ISSUED: `_C-2a _a 00 / SIGNATURE: Aff BuildinE Commissioner/I ✓ ctor of Buildin2 Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 13SAk V1 Map Number Parcel Number G3 1.3 Zoning Information: 1.4 Property Dimensions: Q2 . SFS 2-81CU13 ► 06 , Zoning District Proposed Use Lot Area(sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required I Provide ReqWred Provided Re red Provided 'ZO ' 9' Z_o ' Zd I-20` 1.7 Water Supply M.G.L.C.40.§54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public )( Private ❑ Zone Outside Flood Zone X Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �� k• ft-.S�(�u0� 13 S NSc�oa-A �tl Name(Print) Address for Service ignatur r- Telephone l7 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 1 Not Applicable ❑ Th6�s 1. Za6rul iso !� Licensed Construction Supervisor: OS-1ce// N t G ryl t A , r n A License Number Wn Adds ' ti/,S-/d2 Expiration Date Si re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ �clnn aS , �,d�,�ci c zAt O Company Name ( 0-767q z� �}, 1 IG 1}l l `�� ��r 14 Registration Number Address �l P� 1 7,F—15,?7-c.-e Expiration Date Si re Telephone � r 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. Si ned affidavit Attached Yes...... No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑. Specify Brief Description of Proposed Work: neto SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be {}FFtCIAL USE=QNL4' Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Q Q �S Dd• Construction U v 3 Plumbing $'p0 Building Permit fee(e)X (b) 4 Mechanical HVAC ZUgp /•/� 5 Fire Protection 6 Total 1+2+3+4+5) 7 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i as Owner/Authorized Agent of subject property Hereby authorize T p r —Zc O ra k Lo to act on My behalf.i all n s ve to w rk authorized by this building permit application. Si ire of weer Date SECTION 7b OWNER/AUTHORIZED),AGENT DECLARATION I, T k p ma S �, �kO r'(A i Lc C) as Owner/Authorized Agent of subj,�-ct property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief I Print Na e '` Sil"f Owner/A ent Date NO.OF STORIES SIZE S-7. BASEMENT OR SLAB it,1 SIZE OF FLOOR TIMBERS is' 2--< to 2 ZX I 3kD SPAN ' l DIMENSIONS OF SILLS Z (o T DIN ENSIONS OF POSTS 3 S C, t—A LC DIMENSIONS OF GIRDERS 3 Z 1'10 HEIGHT OF FOUNDATION THICKNESS ) �� SIZE OF FOOTING t p�� X 7 MATERIAL OF CHIMNEY a 1C IS BUILDING ON SOLID OR FILLED LAND SV L J 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. �.■■rrr■■..■■.r............■•..rr.rrrr••.rrrrrrr.rr.rrr..rrr..■■rr.rrrrrrrr■ APPLICANT f c ro Le' ��Ue lymeJ L L G PHONELj ASSESSORS MAP NUMBER (02- LOT NUMBER I I SUBDIVISION 14l AQc LOT NUMBER 16 STREET �` 0u 6!Z 'Mi I� �. STREET NUMBER ................. ......................................................... OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS v.■ ■rr■rrrr.■■■.r.rrrr..rr....rrrrrrrrrrr■rrr■rrrrrr.rrr.r.rrrrrrr.rrrr.r■ lc � S DATE APPROVED � CONSERVATION MINISTRA OR DATE REJECTED CONINIENN "TS O DATE APPROVED Zi (i I O V TORI P DATE REJECTED CONOVIEENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED O DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS c S L Lv Q PUBLIC WORKS—SEWER/WATER CONNECTIONS /4 fie D RIVEWAY PERMIT Ii fl6. D DATE APPROVED FIRE DEPARTMENT DATE REJECTED COrRviENTS RECEIVED BY BUILDING INSPECTOR DATE I!!C lilllllll!(JIlWGdlll! UI IVIc1JJd(.1/UJf;((J Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: \G iMc(S t "l ",0 Location: �.S �f I c�6�V q1 CitV i J, A " Phone am a homeowner pe arming all work myself. F=1I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Companv name: Address City: Phone#: Insurance Co. Policy# Companv 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 a ffice of Investigations of the DIA for coverage verification. I do herby certify under the pains and enaltfes of perjury at t information provided above is true and correct Signature C / / Date d O A0 Print name /eta s �, { 0 n., " 0 Phone# q Official use only do not write in this area to be completed by city or town official' ❑ Building Dept []Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person:_ Phone#. ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 .0 Checked by/Date CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 1-17-2001 DATE OF PLANS: 12/18/00 TITLE: Eastwood Addition PROJECT INFORMATION: 135 Hickory Hill Road North Andover, MA 01845 COMPLIANCE: PASSES Required UA = 230 Your Home = 164 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 456 30 .0 0 .0 16 WALLS : Wood Frame, 16" O.C. 1166 19 .0 0 .0 70 GLAZING: Windows or Doors 159 0 .350 56 FLOORS: Over Unconditioned Space 456 19 .0 22 HVAC EFFICIENCY: Furnace, 90 .0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to at or cool the building shall be noreater than 125W of the desi ad as specified in g � P sections 780CMR 1310 and J4 .4 . Builder/Designer �� Date `� v� MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 .0 Eastwood Addition DATE: 1-17-2001 Bldg. Dept. Use CEILINGS: [ ] 1 . R-30 Comments/Location WALLS: [ ] 1 . Wood Frame, 16" O.C. , R-19 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1. U-value: 0 .35 For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS: [ ] 1 . Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1. Furnace, 90 .0 AFUE or higher Make and Model Number THERMOSTATS: [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 .5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: [ 1 Ducts in unconditioned spaces must be insulated to R-5 , Ducts outside the building must be insulated to R-8 .0 . DUCT CONSTRUCTION: •[ j ' All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS : [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 1250 of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS : [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only) ------------------------- ,per .Jfe TDonro�caort.�rP.czl(,fi o�..��4il�,it2cQe� t'1 �\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR i Registration: 107679 Expiration: 8/5/02 Type: INDIVIDUAL THOMAS DAVID ZAHORUIKO Thomas Zahoruiko 185 Hickory Hill Road North Andover,MA 01845 — Administrator ✓fie �omvnwozcuea�i �✓G���etta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 055417 Birthdate: 04/05/1960 TM 1 Expires:04/05/2002 Tr.no: 21877 Restricted To: 00 THOMAS D ZAHORUIKO _ 185 HICKORY HILL RD «� N ANDOVER, MA 01845 Administrator I T F� I— L.A r.1 a� L A �► r� IU IJoV.22�19gZ ADD IT ION) 21. PQov1 vaoc. IZ f�D1necKi t2' 1 2o' - 2' mor 4 � ��- �' T F-!� oFFSrcTS SHo�.Jr,J �vpp lTi4 Zowj iu G V Iz/ ro/9 � �7 71 f `111 OF ES ` ------- 13>yM N ►EttE� s 12(!c �9Z 0 I TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road,North Andover, MA 01845 978-687-2635 fax 978-689-2310 Constr. Spvsr. # 055417 HIC # 107679 Fed. ID #04-3516982 Agreement for Construction Services December 29, 2000 Parties, Contact Addresses, Telephone Numbers: Client: Ike and Kathy Eastwood Contractor: Tara Leigh Development, LLC 135 Hickory Hill Rd. 185 Hickory Hill Road North Andover, MA 01845 North Andover, MA 01845 978-794-3025 978-687-2635 Location of Work: 135 Hickory Hill Rd.,N. Andover, MA Description of Work to be Completed: Addition/expansion; see attached Scope of Work/Plans Attachments: Scope of Work Plans Limited Warranty Proposed Work Schedule: Proposed Start Date March 15, 2001 (foundation installation may begin prior, as weather conditions allow) Proposed Completion Date May 15, 2001 Payment Schedule: At Time of Agreement 20% $16,756.00 Completed Frame 20% $16,756.00 Roof, Windows Complete 20% $16,756.00 Siding, Rough Mechanicals, Insulation, Drywall 20% $16,756.00 Completed 20% $16,756.00 Total as Proposed 100% $83,780.00 1 TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road,North Andover, MA 01845 978-687-2635 fax 978-689-2310 Permits: By this Agreement, Client acknowledges its authority and authorizes the Contractor to apply for and acquire all necessary construction-related permits (From time to time there are additional permits and approvals required prior to building permits, which have not been provided for in this Agreement. These may include Special Permits, Conservation Commission Conditions, Planning Board Approval, or Zoning Variances, among others, and these are not included, if necessary). Unless specified in attached Scope of Work, costs of permits, as well as any costs for application or documentation required to apply will be passed through to Client, over and above the terms of this Agreement, for reimbursement. Client acknowledges that no work can begin until all necessary permits are in hand, and that Contractor will use good and reasonable efforts to acquire the necessary permits, but Contractor does not control the timely issuance of said permits. Client agrees to endorse all applications as required to facilitate permitting. All work and schedules, as well as that of any subcontractors, will be subject to all applicable permits being available on a timely basis, and will be performed by licensed and insured professionals whenever required. General Conditions&Definitions: 1. This Agreement constitutes the entire agreement. 2. Any changes are to be documented in writing and signed by all parties. Any changes will be paid for at the time of the change request, prior to the changed work being undertaken. TLD, LLC reserves the right to not accept specific requests for changes if and when acceptance of those change requests adversely affects integrity of work product or schedule. 3. Additional work will be billed at the rate of$42.00 per hour for licensed labor, $28.00 per hour for common labor unless otherwise agreed. 4. Work sites will be left in equivalent condition to those existing prior to contracted work; unless specifically agreed, no existing site conditions will be improved. 5. Any specific work hours which are restricted by local statute, agreement or association, and which adversely affect contractors' normal work schedule will cause completion time to be extended accordingly. 6. Completion time will be extended due to any delayed inspection services, beyond those specified by the current Massachusetts State Building Code. 7. Contract will be considered Substantially Complete when all work has been initially completed; repairs and warranty are beyond the scope of Substantial Completion and final payment will not be withheld due to repairs and warranty items. 8. Non-payment or delayed payment according to the Payment Schedule will result in work stoppage for the duration of any payment delays, and completion time extended accordingly. 9. Late payment will result in a finance charge applied to the entire balance due at an annual rate of 18%. 10. Only those work items specified in the"Scope of Work" and"Plans" are included in this contract, and this specifically excludes any items not specified, such as upgrades to electric service, water service, furnace/boiler, or other unspecified systems. 2 TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road,North Andover, MA 01845 978-687-2635 fax 978-689-2310 ,I Scope of Work Construct an addition/extension per attached plans and specifications, including all demolition, cleanup, disposal, site stabilization and redressing. Provide basement with walkout 9-lite steel door and related grading/stone retainers in rear yard. All materials and specifications to match as closely as possible/available with the existing structure, including 2x6 wall frame, plywood sheathing, Andersen windows, plaster finish, stain-grade trim/doors R-19 walls, R-30 ceiling, R-19 floor, 10"thick poured concrete foundation, 4" thick concrete slab Electrical to include wiring for CATV, telephone, wiring for ceiling fan. Heat to be extended from existing circuits. Wall paint color choice, (2) coats, standard finishes. Allowances: Carpet $20.00 per yard materials and labor (including family and new living area, master bedroom, closet, upper hallway, reworked bedroom) Cabinets for window seat area and bath $1,600.00 Plumbing fixtures (incl. sink/counter) $800.00 Tile $1,000.00 materials and labor Changes from 12/18/00 Draft: rework master bath with corner tile shower, changes per plan ($820.00) added two basement windows per plan($640.00) Options Available (per requests): rear deck+-390 sf ($5,850.00) front porch extend to north corner, add second stair($1,685.00) front porch extend around north side to addition jog, add second stair ($7,960.00) 3 J TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road,North Andover, MA 01845 978-687-2635 fax 978-689-2310 Additional Conditions for Residential/Home Improvement Contracts ONLY: 1. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 2. All home improvement contractors and subcontractors shall be registered, and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617) 727-8598 3. Client is entitled to a three-day right of cancellation under MGL c.93, ss48; MGL c. 140D, ss 10 or MGL c. 255D ssl4, as may be applicable. 4. Client is entitled to owner's rights and warranties under the provisions of 780 CMR R6 and MGL c. 142A. 5. Unless otherwise specified or notified, there is no lien or security interest given on the residence as a consequence of this contract. 6. Any and all necessary construction-related permits are necessary for work to commence. 7. It is the obligation of the contractor to obtain such permits as the owner's agent. 8. Any owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guaranty Fund. 9.The contractor and homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as pr vi ed in MGL. c. 142A. Owner Contractor r, . Z4/,? nI This Agreement is available to contract only at the time of presentation. Agreed this S day of TA 4.01.7 , 200$, by: Client Contractor 4 NORTfy own o _ 4Andover V% O VM No. 3D LA /�QM4000/ o o dower, Mass., COC HIC ME WICK 0RAT E D P'P tC7 7 4 ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... A...........�As. `..w. .. .�.... ........................... ......................�....... Foundation has permission to erect./.42'm . ... buildings on ./j. 5 .L7.�C.. a�' ...ly!.��...R......'...... Rough to be occupied as.. t�iV1 ...8�✓r.M..'�....�` p Al���N... .......................***"*' '*"*""*"**"*"*".... 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. 1" 642 AJ / 8 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR C Rough .........41M r ............................................................................. 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 Budding Inspector. Burner F Street No. SEE REVERSE SIDE Smoke Det. e PAGE r RIvHT Et�tiAT�or�{ EREAP, Lt V AT t o fJ � o� '� sTRF.Er EI.Ev�ZIa1`! E 1 kYT61VS\oN � t i 1 I f ( 7-7- 1 1! 7FT, Ji7 1 1 '---- I --T I wilOwS .r _ -------- 1- —----- _ - --- -- R LLJ - -- - --_ 4 �\.Ook PLA)J a-XS EMtut PLAO.1 _ Rao F-(, - -._ UD6GK* t2 cE�iw�G RhY to I DI P.G• c.owuacT IW — — — Ct 3(�,o s-F.l $ -1w2842-2 `ZEWA K WALKocr J 9 — — — — CAADS,S' A-LITE CAB! CED A0.-1.1.10s ORCAT f J�ISg�B t7 i �ooR Fl NISHE1ll -71 NN-T EavE DD•()QJ 20x\Z �nD-o x\s�1 uG ` 1' S Sao i ----------_ -..... _. . 2xg ao�sT®11151 •'sPa MASTa'k, ;5%TE DE'TERAWS sTeP y SUITt i GIQ : vT-TH0.0 '•� ?ulsi /CTE u� � EXIST�NCti 1l-'b X I9"� WALL g F.IJTTJ � W.I.G I.C. PLUS aNTN `s9 So \,JtW 9KsEA tK7j- f]� LXl$T1\ I FR�os;D ~ o 7 EXI.TI _ t NEW � J K ITi r L`11 RmM (� i i ��-,Zri I N I � Flu,sHe•D !a o� !v 1 ® O O LO acT. 2646 I — (REwwRlt� I A24�21 A7821 ' _- 4 Q N fL_1r 1-00151r I-,ToIsT til M .Z t2�-bR1� ticXi.� F AM��r Ra�M kwtiTloN cou N-OAI IoN :Soo >1�eCt .QNO7�S _ � 9cv IlS1X� PONS 1 COOK'r ' i rAol-4)45 AXI - c+3seaobd �� 9li�,Olk„02 � 9cv\1s1x3 S40001'Isis Dd,�h — W-4 NZ V4 Coo ?4,')bga31) -AWL 51.E 9x2 Q�soea21�1 Lf --- kCr� e , A I Location Flo. f Date °"'" TOWN OF NORTH ANDOVER FmisMiML p Certificate of Occupancy $ * Building/ ame Permit Fee $ /: �'s ' �cNFounda it Fee $ � sus t Other Per ;p9 $ S%ver Connect W*Connection Fe - TOTAL-10 $ /. NO ' Building Inspector v Div. Public Works 4cation No. ✓ Date Fi ,'°"r" TOWN OF NORTH ANDOVER A Certificate of Occupancy $ Building/Frame Permit Fee $ CHU t� Foundation PArmit Fee $ ' Other Permit Fee /p $ Sew�ConAwon vOc 0 $ Water necff y*F e �� $ TOTAL a,P, ' �+ Building Inspector 3 Div. Public Works Location /`-�`S '/"�F---�.`-a'`✓�f .�e.c° No. Date / T MORT� TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ - - ' Building/Frame Permit Fee $ ""°' ' Foundation Permit Fee $ sACMUSE cher Permit Fee $ �S.j!y0G Sr Connection Fee $ of Wate ; onnection Fee $ • • 6 d J' L 4- $ 'Bjj 'Id"� Inspector P/ '✓ r' �' Div. Public W- r 3 � PE ".i�r:�•-' s' S APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. L ,j PAGE i M94P 4140. - ,LOT NO.- 1 !'l 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE _ I SUB DIV. LOT-ANO. LOCATIO ZISIA-t bry ff, I I Q PURPOSE OF BUILDING OWNER'S NAME1 NO. OF STORIES !r CCT 'SIZE C ' _ OWNER'S ADDRESS r- tat Guoiv _ BASEMENT OR SLAB ARCHITECT'S NAME J �� t ; SIZE OF FLOOR TIMBERS IIS-T�j7 I/� 2ND 2 a it 3RD BUILDER'S NAME r��&t D. 7 v,��.`,� k p SPA G lGJ DISTANCE TO NEAREST BUILDING }� r' Y` 7 V` DIMENSIONS OF SILLS DISTANCE FROM STREET .t DISTANCE FROM LOT LINES-SIDES'I'zz REAF7f ] " GIRDERS AREA OF LOT err^ FRONTAGEI //�/1 HEIGHT OF FOUNDATION \ r// L / THICKNESS IS BUILDING NEWYe i„ !_ V C•� SIZE OF FOOTING +7 // X L� IS BUILDING ADDITION 1\-)T MATERIAL OF CHIMNEY L? IS BUILDING ALTERATION Up IS BUILDING ON SOLID OR FILLED LAND L/ ' WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ] IS BUILDING CONNECTED TO TOWN WATER J BOARD OF APPEALS ACTION. IF ANY f C IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 1 PROPERTY INFORMATION LAND COST `6 SEE BOTH SIDES . 2a=/10O ESG/GlEST. BLDG. COST wPAGE I FILL OUT SECTIONS i - 3 ' ` + EST. BLDG. COST PER SQ. FT. J - �i t' o EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 _ V ,+ ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING - SEPTIC PERMIT NO. AQ APPROVED BY 1 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUI ING INSPECTOR DATE FIL BOARD OF HEALTH GNATURE OF?,E* W OR AUTHORIZED AGENT OWNER TEL.# ® L.# s FEE ! r`i„TR !1� #o,7r� PLANNING BOARD PERMIT GRANTED ,g 4 BOARD OF SELECTMEN w BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION I 8 INTERIOR FINISH CONCRETE -I�y�_-II� 3 I 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER f- _ DRY WALL UNFIN. 3 BASEMENT I _ P AREA FULL FIN. B M'T' AREA _ '/, FIN. ATTIC AREA N_O B M-T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING _ _ J�j�� _ _�✓ STONE ON FRAME SUPERIOR IJ POOR ADEQUATE 1 NONE 5 ROOF 10 PLUMBING } GABLE HIP BATH f3 FIX.) GAMBREL MANSARD TOILET RM. 12 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 11 PIPELESS FURNACE FORCED HOT AIR FURN. TIMB54 2& OL STEAM ol STEEL .' 8 COL V HOT W-T'R OR VAPOR WOOD RAFTE AIR CONDITIONING RADIANT H'T'G UNIT HEATERS ` 7 NO. OF ROOMS GAS OIL B'M'T 12nd I ELECTRIC 1st 3rd NO HEATING 0 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. i ***************RAOLA--s *Applicant fills out his section***************** APPLICANT: .�,y„l L �e� 3 S Phone LOCATION: Assessor' s Map Number U* 0 Parcel Subdivision Lot(s) j Street �' fG 11222 2L�� St. Number t ************************Official Use Only************************ RECO DATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved ( �2 Town Planner Date Rejected Comments SAA) Date Approved Health Agent Date Rejected Comments rowly > l) Public Works - sewer/water connections driveway permit P -• /,SCG Fire Department Received by Building Inspector Date 1 4 IU �GAL� l " =tires i.PL- 2Zj I' r t4' f T 1GILD�y I r �g � Fl.use,N Z��tJ L-ar q 0 o N N t✓ `,a1N Of 8 - -- .13O7Z N 1 �t 1. o O rD 2 4 �Q�� DEC10 199' C.AuEe, i..loV.2Z)J q �C.crr- C__..�.�c��s >✓.L,.S�2 J 1 0 �4 2 o D r�F rz ►"(G.a D o k.l �,rte, 1-1 d 2.-T-1-4 A U n o•r�rz ,t`'{q V--,ore--1Imo!✓ 21 84 1 LP ,I T F-!� oF'FSETS rj41a..Jw.r n �> N OF .v W .131 -- -- I 'fat u►� t Z-2- e,7' -2e,7 DEC 1 0 19�� I NORTH �� > > over 0 1Townof . i. �I , 13 No. 5 4 o dower, Mass., COCHICHEWICK V '7 A°RATED PPa\ Cl '9S H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR 14.&10 THIS CERTIFIES THAT...;r4h. Of SPA o#•4•�#.60" ' " Foundation a 0 has permission to erect.l� .�uildings o Tf.��. �� � ` � ° R ugh Chimney to be occupied as.. 1AICA ..W ' ! � provided that the person accepting this permit shall in every respect conform to the terms of he applicat' /� 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. MW IN FOUNDATION ONLY PLUMBING INSPECTOR REGULATED BY PARA. 1143-S. H, Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MO bd y� FEE PA D o o. � Final "o ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough PERMIT FOR FRAME/BUILDING ....... Service ..... . .. ... ....... ............. ...................... BUILDING INSPECTOR Final DATEJ�' '��r FEE PA{p 4' a Permit Required to Occupy Building Occupancy q g GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor D Wall To Be Done Dry FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL �� CONSERVATION FINAL street No. r" 4rs'� _ Smoke Det. OrMrn /MATED �inini r•� r_ r nRl\/FWAY ENTRY PERMIT__ 1 ' ' NORT1y�"� { 0'" o Andover O ..;. No 5 o ATo " dover, M a � ass., 19g� Acnlc ME wIC It V '7 RRCoA TE CO) P"? ,�� �. BOARD OF HEALTH Food/KitchenPERMIT T D Septic System kA v BUILDING INSPECTOR THIS CERTIFIES THAT. ... Foundation ` has permission to erect.&.@0149.... uildin Tf.��. ��. � .�.. �<<••AVe Roug a - Chimne w j to be occupied as.4**Alt&.X00.016,P-4904fi h*W...... ��I ....... y hall in every respect conform to the terms of he appli provided that the person accepting this permit scatiMl�1 /! 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. PERMR FOR FOUNDATION ONLYLUMBING.I P OR REGULATED BY PAWL 114J4 &C. j' Ro , �� VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MODdTE y FEE PAD UNLESS CONSTRUCTION STARTS ELECT CAL INSPECTOR PERMIT FOR FRAMUBUILDING Rough Service . ... ..... . .. ... ........ ............. .................. �. FEE PAID:�,�.__.. BUILDING INSPECTOR Final CZ,( ' DATE/' /v� i, � � L \\ �� Occupancy Permit Required to- Occupy BLcilding GAS 1111SOECTOR &g'0 k l! ;.L- Display in a Conspicuous Place on the Premises — Do Not Remove No Lathingor Dr Wall To Be Done Y FRE DEPARTMENT _ Until Inspected and Approved by the Building Inspector. Z Burner PLANNING 1��2N " FINAL �/ f CONSERVATION /S FINAL Street No. 0.10 1G� -.PAp Smoke Det. zf�`73 �i1�SFWFR/WATER FINAL. DRIVEWAY ENTRY PERM l` CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 545 ! 992) Date FEBRUARY 5, 1993 THIS CERTIFIES THAT 1 THE BUILDING LOCATED ON 135 HICKORY HILL ROAD (LOT #10) 1 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. .U• '", CERTIFICATE ISSUED TO Thomas D. Zahoruiko o � 185 Hickory Hill Rd. ADDRESS North Andover, MA "'CHUS� Building Inspector � i