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Miscellaneous - 145 CARLTON LANE 4/30/2018 (2)
145 CARLTON LANE 210/106.C-0121-0000.0 i 1 Date. ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION CHU % k7.�. ............................�1. This.certifies-tha .4...... ......................... has permission for gas stallation ........ ....................................................... in the buildings oj............ at ......(,4V............................. .................... North Andover, Mass. Fee-:s�........... Lic. No--!?�.TN.. ...�.�4............................................... ............. GASINSPECTOR Check# 31.1 j MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY �/I -Il-406;li'�,�� MA DATE PERMIT# JOBSITEADDRESS /H � OWNER'SNAME _ GOWNER ADDRESS _ _ TEL j WAI TYPE OR OCCUPANCY TYPE COMMERCIAL[ EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES Q NO APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER1 CONVERSION BURNEREZj COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE — FRYOLATOR _ FURNACE GENERATOR -- GRILLE INFRARED HEATER LABORATORY COCKS v_ f __ .. _.._ I __ _j MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER _ i _ .. _ UNVENTED ROOM HEATER _ � I WATER HEATER OTHER INSURANCE COVERAGE I hale a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [�(NO �1 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 1 9 LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY E] BOND V OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the F 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 I 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 comp lance with all P inpr io of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 0 ' 'P� -- LICENSE# _ G" NAT R MPIP MGF 0 JP 0 JGF LPGI 0 CORPORATION A# PARTNERSHIP 0# LLC[]# COMPANY NAME: DDRESS F CITY , fJ :�j STATE ZIP�� TEL FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No Ls S f THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES t i t �-� The Commonwealth of Massachusetts - Department ofIndustria[Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: BuilderslContractors/Electricians/Plumbers Applicant Information f Please Print Legibly Name(Business/Organization/lndividual): /A Address: J City/State/Zip: "/ t1f� �hone#:_ Are you an employer?Check the appropriate box: Type of project(required): 1.Temployer I am a em to er with�_ 4. F16.I am a general contractor and I ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 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• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.E1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL11 lambing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12. Roof in insurance required.] employees.[No workers' � ired.] 13.❑Other comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name% Policy#or S elf-ins.Lic.#: l—,� r �~l kation Date: i Job Site Address: / Y-&ft 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 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert rfy7 der the pains penalties yury that the information provided above is true an d c orrecI Si ature: Date; I 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 Instructi®ns 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 dwellinghouse 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 emplbyment 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-contract6r(s)name(s),address(es)and phone number(s)along with their certificates)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 maybe 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 printedlegibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the even 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,meed 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. Anew 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: Tho Cmm. onwoalthbfMassarhuseats Mpartment of ladustdal.Accidents Office of I11vestigatiions 600 Washington Street Boston}MA 02111 Tel,#617-727-4900 at 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.ntass,govldia Date. . .C�. �.�. f NORTH '4tiao� TOWN OF NORTH ANDOVER o SO I p PERMIT FOR PLUMBING Ss�c„us� � This certifies that . . R,t r V L,4,v d • '�• S hA r rA i/%j has permission to perform . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings o . . . . . . . . . . . . . . at . . . . . . . . �G �". . . .I . . . . . . ., North Andover, Mass. Fee. . U. . . .Lic. No.. .�.Y , . . . . . .�. . .���z2� � u. . . . . . . . . . —90--L- 6520 p PLUMBING INSPECTOR 1P Check tt 1 0 -- 6520 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) nn /VU, �C>9✓,e..i Mass, Date' o�9 Permit # Building Location l�/� �,r� b� Owner's Name:& %ri 5t✓�r��•e.c G Type of Occupancy New ❑ Renovation ❑ Replacement,K Plans Submitted: Yes f7 No El FIXTURES z " Z YP 0 0 a f- " J } V < W W F W Y J Vf V) 7 V ¢ C rt Q �' Z O Z a _ �" V W Vf V Z C V y W 41 Uj O 7 CC (rUj < 0 < w Occ y c W S _ �• r o Y S Y 4 < Y d W 1 Y. W .. ►-. V y F. O Y a 7 0 z o 0 V1z W ► l O V z 0 10 SUa-BSMT, BASEMENT —74� IST FLOOR 2140 FLOOR 3R0 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR aTHFLOOR Installing Company Name Kirkland Shaw Inc. Check one: Certificate Address ; Adams St. . Riir11ngtnn MA. 01803 ,Q Corporation 1883C Zio code( ) ❑ Partnership Business Telephone 862-1097 ❑ Flrm/Co. 1k Name of Licensed Plumber -Stephen C. Kirkland INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantia) equivalent which meets the requirements of MGL Ch. 1 a2. Yes j7 No ❑ If you have checked yep, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy l Other type of Indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. Genera) Laws, and that my signature on this permit application walves this requirement. Check one: Signature of Owner or Owner'sent Owner ❑ Agent ❑ 1 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 e` knowledge and that all plumbing work and installations performed under the permit issued (o► this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. 9jVffa ure o censod I Tumber 1'e rmi c fee: jQr 0 D Type of license: Master LI Journeyman Receipt J License Numaer 9431 Location y� L /,v, No. y- No. ,0 Date y NORTH TOWN OF NORTH ANDOVER 3: i • O h p Certificate of Occupancy $ b''�•°'�4�' Building/Frame Permit Fee $ ' ss�CNUSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ -� Check # rA S 13725 1/ ✓�'y Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: /30 DATE ISSUED. Yaw ® � SIGNATURE: 4000#A (&AAW0"- 3; Building'Commissionefflp§34ctor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1fts GA-ROMAJ C- A) y 10G . C lal ll, z)vt� A apml Number //�}�/' Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 4.34 AMS Zonin District Proposed Use Lot Areas Front- ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public X Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT 2.1 Owner of Record / S i�A/ SC. ink Ar%v.9 ec k 4CptAi 0 � L N Lk/ N- N Da Vt- � N P t) Address for Service 6W l Si ature Telephone 2.2 Ownc4 of Record: Name Print Address for Service: M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ _ Company Name Registration Num�� � Address J � t��p 2 8 2000i � �°Itt1\ Expiration Date ULDING //;E�� Signature Telephone__ f • e I 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 permit. Signed affidavit Attached Yes.......G No.......C SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ I Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: tiF-:-w RA` L'i-N Q� Ac-t, D 'PLMI?t -) SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ', OFFIIAT.USE ONLY Completed by permit applicant y 1. Building (a) Building Permit Fee // a Multiplier C� ' 2 Electrical (b) Estimated Total Cost of _ Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical(HVAC) 62 5 Fire Protection 6 Total 1+2+3+4+5 c 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 to act on al. . all matters relati t or authorized b this building permit application. Y gP � -�-( Qb / Z Si na re of Owner Date SECTION 7b OWNE 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 Signature of Owner/A cut Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS Ist2 ND 3 KD SPAN DIMENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGIIT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE - FORM U - LOT RELEASE FORM _- INSTRUCT IONS: This farm is used to verify that all necessary approvaislpermits from, Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant andlor landowner from compliance with any applicable or requirements. "APPLICANT FILLS OUT THIS SEC T ION*"'"�*�" APPLICANT 0R F� �J<lnr �%'Gl<� PHONE (5 l � LOCATION: Assessor's Map Number PARCEL SUEDIVISION LOT (S) 34 A-1 STRE=T ITS C YAR L OBJ �. N ST. NUMEER OFFICIAL USE ONLY - OMMENDA'ION FTOWNAGENTS: �ew►o�e + e��ac� aa� )a, oOE� �E�[� C SucVATION ADMINISTRATOR DATE APPROVED DATE REJECTED I COMMENTSVeQtkGk^L `nk ,h �1n i A(, L� (lCeA N0 `Q d 'N tam TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE.APPROVED DATE REJECTED E?TIC INSPECTOR-HEALTH DATE APPROVED d DATE REJECTED COMMENTS V PUELIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIR;_ DEPARTMENT RECEIVED BY EUILDING ! ISPEC70R DATE Revised 9197 im }4a f 4. h1 M 0� 4' 0 0 LOT34-A-I `c Rle w.00 `tom pl 0 r.>L zs v SaK,.� 5iz-� mPtro b 7 cIC r C N Cl o JOHN S. LAUHETANI _. #34311 LOCATION OF STRUCTURE(S) BASE[]ON LINES OF OCCUPATION �.��jJf�s5401j►� j ONLY. A MORE ACCURATE LOCAT!ON WILL REQUIRE AN INSTRUMENT SURVEY. Scale: 11= ZOO JUM S. ETANI 10FESSIONAL LAND SURVEYOR, AMERICAN SURVEYING COMPANY HEREBY CERTIFY THAT THE VE MORTGAGE INSPECTION 1264 Main Street,Waltham, MA 02154 (761) 893-6477 Jw PRE ARED FOR M� 4f' aAN IC IN NECTIONNOT INTENDEDHIA MORTGAGE Mortgage Inspection Plan IS NOT INTENDED OR REPRE- tED TO BE A LAND OR PROPERTY SURVEY. NO CORNERS WERE THE LOCATION OF THE ORIGINAL RECORDED AT " COUNTY REGISTRY OF DEEDS IT CANNOT BE USED FOR ES_ DWELLING SHOWN HEREON EITHER BOOK ALL—PAG L Cert.k I.ISHING PENCE, HEDGE OR WAS IN COMPLIANCE WITH THE LOCAL PLAN REFERENCE: ' DING LINES.THE LAND AS SHOWN APPLICABLE ZONING BYLAWS IN EF. DRAWN PER TOWN OF ASSESSOR'S EON IS BASED ON CLIENT FUR= FECT WHEN CONSTRUCTED WITH RE- MAPA PAFa L# KI pD�TED IED INFORMATION AND MAY BE SPECT TO HORIZONTAL DIMENSIONAL ADDRESS: _ N JECT TO FURTHER OUT-SALES, REQUIREMENTS ONLY),OR 15 EXEMPT INGS,EASEMENTS AND RIGHTSOF FROM VIOLATION ENFORCEMENT AC. BORROWER: C_`? -I L? f. NQ RESPONSIBILITY IS EX. T10NUNDER MASS.G.L.TITLE VII,CHAP, DED HEREIN TO THE LAND OWNER 40A, SEC. 7, UNLESS OTHERWISE SUBJECT DWELLING LIES IN FLOOD ZONE OCCUPANT, IT IS NOT INTENDED NOTED OR SHOWN HEREON. A CON, AS SHOWN ON NATIONAL FLOOD INSURANCE ROGRAM FLOOD 3E RECORDED. FIRMATORY INSTRUMENT SURVEY INSURANCE RATE MAP D TED-AVE Z 1 79 3 _ L+IS ADVISED WHEN STRUCTURES ARE COMMUNITY PANE25009-1 OrJrrJA rE - SHOWN TO BE v OR LESS FROM FIELDED DRAFTED CHECKED ENT � � o PROPERTY OR REQUIRED ZONING ENT R F,# b SETBACK LINES, BY C-ht`s Crf I Qi I r�, c• nATF - 4- 0J t�,A..�G ,._-,'_G, F R Lfi�J...r_PCF EO/TO*d (rinoo Ol ),3)66S NUD I Z131,Jd WONJ PS:60 866T-SO-,kUW BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11,S 150A The debris will be disposed of in: q-1 Q,.6�'e) S�Q' Location of Facility^-r`, Cis Signature of Permit Applicant 00 i Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector O�,AORTF,'1 Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta ",,j5� Building Commissioner (978)688-9545 -'(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE 3. c�—4 . ®� JOB LOCATION A4456 16 X IQ 6 C 1-2t Number Street Address Map/lot "HOMEOWNER I©QS I Fi`v h/�J r"\ b t��`I�4 rq?8k,U � Name Home Phone Work Phone PRESENT MAILING ADDRESS l AQ 1�1 ©/V LW �b +V ktt 0v A- 0(AC A- DISK City Town _ State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws,rules and regulations, The undersigned"homeowner"certifies that he/she understand a Town of No.Andover Building Department minimum inspection proced res and r ements and that he/she will comply with said procedures and requir HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL ;, r rx E MAR Z 200 SUILDIiVG NORTH T01%7m � of �:� 4 over No. 70 dower Mass. Of/as > > COC MIC HE WICK � ORATED PP��.(5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System r4:..A C BUILDING INSPECTOR THIS CERTIFIES THAT .. �� Foundation R .. g l � S CA rI+0tj L.,P►N� - has permission to erect...... ............. buildings ............. ..... .............-------------------.--.... ........------. Rough 1la'xak' &PLN bFcK #kW4k(r �� S{N��. V�' Chimney tobe occupied as....................................................................................................... ................................:................................. 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. lot . PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. , / Rough Final PERMIT EXPIRES IN 6 MONTHS yo2X- ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS T Rough . ..... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. x• SEE REVERSE SIDE Smoke Det. Location 145 0 4<1 �r�i A/ t: No. 370 Date 9 NORT" TOWN OF NORTH ANDOVER ? •' • O OR p Certificate of Occupancy $ 41 Building/Frame Permit Fee $ � ` "a° Foundation Permit Fee $ SsArwl Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ PCs Building Inspector 368 —49-9 13:33 25.00 PAID Div. Public Works 'rI21Vf I T NO. -37g APPLICATION FOR PERM T TO PI D*-V06""*NO TI-I ANDOVER, MA FOR I.o'rN0. / r 2. VOIzI)OFo\\[PA-jUjk /02 DATE ZONE SUB DIV. 1.01 NO. ILO('.TION 14 - C" ,1 QC-10:1 }' 1 I'llitPOSE OF I1lI II.IIIN(: g �^t X \^) � �rt„� M Ll�� O))'IER'SN.�ME J7oP,,Tv(FG�/`/�l/�C [��lAl/�/ � NO-OF STORIES G Ft C SILIETC1 .011'NF.It,S:IDDRESS /J _ s�C)A1 GJ—�. BASEMENTORSLAII AIAI,I E [.-! V SIZE OF FLOOR I IAIBEIiS lsl zNn 3RD --Illill.l)Elt'SN.\ntL SPAN DIS TANCE-IO NE.ARES-r BUILDING DIMENSIONS OFSILLS - D15IANCE FROM S'I REED DINIENSIONS OF POSTS DISTANCE FROMLOTLINES-SIDES REAR DIn1ENS1ONSOFGIItDk:RS AREA 01• LOT -- FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS 111111 DING NEW SIZE OF FOorING IS IIUB.DING ADDr1ION nIArERIAI.OF clnnlNE\ IS 11111LDING AL fEltAr1ON J IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 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 I1Ns'111C111ONS 3. PROPERTY 1N1 ORNIATION LAND COS-r EST.BLDG.CoSTjqf 5 C70 PACE 1 FILL OUT SECTIONS 1-3 - EST_BLDG.COST PER SQ. FT. _ EST. BLDG. COST PER ROOM I'L6('11IC NI ETERS\I DST BL ON OUTSIDE OF BUILDING SEPTIC PEItnIIT NO. I'I'.\C'IIFD(-,:\RACFS NIUSTCONFORM TO STA'I'E FIRE REG I I LATIONS 4. APPROVED BY: I'I.ANS MAST 11E FlITI)AND APPROVVI)11\'BUILDING INSPECTOR IIIIILDINC INSPECTOR ` 940ERSTIiL!! CONTIUMLN SICNAI'(110' OF OWNER OR R All]IIO1ZED AGENT ` coN•nt.l.lct>< — I'V101IT GRANTED 12c\�S�II i/S199 NORTH pFq<_:,. own ® 1 V ;.� . zA 4g C �� i� move %p AORATED P'll,G C S SL BOARD OF HEALTH PtRMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................To!zg`�--�J........5�( t_,�At,�.6.j� ............................................................... Foundation has permission to erect........ � %? . buildings on .........I. 5.... ....... .. .. ................ Rough to be occupied as.. 8.. fi....x....I.. ..�' 1-... ���Q ...S� Z�........... Chimney ..........................I.................... 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. 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 ................................ ............ ........Q-�........... 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 —/ 33Z��� Street No. SEE REVERSE SIDE Smoke Det. 1-11;12N1CT NO. Jig 7e APPLICATION FOR PERMIT TO TCANDOVER, NCfk FO IIEcOlinO7A1L - Ytin F: SUIT 0111. I'M No - ,1 0(:%HON O.t()('%YION l// ;),Q�!�� ` I'll RPOSI:OFBUILD ING g 'X �Z �' () -t � 11';11:12'S N:\i\I I: 'T ICT( /V N //v/,` NO.OF STORIES SIZE /O11'N I:R'S:1DDIt z— RASEAIENTORSLAD .flit ill]-I:( I SNANII: SIZE OF FLOOR"I.IMBE12S- 1" 2— 3— HIM I)L.WS NAME SPAN DI5 f:1NCF.TO NEAREST ❑ lli.DING DIMENSIONS OF SII.I.S D Ii 1 ANCt:FIlO�\1 S I REE'T DIMENSIONS OF POSTS DISTAN(:EFROM 1-0I't,INES-SIDES REAR DIMENSIONS OFGIRDERS t It t_.-1 OF LOT -- FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS IIIIII.DING NE11' •� S- SI"LE OF FOOTING X I5 UIIII-ll INC:1DU1"IIC1N NIATE111ALOFC11ININEI' IS IIIIILDING AI:fEItA'TION IS Mill DING ON SOLID OR FILLED LAND 11'11.1.IIUILDWG CONFORM TO REQl11REAlENTS OF CODE IS BUILDING CONNECTED TO TOWN WA"TER i1OAPD 01-APPEALS ACTION, IF ANI' LS BUILDING CONNECTED TO TOWN SEWER IS 11111LDING CONNECTED TO NATURAL GAS LINE --- - - - - - INS7(I!-TI<)NS 3. 1'ItOPER11'INFORMATION _ _ _ LAND COST -- - EST. BLDG.COST 5 p0 I'A(:E l FII.I.OU'f SECI-IONS 1-3 EST.BLDG. COSTPFIt SQ. FT. EST. DI-DG-COST PER ROOM ILFCTIIIC\I ETEIIS NIUS'I-DE ON OUTSIDE OI'Otlll-DING SEPTIC 1 LIm TT No. A 1-1,A( 111,11 G:1 R.1C4:5 f,I UST CONFORM TO Sl':1TE MRF Ii k:G111,vi-IONS -I. I'I..1NS°\IIISI IIF AND APPI1OVk.D)11'111111.1)ING INSPECTOR -- I1111LDINC INSPECTOR ! WNERS TELFJ g 7z� " 6780 f - 9406 � aLL, CONTIt.TELY SIF. OF 0WNE11 Olt A(I1110It IZED AGEN"I II.I.C.N I'CIL\I IT GIt:1N TLD t9 -- AORTH Tov M- of 0 No. y AU021-1 0 �_o C.11 Sit ove �A �V ORArE0 p`P��t� BOARD OF HEALTH PhtIMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................To�s�—�........Sc......t�. .!q!.....C ....................................... Foundation has permission to erect.........v' %�............... buildings on .........I.` ....�' . ... .................... Rough t0 be occupied as............Fj....�t....x....�.. ..�' fi...`� 2 ��...S( .......................................................... 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. 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 ............................... ...................... .........ate........... Service BUILDING INSPECTOR • Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location No. Date N°RT►, TOWN OF NORTH ANDOVEIV �G A Certificate of Occupancy $ } ; Building/Frame Permit Fee $ �SSACMUSE< Foundation Permit Fee $ � Other Permit Fee $ Sewer Connection Fee $ Cu Water ConnectionFee $ r TOTAL $ Is01 �O Building Inspector aT2 8576 1 . Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4J0. LOT NO. �4., I 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. Lf 30 /l 324.71 3/2 LOCATION 1*5 CARLTON LIgN,E PURPOSE OF BUILDING !� OWNER'S NAME agAKA/A SUZ,4A1 AjEcr CORELAMD NO. OF STORIES 2 SIZE 3400 sq l OWNER'S ADDRESS /*6 CA,2LIM4 L.,WgBASEMENT OR SLAB i5ASEMENT ARCHITECT'S NAME NIA SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME jo#tj N6L/SN7 /gC C�W SPAN DISTANCE TO NEAREST BUILDING 2„00 Fr DIMENSIONS OF SILLS DISTANCE FROM STREET 2-35 FT. APRX0X • POSTS DISTANCE FROM LOT LINES-SIDES 3,,# 3$ REAR 2001 GIRDERS AREA OF LOT 4-34L ACj2FS FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW HID SIZE OF FOOTING X IS BUILDING ADDITION Affs' MATERIAL OF CHIMNEY BRICK IS BUILDING ALTERATION lvo IS BUILDING ON SOLID OR FILLED LAND SEDiQOC.�C WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yEs IS BUILDING CONNECTED TO TOWN WATER YES BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER Q", IS BUILDING CONNECTED TO NATURAL GAS LINE ye-s INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH BIDES 1 EBT. / BLDG. COST ,� PAGE 1 FILL OUT SECTIONS 1 - 3 lsEBT. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 � EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING Ali PypJ 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS R� /�v PLANS MUST BE FILED AND APPROyep BY BUILDING INSPECTOR DATE FILED. SUILDING INSPECTOR -81 URE OF O ER O TH ED AGENT ` F E E OWNER TEL.# PERMIT GRANTED CONTR.TEL.✓/ ri 19 CONTR.LIC.A, 0 L I qH.I.C. 64Z BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYSTORIES THIS SECTION MUSTSHOW EXACT DIMENSIONSOF 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 �_ a 1 2 I3 - CONCRETE BL K. PINE BRICK OR STONE HARDW D _ PIERS PLASTER _ _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M-TAREA _ 1/1 v, '/ FIN. ATTIC AREA 7T- N_O BMT FIRE PLACES i HEAD ROOM MODERN KITCHEN Z- 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. & FLOOR I_ BRICK ON FRAME CONC.OR CINDER BLK, STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP ) BATH 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 11 HEATING a 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 BB'M'T 2nd ELECTRIC 1st !j 13rd NO HEATING NORT own of � � � - 4 over ki No. 339 - x . port, dower, Mass., -AQ 14 199 C o LAKE COCHICHEWICK A�RATEO P*' f� BOARD OF HEALTH Food/Kitchen i Septic System - BUILDING INSPECTOR THIS CERTIFIES THAT A'R!!dk4!'V\... .. 07-A lt_1 .Popa.uAx.b ............. Foundation has permission to ..................... buildings on...�4 ....04A. ... ......................... Rough 04 to be occupied as... .D'�.: �.t? 't4 .... °1.1�k, ...��� Chimney Ch' I provided that the person accepting this permft hall in every respect conform to the terms f 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough, Final PERMIT EXPIP-,EIM4 MONTHS ELECTRICAL INSPECTOR UNLESS CON TR N T Rough ............... Service BUILDING I PECTOR Final , Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F�agh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT 1 Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT ..LVCL;�.- F'Lrfl . SCALE: 1"- :_UOQ+ a' 104.04" 8.023.55 17QG31 LOT 58.54, 161.0 C BECK 134.56' f � 31 96•C 0 2 STORY i WOOD 35 20 5. 3 412.99' NEW PORTICO O rri 211.00 r N � n 199.G1' 273.20 <., . ' 199.93 65-16 53.9 0� l 237.09' 20�DRAINAGE �EASENIEHy —" r r r f Com 237.09 , 1 FURTHER STATE THAT W UY PROfMotiAL n� OPINION the principle shuattw/s and accessory NOTE: This mortgage Inspection was preparedii j l.w N outbuldings. epecMically for mortgage purposes and Is not N to be roiled upon as a survey. EK Survey accepts C U I`d FC I i I i no reepansislity for damages resulting from said O reliance by anyaee a%er than the said mortgagee CG,r ��y0 P Mlth the eetb" requirements of the local zoning and its assigns In connection Mfih its proposed mortgage �p y0 ordlrmnose. and that there are no encroachments of Anoncing to sold martogogor.. SURE M�t « b either ray across property tines CERTIFICATION m showaL BAYBANK H.=,RVARI; TRUSI CO. A'SOc This mortgage Inspection was prepared M accordance Mtth d)2.PLY r not In a Flood Nocard Mea Property is In a Flood Hazard Area. the TedmW Standards for Mortgage Loan Inspections as 3. Infamatim Is hsufflolent to detwmhe Flood Hazard. adopted by the Massachusetts Association of Land Surveyam Flood Hazard determined tom latest Federal Flood Insurance and CM EngineeM Inc. Rote Yap PaneL ( I/V $0u,rq 17 IGJL0 P -I- LIGHTS ov T. IAATCW FLCO',; �,Fil 3 L� PE TA L- WGHT ad 1 INTO EPz,,-rIkj6, 619CWT 70 it 'A C S)(IST61 r;S TA 1 L- 1 I / , - I 43VV Dr,11P 50 iuilf C—)L-GF'Z -0 L 16.4'r.$ 06 FACS OF CX I L-r IM 6 CO L V M.11 EAST- -AIDS T' (A Zzbp-) =V Au. �j'�ijG��'gQ;:;. 1r��p �E5>uRE —TREA'tEp Au- Fit-4115H Y/oGO GI.c�Z �I4C t �/11T;e� COf tJ�.5�D1fJ"' PAINTINGS Do ft 3 DECD r1Rr;NCS ;c G�E�TE 1 ; j Jr .4 - �- t «1►TZ E 1 i a-m FINISH t ��GTIDN o�! A-A r i I In etix Suite 300 800 Turnpike Street North Andover, MA 01845 USA Tel: +1(508)7258081 `r Far: +1(508)725 8082 C _ COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY OF ONE ASHBORTON PLACE r MASSACHUSETTS BOSTON,MA 02108 ^� ' g= CAUTION IXPIRATICN DATE FOR PROTECTION AGAINST Qz EFFECTIVE CA TE =•C-NC- THEFT, PUT RIGHT THUMB Ru ti1y PRINT IN APPROPRIATE NONE - BOX ON LICENSE. JvN'= 3 1 B 5 F ,� T U Z v BLASTING OPERATORS S5 027-42-5903 �ET`IUE.:t .1-N r1 `+ MUSTINCWDEPHOTO. T I PHCTO(BLASTING OPR ONLY(i FEE" t ,J VOT•:ALO uNrL<_1GNE 3Y_ `.Se_:NO OFFICIALLY STAMRED CR-JGNA,RE OF"•-E r:,MM15SIONEP - HEIGHT: DCB: i T 3!05/1952" .=„_, -�� ?!IB CCCUMENT MUST 9E « SIGN NAME W FULL ABOVE SIGNATJRE UNE E.oNA^JAE OF L'CENSEE - - CARRIEOONTHEPEASONCF 'HE !ICLDER WHEN EN- OTHERS•aIGHTTHUMB PRINT I GAGED IN THISOCCUPATION. ' n5 Massachusetts w _ ;;�. sem• ..-.<.;;;� . 01844EN MA v 01844r2313 The Commonwealth of 3lassachusetes -- - - Department of IndunTial Accidents 5 Ind IIIOIL'~AW 600 Washington Street Boston,,Nass. 02111 Workers'Compensation Insurance Affidavit name: l locatiom ctty �v� ��'' / / i �c� *none it 4-x Cj I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity G I am an employer providing workers' compensation for my employees working on this job. comoanvurne ..: address- city- Phone#- insurance co poticv# I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name* address. Ott• - Rhone#r insurance co - policy If eom22nv name- .... ... _.. address, CLv. insurance co R ' :eLtbactrad ons cc necEMY.i2 a Failure to secure coverage as required under Section:5A of N(GL ta:can lead to the imposition of criminal penalties of a fine up to SI-500.00 and/or one years'imprisonment as well as civil penalties in the Corm of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigation of the DIA for coverage verification. I do herebv cervi der t pains penalties o ury thar the fnfornsaaon provided above 1s e d correct Signature / D // Print name 'J o ,�V �/ S�j Phone# �ir ✓� ofrtcial use only do not write in this area to be completed by city or to- official city or town: permi"cense 9 r;Building Department []Licensing Board []check if immediate response is required []Selectmen's Office []Health Department contact person: pboae 1710ther (avimd IRS P)A) e Location 1/37— 1114ke t �� f No. Date ✓� 0 �� MORTM TOWN OF NORTH ANDOVER 3?0'••,•o I• 'ho 0 0� Certificate of Occupancy $ Building/Frame Permit Fee $ s�cHus Foundation Permit Fee $ Other Permit Fee $ / TOTAL $ Check # f i 8270 f Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVA OR DEMOWSH A ONE OR TWO FAMILY DWELLING .O 7 ': _ o m BUMDING PERMIT NUMBER: �02 DATE ISSUED: Z, 3--- SIGNATURE: /all Building Commissionerllnaxdor of Buildings Date �r SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number. 06 CIC2 1 Map Number Parcel Number (�, 1.3 Zoning Information! � j(J 1.4 Property Dimensions: N -ZminR District Proposed Use I Lot Area Fronts it 1.6 BUILDING SETBACKS ft Front Yazd Side Yard Rear Yard Reqwred Provi Required Provided Required Provided 1.7 Wdta Sspply M GI—C.40. 34) 13• Flood Zone Infamatioa: 1.1 Sew—p Disposal System: Public 0 Private 0 zow Outside Flood Zane ❑ musicipal ❑ On Site Dkpaul Systam ❑ SECTION 2—PROPERTY OWNERSHIP/AUTHORIZED AGENT 1't,'.0 i C. 'i`=t r!Ct; Y"S 2.1 Owner of Record r Name( ' t) 7 Address for Service: r W a Si }u a Telephone 2.2 Owner'of Record: Name Print Address for Service: w Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number �a Address Expiration Date Signature Telephone a 3.2 Registered Home Improvement Contractor Not Applicable ❑ { Company Name Registration Number r' Address !` Expiration Date Signature Telephone Y` SECTION 4-WORKERS COMPENSATION(M. .L C 152 4 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.....,.0 No.......0 SECTION 5 Description of Proposed Work kbeck aR a 6k New Construction ❑ Existing Building 0 Repair(s) 0 Alterations(s) ❑ Addition 0 Accessory Bldg, 0 Demolition 0 Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIAL USE ONLY Completed by permit applicant 1. Building �0 0n1 (a) Building Permit Fee �,` U Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(e) 4 Mechanical HVAC 5 Fire Protection L 6 Total 1+2+3+4+5 Check Number SECTION 72 OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authori2e IO act OA My behalf,in all matters relative to work authorized by this building permit application. Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, • ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge i and belief Print Name r e of Owner/A ent Date STORIES SIZE ENT OR SLAB FLOOR TIMBERS I ST2NU3KIJ SPAN DIMENSIONS OF SILLS t DIltIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING - X — MATERIAL OF CHEVNEY 1S BUILDING ON SOLID OR FELLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE � 3 ` I I _ f I ` h C2 ADD I T! oN o��--_I .DEG : p? I� 9 `' X /0�'-6. !'_ WALLS /yAty 013. C� oo S __ NEW 1)Eck /Ss .oX S o N 0 FIFII 11111111 I I till Er-o o —r v E 24iL MG) I I � j w DECk sC ,A L E �1" Gr4 , wLsP c� r � « C23 - ! A ` Town of North Andover Of,10871,� Community Development and Services Division o?•'"��•� °o Office sof the Health Department 400 OSGOOD STREET North Andover, Massachusetts 01.845 �.�s°°''•�'''�� Susan Y. Sawyer,REHS/RS 3'ACN115'p Public Health Director (978)688-9540-Phone (978)688-9542-Fax Date: M&CCh 03. aUv!6® Address: V46- O&C(�pn LVV,North Andover,MA 01845 Re: Application for: aJ_J4+1.vY1 Dear: Your application for lxu� Lvrl at M-T Cur(" has been reviewed by the Health Department. The application was denied on, 2004 for the following reasons: 1. ❑ Missing information 2. Passing Title 5 inspection of septic system required 3. Location of structure not acceptable 4. ❑ Undersized septic system To address the problem(s): If#1 Is checkea, please supply: a. Floor plan of exista., and proposed addition-all rooms b. Certified plot plan showing nc-1se,septic system and proposed project in scale If#2 Is checked: Have the septic system inspected by a certifies,Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If#3 is checked: Relocate the project If#4 is checked: a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult an engineer to determine the flow capacity of the septic system. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, eviewer Cc: Building Department File H!1ARf)UI :�PPLAL.S tib$-)541 13(IIIJANG 688.9545 ('ONSERVA')ION 688-9530 NURSE 683-9543 PLANNING 688-9535 FORM U - LOT RELEASE FORM 3 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION* APPLICANT J MC PHONE5�1&_ Z 80 3-7 3 2 LOCATION: Assessor's Map Number --i-"(0 L-` PARCEL___L3L SUBDIVISION_ LOT(S)---- STREET S)___STREET eA n L I dAr L — — —_ ST.NUMBER Ll ***** OFFICIAL USE ONLY MN!TS OF AGENTS: I CONSERVATION NISTRATOR DATE APPROVED ' 45 It DATE REJECTED_ --_I V"c� .��0 Z'C5 COMMENTS X r TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSP CT, R-HE ATE APPROVED— f CTED__ — IC INSPECTOR EAL DATE APPROVED o2 D _ --_ DATE REJECTED—as COMMENTS �& 6 T PUBLIC WORKS-SEWERNVATER CONNECTIONS DRIVEWAY PERMIT — FIRE DEPARTMENT — RECEIVED BY BUILDING INSPECTOR--- _ DATE— Revised 9197 jm NORTH Town of No- 7v19 _ /pv� o`A. over, Mass., S `'3 ' OO 'r COC MICKEWICK \, oRA-rED S V 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT.....&.r!. 4! .... .. ! ....... /«. ........... ..`� A ... .t ..� FoundationBUILDING INSPECTOR has permission to erect....1.6!V.?.y .... buildings on I CA��toN SAN ugh T rr w� A��I �� to be occupied as.. .................. SV/V 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 elating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 6 AR , PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this rmit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIONS ART ELECTRICAL INSPECTOR S� Rough . Service .. .. . . ................................... BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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.