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Miscellaneous - 15 ABBY LANE 4/30/2018
(LGfZ� BUILDING FILE i I' I I I I I y i North Andover Board of Assessors Public Access Page 1 of 1 NORTH North. Andover Board of Assessors s1roperty Record Card Click Seal To Return Parcel ID:210/065.0-0285-0000.0 FY:2013 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels Search for Sales si ,a Summary Residence I Detached Structure Condo 15 L•2 ABBY LANE Commercial Location: 1.5L-2 ABBY LANE Owner Name: HILLARY,JEREMY HILLARY,LISSA Owner Address: 15 ABBY LANE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 10-10 Land Area: 0.80 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 4460 scift ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 993,000 994,200 Building Value: 729,800 697,300 Land Value: 263,200 296,900 Market Land Value: 263,200 Chapter Land Value: LATEST SALE Sale Price: 1 Sale 10/10/2007 Date: Arms Length Sale F-NO-CONVNIENT Grantor: NORTH ANDOVER Code: REALTY Cert Doc: Book: 10936 Page: 65 http://csc-ma.us/PROPAPP/display.do?linkld=2254801&town=NandoverPubAcc 3/18/2013 Residential Property Record Card PARCEL ID:210/065.0-0285-0000.0 MAP:065.0 BLOCK:0285 LOT:0000.0 PARCEL ADDRESS:15L-2 ABBY LANE FY:2013 PARCEL INFORMATION Use-Code: 101 w Sale Price: 1 Book: 10936 Road Type: , T Inspect Date: 06/16/2007. Owner: Tax Class: T Sale Date: 10/10/07 Page_ 65 Rd Condition: _P Meas Date: 06/16/2007 HILLARY,JEREMY rot—Fin Area: :4460_ _ Sale Type: P7—Ge-_ rt/Doc: - Traffc: � �_` Mnt _ Erance: —'�= X_ - HILLARY,DERE Tot Land Area: 0.80 Sale Valid: F _ Water: Collect Id RB _r Grantor: NORTH-ANDOVER REALTY " Sewer lrispectReas: S Address: - - - — — 15 ABBY LANE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 E RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 9 Main Fn Area: 2237 Attic: NBHD CODE: 10 NBHD CLASS: 10 ZONE R2 Story Height: 2.00 Bedrooms " _ 4 Up Fn Area: 2223 Bsmt Area: 2209 Seg Type Code Method Sq Ft _Acres Influ-Y/N W_Value T C_211, lass a - Roof: H m—FulTBaths��3 Add Fn Area: "��Fn Bsmt Area: 1230 1 P 101 S 34651 0.795 _.. - - 263,157 Ezd Wall: ' FB_ Half Baths __1 Unfin Area: Bsmt Grade. G VALUATION INFORMATION MasonryTr m:_ 52 Ext 66tHFix:`'3` Tot Fin Area: 4460- " "" Current Total: 993,000 Bldg: 729,800 Land: 263,200 MktLnd: 263,200 Foundation: CN Bath Qual. L Kitch Qual: L Eff Yr Built: 2000 •wMkti AdlRCNLD 729800 Prior Total: 994,200 Bldg: 697,300 Land: 296,900 MktLnd: 296,900 m �._._ - Heat Type: FA Ext Kitch: Year Built: 2006.......Sound Value: Fuele Typ :' G' "+Grade: -_. VE'_"YCostBldgY _729;8007,' Fireplace: 3 Bsmt Gar Cap:3 Condition: E Aft Str Val 1: _ �— — Central AC:-' "Y"''BsmtG_ar St=:856 Pct Complete: 100 "�Att Str Val2: Att Gar SF —. -%Good P/F/E/R: ///95 Porch Type Porch Area Porch Grade Factor S 144 W 228 SKETCH PHOTO 19 12 W S 12 228 Sq.R 12144S 7an 12 FU/FM/B 2209 Sq.Ft 38 36 i..... a 18 qXt 15 L-2 ABBY LANE Parcel ID:210/065.0-0285-0000.0 as of 3/18/13 Page 1 of 1 Location /37 ,4& Y 1,,4 AI� No. n Date MORTN TOWN OF NORTH ANDOVER aPOW . + ; , Certificate of Occupancy $ CMUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check #/6 73 18956 Building Inspector MONTH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �/ •.nn d`44 ,SSACHO`'`4 Permit NO: Date Received: Date Issued: 2 � . IMPORTANT: Applicant must complete all items on this page LOCATION__J5____jO��S 1 (,f vo,e- Ce T a Print PROPERTY OWNER ` 0���. .Qr�t)lodtl` R..¢A 141/ L O/'0 Print '1 MAP NO.: Wc PARCEL: �y ZONING DISTRICT: O� TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential i New Building ne family ❑Addition ❑Two or more family G Industrial D Alteration No.of units: V Repair, replacement G Assessory Bldg ❑Commercial ❑ Demolition t Moving(relocation) n Other ❑ Others: 7 Foundation only DESCRIPTION OF WORK TO BE PREFORMED (f OA 51!-v� 5tra e i4a, &644 v�ao L U I i Identification Please Tyne or Print Clearly) OWNER: Name: �f-F�� �•"��� i` =�` Ca<� Phone: Signature Address: �� ( �-�'Srt �fe A.AW w� -fit�F-eC�►I(( /x"19 S�j CONTRACTOR Name: Phone i G Address: Supervisor's Construction License: Exp. Date: � Home Improvement License: Exp. Date: ' ARCHI'T'ECT:ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT:$1/1.00 PER S100/A00 OF THE TOTAL ESTIMATED COST BA SED ON 5125.00 PER S.F. r OO I:e</7. Total Project Cost :$ `�� ��' 7 !J x10.00=FEE:$ Check No.: `l ; Receipt No.: '� 1 Location No. i Date Qf f ,.QRTFTOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ Building/Frame Permit Fee $ � • AC NUS Foundation Permit Fee $ Other Permit Fee $ t' TOTAL $ j�'C?✓-7 Check #16 73 18956 Building Inspector J TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art Ji Swimming Pools Public Sewer �! Tobacco Sales Well !.j —' Food Packaging/Sales Permanent Dumpster on Site Private(septic tank,etc. �.- I NOTE: Persons contracting with unregistered contractors&)not have access to the guaranty fund Signature of Agent/Owner V ( Signature of Contractor _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DA E JECT ATE APPROVED CONSERVATION ❑ COMMENTS DATE R CT ATE APPROVED HEALTH COMMENTS t 'Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: __Comments Conservation Decision: Comments Water&Sewer connection signature&date Temp Dumpster on site yes—no— Fire Department signature,'date Building Permit Approved and Issued by: ' I A I •r Bui I din qetback (ft.) Front Yard Side Yard Rear Yard Required Provided Re uired Provides Re uired Provided DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: N(YI'lS and DATA—(For department use) I T I C f E { I Doc:INSFEC'1'IONr11_SGRVICGS f)PI',1R 1'1viI N I.ISPbORMn> CreaueJ AK 1,11120 w, V .0 Building Department 1 The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Debris Removal Form ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ` i ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Form ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) i ❑ Building Permit Application ❑- Form U- -- - ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:I%SPECTIOVAL SERVICES DEPARTMENT:BPFOR\IU5 f CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 514 (2/2/06) Date: August 29, 2006 V _f THIS CERTIFIES THAT THE BUILDING LOCATED ON 15 Abby Lane MAY BE OCCUPIED AS Single Family Dwelling IN ,.,ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issu6d to; North Andover Realty Corp 459-East BroadVvay Haverhill MA 0183/0 Building Inspector t ail NpRTH t_ Town of : s 4Andoveri O -_ No. 6"IAI t( �O LA E = dover, Mass., •� - I� COCMICMEWICK 7,9 ADRATED `s BOARD OF HEALTH Food/Kitchen Septic System BUILDINC-INOR THIS CERTIFIES THAT..............�f.. . . ftfr.. eef . ................................................................................. Fou as i� ,oL�n has permission to erect..................................... . buildings on.. .. �da? ................................ Ro�, � <;,. , to be occupied as........... /6 . ........ .�.. .. clues .,, provided that the person acceptmg ih' rmd shall in every respect confo to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECYOk VIOLATION of the Zoning or Building Regulations Voids this Permit. oug Fina C.^X PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STAR S , ELECTRICAL INSPECTOR Service BUILD IAI_ ECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a ConspicuousPlaceon the Premises — Do Not Remove F_; �j� No Lathing or Dry Wall To Be Done f FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. tv SEE REVERSE SIDE Smoke Det. 1,r PAGE 01/01 23. ..... LANE OF ABBY 49' MUNDA TION rL.;;;22 1.0 LO T 5. MUNDA 710.N LOT 4 ZONING DISTRICT P-2 MIN- AREA S.r. MIN. LOr VIIDFH 100' AM. rPOMTAGr 100' MIN. FRONT SMACK = 2o' MIM SME SETBACK* 20' M-M. RFAR SETPACK 20- THE STRM"Z)Alf MAY Cr PlACL-d a ,?rJIUM, UPON A SIDE` LOT U'Mr WITHOUT A SIM -lfVACK, PROV100 THAT TIE ADJACENT L07 TO WHICH TNN ZERO SETBACK IS LOCATED HAZ' ME #Eoufm sm)-r ),APD SFTOACX. FOUNDATION LOCATION PLAN cEwmy TNA.T 7,w aRMARY s7pwrtiRc smwAF rtNFORA(s To ME MRIZONTAL SWraAeK fflE0U1M-rM4Wn Ar Ithr LOC"AL APPLICARAX Za*M.- fir-kANT 14 4rrtrCl WHEN CDAWFUC713- 01'JS --'R71nCATl0N iWES UOT COICUff ANY 07HfR RESWMAW WON AS owrits 40'awDI7a04M1 CUENT.- MOR TH ANDOVER REALTY' nilsDPAW%W Swr,L Hot pE USM gy rNr WpVt),aR A,& P'JRp'ogf 01`40 MAN THAT W7LWfD A&0Vr.f=CPT W17V rmr THIS CERMICA Mv 1.5 MADE AND UMITroo WgffrEV PERMISMM Of CAMMMASM A SCAM AvC- M THS' AROV4- CL1ri9r',P "VRAMOW NIS DOWMV 15 TMF LVPMCM7M PRoprpry flF CHRAF27AAUM & SrMl 4NC. AM.0 ANY LfMALINONZI-D JISf 15 AftHIMMUCHRINUAWM* mni mrcs ma p4spoN.VR&jry 'rop ThK "UMOOMFO USE OF UdS DRAW= M AMr Wrap- LOCA VON. #35 AGRY LANE, NORTH ANDOVEW mA'wm c*NTA'mFD mlMom. SCALE. i" = 60' DATE: SliI106, REV. 8118106 CHMSTIAMSEN lsz SERGI -WtXSM#Asvqvrm� 1111,111111 I.X "ND yD#s 160 suaAcp IM AwvrqwmNA, oram TM 8-W'g -QY ChM-MAMEN& URGI INC. DRAWING No.- 9,7066Clo 00FTH Town of over i dower, Mass., 02 . 4 40,E O s=- LA COCHICMEWICK V ORATED `S BOARD OF HEAL'T'H PER T Food/Kitchen Septic System UILDIN OR ���' THIS CERTIFIES THAT..............�.L .,A...... .... �� ..... . .... . - Fou dation r ............... buildings 4N. . .it...................... has permission to erect..................................... gs on..� .. ,.. . . � It� .......... tobe occupied as........... ... .../.�,/.. ........ , ,.�.. ................................................................... provided that the person ccepting�h' rmit shall in every respect confo to the terms of the application on file in Final ; this office, and to the provisions of the Codes and By-Laws relating to Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPE O VIOLATION of the Zoning or Building Regulations Voids this Permit. oug Fin PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCT'I STARS ELECTRICAL INSPECTOR czugh 7,�=�a ....... .... ... ... ..... .. ............ ............................... Service BUILD _S CTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous "Place on the Premises — Do Not Remove F' o�� L, No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. j �" SEE REVERSE SIDE Smoke Det. fp ` NpK fl-1 Town ofAndover _ �S3 No. N. Z = = G� • 3d . oG = LAKE dower, Mass.,T COCKICKEWICK RATED �C S BOARD OF HEALTH PE Food/Kitchen RMIT T D Septic System THIS CERTIFIES THAT �BUfILD G INSPECTOR� .. ....... .............. Q f, W"' """' Foun ation has permission to erect... .......................... . buildings on.... i� g • Rou h �' Ge to be occupied as..........o Q �. ....sir••V 1/..r..... .................................................................. ey provided that the person accepting this permit shall in every respect conform to the terms of the application on file in nFinal 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. PLUNfAING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rou c)4 7.—i( l� � PERMIT EXPIRES IN 6 MONTHS Fi -c)14 ELECTRICAL INSPECTOR UNLESS CONSTRU ST S ok- 7•-5--ak Pit-t B0010511LIMMECTOR Service Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough c, No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. lrl' &VI'�,�,,;� SEE REVERSE SIDE Smoke Det. IVA _11qfz i i yORTJI A tao °s~O " ° AL 0 Art �9SSAC HU APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit # ADDRESS/LOCATION OF PROPERTY : 15 Y Map S Parcel ',�2 7 Lot Number a SUBDIVISION T-J^,P DATE REQUESTED FILED/READY FOR INSPECTION D ©(o CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. j SIGNED i ROUTING CONSER`,/AT1�.'IV PLANNING DPW -WATER METER 01- SEWER/WATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW I t-4-CO - Signature File: OC form revised 2006 �" G�4 it �� : t; ; U �J ` ' r � �• � ♦ � y „ NORTH TO" Of _ 4 over 0 t� No. j:57/A/ S z dover, Mass., 02 A � 0 — L A Eo%. COCMICME WICK 'tl,9s RAreo PPE '�� BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR { THIS CERTIFIES THAT.............. ! . .... .�.....a . ................................................................................. Foundation PER T �� . ................................ Rough I has permission to erect..................................... . buildings on ..� ....... 4 *V ` • Chimney to be occupied as.............rwi /!�,/ �c........jam!� /.�.. . ................................................................... provided that the personmg'[hrmd shall in every respect confo to the terms of the application on file in Final I this office, and to the provisions of the Codes and By-Laws relating to 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STS S Rough . .... ................ ............. Service ........ ....... .. ... ...... .. .. BUILD I ECTOR Final i Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a ConspicuousPlace 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. l Smoke Det. SEE REVERSE SIDE NOPTN O� ,No y�NO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �SS�cHu5�4 Permit NO: " G Date Received: Date Issued: Z 0 IMPORTANT: Applicant must complete all items on this page LOCATION__ Print PROPERTY OWNER OT-41. .Qn QW ("n/D �c Print N1AP NO.: C06 PARCEL: 2 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0 TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential New Building ne family D Addition `Two or more family E. Industrial Alteration No. of units: Repair, replacement `Assessory Bldg C Commercial Demolition Moving(relocation) Other Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Tyne or Print Clearly) OWNER: Name: bG��t ��^��1� i Phone: Signature Address: <<�� L--ASt �foA�Wa►n ���E-?f�tt(( CONTRACTOR Name: `j 1� V-6-d7l(0 tps.� t�4//'o t ( Phone• Address: Supervisor's Construction License: Exp. Date: I Home Improvement Liccnse: Exp. Date: ARCI IITECT:F.NGINF.ER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDLNG PERMIT:$111.00 PER$11100.011 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. .. ,_ o O 1_7,r Y 7 / — Total Project Cost :$ S-S ��� 71s xI0.00--FEE:$ Check No.: Receipt No.:,ze i i I 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. APPLICANT FILLS OUT THIS SECTION APPLICANT Nor4 44�u e r &L4 . rp PHONEj3g—Z)_Y7 � LOCATION: Assessor's Map Number�S PARCEL ppk SUBDIVISION h''tv t"imA LOT(S) STREETSQ�� N� ST. NUMBER OFFICIAL USE ONL RECO#PENDATIONS PJF, YVN AGENTS: CONSERVATION ADMINIST OR DATE APPROVED 11 II DATE REJECTED COMMENTS-&-i r,5 t-OWN PLANNER DATE APPROVED a DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIV Y/PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSIDE C OR DATE Revised 9197)m - I Permit Number REScheck Compliance Certificate Checked By/Date 2000 IECC REScheckSoflware Version 3.6 Release 1 Data filename:Untitled.rck PROJECT TITLE:PLAN NO.3843 CITY:North Andover STATE:Massachusetts HDD:6322 CONSTRUCTION TYPE:Single Family WINDOW/WALLRATIO:0.16 DATE: 11/27/05 DATE OF PLANS:3-5-03 PROJECT DESCRIPTION: COLONIAL HOUSE DESIGNER/CONTRACTOR: BRUNO ASSOC. 28 BERKELEY ROAD N ANDOVER MA 01845 COMPLIANCE:Passes Maximum UA=580 Your Home UA=498 14.1%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter -Value R-Value U Factor A Ceiling 1:Flat Ceiling or Scissor Truss 2173 30.0 30.0 37 Wall 1:Wood Frame, 16"o.c. 3145 13.0 13.0 123 Window 1:Vinyl Frame:Triple Pane with Low-E 492 0.350 172 Door 1:Solid 96 0.350 34 Basement Wall 1: Solid Concrete or Masonry 2239 19.0 19.0 132 Wall height:8.0' Depth below grade:7.0' Insulation depth:4.0' COMPLIANCE STATEMENT: The proposed building design described here is consistent with the'buil&�g plans, specifications,and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 IECC requirements in RES checkVersion 3.6 Release l (formerly MECcheco andto comply with the mandatory requirements listed in the RES checkInspection Checklist. a Builder/Designer Date t l"S7 "Q e L ER EScheck Inspection Checklist 2000 IECC RES checkSoftware Version 3.6 Release I DATE: 11/27/05 PROJECT TITLE:PLAN NO.3843 Bldg. Dept. Use I Ceilings: [ ] I 1. Ceiling 1:Flat Ceiling or Scissor Truss, R-30.0 cavity+R-30.0 continuous insulation Comments: I Above-Grade Walls: [ ] I 1. Wall 1:Wood Frame, 16"o.c.,R-13.0 cavity+R-13.0 continuous insulation Comments: I Basement Walls: [ J I 1. Basement Wall 1:Solid Concrete or Masonry,8.0'ht/7.0'bg/4.0'insul, R-19.0 cavity+R-19.0 continuous insulation Comments: Exterior insulation must have a rigid,opaque,weather-resistant protective covering that covers the exposed(above-grade)insulation and extends at least 6 in.below grade. I Windows: [ ] I 1. Window 1:Vinyl Frame:Triple Pane with Low-E,U-factor:0.350 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ ]Yes[ )No Comments: I Doors: [ ] I 1. Door 1: Solid,U-factor:0.350 Comments: I Air Leakage: [ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] I Recessed lights must be 1)Type IC rated,or 2)installed inside an appropriate air-tight assembly with a 0.5"clearance from combustible materials.If non-IC rated,the fixture must be installed with a 3"clearance from insulation. I Vapor Retarder: Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. I Materials Identification: [ ] I Materials and equipment must be installed in accordance with the manufacturer's installation instructions. [ ] I Materials and equipment must be identified so that compliance can be determined. [ l I Manufacturer manuals for all installed heating and cooling equipment and service water heating I equipment must be provided. [ ) I Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. I Duct Insulation: [ ] j Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-6.5. I Duct Construction: [ ] I All joints,seams,and connections must be securely fastened with welds,gaskets,mastics(adhesives), mastic-plus-embedded-fabric,or tapes. Tapes and mastics must berated UL 181A or UL 181B. Exception:Continuously welded and locking-type longitudinal joints and seams on ducts I operating at less than 2 in.w.g.(500 Pa). [ ] I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to I partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. � I Service Water Heating: j ] I Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the I water heater has an integral heat trap or is part of a circulating system. [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Circulating Hot Water Systems: j ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. I Heating and Cooling Piping Insulation: [ ) I HVAC piping conveying fluids above 105 OF or chilled fluids below 55 T must be insulated to the I levels in Table 2. Table l: Minimum Insulation Thickness for Circulating Hot Rater Pipes. Insulation Thickness in Inches by Pine Sizes Heated Water Non-Circulating Runouts Circulatine Mains and Runouts Temperature t Fl Up to 1„ Up to 1.25" 1.5"to 2.0" Over 2„ 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by pine Sizes Pigg System Types Range(F)F) 2"Runouts 1"and Less 1.25'to 2" 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) I FF9=11'1 :PCJDEPTS INSUPRNCE FAX NO. :97861333147 May. 10 2005 10:01RIh F1 I C 1T?*.iWUL);y- ACORQ„ CERTIFICATE OF LIABILITY INSURANCE I D.5LI-012005 ouvcP'a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATC m. p. ROBERTS INS AGENCY INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, CXTENO OR 1060 OSGOOD STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTH ANDOVER, MA 01045 978-683-8073 1INSURERS AFFORDING COVERAGE NAICI NORTH ANDOVER REALTY CORP. :INSURERA SCOTTSDALE INSURANCE 459 EAST BROADWAY i 7NauRr•R R: HANOVER INSCE PAVERHILL, .MA 01830 IINyJ(tlic L,ztrTeD 9TATP,9 .T,TX2ILITY _N4Up-pal i — - __. 978-686-7724 i INSURER rt. ML AMP.' 110MI ASSURANC8 NS/AIL; _ .INSURER IT_ COVERAGES THE POLICIES OF INSUI V,NCF:I.I$TE0 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDI('ATED.NOTbVI I'HS t+\NDING ANY REOUIriCIv4ENT, TERRA OR CONDITION OF ANY CONTRACT ON O'I HL''N DOCLNF.NT WI'rH 11F.SPI:C'I 'It)VYHICH THIS CERTIFICATE UAY BE ISSUE.( It MAY FERTAIN• THr IWAINANCt At FORDED BY THE POLICIES DE30RIBEO HEREIN 18 SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDI 170NJ Or SUCI I rC•UCIES.AGGRc3A,TE LIMITS 6HQW04 MAY HAVE BEEN REDUCED 2Y I'MO CLAi1+IS, —tl Ann. �• ?OLIfVKUTAG@R '-rCC -LTR DATTI\'• PC41'C'!�•%�'I ^,T!QNI LI,,,I�.,, MINI j 1 cr,ucpA. wt.ar•.:Iv I !C/u'AJ tlCcuryv�r!C' j z 1,000, 000 i A1;ITGC TO ttacc { :C)I(NJFRr..lpl;rNrFA;y.Llnnu.Ir/ I ; ��r.N+izr-s!r:,rv,:,.r,n ' s 100, 000 —- Clr.iM9 N1AGr l.1)..�!7l'l•ihi i I {Nf_n rXFl,�ry ra+n pnrxc-.r tt .. 5, C 00 A CLS1133206 03/13/05 i 03/13/06 j P.k'L7Nq'•tiAUJ11JJLIRY j ) 1 ,,000, 000 GENEIAL AG^RCGATC j 2.000 000 AGG:4F%:YRF.IN4IT APPI.r:S PCR:i PRQOLR)T .r,'QIN''JOt'Ac_U 4 7 0 00 000 Y PRO .... nl:rcnaal_e.no;urr I CUMOINCDswr,I.rI,NIT 1000,000 (cnn<r+dom! I + '!i•V Y x',17 CG - I FCQiIYINJJN'! • ; { I r•ir pyigrn7l 3 X:7vI+Fr�',':., AMN-5069646 02./06/05 i 02/06/06 bUL9LYINJURV ,, - }{ �NCJJ-CwNCDA'JTOS I I (PYiuuu�ianj - I I morcRTY OPNAa3c .:.:N•.t•t Wwi, 7v AUM ON_Y CAA (:i,JGNi 1 ANY!,.MT I IEA ACC .1 OTHCR'I.7AN i AI R(YONI Y- _cy,Cc:i$;lMb HTY { f+V;!•I C7Cp11RR_Er,Cl _ r 1 AGO, C00 AQUAEGATE S CUP1005937a ! 03/13/05 103/13/06 ) >v. I:a(l:�S'JO'dL`CN A°IONl,NC j TOR'YLIWTS X -h _ Cr+IPLorcr�uP.alLrr- j WC6643936 i 03/13/05 03/13/06 r'�.eccNAGDIL.=_NI y 500,000 {•t JV,V.1'(NL11,:.yLl•:)I'V'_ J°F._GF.N.GU6FF GYCLVCGUI I I C.L.OI SrASG r-A FNIPI UYFI{b _500_000 SrCCIAl r7(r NI;h7N50++!><,' ___ _ k.l..ply EAyE•rC7l ICY�_IMI�a SOO,_O OO -Oi`iIt i I I _ '.:r.:PT-)N r01•EIRA T:ON,': J'Jki If-INS/Vth;L•L t yrtxCLUS ONS AC10•c'lT 81 K.i OR-SEMF.NT:FI PF'G;I P,CCIVIg17NS IF'j( rAx' 978--975-0442 CERTIFICATE HOLDER CANCELLATION DnUV,U ANY VY I'Mt..m VVt 5C(;ANCCt.I."0.•.Pr;RP'I•Ir r.CF'.F=-::::r+ TOWN OF ANDOVER 10 36 6.ARTL£TT STREET I DATE.1HEHrpF, IH} ISS!dNI;,INy!Mk l Y'+ILL tNL`cAYUR'IU LS\iL_ •;:.Ys rnT h. I NOTIf.F TO TNF Cr•FTI:L\TG i.du O'nF NAIA:fI Ti.TPF'41 :+,!: .4,ii i.iw- Ir,�I�;! ,:I41,:-I ANDOVER, MA 0181.0 IN:!'Utlt NU Utlu''tiAilf,7(Y UK I,IA.✓.71.11'+.Uh hPJY SIN;i LI0N Int IN;IUNt K, 'j 71 R7,PRr$rNTATIVr-A A;)TI IORUCD RCPRCSCN? T vC AC0RD25(200V08) RPORAT)ON 1988 The Commonwealth of Massachusetts t= Department of Industrial Accidents Ofceeflases0atiens __- -- 600 Washington Street ' Boston Mass 02111 .. v Workers'Compensation Insurance Affidavit name: location: city phone# F7 I am a homeowner performing all work myself. F-1 I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers'compensation for my employees working on this job. ct mnanv name Weil � #} 4 fxxxx address::::::::: city. .41(�fphone# L1 eZc in"surance c . ! /ate oLc .# 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: i xx company name• address. city hone# P i insuranceX. 'co 1ie cimnanvnanm address. ,.; cifv insuranceco. ONE= 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$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a COPY of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby c ify under the pains and penalties ofnp'erjury that the information provided above is true a d c`orr ct Signature CJ^^� �� (r��/ '�'�- Date Print name /a�A2S \l �AY'(�O I Phone# �l�t .?9' C9T1 6o official use only do not write in this area to be completed by city or town official . city or town: permit/license# nBuilding Department OLicensing Board check if immediate response is required pSelectmen's Office Health Department contact person: phone#; nOther (revised 3/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any.. contract of hire, express or implied,oral or written: An employer is defined as an individual,partnership;association; corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual ,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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, 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. '�✓ -�4 ".Z"9 Yd b �f,� � G ' // /5 / /./,�. f ��'." �F s:+sr+ n.f' Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may-be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the,application for the permit 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. o k,y�,� �f RNM City or Towns 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 permittlicense number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. u EON— The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents . Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406, 409 or 375 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: �jyb (Location of Facility) Signature of Permit Applicant Fire Department Sign off: � "~ �x Dumpster Permit 1 cab Date i �/ce �an7yto�uaeal!/ o�./�aaeiac�irn;�rr _ BOARD OF BUILDING_. ULAT"s License: CONSTRUCTIQ3,,,WQERVISOR Numbert CS 0343.. Bi thdite: 07149M96-5 WPWxpires:,07/1.9/2G17 Tr. no: 14926 RdstriCd 60. JAMES V--CARROLL 163 HIGHLAND RD' G / ANDOVEP. MA 0181(, Commissioner ti i i i i i NameA F Location—r---? Check# Date Note: F NORT rr, TOWN OF NORTH ANDOVER j 0 0 ..��°�, Sewer Mitigation Fee $ ® j a j Sewer Connection Fee $ 1 SS'c""s�t Water Connection Fee $ Meter Fee $ 8 Other $ RECEIPT NO. TOTAL $ 1 45.9 �ZA Div.Public Works WHITE: Applicant CANARY: Department PINK: Treasurer GOLD. File 'yt� i 2077 I APPLICATION FOR SEWER,SERVICE CONNECTION 4-7 North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in' Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. Street ��6 ��79 — Z77 � i or�sudivisio lot no. OLlreza—c wner Address Contractor Ad ress APPlica" Sigriature PERMIT TO CONNECT ITH SEWER MAIN The Division of Public Works hereby gran ts ermission to - to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. DivisiotJ of Public Works By ;/L� Inspected by Date See back for rules and regulations i APPLICATION FOR WATER SERVICE CONNECTION I North Andover, Ma s.`Ja , 21 19--` 4 Application by the undersigned is hereby made to connect with the town water main in LStreet, subject to the rules and regulations of the Division of Public Works. The premises are known as No. Al 5 Street or subdivision lot o. 1 Atet�' 6 ux Owner Address ' Contractor Ad e s a icant's Signature r ltit� D PERMIT TO CONNECU WIT /WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at Street subject to the rules and regulations of the Division of Public Works. I � Boa d Public Works r BY Inspected by Date See back for rules and regulations s GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT Tills form shall be used to assist the Building Depa.=ent in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. ti,4r4� r U Permit Applicant Property address Map/ areal "- Single Fainly Two Family applicant's Phone Number I the undersigned applicant for the above property attest that ere dauaJaed building permit(,or whidi this Ibrm is cuniplac f ooes comply with the EKEIvtPTION section 8.7.6 ofthe Growth Management Bylaw.I also understand providing this form docs nut absolve me or any party to this permit from the requirements of otataining other permits required prior to the issuance of the building pemna. Further I understand that my interprdation of the exemption status is subject to review by die Building Department;uid is unit t utl'ii;1ally accepted when the building permit is IsaUed. Based un section 8.7.6 of the North Andover Growth Bylaw the above lot and die work as applied for on die above lot,in die bwldine, permit application and associated attachments,complies with one or more of the following sections as indicated by a check mark This is an application for a building permit for the enlargement,restoration or reconstruction ol'a dwelling"o esistaice as ol'the effective date ofthis bylaw,provided that no additional residential unit is created. The iot(s)was/were created prior to May 6, 1996 acid are exempt from die provisions of section 8.7 of die Zoning Bylaw. This application is for dwelling units for low and or moderate income I'arnilics or individuals,where all ofulie uunuitiun> of S.7.6 are ma and or represents dwelling units Ibr senior residents,where occupancy ol'thc units is restrtaed to senior c uzuts through s properly executed and recorded deed restriction running with the land.For purposes ol'this section"senior"shall me:ut persons over the age 01755, This application is part of a development project which voluntarily agreed to a minimum 40%permanent reduction in dctisity(buildable lou)below the density permitted under zoning and feasible given the environmental conditions ol'the tract,widt the surplus land equal to at least ten buildable acres and peen anently designated as open space or farmland.The land to be preserved shall be protected Bom developmem by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,car tidier s niilu mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and nut held by a Developer in common ownership with an adjacent parcel un the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scll%duling provisions for the purpose of constructing one single family dwelling unit on the parcel. 141 This application represems a lot which is ready for a building permit(all other permits from all other boards and onunissions have been received and the project is in compliance with diose permits),and the Development Scheduler does nut aaonuncdate issuing a building permut in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this E\EMPTiON. PLE.kSE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTivtENf IN MA.KINU.-t DETERMINATiON THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTION'S. B1' SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE AiTACHED BL'ILDPIG PERWT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL.OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR NOT IS GROUNDS FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPL CANTS SIGNATURE DATE TI-US FORM TO BE ATTACHED TO TE11 BUII.DENG PERAT APPLICATION Location /T ��— No. Date ,.oR•� TOWN OF NORTH ANDOVER t 1, _ 9 a > Certificate of Occupancy $ cHusE�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t � �`' Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN E`AMN:1TlON S CH Permit N0: LSDate Received: i Date Issued: D b Ifi1PORTANT: :1 licant must complete all items on this page LOCATION ` Printp PROPERTY OWNER K10t'�-�-, Print Print ,Nq,kP NO.' 65 PARCEL: 011-tZONING DISTRICT: TYPE AND USE OF BtiILDING HISTORIC DISTRICT YES 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition =Two or more family Industrial _... Alteration No. of units: Repair, replacement Assessory Bldg Commercial is Demolition Moving relocation - Other Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED IF1�cs�- Identification Please'Type or Print Clearly) ��I ✓�oJo2 Phone: 77ro OWNER: Name: ii Address: q5 j J�Aqt 13 CoA& - I- CPhune k -07 x'76 CONTR.ICTOR Name: ,lddress: tc3 t-�(t��,t,�� � r 4^&We2 - Supers isor's Construction License: CS 0G 3 5'0 3 Exp. Date: 7 Honic; Improvement License: Exp. Date: RCH11'ECT.E GINEER wOo'amc:: Phcne: q7R Address: pl L�e� • Reg. No. FEE SC'HEDL LE:BE LDI.1 G PERMIT:510.00 PER 51:?00.U0 OF THE TOT IL ESTLDI.-1 TED COST B.ISED 0, 5!'5.'00 PER S.F' Total Project•C'ost :$.____3ecW xI0.WFEE:S A.616 Check No.: < Receipt No.: T}'PE OF SEW'ARGE DISPOSAL _ I Tanning'Massage Body.art Sti imming Pools Public Sewer - _ Tobacco Sales Well _ -- Food P,ackaoing Sales _ r — Permanent Dumpster on Site _ Private(septic tank,etc. _ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do ZI; not have access to the ►uarantp.Ju Signature of Agent,OWncr "''` Signature of Connd trac Plans Submitted k' 'Plans Waned Certified Plot Plan Stamped Plans � - THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ i17 ❑Water Shed Special Permit CI Site Plan Special Permit J Other COMMENTS �-7� DATE REJECTED - DATE APPROVED CONSERVATION COMMENTS Iti - _ DATE-REJEC'T'ED DATE APPROVED HEALTH CONIMENTS :.+ : . '! _r ; z.r.)rf. 1� Zoning Board of Appeals: \ariance. Petition No: ._/oning`Decision;receipt Submitted -,es P arming 8-mrd Decision: ,)1lSC1'N {tion Duci;ion: = Comments. 'k':,tQr& S,:�%Lr connection-i;;natu-u ,late r . �,. i imp Dempster rn site yes no fire Department si`r,nature Jute -. Building Permit-. ppcovudznd4ssuvc-b} ' ' Building Sctback Front Yard Side Yard Rear Yard ReqUired Provided Required Provides_ Required Provided DIMENSION Ntimber n[ Total squarc reetnyOoorarea, based onExterior dimensions. Total land area, sq. ft.: NOTES and DATA-(For department use) ______ Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Perrriif Application u Workers Comp Affidavit l a Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Addition Or Decks a Building Permit Application • Surveyed Plot Plan Workers Comp Affidavit • Photo Copy of H.I.C. And C.S.L. Licenses • Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraul� Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) I I Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned)to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of %ppeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application oc:I\til'F,C'r11)\,�1.SGR\'1(to DFP 1117'11F.N'IAPFORa105 I I d r.f.l o•� pn�xt=nt q � .. elk 1 F • B�3toti,WA 02111 Workers'Compensation tnm=m=Affidavit APPLICANT INFORMATION; . Please PRINT Legibly i Name: Location; City: Telephone#: ❑I am a homeowner performing all work myself ❑ I am sole proprietor and have no one working in my capacity �(i am an employer providing workers'c/o�mpensation•for my em`pployees+working`on this job Company Name:_ � {'h �4✓1 1�Q� l�L� ( (� Cie' Address: A S Ci ( Yep l�,•� 1 Telephone#.. 5-94 —783Y ' Insurance Compavy:�1meriUw o�►+� � ��AAce 1ne Policy#, �1Q oaY�1 3 S o�b0G 3 • i ❑I am(circle one) •sole proprietor,general contractor or homeowner and have hired the contractors listed below'who have the following. t, workers' compensation policies: Company Name: i Address: City. Telephone#: Insurance Company: Policy#: Company Neme: . i Address: Giry: Telephone#: Insurance Company: Policy#: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B 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$100.00 a day against me. I understand that.a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. .1 do hereby,cerYr;fy under the pains ��and penalties of perjury that the information above is true and correct Signature: -� l ewes Date: d so 0& Print Name:Jame S Y rrdt 1 Phone# G(?13 59 34 _ O:Mrial Use ONLY-Do not write in this area o Building Department City or Town: Pennit/License#: n Licensing Board D Selectmen's Office o Health Department D Check if Immediate response is required o Other ;a, MORMAnON&INST'RUCTIONS Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law"an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. .However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the-dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employes. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business onto construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally;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 beenpresented io..the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the. Department of Industrial Accidents for.confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should.be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law"-or if you are required to obtain a workers' .compensation policy,please call'the Department at the number listed below. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like.to thank you in:advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department.of Industrial Accidents Office of Investigations 600 Washington.Street . Boston,MA 02111 Fax#(617) 727-7749 Telephone# (617) 727-4900 ext. 406, 409,or 375 FROM !M.P. Pn!_at-t5 Insui trce FAX NO. :19'x9 933147 MC+t 15 2@Of; C�'�: .�Af'i P1 L ACQRDTw CERTIFICATE SOP LIABILATY I NSUR�1 DATE{mr�ro�fYvrr IHOLOIpRODUCEF; i i i ✓�ZP, "�0977/r72(Yr2l!lCC7I.L/"L IX.J✓�.lX4:XLC1L000Q�Q . `i• * BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR r e i Number: CS 063503 �--,. Birthdate: 07/19/1965 Expires: 07/19/2007 Tr. no: 14926 Restricted: 00 JAMES V CARROLL HIGHLAND RD ANDOVER, MA 01810 Commissioner r10RTF► � Town of S 4 • _ _ _ Andover No. p�3 m= 4° dover, Mass. d • O 4i O COC NIC KEWICK ��� �dSDRATED i'Pa`y�5 77 PERMIT T BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT..............T BUILDING INSPECTOR J... M ....... .... .. �... ......... .N.4*........44...... has permission to ere .(dj Foundation ' g .....Ir......A.....!� j*$1.4C •••• Rough to be Occupied as p .......... . ...�i�,�. Vl..1.. ..... �........ ....... Chimney Provided that the person accepting this permit shall in every respect conform rm to the ter •"a*' this office, and to the provisions of the Codes and-By-Laws relating to the Inspection, Alteration andConstruction of Final Buildings in the Town of North Andover. VIOLATION of the Zoning or Building Regulations Voids this Permit. PLUMBING INSPECTOR 60 Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRU ST S_ ELECTRICAL INSPECTOR Rough Service ce ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Final Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. FESEE REVERSE SIDE Smoke Det. ,h f f 4f 7 Date... :6. ... .. ..... ... aaORTM OF1'O 3� TOWN OF ORTH ANDOVER O 9 • - PERMIT FOR GAS INSTALLATION 9e �,SSACMUSE4S !.'. . This certifies that . . . . . . . . � . . . . . . . . . has permission for gas installation . ... . . . . . . . . . . . . . . . . in the buildings of . .. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . at !��. . . . . . . — f , North Andover, Mass. Feer. . . . . Lic. r�o../.!3t�. . `I�� y �� . . . . . . . . . GAS IN$£�GTOR Check# 33 _ 5649 MASSACHUSETIN UNIFORM APPLICATON FOR PERM TO DO GAS F rFrING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations t S� A 6ti (�• Q— Permit# Amount$ Owner's Name 'mak New Renovation ❑ Replacement E] Plans Submitted ❑ v� U y C4 V CC+ CW7 F z F Z W W W E" W U P4 zQ ww rW� F F O O z O vFi SUB -BASEM ENT B A S E M ENT 1 1ST. FLOOR j 2ND . FLOOR 1 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8 T H . FLOOR Ej (Print or type) Check one: Certificate Installing Company Name Mjrnj14— 'i—aU4- �=�C Corp. Address l -"� 3 0 Partner. l 4.A Civ-�'— 1'V►0� Business Telephone -t 6- s-7.—18(7 Firm/Co. Name of Licensed Plumber or Gas Fitter AA ICA, �4A LQ, VSURANCE 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. 4iability 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 13 Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By. Signature of Licensed Plumber Or Gas Fitter Title M Plumber 11 3 S�� City/Town Gas Fitter License Number © Master APPROVED(OFFICE USE ONLY) rl Journeyman Date.!:.�. WN 0 NORTH ANDOVER P p T FOR PLUMBING 14US This certifies that has permission to perform . . . . . . ... . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . .. North Andover, Mass. A I Fee.(?��. Lic. /.. . . . . . . . . . . . PL 1�1 I'm INSPECTOR Check ff 3,J33 UOYI 7023 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location 15 L —3 ti, Owners Name DatePermit# Amount Type of Occupancy New ® Renovation Replacement Plans Submitted Yes No FIXTURES z U H a W z a O W r Gra w z y W o 3 z > O &SFA Nr I I f i Isr FL" I � 3 QL a 3I�FLOCIt 4M FL" 11" 6I HIM 7M FLOQ2 gm jn-" (Print or type) Check one: Certificate Installing Company Name %�C(� s Corp. a(o Address 33 Partner. 1 Business Telephone —297. Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity ❑ Bond ❑ i Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance tgnature Owner ❑ Agent I hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this..application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By: tgna ure o asLl— ~um er —A- CJ Title Type of Plumbing License City/Town t r 3s stcense Mumoer Master ® Journeyman ❑ APPROVED(OFFICE USE ONLY ZONING DISTRICT R-2 MIN. AREA = 21,780 S.F. MIN. LOT WIDTH = 100' �4BBY MIN FRONTAGE = 100' MIN. FRONT SETBACK = 20' 00 N� MIN. SIDE SETBACK* = 20' .0' MIN. REAR SETBACK = 20' (* - THE STRUCTURE MAY BE PLACED UPON A SIDE LOT UNE WITHOUT A SIDE SETBACK, PROVIDED THAT THE ADJACENT LOT � 92TO WHICH THE OSMACK / ry HAS REOUIREDSIDEYARD SETBACK.) ^p ti 37' 25' EXISTING 92 FOUNDATION T.O.F. EL.=226.5' �. LOT 22 •�J FOUNDATION LOCATION PLAN W+HORVOTAL C'K'R' �OF THE "s 'o APPLMIBLE ZONING BY-LAWS/N EFFECT WHEN CONSTRUCTED. (IN/S CD7TT17C477ON DOES NOT CONSIDER ANY OTHER ORDERS OFFo CON°MNAEOM) *E71ANGXEASEAlEN15, CLIENT: NORTH ANDOVER REALTY TTAS DRAWING SHALL NOT BE UM BY THE CUENr FOR ANY PURPOSE OTHETt'THAN THAT OUTUNED ABOVE.EXCEPT WITH THE THIS CERTIFICATION IS MADE AND LIMITED WNM ff"MN Of CHR/Sn4WN At.SERC/ INC. FURTHERMORE THIS DRABTNO IS THE COPYRIGHTED PROPERTY TO THE ABOVE CLIENT. OF CHRWUNSEN&SEMI INC. AND ANY UNAUTHORIZED USE LS FROHMIED.CHNSiIANSEN d SERO/ TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE WING OR ANY/NM- LOCATION: ABBY LANE, NORTH ANDOVER NAWN COWAINED HEREO �*AOFMA SCALE: 1" = 60' DATE. 2/22/06 MIC AEL cyG g � �CHRIS rIANSEN &SERGIp , , NO SMA"ST. HAVERNIL4MA. OfM TEL 978 373-WIO '�Ut�Eu. � "r 02°08 BY CHNISrU NS"'& SEW #4C, DRA NO. 97066010 N0RTH C � 4 Town of O M'... No. pS3 Y_ - AK E dover, Mass., • COCMICMEWICK 7�S RATED P'p� �5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System `T � �r dUIDINGIN TOR THIS CERTIFIES THAT.............. M �......�.�ro... .........� � 1�, Foun anon has permission to erect... buildings on.. " p ...� ...... ..... .....1�lLI!�,............... .. Rough 41,4- '�r/. T tobe occupied as.........06 .r....... f.v.r..... .................................................................. eY provided that the person accepting this perm shall in eve respect conform to the terms of the application on file in p p p g p every p pp. 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. PLUbAING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. —� /) 7—%t -0`"� jP& PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU ST S ELECTRICAL INSPECTOR ............. ... ... :..... ........... . ......... ............................. Service BUILD ECTOR Occupancy Permit Required to occupy Building GAS INSPECTOR hgououg Display in a Conspicuous Place on the Premises — Do Not Remove R No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. W, /'` j SEE REVERSE SIDE Smoke Det. E ➢ „3� i l,y='TT�OiW +m p sL 11s d I I MATCH LINE � DEP FILE#242-1296 SEE SHEET 2 Ci-�.m My ,d 1■IEI w,0 9xx tE .m°^'�A v,r g `49 r ! l➢l 1 r 1 r1ll @v,Y ' m /s i,E� ma,aJlrp/ ai� �,ii LOT 12A w,: cTtY s m JPME90'ANOFLO ➢ 0 - -_--- --�--1 I `i��$I Ham,�EN °�+e J� MV,T OVT•M1.W WP ml 1 ® i Id� 1BlX� ➢ 47@ 'I/ LOT 11 `, rwc sEwFn STORAGE AREAS:DETENTION POND#1 `qP J." J m % E%IRMc yyy J A m0 '-ao--__ m / rto> / xaRmAmemd°oF oulvlo Els s Nr sq 4 LOCUS MAP RIPRAP f �� \ ,-osvl� PA�a euswl>=lwwrew uorE.,uF,00vF,.a an.K srorx.cEElEvn„aN,nasar_ LEGEND sm�ira+n nor+m � F,/� /� I� �t� ��w_�H"';ate nMK Nei Nmvwww�tavov oFwoRKa r�®,J'lr�,.s f t,m i 1 ° EEnuc ® unuHo� 41 LOT 10 x1x Q .- a ERARucE PmE ILu LOT 'moi�16n trm 71/ITvco4'BB >/(� w<nm nrm eEcnw dwwuP A J it I� LOT 5u imExmnANr ,S LOT4 —wF- WATEHMNNdMIE VALVE f'�1i ON�I �j il1l TJX N PON. 1 e Tax wwsro rnlmuc 0— eEwrnwawaedae+eaMaM C li 5 i11I1 J IJOEIINO TY— 6M46TeEiMwn1OB A_pn r i i I'�q WmR 11 r LOT 9 Ewenx° WEIR i�!Ill NOOSE 1 O HOO6EC6 � LOT 3 —,— Lus MNN a� 0� ,` IE I 1 I�I � � l°I MATTHEW REMIe 1d1 � N.E,ue TOPFNp. H'F ® Ep011NG EIX£OFElE0,N1�NONFIGELEN LINE: ➢`\��,1 11� 1111 TOPa p, � w�610�L�W°ET •3ZJ.m 06KEM1ENMKRPALlV 11d19T ' 1 1 I sEort.FNr f�II 1 m/ I ly I1;L 1\+^'A �\Po�V S�ii HMORANr �.IDSm d.�.C6�p __Im__ mtlmlxO ELLVAn°N WNTOUR I` `11 , + °r"I a- wEr�iuo .Erx;EOF mr+nEwuo a ` ` HOME �� —,m— LMROF IO°6UFTERIDNE h / EXIETNO x .. E�\ L`�L�L�•n„m 1 me,•W LOTS No�usE ,TImPORAM —v— ,nurtoFm'xoatmemNE n2a eMx ^; . � re' Lxrtoi3s xaOIETWW3vNe �__ aA"wPmwu xoEWmrcne< PLT10 SMH !'.'• RMS mrAl sMH LOT 2 E FRW EWi0Ef11N0 A ___➢ ® `\ � .y15]+' INVOVI'.MI1.BB MEOP geeY ELEm3(rYP.) EXISIMO JENEMTMWUY 1WT0 VARK VEGATEO +0 , iA•M�1rt.E0 wE wT PAV MEM(IYPJ KOL°E �.� I I WORKi i I M•OMr•,lBd1 RIM Yp'fa 1WA0 Rd]+ //-- ,p s � INv,Yart-tro.1E WWF ➢ I uNOseuEM11L°'AR6A Inv, TTA LOT 1r �/ 6 i / 1 PAVERE PjpptPlp 91121 L MV t3.OUr 9N t4 m I I ro S l '” wizM:ioB°o'n'eut�w nm� ;n . Noaunn� EomruuoERaveef1mnl Erv,rour-+Ee.+o w' s"TM xWEE� I /® DCIBNRffiB / EATiW//PwIfg9Mi pgAM� POA.300.6E INV 1TOIli•9111T WATER MAIN t0 STONE nWWER 9MH ,Y OIIr BeAO ®� J�� OF t i FNA1H1910]8 /�/ i I u WvpRAM OPEN SPACE B 'N"rv�alR"1: men3f01° LOT 1 10 I OMN6� INV,S OUT-SWM 3' m 1VF OPEN SPACE AE ME. " PLAN 'p"flDO°11� LOT6 .mA4 sl.M 19iT29 40' 0 40' w ffiYM A(LFen I 1 _NORNETOP—� tYROPOR/IN HY02Wi ➢ I ! SCALE:1".40 RlsnAx l 1 1 +n-2 rRLspRAry ncHs unsERe OMPIAE OMHE PoM 9M.W @ I of rwcsEwm -,wee WV+TM=+roar(pMN,E SHEET!OF + _ I I EASEMENT +rM.,roYE10191Q RN,YM.,E&dl(Wd) CONSERVATION AS-BUILT PLAN rn°iesswxAi ➢ 31•pur'-;a,e 1 IXt0.SgOplINiRYOWVN_"C"__ n"' °'ir-'E°" ' "AUTUMN CHASE" ® eEm f M EHH MVMe;trwl-cI RAT� `i^'� =-u_ =1TWlT•1Nrov.W,Yeur-,roee NORTH ANDOVER,MAS S. ILL. 16WRINOHILLR RTHAN(WlmMe --------- NORTH ANDOVER REALTY CORPORA TION ,6CM _ ' SUMMER STREET P�OFESSILIA NS ENS,SERGI.INC. CHRISTIANSEN&SERGI,INC. orv,rour•+eaT4 INv,T ouT-,mao a'T"'LL'M"0ro'��80'�