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HomeMy WebLinkAboutMiscellaneous - 14 NANTUCKET DRIVE 4/30/2018 � . <. S I� !� �I I r i I I i i � r- 's Date.... .�.'.�y d ..... � f NORTH 1 TOWN OF NORTH ANDOVER o PERMIT FOR WIRING TID ACMU This certifies that ....... i has permission to perform ........... ..............................................E.. . wiring in the building of...............M-0.v Rf. a...................................:,.... r at....JY./l/ , 'b 15€T......`-'�....................: North Andover,,,Mass. Fee.3-5. .. Lic.Nol..7�...74A............. ....... %' } ELECTRICAL INSPEC"ISR Check !/ o 8461 2012 Massachusetts EIectrical Code Amendments 527 CMR12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§,3L,the permit application form to provide notice of installation of wiring shall be uniforin throughout the Commonwealth,and applications shall be filed bn the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.01c. 166,§32,an electrical permit shall he issued to the person,fum or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in M.G.L�143 3L. Permits shall be Of as to the time of ongoing construction activrty,and maybe,deemed_bythe,Inspector_of_Wires rabandoned_and.invalid..if_he_. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the.permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job;growth and long term economic recovery and the Permit Extension Act fiuthers this purpose by establishing an automatic four-year extension to certairrpermits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008.and extending"through August 15,2012. isle 8—Permit(Date Closed: Note:)Reapply for new per ❑Permit Extension Act—Permit/Date Closed: ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: in accordance with the provisions of M.G.L.c.143,§.3L,the permit application form to provide notice of installation of wiring shall be uniform throughoutthe Commonwealth,and applications shall be filed' on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.01 c. 166,§32,an electrical permit shall be issued to the person,fine or corporation stated on the permit application. Such entity shall be responsible for the notification G of completion of the work as required in M. .L.8;.143,.6 3L. r Permits shall_be limited as to the time of ongoing construction.activity,and maybe.deemed_bythe.Insp.ector_of_Wires abandoned.aad.invalid-Mlle.—. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the.permit application. ❑ The Permit Extension Act was created by Section 173 of Chagr 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job;growth and long tern economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008.and extending"through August 15,2012. ❑ Rule 8—Permit/Date Closed: pp Y 1®Tote:Rea for new 1 permit❑ ❑Permit Extension Act—Permit/Date Closed: s Commonwealth o f Madjac woffi Official Use Only 2epartment ol5ire Serviced Permit No. � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: l/ //Z—/U �3 City or Town of: DmaazioaC A To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 10-ib Aef Owner or Tenant Telephone No. Owner's Address S Jq 61 Is this permit in conjunction with a building.permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity n Location and Nature of Proposed Electrical Work: i Completion ofthefo"owing table may be waived by the Inspector of Wires. No.of Recessed Luminaires l No.of CeU. Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting grind. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o,of etectton and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained Totals:P '' " ."""""".""...... """""' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Ell Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent Ballasts Heaters y No.of Water KW No,of BNo.al of Data Wiring: Signs No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: (l d,V e— Ttel 0LA-`Tc—. St'. c"r'_a U J Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 600, (When required by municipal policy.) Work to Start: //' t L J Inspections.to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability,'insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such c v age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify;under the pains and nalties of perjury,that the information.on this application is true and complete. FIRM NQ1VIE: ji�l71�i,r rd LL. c`*Z_ �-rv� t LIC.NO.: 1 Licensee:` '�, ;�^(��gfvty/�-LZ; Signatures LIC.NO:: t/ (; (If applicable,enter "exempt"in the license num be line.) Bus.Tei.No.. L' y P Address: ]IU B S�` E lYle, ,ven F a2 A- �1 �,/N Alt.Tel.No.:C/166-kIV-7/g7 *Per M.G.L.c, 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER. I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. The Commonwealth of Massachusetts I } Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/()rgmtiration/Individuall: fl (�- h �v h CJI I C& Address: 0 Cl`,�Ov1 ST City/State/Zip: � t��1�'�#nJ t Phone Are an employer?Check the appropriate box: Type of project(required): I. 1 am a employer with G 4, ❑ 1 am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 7. ❑ Remodeling 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their �r exemption right of MGL I I.❑ Plumbing repairs or additions 3.❑ I atm a homeowner doing all work g p 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 41 must also fill out the section wow showing their workers'compensation policy information. I omeowners who submit This aliidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =C'ontrictors 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 and job site information. /_� �I Insurance Company Name: dl�l/CvsIMWee , 11t%A /'r,/AL fAtl�� ' _____ Policy#or Self-ins. Lie.#: Kt IT (any q_3 Expiration Date: 0®!�� 1,400(7 1$ Job Site Address: Y/ � kv( ``� ° QVC City/State/Zip:�� 0 y 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 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 fol i urance coverage verification. I do here ce under tl c n and penalties of perjuiy that the information provided above is true U I )rrecL /Signature: Date: 1 / v Phone#: Official use only. Do not write in this area,to he 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#: ! I I � I I BODIO RESIDENCE \ I / BATH PLAN - AS BUILT CH 107" i I !; I !COPYRIGHT 'RESIDENCE OF: ;CLIENT APPROVAL: I SCALE: PAGE j BY BLACKDOG BUILDERS, INC. Carol Bodio 1/2 - 1 ( I I I iTHESE PLANS MAY NOT BE SUBJECT: DATE: DATE: USED IN ANY WAY WITHOUT WRITTEN PERMISSION OF I Master Bath RemodelI ( I , THE COPYRIGHT OWNER i 9/12/2008 I REMODELi - -- ---- -- ----- - -- -- - -- r LL- i co (0?0 Master closet Replace toilet and vanity F 77///;�7 with comfort hieght units Widen door I! Remove walls / Remove vanity / � � 1 BODIO RESIDENCE j MASTER BATH - rAAAi ivc CHANGES Tub remains as is ! ( 0\ CH = 107" j C 0 j i (COPYRIGHT ;RESIDENCE OF: CLIENT APPROVAL: SCALE: -PAGE BY BLACKDOG BUILDERS, INC. I 1/2" = 1 I Carol Bodio i i ! 'THESE PLANS MAY NOT BE ! I 1 'USED IN ANY WAY WITHOUT SUBJECT. 'DATE: I DATE: E !WRITTEN PERMISSION OF Master Bath Remodel ! 9/12/2008 ii ' i THE COPYRIGHT OWNERREMODE ! Toilet and vanity get replaced in the same ° AZO I location with comfort height units I � Threshold rough Full height wall Wall at tub frame height - Y deck height n All, I I I u f I 1 -3 �o t BODIO RESIDENCE MASTER BATH - PRESENTATION PLAN CH = 107" Extend tub deck into shower Padded, fold down seat as a bench, closed to the floor mounted to the wall COPYRIGHT RESIDENCE OF: CLIENT APPROVAL: SCALE: ' PAGE I 1 I BY BLACKDOG BUILDERS, INC. 1 ' 1/2 = 1 I I I Carol Bodio I I ;THESE PLANS MAY NOT BE j i I I USED IN ANY WAY WITHOUT (SUBJECT. ,DATE: ; DATE: 1 WRITTEN PERMISSION OF Master Bath Remodel . i , 9/12/2008 . ; i i THE COPYRIGHT OWNERDEL REMO , J - -- -- --- i I ' 1 . 02. �oc� �1b I f I 12" - 216'11 13 i c 1 . VBD18 34 1 /2" high, FEL BODIO RESIDENCE MASTER BATH - FINAL LAYOUT 2. VSBB36 34 1/2" high custom cabinet CH = 107° 3. SM-08 4. MTK-08 j ;COPYRIGHT RESIDENCE OF: 'CLIENT APPROVAL: SCALE: PAGE j { !BY BLACKDOG BUILDERS, INC. I Carol Bodio 1/2" - 1' I - i ;THESE PLANS MAY NOT BE i USED IN ANY WAY WITHOUT ;SUBJECT: ;DATE: rDATE: WRITTEN PERMISSION OF Master Bath Remodel 9/12/2008 { i 'THE COPYRIGHT OWNER REMODEL - - - ---- --- — — i f ` i �� El 1 0 0 I � ; l i V MANTO -a G it:COPYRIGHT IRESIDENCE OF: 'CLIENT APPROVAL: PAGE SCALE: AZI BY BLACKDOG BUILDERS, INC. Carol Bodio NONE !THESE PLANS MAY NOT BE 'DATE: DATE: 1 USED IN ANY WAY WITHOUT SUBJECT: 1 Master Bath Remodel N OF WRITTEN PERMISSION DESIGN 1 i I i 7 9/12/2008 B U I L D I JHE COPYRIGHT OWNER REIA DEL J -AD COPYRIGHT RESIDENCE OF: CLIENT APPROVAL: ; PAGE 'BY BLACKDOG BUILDERS, INC. NONE I Carol Bodio I THESE PLANS MAY NOT BE USED IN ANY WAY WITHOUT !SUBJECT: 'DATE: DATE: WRITTEN PERMISSION OF Master Bath Remodel D F S 1 9/12/2008 !THE COPYRIGHT OWNER REMODEL: F i I , � y I ' !� I J ! Ic I ��� I ; COPYRIGHT iRESIDENCE OF: TCLIENT APPROVAL: SCALE: I PAGE 1 NONE I BY BLACKDOG BUILDERS, INC. i Carol Bodio I { ;THESE PLANS MAY NOT BE SUBJECT: i DATE: DATE: USED IN ANY WAY WITHOUT j ;WR PERMISSION OF ; Master Bath Remodel — i ! ITHE COPYRIGHT OWNERRE MODEOL 9/12/2008 — I ' Date........ ............... f NORTH " TOWN OF NORTH ANDOVER PERMIT FOR WIRING (. This certifies that 5 nn > +� ,� has permission to perform ..........1. ... ...: :: f.....:�..:,:. ..,....J �......�,...-:���/f1 n wiring in the b ilding of....:.... .... 1.. .f..,7 /� g � ....... . �.....:.... ���7 t:../ � a� .......................... ,North Andover,Mass. at......�.. ..... 1 , lJ Fee.. !.-.:? Lic.No./�J��............................................................ 3 ELECTRICAL INSPECTOR Check 4933 Commonwealth of Massachf setts Official e Department of Fir Serlfices Permit No. Occupancy and Fee Chec f BOARD OF FIRE PREVENTI VN GULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERO PERFORM ELECTRICAL WORK All work to be performed in accordancMassachusetts Electrical Code(MEC),527 vMR 12.00 (PLEASE PRINT ININK OR A INF RMATION) Date: City or Town of: To the Inspector of fres: By this application the undersigne give ice of his or he intention;form the electrical work described below. Location(Street&Nu r) Owner or Tenant Telephone NO. Owner's Address Is this permit in conjunction with a building'permit? Yes ❑ No EJ/ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security Y S stem Completion of the folloi4dn table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.o Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers . Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydrom-assage Bathtubs No.of Motors Total iig Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of E ectrical Work: (When required by municipal policy.) Work to Start: o Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: ServicesLIC.NO.: I q 3_1(' Licensee: John S. Bassett Signature _ LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line.) Bus.Tel.No.- 60.1 594 5928 Address: Alt.Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Lic.9hsee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ,g )ate. .� . .'. 7 AORTIy -Of.", •°.;._'voo� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,S'S US� This certifies that . . y.- u .. . . has permission to perform,,!?-� u -Y . . . . . . . . . . . . . . . plumbing in the buildings of . . - -u< . . . . . . . . . . . . . . . . . . . at. . .''' t=.: . . . . ., North Andover, Mass. Fee . . . .Lic. No.. .!�`�a PLUM Ig N INSPECTOR Check # 71 792 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date / / L Building Location /VJ� �/L�(,�G ,I Owners Name Permit# 7 9 �- � '�,, � Type of Occupancy ®rl Amount New Renovation Replacement91Plans Submitted Yes No FIXTURES z x � H � a un o z z a z z 3 H v as Q w z a a a N H A a � *0 AM w o x 3 a as A � Q SLBBgVIC &1S�1VINT 1SL FLOOR Cn �FLOOR 41H 11 M SII3H-0m 6MHJ" 71H MOOR 8IH HIM (Print or type) f Check one: certificate Installing Company Name �/ Gd�� '�' C._-- ®; Corp. Address �'/ J' ` � Partner. t usmes a ep one 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 indemnityElBond . Insurance Waiver: I the undersi ned have been made aware that the licensee ensee of this application does not pp have any one of the above three insurance Signature Owner rl 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 lati s performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas h e State Pl . bi ode and Chapter 14'L of the General Laws. By: 1 re cense um er Title Type of Plumbing/f-icense C�-�VCity/Town icense umoer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Location `� 1 �I /U A►� `' C I��l D P�, No. c `L� Date 9',�0- MGRTh TOWN OF NORTH ANDOVER 3? •• O 9 ' Certificate of Occupancy $ Building/Frame Permit Fee $ 1 ) ccs s�cHus ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ lea i Check # /S f- 1493 MA Building Inspector ,ss(i a s-- a s ° ' AND VER STREET )4-ou5r. 4- )a -1� ( PUBLIC 60' WIDE ) N Nlf W THOMAS D. & L L TERESA MAHONEY =Q '-4LOT , 1 � Q W o S q • }•- 136.12' -'i � . 19.6 w_ 11Y� o � � 14.0'0 0 16.0' 0 30.8' 25.6' m C=; N 7.0' S �. `. Cq �Q�P Ivy 00 '•0'3.0' EXISTING FOUNDATION "R IlkC p 10' TOP OF FOUNDATION=229.37' 0) O o, 7.0' N 25.6' o 0 35.6' �17­ 0L OT 13 t s.o' NIF THOMAS G. MARIE HILL AREA=1,3,602 f Sr 19.5' 136.10' -.� NIE THOMAS G. MAR/E fill N/f EDWARD � LOT� 12 JOAN F. MAILNOT O N�f ELLIOT R 000N v & LOREJ7A JO gATTAGLIA I HEREBY CERTIFY THAT THE FOUNDATION ON LOT 13 IS LOCATED AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE ZONING -LAW OF THE TOWN OF NORTH NDOVER. .. .. . �'`''�" O GREGORY yG ........... . . ... .................. PROFES ON L. N SURVEYOR R. c� CORCORAN DATE:...... . , .. }�, No. 38034 ... �A90FESS1���@ i CE'RTIFIE'D PLOT o A K I N S, Inc. Consukn' glneem &land Surveyors 1215 MAIN STREET . UNIT 111 PLAN OF LAND IN TEWKSBURY, MASSACHUSETTS 01876 N.ANDOVER, MASSACHUSETTS PREPARED FOR: CORMIER—ANDOVER CONSTRUCTION CORP. CHATHAM CROSSING 59 CHANDLER CIRCLE ANDOVER, MASSACHUSETTS ... SCALE: 1"=40' DATE: JUNE 26, 2001 JOB NO.51165-13 SHEET 1 OF 1 COPYRIGHT 0 2001 BY DANA F. PERKINS, Im. Location No. Date 30'U (' NORTH TOWN OF NORTH ANDOVER F 9 y Certificate of Occupancy $ � �',S''•°^'<�' Building/Fra)iie Permit Fee $ sAGNUSE Foundation Permit Fee $ ` S Other Permit Fee $ TOTAL $ / Sr Check # �-3 L f Building Inspector l 1vT` ! 01f TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENO, OR DEMOLISH A ONE.OR TWO FAMILY DWELLING BUILDING PERMIT NUMBIrR: DATE ISSUED. —CR 00 c SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number n, 1 Zoning Information: 1.4 Property Dimensions: a D 4&I Zoning District Proposed Use Lot Area(sO Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R Fred Provided Re red Provided 7 Q 1.7 Water Supp)M.GL C.40. 54) 1.5.1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Private ❑ Zone outside Flood Zone Municipal On Site Disposal System ❑ Public e SECTION 2-PROPERTY OWNERSIIIPJAUTHORIZED AGENT 2.10 Record i C 1 (J 1 i S f Address or Service: QJ ignature Telephone 1 I 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licens onstruction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address �7v v14 Expiration Date gnature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Tele hone SECTION 4-WORKERS C01bI1PENSATI0N(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 permit. Signed 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 Des •ption of Proposed Work: 4 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to bei Completed by permit a licant MAN 1. Building r (a) Building Permit Fee d v Multiplier 2 Electrical (b) Estimated Total Cost of /7 J D O Construction 3 Plumbing O O Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 0 &d Check Number SECTION 7a OWNER AUTHORIZATIO TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b WNER/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 Print Name 00 Si at e of Owner/ nt ate NO. OF§1244ES SIZE R SLAB E OF F OR TIMBERS Is r. 2 'j 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS / DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION r THICKNESS (O SIZE OF FOOTING 2 / 'Z. X ' MATERIAL OF CHDANEY m IS BUILDING ON SOLID OR LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a The Commonwealth of Massachusetts Department of Industrial Accidents ' d Office of Investigations �F Boston, Mass. 02111 Workers'compensation Insurance Affidavit M 5 Please Print Name Name Location: 7V- Phone # CI I I am a homeowner performing all work myself. 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. `# Company name: 1 Address �.� (� ���� 6k. � Z Phone City Insurance Co.. Com an .name: Address Phone : Ci I" Insurance Co Policy# - Failure to secure coverage as required under section 25A or MGL 152 can lead to the imposition of criminal penalties .- i fine up to$1 500 00 and/or one years`imprisonment as well_as_civii-penalties in-the-form-of a-STOP-WORK_ORCIFRand afiine-of><.$'1.00:DD) day egainstme. i understand that a copy of this stateme a arded to the Office of Investigat` a DIA for coverage verification. under th n d penalties of p ry f at the' rovided above is true and correct. I do hereby certify // v A Signature Date ° ! Fhone.# a Print name official use only do not write in this area to be completed by city or town official' { City or Town Permit/Licensing El Building Dept E] Licensing Board ❑Check if immediate response is required Selectman's Office I � Contact person: Phone A Health Department dOther i r... .. ...r.... Town of North Andover a� thORT11 4St,E0 PSA Building Department 0 27 Charles Street 4 - h North Andover, Massachusetts 01845 4 g �y 978 688-9545 Fax 978 688-9542 °� COCpIC,wW CN SSACHUS DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in/at: Cri cility location Signatur pplicant Da7e NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. (3 Zt (Y GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVER BUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the neces information as requested below. rPerma a1(dG4 41- Permit it A plicant Property address Map/Parcel f740 X70 i ZZq Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw.I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior,to the issuance of the building permit.Further I understand that my interpretation of the exemption status is subject to review by the Budding Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot,in the building permit application and associated attachments,complies with one or more ofthe following sections as indicated by a check mark. This is an application for building permit for the enlargement,restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw,provided that no additional residential unit is created. The lot(s)was/were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals,where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land.For purposes of this section"senior"shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density(buildable lots)below the density permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland The land to be preserved shall be protected from development by an Agricultural Preservation j Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit(all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits.Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAN SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF O ABO MPTIO WHICH DOES NOT COMPLY WHETHER DONE TO MY KNOWLEDGE OR NOT IS GRO FUSAL B UILDININ TO ISSUE A BUILDING P/RMIT. APPLIC GNA DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION FORM - U - LOT RELEASE FORM INSTRUCTIONS- This form is used to verify that allnecessary 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. mamma 0 Nis now 9 amp Nam a a 9 Enos no am Mona ago noona Nam a News amonammommom so we=as awn a as APPLICANT PHONE ASSESSORS MAP NUMBER LOT NUMBER SUBDIWSION.� ����� Z12 S5• E LOT NUMBER STREET UCti�I' STREET NUMBER 1 . .......... OFFICIAL USE ONLY OMMENDATIONS OF TOWN AGENTS 9 . ...8�! ..�.. ....................■,,,,,,,,,,,,.,,.r...,.,..,,. ■,,,,,,,aa DATE APPROVED -� "L b CONSERVATION ADIVIINI:STRATOR DATE REJECTED COMIyy1EN'I•S Ajo -L- Ir\ t 0 0--, DATE APPROVED OF TO DATE REJECTED CONRVIEENTS DATE APPROVED _- _.... FOOD INSPECTOR DATE REJECTED DATE APPROVED SEPTT IN CTO - TK DATE REJECTED COMMI;N"fS �liGtiT� PUBLIC WORKS-SEWER/WATER CONNECTIONS off- DRIVEWAY PERMIT /ATE APPROVED "/' FIRE 15EPARtMENT DATE REJECTED COMMENTS RECENED BY BUILDING INSPECTOR DATE I i i OD \Z Z Z m m Z Z 99.87' I LOT 13 LOT, 1 13,602 sq. ff. c" 1 N/F R. CORM/ER 12 N/F , LOT / ifFFCO9 6' 19.6' Proposed Proposed Unit Unit 1w rn FF=229.0 FF=229.0 fV #300 GF= GF-- 226.0 F=226.0 226.0 Co a 1 0.00' S is + EDGE OF PAVEMENT " C.L. I. WATER m 8" PVC © S• S+ NANTUCKET S. o z DRIVE L!N OF Mq � �` �P SS O p ( 50' WIDE I z o DOUGLAS E. 'yc o LEES m 0 N Q : L y 4 93 0 0 U z DRAINAGE EASEMENT PROPOSED PLOT PLAN DANA F. PERKINS, Inc. Consulting Engineers k Land Surveyors LOT 13 1215 MAIN STREET a UNIT 111 TEWKSBURY MASSACHUSETTS 01876 ........... .................. .................:::.....�::. CHATHAM CROSSING PREPARED ED f R: RAY CORM A I R E NORTH AArDO VER MASS. 59 CHANDLER CIRCLE ANDOVER MA SCALE: 1"=40' DATE: MAY 3,2001 JOB NO.51165 SHEET 1 OF 1 COPYRIGHT Q 2001 BY DANA F. PERKINS. Inc. DPW 350 0 �NOArN o TOWN OF NOk RECEIPT `S3ACHU5�� nw—z , This certifies that .../4 �Lr ^ has paid........................ 1 ..............�... ®.lJ...4..{ddd............................. for Received b Department ...................... WHITE: Applicant CANARY:Department � PINK:Treasurer � DPW 351 Date .........'.-1'............ i TOWN OF NORTH ANDOVER I * * * � = RECEIPT o. s`4ACHU5E This certifies that ... .......CV �� haspaid... .................` .1..( ............................................ L4.14 er for .......5..aAe- .. rf.. :......f.................... ................... XP 7� Received b ... ....... LIX.�sI�! ........................ y.......:....................../ 1� Department...................... !:..1 r.I. ................ WHITE: Applicant CANARY:Department PINK:Treasurer A X u . ' Y''APPLICATION'FOR WATER ISjERVICECONNECTION F a a 11 �P tea �a } , ' 3 � -h .yr?iaKP0 1 , s. �' #gf s� + t Noittit Andoyer;'Mass ' ._` Cry �t Iii, s. •t y y t APpliCation'by the undersigned is hereby jmade to con ect"with the town water rnaiiitiri # tStreet e subject to,IN pules and,,regulatioris of the -y%Division of Public Works tee. �3. :?M, n = J��cSP.; f `1 €' � rb,*'"- ; 3s # s A .'_ a.4'. �,' The`Premises are.kh6Wn as NO Street ` w=: t�a�r F , �#' 4KP i3•' $ q. C {y s si 3 { 3ubdrvi51on lotno a -. + €''. ,s �' _ > •r y�r' t + . r rx e e a �# �,,.-� i%�•�'� v s'� �:.y �k�� ,'TjS',� T Y i�.: r'€� OWner, ' ^' nr- [ t , `• a s' a a� �. +i' "s ,r Address .- �. z� ' , 7,57a �Y.'r a^• a, i�:r 37 }g `� �, � , Al a v Coritrac�or Address. 5 �At { �� ,�. S f:APPlicant' gnature i K fL/ 41 L16 � 00 0e) PERMIT TO CONNECT WITii WATER MAIN a r ' The Board,of Public Works hereby grants Permissi'on to "� ; ' �'YY1 e�. - ' t to make a IPI 1: wit�►rthe Street {sutect to therules'and regulations'`of theDiuisioi of Public Works Nw,d+,3' 4 q4 t' 4'k .w+e a , r •`�rb6ard of Public"Works ;' ,. a i�°# i• Inspected bye . i A '.' rr 'V Date -i Seesback for rules and regulations' r $r s, -., a Y r� e I 1669 APPLICATION FOR SEWER SERVICE CONNECTION � d North Andover, Mass. e Application by the undersigned is hereby made to connect with the town sewer main in (�/ Street, subject to the rules and regulations of the Division of Public Works. /� The premises are known as No. 1—z _ j Iva V�� Street or subdivision lot no. f' , R14f 4 An ' vel'-- Owner Address Contractor Address Applicant's nature Ir r. F PERMIT TO CONNECT WITH S WER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at /V�-�� C� � Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations I TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J.WILLIAM HMURCIAK, P.E. ( DIRECTOR Telephone 978)685-0950 � NORTh Fax(978)688-9573 to O � _ A * o a « �9SSACtilISEt�y DRIVEWAY PERMI TS .DATE M A Y LOCATION Z. ( ,... hI A&]7'1_0 BUILDER phone OWNER 24Y C &Rl Eg phone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET . CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY, FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. I i f,,aRTN AUTOMATIC LAWN IRRIGATION SYSTEM PERMIT Too TOWN OF NORTH ANDOVER MASSACHUSETTS Top SNCHU'S ALL INFORMATION MUST BE PROVIDED,BY A LICENSED PLUMBER, PRINTED IN INK AND LEGIBLE.IF NOT THE PERMIT WILL BE REJECTED. DATE: LOT#: LOCATION: I Z— Iv AiJ l L .I��i✓ NUMBER STREET NAME BUILDER: NAME TELEPHONE NUMBER STREET NAME TOWN/CITY&STATE OWNER: NAME TELEPHONE NUMBER' STREET NAME TOWN/CITY&STATE PLUMBER: NAME TELEPHONE NUMBER STREET NAME TOWN/CITY&STATE LICENSE NO. EXPIRATION DATE: SERIAL NO. IRRIGATION INSTALLER IF NOT THE PLUMBER INSTALLER: COMPANY TELEPHONE NUMBER STREET NAME TOWN/CITY&-STATE INDIVIDUAL NAME TELEPHONE The plumber,must install the connection to the municipal water supply within the building,the water line to the outside of the building and the backflow device. A registered irrigation installer may then install the balance of the Automatic Lawn Irrigation system.NO irrigation heads will be allowed in the right of way(near edge of pavement).ALL irrigation heads MUST be at or behind the property line.All heads installed in the right of way will be removed immediately upon notification and said plumber or installer will not be allowed to perform any future work on the municipal water"supply, until the heads are removed from the right of way. Sign below that you have read this paragraph and understand it. SIGNATURE OF PLUMBER DATE THIS PERMIT MUST BE POSTED AT THE CONNECTION/METER LOCATION FOR THE INSPECTOR. INSIDE CONNECTION METER(IF APPLICABLE) BACKFLOW DEVICE RAIN SENSING DEVICE COMMENTS ORTH Town o �.: ndover 0 No. yJ ~ ?,o LAS o dover, Mass., COC MICME W ICI( TED SSACHUS� FOR EXCAVATION AND FOUNDATION �O1" 1/1'1 r N�• � •I..... ...... ... ... .... r► Cdy......... .... aca.sr.pf......... ....?HIS CERTIFIES THAT ..... ..... ........ has permission to excavate and pour foundation at .. Q 3 � ... ........ A. V....... �...... .... ..... ..... for the purpose of..� �Om ri1� �.•.S �� n ...a �� 00 The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. .. /'!�.................................................................. BUILDING INSPECTOR AORTH Town of over No. :a 1 Z11 -as- ago o� �o� !'Al. dower, Mass., �d ADRATED PC S SE BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......C..ortmitr%....Aujua �O�s �O r...... . ............................ ........................... .. .... . ••••�••••'• ••••• Foundation has permission to erect ...... buildings on ..�0 .13.....*.J V NAOJ U G�C �R • Rough to be occupied as..6. ka"" A....S4.1.1...A*'4�J...Dt 6% )"1 I 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 Ins action, Alteration and Construction of Buildings in the Town of North Andover. M 4 0) P 3 17 Se � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR Rough II ..........CA ........................................... 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 Dec. t � 3 AScheck COMPLIANCE REPORT assachusetts Energy Code Permit # AScheck .Software Version 2. 0 Checked by/Date ITY: Lawrence TATE: Massachusetts �d�� DD: 625 l3 ONSTRUCTION TYPE: 1 or 2 family, detached EATING SYSTEM TYPE: Other (Non-Electric Resistance) ATE: 5-16-2001 ATE OF PLANS : 5-11-01 ITLE: CONDOMINIUM ROJECT INFORMATION: AY CORMIER OT 13 ANTUCKET DRIVE OMPLIANCE: PASSES .equired UA = 268 our Home = 263 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------ EILINGS 1132 38 . 0 0 .0 34 ALLS : Wood Frame, 16" O.C. 989 19 .0 3 .0 53 LAZING: Windows or Doors 185 0 .350 65 LAZING: Skylights 35 0 .410 14 OORS 21 0 .350 7 OORS 84 0 .350 29 LOORS : Over Unconditioned Space 1282 19 .0 61 VAC EFFICIENCY: Furnace, 83 .0 AFUE ------------------------------------------------------------------------------ OMPLIANCE STATEMENT: The proposed building design represented in these ocuments is consistent with the building plans, specifications, and other alculations submitted with the permit application. The proposed building as been designed to meet the requirements of the Massachusetts Ener-gy Code. 'he heating load for this building, and the cooling load if appropriate as been determined using the applicable Standard Design Conditions found n the Code. The HVAC equipment sele-ct, to at or cool the building hall be no greater than 125% of the de loa as C n ections 780CMR 1310 and J4 .4 . uilder/Designer Date r i AScheck INSPECTION CHECKLIST assachusetts Energy Code AScheck Software Version 2 . 0 ONDOMINIUM ATE: 5-16-2001 ldg. ept. se CEILINGS : ] 1 . R-38 Comments/.Location WALLS : ] 1 . Wood Frame, 16" O.C. , R-19 + R-3 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 SKYLIGHTS : ] 1 . U-value: 0 .41 For skylights without labeled U-values, describe features : # Panes Frame 'Type Thermal Break? { ] Yes { ] .'No- Comments/Location DOORS : l 1 . U-value: 0 .35 Comments/Location l 2 . U-value: 0 .35 Comments/Location FLOORS : Over Unconditioned .Space, R-_19 Comments/Location 4VAC EQUIPMENT EFFICIENCY: ] X . Furnace, 83 . 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. Receseed lights must be type. IC rated and installed with no penetrations- or installed. inside an appropriate air-tight assembly with. a D .H" 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: Ducts in .unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8.0 . DUCT CONSTRUCTION: . ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts . The MVAC system must provide a means for balancing air and water systems_. TEMPERATURE CONTROLS: l 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 125% of the design load as specified in sections 780CMR 1310 and J4.4 . MISC REQUIREMENTS : l 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) ------------------------- Town of North Andover aF AO oTh �� Building Department �? g���1, "b'a �0 27 Charles Street 0L North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 T O COCMi[�wKM 1 .acHU$���y APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS / '44,7 Z&e �7-1 LOT NUMBER 3 SUBDIVISION DATE REQUEST FILED DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED,WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE($25.)DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE j OFFICIAL USE ONLY i ROUTING CONSERVATIO - J DATE 7 Z PL DATE D.P.W. —WA R— DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED RRIOR)TO THE INSPECTION QUEST DATE. OIOIG ATURE/D A TN Location No. l Date 2 U NORTH TOWN OF NORTH ANDOVER I.- p i Certificate of Occupancy $ �Ss Building/Frame/Frame Permit Fee $ACMusE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ =` Check # o" 1564 0 6//— / Building lnsp Or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .p BUILDING PERMIT NUMBER: DATE ISSUED: X SIGNATURE: Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION 1 O 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 aired `Provide Rapired Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54)- 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J Public ❑ Private 0 r SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 7 2.1 Owne f Record Name(Print) ress for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z M 'j Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: �J zzz �� � � '� 4'�/ C�� License Number Address � f�'� Expiration Date (`�r Sign re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name m Registration Number Address Z Expiration Date Y/ Signature Telephone SECTION 4-WORKERS COMPENSATION(1VLG.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.......0 SECTION 5 Description of Proposed Work check all applicable New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) ❑ Addition 0 �' 1 Accessory Bldg. 0 Demolition `" 0 Other 0 Specify Brief Description of Proposed Work: ' i SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICLiT.,USE4N :Y, Completed by permit applicant 1. Building (a) Building Permit Fee (JCS Multiplier 2 Electrical (b) Estimated Total Cost of of OD D ^—'— Construction J 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Qp► Check Number SECTION 7a OWNER AUTHORIZAT161,KTO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property erty Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T VIBERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 7r-1 �-- Lf v _ v I Tr.no: 3593 �II�M�FtI,�IN�Rp ANpQVER, MA M8I'Q: p,drj nf�tr0tor �f. North , Andover Building Department Tel: 978-•688_9: 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) gnature ofermit Applicant Date NOTE: Demolition permit from t�e Town of North Andover must be obtained for this project through the Office of the Building Inspector i The Commonwealth of Massachusetts Department of Industrial Accidents fi Office or'/nvestigatlons Boston, Mass. 02111 Workers'Compensation Insurance Aff1davit Ik ` Please'Print Name: i Location: t 2ty Phone b am a homeowner performing all work myself. �I am a sole proprietor and have no on6 working In any capacity I am an employer providing workers' compensation for my employees working on this job. Comsernr_name: . .. d G�r�`~4 ✓��� � �d�Si CaQ Address !t tsu ce rr P_!i ename: Add rss G'�-G Jy /n C� J CitY: Ins—Um.oeco, / •o! failure to secure coverage as required under Section 26A or MGL I'52 can leant to the►�p�itton of aiminai penalfis.or a fine up to si 500.oo and/or one years'imprisonment as'well as c1W penalties in the foin�►of a STOP WOW C RDM and a tine aF($100-00)a day against rne. I understand that a copy of this stated to the Offite of Investigations of the DIA for coverage verfflcation. I do herby certify under r p nd,p =Of that th aft bo e'ar►ti cared Signature Date Print name- -; �/ �i�'�i2- Phone Official use only do not write in this area to be completed by city or town official* Building Qpt ©Check if Immediate response is required Building Dept p Licensing Bard +. p Selectman's Office Contact person: Phone# !� Health Dep r(merrt p Other 4fA WORKA#A N'S COMPENSATION . 5;j, NORT, Town of over COCHIC 10 dover, Mass., oddp AORATED p'9�\,`�5 S H E BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... /0... t/ .......,�P .a. y ?�°G.S ....................................... Foundation has permission to e�eet... �!v.!. 6 g �.�'{...../VlQ N `�- V t +! '�` a "R .... buildin s on ... .... . ................................................. Rough to be occupied as......I........Ropo. Wt.........t.N.........C3A.b .wi.r.N..�-.....�v.r......R�.G...�t��w. Chimney provided that the person accepting this permit shall in every respect.conform to the terms of the application on file in Final this office, and to the provisions of the Codes and 713 Laws relatin to the Inspection, Alteration and Construction of ' / Buildings in the Town of North Andover. tq -3 Q 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 III/../.L/.......................... ........................ 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 Det. 9 pORTry Of tae.y 7geQ 9SSACHl1`-� i CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number o? '�/� Date ' `"3D THIS CERTIFIES THAT THE BUILDING LOCATED ON ^o�/� ��/y�N / y�^�! �• MAY BE OCCUPIED AS Z � IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. °D IYt S e? h 8.47-43 ♦ a 5$&// UN P f R // J CERTIFICATE ISSUED TO rgP R M 1 e n ,�.y�JO v c r �UN B �'• c � Building Inspector : XAO R'K TOo - $ over y No. o,to o�H dover, Mass., "v,9 RATE, BOARD OF HEALTH- b PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT.:A(dlll.h .106.. ..� ....� ' �` c............ '......., o.....• ...... • BUILDING INSPECTOR• undation has permission to erect.............�...................... buildings ASV augh ', g , . . . . .. r to be occupied as 0� Q� , A.11�440.....�rJ4AW �� 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 ofa. Buildings in the Town of North Andover. /" 0107 A ) 3 k°' � PLUMBING INSPECTOk VIOLATION of the Zoning or Building Regulations Voidrthis Permit: PERMIT EXPIRES IN 6 MONTHS ELECTRICAL UNLESS CONSTRUCTION ST' �'S lick Wes , .........I�l� . ..L.. ........................................ Servic (/ BUILDING INSPECTOR Occupancy Permit Required t® Occupy Building lg GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until .Inspected and Approved by the Building Inspector. Burner Street No.Smoke Det. lr7Z SEE REVERSE SIDE