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Miscellaneous - 148 HICKORY HILL ROAD 4/30/2018 (2)
148 HICKORY HILL ROAD 210/062.0-01040000.0 r I I f i I I r r MASSACHUSETTS UNIFORM APPUCATO N FORPERMIT TO DO GAS FITTING (Type or print) Date ` `d NORTH ANDOVER,MASSACHUSETTS Building Locations Permit# Amount$ Owner's Name Vii V New❑ Renovation Replacement Plans Submitted d � U z Cw7 F z F. z FG F (�j p ; O O F V a F W z� a > < o o w o x a� x rOz j O .a U c4 > G o0 O SUB -BASEMENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Check one: Certificate Installing Company Name L .BIZ Lo- /" � El Corp. Address 0 k r`(// ' 1:1 Partner. �uamess Telephone 7 _jj 0 ff��//�irm/CO. Name of Licensed Plumber or Gas Fitter S �GLd✓L� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 0 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 insta tions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac s StateCode and C apter�Zofen Laws. By: Signature of License lumber Or as Fitter Title [3"—Plumber City/Town E] Gas Fitter icense um er easter APPROVED(OFFICE USE ONLY) Journeyman f Y/ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.maS&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le6ibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 E]New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No workers' comp. insurance 5. 9. ❑Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself [No workers' comp, c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.El Other `.4ay applicant that checks box#1 must also fill out the section below shoe=.irb their—hworkers'c' information. t Momeowners who submit this affidavit indicating they are doing all work and then hire outside contractors musty submita new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the.name of the sub contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below,is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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 for insurance coverage verification. I do hereby cer&fy under the pains and penalties of perjury that the information provided above is true and correct. S10-11 e: Date.: Phone#: F[th only. Do not write in this area, to be completed by citJ,or town official n: 1 ermit/License# hority(circle one): Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector son: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation orother legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including t1ae legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartrnents and who resides therein, or the occupant of the dwelling house of another who employs persons to.do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate 2 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 f necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the i members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should 'be returned to the city or town that the application for the pernaitor license is being nqu.-sted,not the Department.of Industrial Accidents. Should you have any questions.gardirrg the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license 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 wouldlike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of InveWagations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 4-06 or 1-877-MASSAFE Revised 5-26-05 Fax#617-72.7-7749 v mrw.mass-gov/dia f NORT1� 3?°�`:�``°:' "�O� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING s s �,SSACHUS� t / This certifies that ............ / -{-*�r•............................................ has permission to perform ....... - wiring in the building of..0-7- .. . ,41,� >,.,�-c.- ............................... at../'/ .. .. ...... ..11,,4-Qr............................Northdover,Mass. Fee.'�-'3.. .. Lic. 0:�9��Z rr-� r. L'-..r., � .. ................ ........ :. .. / ELECTRICAL INS R if Check # A Offiiciial'U�s�ep Only Permit o. �L�CJ rJ �, V0416-Me°d�" S i Occupancy&Fee Checkect - y BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 5C2�7 CMR 12:00 (Please Print in ink or type all information) Date / ` / 7 —OL To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Ll 411c4of I, c l l Owner or Tenant e ! O n O i C Owner's Address 0, 5 a 6o v e_ Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building y Utility Authorization No. � Existing Service O Amps /L U 2 Voits Overhead ❑ Undgrnd ❑ No.of Meters New Service Amps Voitis Overhead ❑ ,Unndg�md ❑ No. of Meters Number of Feeders and Ampacity ��\S h 144 l(fn e v 3—3,ect5"n &!�� Location and Nature of Proposed Electrical Work i Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures L1/ Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of D rs Heatinq Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= NO = If you a checked YES please indicate a type of coverage y checking the appropriate box BOND = OTHER = .(Please Specify) -, ZZ_ STV Iy l 6 3 (Expiration Da Estimated Value of Electrical Work$ Worts to Start Inspection Date Resquested Rough Final Signed underthe Penalties of perjury: q FIRM NAME O E/' ltLti LIC.NO. 2,q Cq� - C Lr(yensee 1�b $(' (� Signature LIC.NO. Z? G 7 2-6— /! Bus.Tel No. Address a Sa`P,0,4 Aft Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) o.v Telephone No. PERMITfEE $ (Signature of Owner or Agent) Location i No. �� ! — Date J- � C)Z— ~ NORTIy TOWN OF NORTH ANDOVER F w 9 i *A"* y Certificate of Occupancy $ 9 Buildin /Frame Permit Fee $ � su„ust Av Foundation Permit Fee $ Other Permit Fee $ (� TOTAL $ Check # 15862 C� ;—Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: J ` DATE ISSUED: SIGNATURE: Building CommissionerA Ctor of Buildings Date SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ice/ ��DdL' b�fg (2c( , ( Map NumberParcel Number 1.3 Zoning Informa kon: 1.4 Property Dimensions: Zonin District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided Q 30 ao Q 3 ac I /W Q 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zou6 Information: 1.8 Sewerage Disposal System Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service Signajure Telephone 2.2 Owner of Record: Name Print Address for Service: O Z m Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 0 6NN6ionSpe . KaEP �2 O Licensed Construction Supervisor: I License Number on Address Sr ! 't7 Expiration Date ic re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name 1T II✓c �, N Registration Number r• Ew ' . Address ® l' ZO Expiration Date re Telephone !J r SECTION 4-WORKERS COMPENSATION(NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes....... No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ®— Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief✓Descrippt/ion of Proposed Work: �.�r -'1- ��tJ7�n,1 l�i4fEs�"i ,t,7���/� �Hti N- . n�i Sh �5 i .`r►�, ?1 S�/�S©� 14yo✓ L T© �c'l_"D-y6— 7- sl L v; �y AAA 21zs � ,4PPhr�� /ox in) ��t�7- 12o�� to,lis ecLe- E SECTION 6-ESTIMA11ED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beY' OFFIIALT7S t a10 M at�S Completed by pennit a licant �� N > 1. Building 41 (a) Building Permit Fee Pr/ 2 OD D Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X (b) 4 Mechanical HVAC Gi 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT h as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building pennit application. Y Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION cd 9 9 I N � !t E>✓IJ 1a+Qwn=1Authorized 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 Prin e /o -D-2 Si ue of CKviierFA ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR INMERS 1' 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDAi;EY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE, FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ****************************'*A—PPLIICANT FILLS OUT THIS SECTION*********************** APPLICANT�r4oJS�� �"'�I R IT,i 06 V PHONE ? 7? ' '007 LOCATION: Assessor's Map Number .10&7i PARCEL_ (0 SUBDIVISIONL rr LOT(S) I STREET f —1c.) 'I( ( ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** REC9,MMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTR OR DATE APPROVED 7116 o DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED.BY BUILDING INSPECTOR DATE Revised 9\97 Im M Coy r 1 � � � S w 1 1 Lo-Tr 1 LST ` 1 1 2r.39' �f i ICK�Ry 0 AL E KEEN CONSTRUCTION CO. 21 HEWITT AVE. N.ANDOVER,MA 01845 (978)691-5201 Peltonovich, Joe&Janet 148 Hickory Hill Rd. N. Andover, MA 01845 (978)688-0097 Contract# 1523: Appendix A Date: 7/7/02 Build new screenroom: • Add to existing deck(to 10'x 10') • Install plywood on floor • Build walls and roof to create room • Supply& install Harvey rolling storm windows on two sides • Supply&install Harvey storm door • Supply& install siding and roofing to match existing • Supply& install T& G v-groove pine on walls& ceiling • Paint int. and ext. walls&trim(2 neutral colors,2 coats) • Supply& install carpet in room($330.00 installed allowance, including$75.00 minimum fee) Price does not include cost of permits. Total price: $11,450.00(eleven thousand four hundred fifty dollars) Payment schedule:$1000.00 due upon signing contract $4000.00 due the first day of work $3000.00 due when room is framed $2500.00 due when windows are installed $950.00 due when contracted work is complete Customer Kenneth B. Keen Date Date KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978)691-5201 Peltonovich, Joe& Janet 148 Hickory Hill Rd. N. Andover, MA 01845 (978) 688-0097 Contract# 1472;Appendix A Date:7/7/02 Finish existing screen room: • Move existing slider to exterior wall&case opening • Remove T&G pine on walls & carpet on floor • Insulate walls, floor&ceiling to code • Supply& install six Andersen tilt-wash windows • Blueboard and plaster skimcoat walls&ceiling • Supply& install trim to match existing • Supply& install two cabinets(nat. Oak, 36"w X 18"d X 84"h) • Paint walls, ceiling,trim&windows to match existing(2 neutral colors, 2 coats) • Supply& install oak flooring Electrical: • Supply&install fansafe in ceiling • Supply& install outlets& switching to code • Supply& install one cable outlet&one phone (Cat. 5)outlet Plumbing: • Supply& install baseboard heat off existing zone Price does not include cost of permits or changes made by inspectors(i.e. Sprinklers) Total price:$21,600.00(twenty one thousand six hundred dollars) Payment schedule:$1000.00 due upon signing contract $7000.00 due the fist day of work $7000.00 due when windows are installed $3500.00 due when insulation,rough electrical,rough plumbing is complete $1600.00 due when blueboard is installed $1500.00 due when contracted work is complete i i Customer Kenneth B. Keen Date Date KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978)691-5201 I Peltonovich,Joe &Janet 148 Hickory Hill Rd. N. Andover,MA 01845 (978) 688-0097 Contract# 1602: Appendix A Date:7/702 Finish basement: • Frame partition walls to create @ 225 sq. ft. finished area including under stairs • Insulate all exterior walls • Install blueboard&plaster skimcoat • Supply&install louvered door to boiler room • Supply& install suspended ceiling to match existing • Supply& install trim on base&door to match existing • Paint walls&trim(2 neutral colors, 2 coats) • Supply& install ceramic tile in entry from arae( g 44 sq. ft.,$110.00 material allowance) • Supply& install carpet in remaining area($ 560.00 installed allowance) Electrical: • Supply& install two 4'troffer fluorescent lights in ceiling • Supply&install outlets& switching to code • Supply&install make-up air unit in boiler room Price does not include cost of permits,heating, or phone&cable outlets. Total price: $9180.00(nine thousand one hundred eighty dollars) Payment schedule:$1000.00 due upon signing contract $3000.00 due first day of work $3000.00 due when framed&rough electric is complete $1000.00 due when blueboard is installed $1180.00 due when contracted work is complete Customer Kenneth B. Keen Date Date i The Commonwealth of Massachusetts =1 ;`X iRma y Department of Industrial Accidents b Office of/noestiffsaons 600 Washington Street - '� Boston,Mass. 02111 —" Workers' Compensation Insurance Affidavit lease Ri ail. 3.5 name: 46 k EEnI 1 location: Z/ . Ilu city A 19 NQ ,6 U phone# C] I am a homeowner performing all work myself. JR ! 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: address: city: phone# insurance co • Policy# I am a sole proprietor, ;eneral contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'.compensation polices: company name,• - address: city: phone a insurance co policy# ., „n... company name: address situ. phone# insurance co oh y# Atiac}�,acfJthgrral sheef i!1neccssar m waa.. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby certify under the ins and penalties of perjury that the information provided above is true and correct Signature '/ Date c l0 ^ 6 Z� Print name _ K EiV"g E tA C E...�.. .._ ._. . ._. . Phone# !'7"7-to 2/'sZ ��official use only do not write in this area to be completed by city or town official,_.;.... .. city or town: permit/license# Building Department OLicensingBoard ——"" O check if immediate response is required pSelectmen's Office pHealth Department person: phone#; nOther kcontact i,... �.,...,•� -.,F. (revised lmc rrAl NORTH E o _ dover own 0 0 CO L w� � dover, Mass., AORATED pP�G\,��� S 4 BOARD OF HEALTH PERMIT T D 'Food/Kitchen Septic System THIS CERTIFIES THAT...�0APICI V.�O�..e.....AJ44 *J0Ud& 4....... BUILDING INSPECTOR ......................................................... ........... .... Foundation has permission to erect...�e ol0............... buildings on ... .14�kO ry ��/� Rough ....... ................. ............ ............................. to be occupied as..s.d.!VI.Oowj pN ��ibft •t� �AS*rM��v /CNRo G?r�Jl= 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 B -Laws relating to the Inspection, Alteration and Construction of Building§ in the Town of North Andover. F,40151 C V,O 3,s VAU#0 � 00 -*0 A-/UA P• 2 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. L 42/iB Y j y�� �� Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough /r ... .C. ......................................... 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. 3 5 3 V Date...... ... . U..... .. NpRTM TOWN OF NORTH ANDOVER ,6'6 c? y� �p PERMIT FOR GAS INSTALLATION • SCC ,`a SACeHUSEt Y This certifies that . . �: . . .`. `?�f-.: . . .:: `. . . ���.�'� . . . . . . . . has permission for gas installation . . . .t?` :. . . . . . . . . . . . . . . in the buildings of . . . .Lt'. . . `/. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . L` f. . . . . . . . . . . . ... . . . . . . . . . . . . . . . North Andover, Mass. Fee. .h .�-. . Lic. . . . . . . . . . .'... .F. . . -. . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer t MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT O DO GAS FITTING ype or print) Date C//L v 19 NORTH ANDOVER, MASSACHUSETTS / Building Locations _i t� j r !�I re K �2 �� ` f/ Permit 9 Amount S Owner's Name �— VY New❑ Renovation ❑ Replacement ✓❑� Plans Submitted ❑ :L W n i Z t it i W Z -f •� _ W SUB -B :1kSEM ENT ' BASE .v1 ENT IST. FLOOR 2N D . FLOG R 3RD . FLOOR 4T If . F L O O R 5T Ii . FLOOR 6T 11 . FLOOR 7T It . FLOOR 18 T I1 . FLOOR / (Printortype) �• S �J I Check one: Certificate Installing Company ❑ Corp. Address � �G '� S ❑ Partner. yy�-�v d C) G=7 Business Telephone •0 G/_ ��� V 12-firm/co. dame of Licensed Plumber or Gas h-Fitter �_� � �lifiL v�---'°1- INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ NO If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: E]Signature of Owner or Owner's Agent Owner E] Agent I herebv 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 i lati ns pe rmed and Permit lssu for thi pplication will be in compliance with all pertinent provisions of the Mass use. ,.tat s de a hapter 14 f the oral Laws. Bv: Signature of Licen ed Plumber Or Gas Fitter Title dPlumber City/Town ❑ Gas Fitter (cense i umoer Master APPROVED mi,i-Ici:USF ONLY) ❑ Journeyman r{C2,3 IN WARNING DO NOT TAMPER WITH LOCKING DEVICE. REMOVAL SHALL ONLY BE MADE BY A BAY STATE GAS/NORTHERN UTILITIES SERVICE REPRESENTATIVE. AVISO NO MANIPULE LA CERRADURA. EL REPRESENTANTE DEL BAY STATE GAS/NORTHERN UTILITIES ES LA UNICA PERSONA AUTORIZADA PARA REMOVERLA. I "CONDEMNED" DECLARADO INUTILIZABLE B HEPA60HEM COCTOAHMM, HE n011b30BATbCS1 FOR UNBENUTZBAR ERKLART DECLARE INUTILISABLE LIJn111MUlmon WHEN YOU HAVE REMEDIED THIS CONDITION AND WANT THE GAS TURNED ON, CALL i BAY STATE GAS NORTHERN UTILITIES, INC. BROCKTON DIVISION 617-580-0100 PORTLAND, ME 800-698-0940 PORTSMOUTH, NH LAWRENCE DIVISION 508-685-6382 1-800-552-8464 SPRINGFIELD DIVISION 413-781-9200 SPRINGFIELD DIVISION 413-584-1088 (NORTHAMPTON AREA) f BAYS ANE GAS V JOU NORTHERNUTILITIES, WARNING NOTICE - AVISO TAG COPY y� TELEPHONE CITY /�+1 OWNR TELEFONO STRFC.T j! - �� f �' CIUDAD /ti PRO EETARIO .CALLE .�('/7 / / GUS TU^ f. ///oe / ,e � SUITE TELEPHONE AD DRESS CCION CLIENTEr �.l IJEF/l- iii���"' � APARTAMENTO TE '0 AIR SUPPLY I ❑ PIPING AS ❑ SUMINISTROS DE AIRE THE FOLLOWING PROBLEM MUST BE CORRECTED IMMEDIATELY: SENTING f APPLIANCE LOS SIGUIENTES PROBLEMAS DEBEN SER CORREGIDOS IMMEDIATAMENTE: ARTEFACTO DE GAS ❑ CONDUCTOS DE VENTILACION EXPLAINJ," EXPLIOUE _ I YOU MUST CONTACT A QUALIFIED CONTRACTOR FOR REPAIR: 1 COMUNIQUESE CON UN CONTRATISTA ESPECIALIZADO PARA EFECTOS DE LA REPARACION: i I ❑ OTHER: r PI UMRE fi ❑ ELECTRICIAN CHIMNEY CLEANER I 1 L J F OMP Rt ELECTRICISTA ❑ PERSONA DE LIMPIA EL CANON , O HUMERO DE CHIMENEA OTRO: THIS WARNING NOTICE IS FOR YOUR SAFETY AND PROTECTION. AFTER ESTE AVISO ES PARA SU SEGURIDAD Y PROTECCION. PARA LA RE- r, STAURACION DEL SERVICIO COMUNIQUESE CON BAY STATE GAS / NOR- REPAIRS ARE MADE CONTACT BAY STATE GAS /NORTHERN UTILITIES FOR THERN UTILITIES DESPUES DE QUE LAS REPARACIONES HAYAN SIDO RESTORATION OF SERVICE. HECHAS. } • GAS LLF i ON-CONECTADO METER LOCKED ❑YES-SI f- LOCKED � YES-SI CONTADOR APPLIANCE ��t �. f- - CERRADO y EL GAS SL CERRADO NO DE GAS DE GAS CTO CON LLAVE ElNO-NO ENCUL-N INA �❑ OFF-DESCONECTADO CON LLAVE NO- ` TENANT OWNER C.i15 f U"AlFi.r'IUNATURE I ❑ INOUILINO PROPIETARIO 4q, FIf1MA I)FL!-1]FINITETIME t r - EMPLOYEE T C ' BATF w ,' HORA EMPLEADO ? ! F 205 F E CHA �. i ; ! A Office Use Only/ 01 4E Crum iltilUI'# of ffla0Bar4UBeftg Permit No. _ i9epartment of Public 9_111fetq Occupancy& Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) In� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (X* or Town of NORTH ANDOVER __ To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant 3 Owner's Address Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building �`7�'" t �- ��`"� t'u'b— Utility Authorization No. Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work CUD Total No. of Transformers No. of Lighting Outlets I No. of Hot Tubs KVA No. of Lighting Fixtures I SwimmingPool Above In- grnd. ❑ grnd. ❑ I Generators KVA No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets " No. of Gas Burners FIRE ALARMS No. of Zones Ranges No. of Air Cond. Total No. of Detection and No. of Ran 9 I tons Initiating Devices Disposals No.of Heat Total Total No. of Dis p Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices I Municipal No. of Dryers I Heating Devices KW Local []Other11Connection No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: I INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Complete erations Coverage or its substantial equivalent. YES I have submitted valid proof of same to the Office. YES _ NO Z If you have checked YES, please indicate the type of coverage by checking the appprop ie box. INSURANCE v BOND OTHER -7 (Please Specify) (Expiration Date) Estimated Value of Elleectrical Work S 4 Work to Start > Inspection Date Requested: Rough —l Final Signed under the Penalties of perjury: p FIRM NAME ✓I-,MSL LIC. NO. s Licensee 1"VL A_GL r µ A-�Signature LIC. NO. e-Z7 YO`1_ Bus. Tel. No. 40 3Fs Z Z�y�_ Address A/` 110c> I t w '� Alt. Tel. No. OWNER'S INSUR NCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner ` .gt nt (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) x•6565 �•n 2647 Date. .....�U�... .f�. 0 NORTH TOWN OF NORTH ANDOVER g Fro . (o :,gtiop PERMIT FOR 4W INSTALLATION •rf�((7 H �9SSACMUSE� .N This certifies that . . . . . . has permission for sm installation . in the b�u*ldingss ;./Y`f . . (� . % . . . . . . . . . . . . . . . . . . at . .,17.�'. . . North Andover, Mass. Feed S v� . . Lic. No`x�.7p.5. . o -a �jry 2 111111111115 INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:�'" Location NP Date , ?4°"T" TOWN OF NORTH ANDOVER I Certificate of Occupancy $ `- ° Building/Frame Permit Fee $ S CHUtet. �`�"Foundation Permit Fee $ SS�cNusE i Q� Other Permit Fee $ 0Sewer Connection Fee $ ��� •` �' Water Connection Fee $ NOTAL , $ f � . •, -',Z- Building Inspector Div. Public Works LocationRlli No. I,l :; ;� Date NORTH TOWN OF NORTH ANDOVER p Certificate of Occupancy $ 0 � * Building/Frame Permit Fee $ -` 'ssAc►+usE< _ Foundation Permit Fee $ Othjgeelrit Fee $ — - Sewer lConkAp $ Water�oh,tjon T18ti7$ Q/ 4� $ r • Ver �Cj - Building Inspector r Div. Public Works Location— No. ocation No. Date ! r t + NORT1� TOWN OF NORTH ANDOVER Certificate of Occup -ar rRml ( S clly D-PA }e ,' Building/Frame Peee 4CHUS Foundation Permit Fee SEP$2 d . s�cNusE Other Permit Fee $ j/3 sewer Connection ki� AndgvgyEr eqte. ' Afi57 Water Connection Fee $ 1_ TOTAL $ +- Building Inspector z Gr �; Div. Public Works (PE$1iIT NO., %'; , — APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. j �< PAGE 1 MAAP KVO. I LOT NO. zC 2 RECORD OF OWNERSHIP DATE BOOK I'PAGE — ZONE Z SUB DIV. LOT NO. J 7 R' �J4n - - 1/V LOCATIO /f , 1 PURPOSE OF BUILDING 5, / � n, Yl ///-.nl/� OWNER'S NAME �, rte, �r NO. OF STORIES b SIZE �FVt'S) �� i� v GJ� OWNER'S ADDRESS )� 1( p, BASEMENT OR SLAB �ct ARCHITECT'S NAME 4v ' SIZE OF FLOOR TIMBERS 1ST!j I 2ND is 3RD BUILDER'S NAME 1- ` SPAN C.. 4/) 4 __ DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS )2,�b DISTANCE FROM STREET POSTS ?� A!" C C.j 41 /y> DISTANCE FROM LOT LINES-SID(ESJ# REAL( v GIRDERS �? 1-7 C6 AREA OF LOT � 1-7 s F G•a FRONTAGE a2 HEIGHT OF FOUNDATION '1I; THICKNESS IS BUILDING NEW �•e� Lg SIZE OF FOOTING s. /) X /) 1 r IS BUILDING ADDITION 1 )b MATER:AL OF CHIMNEY ) c j IS BUILDING ALTERATION A ,h IS BUILDING ON SOLID OR FILLED LAND I } WILL BUILDING CONFORM TO REQUIREMENTS OF CODES IS BUILDING CONNECTED TO TOWN WATER LY C BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER / C IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST L �-- SEE BOTH SIDES EST. BLDG. COST % 01?I 7 70,�- EST. BLDG. COST PER SQ. FT. PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER ROOM 1. �" PAGE 2 FILL OUT SECTIONS 1 - 12 J SEPTIC PERMIT NO. it ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ✓` ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUIL G INSPECTOR I r � DATE FILED 'I BOARD OF HEALTH SIGNAT 1 RE OF OWNER AUTHORIZED AGENT OWNER TEL. 7' 63 r F E E 41- / D 0 CONTR.TEL# 6 7 CONTR.LIC.# PERMIT GRANTED �.f-, I ' PLANNING BOARD I + BOARD OF SELECTMEN u R SEP 2 1 1992 i" , �r b r' INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY s-OR lEs THIS SECTION MUSTSHOW EXACT DIMENSIONSOF LOT AND DISTANCE FROM MULTI. FAMILY OFFFCES 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 B 1 2 1 3 CONCRETE BL'K. PINE _ BRICK OR STONE H PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT I • AREA FULL &ZA0 I FIN. B'M'TAREA _ 1/. 1/7 FIN. ATTIC AREA NO B M-T FIRE PLACES y HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 22 J 3 DROP SIDING CONCRETE I WOOD SHINGLES EARTH _ ASPHALT SIDING HARDVJ'D _ ASBESTOS SIDING _ COMMCN _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME I s CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR i ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. (2 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 WOOD JOIST IV PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER mTt&COLS STEAM STEEL B . 8 COLS. HOT W'T'R OR VAPOR s WOOD RAFTE AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GOAL B'M'T 2nd ELECTRIC 1st Lt%13rd I NO HEATING e 5 1 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: komas Q. �1d`C'(Al 1"t Phone LOCATION: Assessor' s Map Number y i��n ) Parcel Subdivision l 1 I Q, Lot(s) Streets O r ���� St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments )A,A'A (�J'A Date Approved ' l 7, Town Planner Date Rejected Comments Date Approved Z Z Health Agent Date Rejected Comments Public Works - sewer/water connections - driveway permit ?►ti Fire Department Received by Building Inspector Date SEP 2 I �' IrJ No. a � tl, I� m !V 1 w S 1 Lo-TF LOT 1 73 L2-Z!o' -�' I CK�R� I 7gG, I I at AL GES r 1 FI E� FC>U u GAT►c s.1 L.oc.A-r�o t►.a NQ- AiDO'uJe .,ML, f �1 oQTI-( A K ii10 . s 2.2.io3► S Lrs� 2.1 r M N 1 �I LL OCT - 2 1992 S Gam—Q-T-ti=y THAT o F'FS�T� SHcw�.J A�E �ot� T4lEr 'T'4iE. o F F src-rs vSE. c p- -T--+EE. F�u i L. T�.►cam, �C�,s�ctt� ,(pl1H Of S K a kJ k.l GoMaPI y (O 1.1C�y A v S c x_H VSE 1 S �a fes., W rT"1-4 TKE-7Zc>kjiuG �ETE.2Ml��t ATto�.t oF' roti i�JG " liw Sy L.A�c!S cF CouFoQ+M rT- ,/ 4D2. 1_l0►� Gor.1F7-o1Z- \,c.! N G-U C o u S"r"i?—u GTE �\ 1V�•- �'t� D• 4 r 'r-tgc9 b c i Town of A ]DRIVEWAY ENTRY PERMIT - --�s - "Arx ' 6 er, Mass., NE WICK R P 's BOARD OF HEALTH PERMIT T LD THIS CERTIFIES THA . . .40414 'AD-1.Z.411-0-9-014.A....................... BUILDING INSPECTOR has permission to erect k 0.0.*.*N&uildings on 4.0 H104.40 141-40pomi mov Rough . �W.4t �J.��!�1.��,y Q�.�.��,W.Vowo votoo�� Chimney to be occupied as. •••• � Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. � Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONT. 3� FEEPAIo ��', ��� RoughECTRICALINSPECTOR �� LESS CONSTRUCTION S A D om ' x,01 d Service PERMIT FOR FRAME/BUILDII Final 4111111111110110- -VA/40 .......... DATE:/ FEE PMV,9/1>1 C BUILDING 1 SPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No j Lapini , to Be Done Until Inspected and Approved by Smoke Det. Is ?� # Building Inspector t1,AL'tIY11%�,7I ►nr.�� ��� •rj ` ,� �' Lhi �a' IZ �� • NoRTtq 0 ndover own o L ,� No- 434 _yam ]DRIVEWAY ENTRY PERMITiz A Ev ower, Mass., /tel' 191-1 ��� �+ .. . /�+ oPf R` I BOARD)PF H ALTH PERMI 11A ..... :h�. �R./. �. .,a .................. . • THIS CERTIFIES THA t1��, •r'• BUILDING INSPECTOR ILt�1� Al �- �� �.�rA*A. .� � Rough y has permission to erect.....�.�� uildings on �� o . �'. �.#/' mroos Chimney W, /�13 to be occupied as.j.6*414a Veww 049/••. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMING INSPEsTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rou h( �A Buildings in the Town of North Andover. R� 1 �G i • REAtED f�AWI. VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES I N 6 M O N D ELECTRICAL IN ECTOR ti ��•� FM ND ���. !�f1 Rough I r. A �� ¢1' ^ C) Service / PERMITfORFIRAME/OUIIDtN�1-ESS CONSTRUCTIONS � .r ANNA", .( �z DATER '�? �� J. �' 0 BUILDING I SPECTOR GAS INSPECTOR ough Occupancv Permit Required to Occupy Building in a Conspicuous Place on the Premises Display p FIRE DEPT. Do Not Remove Burner No La in to Be Done Until Inspected and Approved by Smoke Det. , ' s Building Inspector CERTIFICATE OF USE & OCCUPANCY n Building Permit Number 434 Dete DECEMBER 7 . 1992 THIS CERTIFIES THAT THE BUILDING LOCATED ON 148 HICKORY HILL ROAD (Lot #20) MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/GARAGE IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. NORTp 0CERTIFICATE ISSUED TO Thomas D. Zahoruiko 185 Hickory Hill Rd. y ADDRESS SSA US USE��h Buil ing Inspec or i I 1 .J l�cac.A-t•-�o �►..� N o. Anlcx�yER.,MA, !C5GAcrE,:1c�_ �� QAYE.: l0 l92 o2-t-4-1 A u fl ov E.t�. � M A cis. Ci 0 . s LOT ILL f�OAp Lir 2.1 r 4 M 1 1 1 1 � G�.2T1�� TH o F'P'SE.T� SHow►J AQ:� �OS�, THE., 'TF1 Er dF'rr'SETj �SrC.. ciT 4e— gUt<.Dtt l6 uSPECTb S Ht o�a.l Ll C.vt�tPl..y (G 1..t.C...y A U� .�7 c.�c.1-1 V 6 tE t S �a{C� ♦$�� _ 1,LJ t-t-F{ '�H E x-04 l IU G �E•TE.TZ M t :4:i T l o tiJ o F' �.o t.1 t�y�, `� �, Sy L..A�.!S O� �!o u Fpf�ifr'I Ty� OQ� ►-lOt,..1 CoI.J�O QiP'I f'f'y �. � i n c.�j ;' ,> Ala., � \,t.! N E, Vc1414a.�►1 J � a� Location FL No. W Z— Date Z NORTH TOWN OF NORTH ANDOVER p��t.ao ,•1tiO Certificate of Occupancy $ • : ; Building/Frame Permit Fee $ /25� .I � b'�ne•A �ss�cMuet Foundation Permit Fee $ o j Other Permit Fee $ i Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector r„ 9306 Div. Public Works �Uu PERMIT NO., APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K-40. LOT NO. oC� 2 RECORD OF OWNERSHIP (DATE (BOOK ;PAGE — ZONE 2 I SUB DIV. LOT NO. Le V LOCATION l ; GI; O li ` PURPOSE OF BUILDING OWNER'S NAME J�`�•e VV NO. OF STORIES 6�Ge SIZE X, Z X �0 OWNER'S ADDRESS 1,48 ��'G d,,� `q BASEMENT OR SLAB G RAWL S ICiQ ARCHITECT'S NAME �M V. co-r SIZE OF FLOOR TIMBERS IST �x �or 2ND 3RD BUILDER'S NAME kQ rOr al �1eVV �C(5--.^� SPAN DISTANCE TO NEAREST BUILDING 3 b/ Y/ DIMENSIONS OF SILLS +7�PT --- DISTANCE FROM STREET 30 POSTS N y, C. Y DISTANCE FROM LOT LINES-SIDES Z 7 L,Q�k REAR 0661+- " " GIRDERS N lA'� AREA OF LOT .�7 L70 ^q/ S.� FRONTAGE 1 d� HEIGHT OF FOUNDATION 7/('/ THICKNESS 10 !j IS BUILDING NEW G GNe_CAw SIZE OF FOOTING 'L / ® �� X ��ll I IS BUILDING ADDITION ye's MATER:AL OF CHIMNEY /i d IS BUILDING ALTERATION N(5 IS BUILDING ON SOLID OR FILLED LAND S�L/ WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �/1}S IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IV ^ )O Ai� IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE y INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES, EST. BLDG. COST 7-7, 000 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. I I Z•Sc) ,PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM 2?, D SEPTIC PERMIT NO. N /A ELECTRIC METEPS.MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INS P CTOR DATE FILED -� - �jL OS-,S--'//7 7 42 7 2 31 NUILDING INSPtf;.T01t SIGNATURE OF OWNER UTHORIZED AGENT FEE I [L. OWNER TEL.# PERMIT GRANTED CONTR.TEL.# 19 CONTR.LIC.# 6 5-,5'44 H.I.C.# f 07 i t , t BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY .X S-ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D — —— PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/, 1/2 '/, FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASBESTOS SIDING COMMCN ASPHALT SIDING HARDW D _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 6 FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I-I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABIE HIP BATH (3 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 WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS X AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd—l— ELECTRIC lat�I 3rd NO HEATING NO HEATING 'N�R,rN own of dover No. 207- 17 �. �o .r~ L-1 �irdower, Mass., COCHICHE-CK A0RATED PP���� SF BOARD OF HEALTH PERMIT Food/Kitchen Septic System BUILDING INSPECTOR �.i4 ......... .a..�/..... ............. � THIS CERTIFIES THAT.................................................. � ................................. Foundation has permission to erect..... .Q.Q.+..j_1.0.N... buildings on ............ ........4/1.c4kI—Ck.Y. ......l�L.�....... Rough tobe occupied as........................................ ................ ,7./.J.45. ............................................................................... 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 EXPIRS IN 6 MONTHS Final E UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR Rough ................................................ Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR E Display in a ConspicuouRoughs 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. Smoke Det. i FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** '1 APPLICANT: Lt auJ , - Phone 6-9 3S� LOCATION: Assessor' s Map Number Parcel io 4 ^ � Subdivision � � � r � Lot(s) _ 2 0 Street LZ_4�2 /`l l �� St. Number f�� 4-1 ************************Official Use Only************************ REC NDA TION F TOWN AGENTS: Date Approved Co0ervatiorj Administrator Date Rejected Comments e WU A Date Approved a Town Planner\ Date Rejected Comments t A � Q , ect Date Approved Food �JI�nssfp�e�c�to�r�-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections "J 3 1iW - driveway permit C Fire artmen Received by Bui ding Inspector Date NORTH Town of North Andover 3?0ry .110 16.6 JQY E E RAQ: �,�w OFFICE OF N TOWN CLERK ITY DEVELOPMENT AND SERVICES OR 101 146 Main Street i NFR Z6 �C 36 A� 01845 �,,..o-:• �� "`North Andover,Massachusetts "SSACHUt2- is to C::t,)ftt twenty(20)d;A �8d FY©8�8;��Imm q�O•.i Lti%IIO�it� � d an � Joyce 0. w Any appeal shall be filed TsricWcwithin (20) days after the date of fi'ing of t,lis f%<otice in the Office of the Town ' Clerk. G BOARD OF APPEALS DNOTICE OF DECISION t Property: 148 Hickory Hill Road Date: 4/26/96 Ester & Janet Levy Petition: 04-96 148 Hickory Hill Road Dat North Andover MA 01845 e o Hearing; 4/23/96 The Board of Appeals held a regular meeting on Tuesday evening, April 23, 1996 upon the petition of Michael & Ester & Janet Levy requesting a variance from requirements of Section 7,Paragraph 7.3 and Table 2 of the Zoning By Laws as to provide relief of for sideline variance of 12' from the requirement of 20'. The following members were present and voting: William Sullivan,Raymond Vivenzio, John Pallone, Robert Ford, The hearing was advertised in the North Andover Citizen on 2/21/96 and 2/28/96 and all abutters were notified my regular mail. Upon a motion by John Pallone, seconded by Raymond Vivenzio, the Board voted unanimously to for the se of an GRANT relief of; 12' to the sideline setback from the required members were: William Sullivan,0RaymondoVivenzio,John for a residential bedroom. Voting Pallone, Robert Ford. aw The petitioner has satisfied the provisions wlO feet theaph 10.4 of the Zoning neighborhood or derogael fromahe tthat the granting of these variances ill not adversely intent and purpose of the Zoning By law. Board of Appeals AT=COPY William Sullivan,Chairmana� ,Aa6R- down Clerk" cry 7-�-�►o;�t �� tis Ni� �c H 7A HEALTH 688-9540 PLANNING 688-9535 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 _ -._- r,_ - . Date. 1..�.�!. .�V. .... 40R7M pf „ao ",ti0 fof '' TOWN OF NORTH ANDOVER _ 9 PERMIT FOR GAS INSTA TION ACHUSE�t This certifies that .l". . . 5 � IV4• • . . . . has permission for gas installation in the buildings of at . . . North A dover, Mass. Fee. .�iU . . Lic. No.. . . . . . . . . . . . AS INSPECTOR Check# �� G 3 7207