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Home My WebLink AboutMiscellaneous - 136 LANCASTER ROAD 4/30/2018 136 LANCASTER ROAD 210/104.D-0168-0000.0 LaMarche Associates 5 North Road, P.O. Box 250 Chelmsford, MA 01824 800-349-1525 Fax: 978-256-8590 January 12, 2018 Building Commissioner/Inspector of Buildings North Andover, MA 01845 Board of Health/Board of Selectmen North Andover, MA 01845 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, cause of loss and LA file number. Insured: Richard & Tennille Travers Loss Location: 136 Lancaster Road North Andover, MA 01845 Policy Number: PHOO100947189 Date of Loss: 01/10/2018 Cause of Loss: Ice and Snow LA File Number: MA-2-34120 On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. John Anderson Adjuster i LaMarche Associates,Inc.-800-349-1525 Page 1 of 1 7 6Y u Date.� � a �........ r Of NOR7h ,� o? TOWN OF NORTH ANDOVER F D • PERMIT FOR GAS INSTALLATION � S SACH USEt This certifies that . . . has permission for gas installation . . . . C1f ''.Q. s . . . . . . . in the buildings of . . . . Q r c C?.(( . . . . . . . . . . . . . . . . . . . . . . . . at . . '�. . . . . . �!MCS � . . .�Z�, North Andover, Mass. Fel.W,.C� Lic. GASINSPECTOR Check# �y <s MASSACHUSETTS UNIFOP-Mr,APPLICATION FOR PERMIT TO OCA GAS FITTiNe We` City/To\nr :. �Ic�c '► /9nddJer Date: T11011 Penial Building Loeatic 13 b (�t�� pzr�;c/10 �._ 7pe of Occupancy: Commercial Educational r ndustriai Institutional Residential l/ New:: Alteration: Renovation; Replacement: �( Flans Submitted: Yes No Q- FIXTURES _ _ -- u� LU U b U) O z r 0 W f-� o Ir Io o 0to a ® z U13 11.1ag .m ® 1- I- W <UJ w z a4 X I P 1PO ' LL z iii w F o z 0 1�— '� Z FW- X W 0 22 9 111.1SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Dame: Central Cooling 23, Heating, Inc. Check One Only Certificate ft Address:. 9 North Maple Street City/Town: Woburn State: MR *4( CorporatiCorporation. 2806C Business Tei: 781-933-8288Partnership Fax: 781-932-9017 Marine of Licensed Plumber/Gas Fitter:..M. Finn/Company ike Bemasconi INSURANCE COVERAGE: I have a current iiabii�,insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ✓ No If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance poiicy 4/ dither 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 Massachusetts General Lawns,and that my signature on this permit application vdaives this requirement. Check One Only Si nature of Owner or Owner's ent On`ner Agent By checking this box ;Ihereby certify that all of the details and information 1 have submitted lore eyed)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under he compliance with all Pertinent provision of the Massachusetts State Plu ng Coda hapter f the eGelneral issue this application will be In By. ✓ Type of License: _... Plumber Title Gas Fitter ..ignatur of Licensed Flu b as Fltfer Master City/Town Journeyman APPROVED OFFICE USE ONLY LP Installer License NU ber: 15137M FINAL INSPECTION. BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: S PERMIT# APPLICATION FOR PERMIT TO DO GAS FITTING NAME&TYPE OF BUILDING ~ LOCATION OF BUILDING SKETCH PLUMBER.GASFITTER_LP INSTALLER LICENSE NUMBER: PERMIT GRANTED E] DATE: GAS FrrIING INSPECTIOR The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Map# Lot# u,p 600 Washington Street Address: Boston,MA 02111 Permit# www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information, Please Print Legibly Name(Business/Organization/Individual): i -)- C i Address: agl free,+ City/State/Zip: VJ obLj_(,n_ MA 6 901 Phone#: -781 - 933-FJ ST Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with . 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2..❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' Building' addition [No workers'comp.insurance comp.insurance.# ❑ � required. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or.additions myself. [No workers'comp. right.of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13. 1]Other R4aZgeo FuM.La 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. tContmetors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.If the subcontractors have employees,they must provide their workers'comp:policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G LO$AL X0 9kKA N CE NEI D K SNC Policy#or Self-ins.Lic.#: SSOOO 2 9 (0 3 C Expiration Date: Job Site Address:_ 3 6 Lci,A co 0-c r `La r A City/State/Zip: �- fila ver. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 wellas 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. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Signature:� J t`--j. `'1� Date lit-/9 Phone#: `7 a 1 ` 933 ` Sd-a 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 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 I 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 or 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 Indastdail.Acmidents Office of Investigations 600,Wtzshington Stt d Boston,MA 02111 Tel:#617-727-goo ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mamgov/dia - 1 COMMONWEALTH OF MASSACHUSETTS IN PLUMBERS AND GASFITTERS LICEN A&Am8R RN&Y)"AN PLUMBER MICHAEL C BERNASCONI ;` 58 ALBATROSS RD «i i a QUINCY MA 02169-2658 COMMONWEALTH OF MASSACHUSET?S ' DIVISION OF PROFESSIONAL LICENSURF-BOARD OF� IN PLUMBERS�MASAE�� i cf L / .,, LICE LUMBER MICHAEL C BERNASCONI 58 ALBATROSS RD QUINCY MA 02169-2658 LICENSE NO. EXPIRATION DATE SERIAL No. COMMONWEALTH OF MASSACHUSETTS DIVISION OF•-. ,...D OFJ BOARD OF SHEET METAL WORKERS AS PSNH&SIER UNREST oICTED MICHAEL C BERNASCONI 58 ALBATROSS RD y QUINCY MA 02169-2658 LICENSE NO. EXPIRATION DATE SERIAL NO. L PER.ItiW NO. a APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. b/f-AGE 1 MAP i-40. I LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK :PAGE — ZONE SUB DIV. LOT NO.—7 LOCATION >✓ / /J,___ PURPOSE OF BUILDING OWNER'S NAME 9 �y NO. OF STORIES SIZE �iticY uy� o•I.r,� tet- c u� G'Gi?,� OWNER'S ADDRESS '� BASEMENT OR SLAB ARCHITECT'S NAME ,� V U SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME �jg-�/f 5-:t. /t /, / �t SPAN DISTANCE TO NEAREST BUILDING ,O i DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR n a '7 GIRDERS AREA OF LOT G/ Vi®3 5-� J� FRONTAGE d�' � HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW/ / / t/ f SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION .i IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Yom, IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY < IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST AD PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT.. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR - DATE FI l /57 BOARD OF HEALTH SIG ATURE OF ER OR AUTHORIZED AGENT FEE . C) OWNER TEL.# PLANNING BOARD PERMIT GRANTED �sQ CONTR.TEL.# 19 -�–� — CONTR.LIC.# BOARD OF SELECTMEN 7117 BUILDI G INiPECTOR c ti i� 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 8 INTERIOR FINISH CONCRETE 3 1 2 I,_ CONCRETE Bl. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN 3 BASEMENT I . AREA FULL I FIN. B'M'T AREA _ '/. 1/1 '/, 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 HARDN'✓D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR 1. 1 POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13BATH 13 FIX) GAMBREL MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING ��ORT `a, Town of P�_ . -o 4 over L No. 08 �¢' �'.,�Iµ4r.4�,,�4ny __? , lw Zo ' 1 � v dover, Mass., APO 11. 7 19 � coc.".ii_ICK V AERATED PPS\ S '-1 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT..... *.rxw...eow. ...0..M. ...elloo.10 BUILDING INSPECO............ Foundati has permission to erect...fV#V.*Ae buildings on ....11.4... /.r e..400rj . W.4 �... Rough to be occupied as..../Cr. /I..S.,1�....../rl..o.IMJ....�.�1fI.....I •t. , "r y� Chimn � , C provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 7 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. # $4 r4 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR • Rough ............. .... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT Location I&A Flo. ? Date /Of _ J NORTH TOWN OF NORTH ANDOVER O? •• • OOA Certificate of Occupancy $ - 13 Building/Frame Permit Fee $ . U J a �'7s'"•°'''t�' Foundation Permit Fee $ s�cMuS Other Permit Fee $ Sewer Connection Fee $ �i1—S3 Water Connection Fee $ TOTAL $ GSA , /c/J Building Inspector ! l 6872 c� 01/24/94 09:50 2,4-9.00 PAID 6 8 i < Div. Public Works LUation / 3� Na. 6-dZ Date //'�^�-3 T" TOWN OF NORTH ANDOVER 3?O•t"w .•1�0- v p Certificate of Occupancy $ s - Building/Frame 13e?mit Fee $ J SSACMUSEt Foundation Peritmit.Fee- Other Permit Fee $ Sewer Conn4ction Fee f$ Water Connf(Pk�* Fee,, $ .. TOTAL I� AS D• O Oat- „f Building Inspector 6699 _ Div. Public Works Location.... No. 5: — Date NORTH .TOWN OF FORTH ..ANDOVER 3?0•�,..o :•;goo t Certificate of occupancy..- c Building/Frame Permit Fee $ ,SSACMUsFoundation eji Fee $ Other Permit Fee .9 � ��- 7 t Sewer Connection Fee_ $ � ` Water Connection Fee $ TOTAL Building Inspector 14 6703 ` Div. Public Works Location �arrGe� i'' jO� 37 No. .5 L Date /O- 173 NORTH TOWN OF NORTH-ANDOVER Ott �ae ra1ti0 F , , Certificate of Occupancy :$ +li� Building/Frametmlt Fee ssA�M�s<� Foundation Permf�pee $ Other Permit Fee $ iY4 (bio Sewer Connection Feed $ Water Connection Fee �&$ 1(2" TOTAL $ r2or U B ' i Insp ctor C� A ` 6 4 9 4 Div-�ub)I6 Works PER1117 ,,� � APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER MASS. oZ, , PAGE 1 MAP d40. t/ f1 LOT 0. 2 RECORD OF OWNERSHIP jDATE BOOK PAGE ZONE L/ I SUB DIV. LOT NO. 3 —I LOCATION /,�j�N Cl9� � z �J J PURPOSE OF BUILDING OWNER'S NAME /^[r�e�l NO. OF STORIES / SIZEA 74 OWNER'S ADDRESS /' �+ ,�•� ,/�j A� / BASEMENT OR SLAB -7' ARCHITECT'S NAME ! SIZE OF FLOOR TIMBERS 1S/Tj ij U 2ND 3RD BUILDER'S NAME SPAN _ DISTANCE TO NEAREST BUILDING �� DIMENSIONS OF SILLS _ DISTANCE FROM STREET �/� POSTS DISTANCE FROM LOT LINES—SIDES / 30 REAR �s.+,� " GIRDERS J / •y AREA OF LOT % f�.t"�!T FRONTAGE HEIGHT OF FOUNDATION THICKNESS /� // IS BUILDING NEW . .f SIZE OF FOOTING o o X :�L co, IS BUILDING ADDITION MATERIAL OF CHIMNEY �� ax IS BUILDING ALTERATION �� IS BUILDING ON SOLID OR FILLED LAND .SO WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER Ve-5 A BOARD OF APPEALS ACTION. IF ANY !� / IS BUILDING CONNECTED TO TOWN SEWER / C f IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST „ SEE BOTH SIDES r..�,,., F" A L') - L� ro F� EST. BLDG. COST v o PAGE 1 FILL OUT SECTIONS 1 - 3 �° V O EST. BLDG. COST PER SO. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 � �j ,67 O EST. BLDG. COST PER ROOM �d O SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH SIGNAT f OWNER OR UFHORIZED AGENT FEE OWNER TEL.# BANNING BOARD PERMIT GRANTOW (, CONTR.TEL. Is - CONTR.LIC.#__ 7L-rO w BOARD OF SELECTMEN O �� BUI iN INSP[CTOR 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 I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. i 3 BASEMENT AREA FULL FIN. 8'M'TAREA _ '/4 s/1 s FIN. ATTIC AREA _ NO 8 M FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ k WOOD SHINGLES EARTH _ ASPHALT SIDING HARDNY'D _ ASBESTOS SIDING _ COMMCN / VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. & FLOOR _ *{ BRICK ON FRAME a I CONC. OR CINDER BILK. STONE ON MASONRY WIRING -- STONE ON FRAME G s SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) L F-LATJ SHED WATER CLOSET _ ASPHALT SHINGLES / LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING 11 MODERN FIXTURES _ L/ TILE FLOOR (/� • TILE DADO 6 FRAMING 11 HEATING ISV� r WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS / AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OILELS B'M'T 2nd ECTRICs 1st 13rd NO HEATING FORM U - LOT RELLSE FOm [ INSTRUCTIONS: This form is used to verify that all necessary 4 approvals/permits from Boards and DepaxtMe•+ts having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state lav, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: .�d�,� �� ,�. moi--12rylE/ �MC-0. Phone 3 s-y LOCATION: Assessor' s Map Number =�D �_ Parcel Subdivision �iiL u� /�S fi/� ,L�s Tri f�f Lot(s) 3 7 Street �ig.,� ca.�s�� I2�Jl �v - St. Number ************************Official Use Only************************ RECO291ENDATIONS OF TOWN AGENTS: Date Approved U conservation Administrator Date Rejected • Comments X. Date Approved CL Town-PlannQ Date Rejected Comments Date Approved Health Agenz Data Rejected Comments r Public Works - sewer/water connections - drivewav pe=it Fire DepartZent Received by Building Inspector Date � v � 51993 c 1-7 w W19 �x Ld 00.1 Ito �.r.� stir; •�� - � � '! r - y'i �! 'f � � .� r ♦ �. SII � �� ! A '�lXr ��'' w�I' y.��t {,: ,r /� ' St 111.l)IN(; /'• hl:e;�c 'Iitr:c ii•, �It�•i ::()NSJ:I tVATION `'"" 1 11\•1::11 IN I)I' I t 71 fill;,•1 i;-'.; Ilii�l:l'i l VNING lac ('()f%lr%IL!NI"1'1' 1)1:`l1s1,()I'11113N'I' K.-MU . Il.l'. Nla.titlN, I )Iltl:c:ic )li CHIMNEY API'LICAI"IOIJ ANO 1'L1:C,II1' ATE ,r. 2 1'Lltr11'1' # S 'CATION__�� NER'S NAME: S 7-L — ILDER'S NAME: — SON'S AME: ' ' ' SON'S NAME: �/^ i r �i\ �� 1�`i� SON'S ADDRESS: ,v C%u,tty ; ;' J SON'S TELEPHONE: Ll TERIAL OF CHIMNEY: rERIOR CHIMNEY: LXI LRIOR CHIMNEY: \,j 14 BER AND SIZE OF FLUES: -'>e,.l _--------- 1ICKNESS OF HEARTH: ' / --------- ZZ cfvunney an (jiAepCnCC CO11(1(14111 •tu 4he. U(ju.iAC111 11.5 u( the cute cull have attle.s cunt .guta iow been neeebed:TE: NATURE OF MASON: .'.WIT GRANTED: '� FLL' 'BERT NICL-TTA A / t 'ILDING INSPECTOR SPECTEU: -- :41ARKS SOLID BLOCK REQUIRED V 51993 THIS PERMIT t, usr GC UISPLAVLU 014 IHE PIZLMISL_� CERTIFIED FOUNDA TION PLAN LOCATED /N X10. Ah1 . MA. SCALE /". 4,o' DATE �6�2-9 93 Scott L. Gi/es R.L.S. 50 Deer Meadow Rood North Andover,Mass. mull awl WIWNT 33.88__ •• - i 50, LAI�[CA,STE� �Afl 5 / CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE qs� THE OFFSETS OF THE BUIL DING/NSPEC TOR ONL Y SHOWN COMPLY AND SUCH USE/S FOR THE 'o rt " WITH THE ZONING DETERMINATION OFZONING �E BYLAWS OF CONFORMITY OR NON-COIVFORM/TY •' . , �SR�o� O A WHEN CONSTRUCTED. WHEN BUIL T. o NORTH oVM Of �� Andover dower, Mass. 19. j T O -l`' LA E 1 1 COCMICKEWICK V ADRATED `c BOARD OF HEALTH PERMIT D Food/Kitchen Septic System `} BUILDING INSPECTOR THIS CERTIFIES THAT. �� ... O +.. .�Au n.0..f...�.. Foundation k' has permission to erect..W.6104/0W buildings on . > Rough ' to be occupied Chimney as.��.�.�.�..�� /./ .W .�.�.,./.�..�r..�.��1.Sr..� provided that the person accepting this permit shall in every respect conform to thilterms 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. PLUMBING INSPECTOR PERMIT FOR FOUNDATION ONI_t VIOLATION of the Zoning or Building Regulations Voids this Permit. SATED BY PARA 114.8-S. B.C. Rough PERMIT EXPIRES IN 6 MO L3 Final ID ELECTRICAL INSPECTOR C TI II__FFSS CONSTRUCTION STARTS 0,;7— v o r FOR FRAME/Btiltt� Rough ..... Service sem_ FEE PAID' rrc)c BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR I Display in a Conspicuous Place on the Premises — Do Not Remove Finalh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT CERTMCATE OF USE & OCCUPANCY Tovwil Q-1 N w1h A- ndoy o Building Permit Number Date THIS CERT IES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE ILASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 01,V40.WT#4 CERTIFICATE ISSUED TO °; o.'a •y p ADDRESS 10 Building Inspector ' , .,- e-a oNvn of 0 ove � L O No.52 . -` A b Y dover, Mass., A V. �' 19AJ /�. COC HICHE-IC ° K �1. -/ �ARATED C, ►-1 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT.... �� .II� ....e4 �.��.�.pA.rX.I.,.. 0.. ............. �L � Sa C"o�� oundation has permission to erect..W.6.04 AVi*buildings on ..�. .�'�.� d Irid �� p a .. r ... Rough[ to be occupied as.J***.$A1..**#Nt#4,YAA)AC141*4.Adll faA.SO.490.A At Chimney A provided that the person accepting this permit shall in ever respect conform to My terms of the application on file in P P P 9 P Y P PP Final Lv,•C- y Y 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. NG INSPE PLUMBCTO PERMIT FOR FOUNDATION ONLt ( a z�C� VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA 114.8-S. B.C. PERMIT EXPIRES IN 6 MO1. r� DATe FEE AID G>'O ELECTR AL INSPECTOR 161tfGSS CONSTRI_JCTf0N STA-RTS e sP- FRAM BU� Rough _ � .��I��R.-.. ..... .. ......... ...... ... ... .. Service �— FEE PAID' d yy c" ..... .... BUILDING INSP..E*"'C** ...R. r i � Final (� ` Occ-upaiiCy PC'TMit RCqLtIT"C'd t0 OCc1:tpy Building AS� NS CT R Display in a Conspicuous Place on the Premises — Do Not Remove h No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. - TIRE D/ PARTMENT l (Burner PLANNING '8 C 3 /� �' S CONSERVATION � street No. � , Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMI` ��