HomeMy WebLinkAboutMiscellaneous - 15 BEECH STREET 4/30/2018 .... ,.... JJ
�CH STREET
210/033 000.0 \
J
I
I
Datev. .:40rs:::�........
Y Gt No°TM,�O
o? o� TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
;,SSACMUSE�
l�
This certifies that .. ..........................._ !. 4... ................................
has permission to perform . � ���'`����'
•��773y
wrong in the building of.....� Gl.....................................................................
at.f ....s ....... PcG-......................ICAL
North Andov ,Mass.
Al -�lSc ' ��IjFee ' ��.... Lic.No . . . . .. ............. .I. •ri�'`'• ........
INSPE R
Commonwealth of Massachusetts Official Use Only
Permit No.
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Z2 6 - ,o 6
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street& Number) / S N L ec-G, Aye—
Owner or Tenant S/- ItCo eek Telephone No. P1,P- 7-8,f/Si;
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.Ise�06
Existing Service '200 Amps l -71YCVolts Overhead,M Undgrd❑ No.of Meters Z
New Service ;?d O Amps d /2(&Holts Overhead Undgrd ❑ No.of Meters
Number of Feeders and Ampacity V,16 3
Location and Nature of Proposed Electrical Work:
Completion ofthefollowing able may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators
KVA
No. of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting
rnd. grnd. B Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
o Detection and
No.of Switches No.of Gas Burners No. Initiating Devices
No. of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No. of Waste Disposers Heat Pump Number Tons KW No.oSelf-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
Heating Appliances Security Systems:
No.of Dryers g pp KN' No.of evices or Equivalent
No.of Water Kms, No. of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
` Estimated Value of Electrical Work: 2oD (When required by municipal policy.)
Work to Start: /2 Z& -Q & Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE XBOND ❑ OTHER ❑ (Specify:) fff6(C �j Mel .�f7�DG
I certify,under the and enalties of per ry,thyl the information on this application is true and complete.
FIRM NAME: LIC.
Licensee: pc/00 C047
4 Signature LIC. NO.:
(If applicabl , enter '-'exempt"in the license number line.) Bus.Tel. No.:
Address: / � iV //�� G'I ST� ! I w Z'& d4z Alt.Tel.
*Security System Contractor License required for this work; if applicable,enter the license number here:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE. ,$
Location xt
No. Date
TOWN OF NORTH ANDOVER
` Certificate of Occupancy $
♦ i �
�'�s'•^•E<� Building/Frame Permit Fee $
+cHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # X113
r f�
+ 8657
�� --Building Insor
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT BgtM&RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED. 46
ic
SIGNATURE: ic
Buildin Commissioner/I or of BuildingsDate Z
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number: O
1� Ggeck-�, o'3> p GUS
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zonin District PrUse 1 Lot Area Frarta ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
R 'red Provide Required Provided R red Provided
1.5. Flood zone Information: System
1.7 water Supply M.CxLC.40. 34) 1.8 sewerage Disposal S
Public ❑ Private ❑ zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHMAUTHORIZED AGENT NtSTOric is ric : Yes o m
2.1 Owner of Record
Name(Print) Address for Service:
a u e ( ,r
Signature Telephone
• 2.2f Record:
i
Name P'nt Address for Service:
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES 90
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: . O
License Number
Address
n
Expiration Date
Signature Telephone
3.2 Registe Ho a Improvement Contractor Not Applicable ❑
Company Namer / 6,k < 13
Registration Number r
Addresses r
Expiration Date
Signature Tel �hone )
SECTION 4-WORKERS COMPENSATION(1VLG.L C 152 § 25c(6) 4
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 bililding permit.
Signed affidavit Attached Yes.......X No.......0
SECTION 5 Descri tion of P11opbsed Work(check all a lkaMe
New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) Addition 0
Accessory Bldg. 0 Demolition 0 Other ❑ Specify
Brief Description
(o)r{'''`�//roposed Work:
�vc.QCC l �l
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFIGIAt USE ONLY
Completed by permit applicant
1. Building 1 (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a)x (b)
4 Mechanical HVAC
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
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTH RIZED AGENT DECLARATION
1, as Owner/Authorized Agent of subject v
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
Print Name —�
10--t2-o`�
Si ature of Owner/A nt Date
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINIBERS OT 2ND3
RD
SPAN
DIMENSIONS OF SILLS
DWENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIN1NE7
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
NORTH
Town of s: Andover
No. ...... ...
0
dover, Mass., 60,�'��'A E
COCHICHEWICK
R*rE D P'
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT....�.t............. ......I............................. Foundation
)4r / D�......'**"*'
has permission to erect ....................................... buildings on .......................150& Rough
'ih ................................................
da-418 - Chimney
tobe Occupied as........ . ..... . . . ....... ...................................................................
provided that the person acce'*"ing this permit shall in every respect conform to the terms of the application on file in Final
0
this office, and to the provisi s of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION Rough
................................................................................................................
Service.
BUILDING INSPECTOR Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
f ,
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
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11, S150A.
The debris will be disposed of in:
�62CE5-1—e
(Location of Facility) .
Signature of Permit Applicant
1 v - (2 --GS
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
4
►
AT-
HOME installed
KSiding and Windows
�kl
�fce U*a�nmea�u�leo��a��✓taa�iadirt��s
_-- Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 126893
Exp7rati6rl '312006
Type: Supplement Card
THE Home Depot.At Ohle Sarvid
UUNROEUN CHHOL1Y
3200 COBE GALLERIA PKWY#20 �
ALTANTA,GA 30339
Administrator
FROM KIMBLY FAX NO. : 6033629679 Oct. 05 2005 11:45PM P5
/ c t
1 HOME IMPR0 VFMF;NTCONTJ1ACT
Sold,Furnished and Installed by:
_ THD At-Home Services,Inc.
Branch Name: &_1 . _ Date: l u I �/a The Home Depot At-Home Services
! t� 345A Greenwood Street,Worcester,MA 01607
Branch Number:_3 Job#: _� �U r�� Toll Free(80.0)657-5182; Fax:50$-756-2859
Federal TD#75.2698460 MP.Liu#C 02439 RI Cont.Liu#16427
' C7 93OL I L � C'f lack 565522; MA Home Improvomout Contractor Reg.#126893
Installation Address: G �
City State Zip.
Pumhaacr S; Last 4 Digits of Driver's lac.k L6 Esp.Mo/Yr: Work Phone: Horn)phone:
LI 1 O
Rome Address:
(If different from Installation Address) City State Zip
E-mail Address(to receive updates and promotions from The Home Depot):
'Pro!ectLttormation: I/We/You("Purchaser"),the owners of tite property located at the above installation address,offer to
contntct with Home Depot U.S.A,Inc.("Home Depot")to ftmrish,deliver and arrange for the installation of all materials as
described on the attached.Spec Sheet.#: incorporated herein by reference and Made apart hereof.
Home]Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it
cannot perform its obtigations due to a structural problem with the home or because work required to complete the job
was not included in the contract.
DF,POSIT PAYMENT OPTIONS
(Subject to fund verification and/or crertit approval.)
1. Check,Cashiers Check or US Postal Service Money Order
CONTRACT AMOUNT $_.1 Q t a i _ (Mack payable to Tl,c Home Depot).
1'Yy2. Credit Card"u&or otherpaymeot options-Circle One Below
*LESS DEPOSIT' $__3 1 Y�
Visa MasterCard Discover American Pxpress
BALANCE DUE
ON COMPLETION $ fl e n aovcment Loan The Home Dcwt Credit Card
Ava dahte Credit.S ob OO()III,&HDCC ONLY)
Minimum 25%of Contract Amount due upon execution
Df thin contract.
Acctli: .0 7`.�a.�.Exp.Date:
Name as it appc=on card:
Indicate Payment.Method For 9q TRYAur signatmc below,Uwe:r$r a to al ow oma Dalxp o charge the above
BALANCE DUE ON OMTLJETTO rete ere credit cur tortlpe�{wait iad f*t
Dat
a rc
HIL, �I AIL or IIDCC Authorization Codes
>i I Deposit Final Pa mcut
6a3s a OF # #
Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate
and pay any balance due. Purchaser also agrees to be Jointly and severally obligated and liable hereunder.
Entire A rreement:This agreement and its attachments,including any financing agreement,contain the complete agreement
etween t rte parties and can not be amended or modified unless in writing in a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep
it to protect your rights..Do not sign any Completion Certificate or agreement salting that you are satisfied with the entire project
before this project is complete. I.aw prohibits home repair contractors from reqquestin or accepting a Completion Certificate sighed
by the owner prior to the actual completion of the work to be performed under the con racl.
You may cancel this transaction at an time prior it) idnigght of the third business day after the date of this contract. See Notice of
Cancellation for an explanation of this m
s right. There will be a service charge equal to 25% of the contract amount if the job is
cancelled by Purchaser AFTER the third business day.
J3Y.MY/ULJR SIGNATURE BRLOW,UWE AGR13F,TO RF..BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGi8
RECEIPT OF A COPY OF TTJIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION.
BY MY/OUR SIGNATURE BELOW, IIWE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR
CREDIT HISTORY AND I/Wl:AUTHORIZE HOME DBPOT AUTHORIZED CONTRACTOR,TO VERIFY AND REVIEW MY/OUR
CREDIT RECORD WITH AN INDEPEND T CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY
INCURRED FROM TNADVI TE MIS ONS OR HIMORS, DO NOT SIGN THIS ''ONTRACT IF THERE AIUI ANY BLANK
SPACES.
SUBMITTED BY: 'I Date: I
S es o taa�
ACCEPTED BY:. _ - Date: 0 4-
on vn r
i IUste:
Horne
NOTIC_K:ADDrrioNAL TERMS,COND17CION:1 AND WARRANTIES ARE STATED ON'12IE REVERSK SWE AND ARE PART OF THIS CONTRACT
White-Fipnp,ch Nile Yellow-tLctomer Ptak-Sala Consultant
_ffN OW SPECIFICATION SHEET - S e She t#:n o
� � _ ,��r��� p V+� Sheet: ! afj 3
Customer: _-,__--Job#: b Consultant:_ 11Date:�b
Existing Window New Window 3
Measurements Grids Pattern' Pattern" Pattern" Window Hinge Locations ' r
L. Rough Opening p o o &Glass Mise Canrt•CPC,Bay,Bow.
Location Style Metal Style Series a a Options items Patio 8 Garden Doors
ILI G m N m �—� N O
{Room 1 Floor} ."Code" Yl N "(Code" "Coa'tte" U Width Heiight UI F j =° j = j "Code" "Code" Worn outside,Lt to Rt;
4 D� ✓�/ �5
7
X
aOH D o Asa, z
l�t �
g�
s 6�5cc= _0q
,o r Tr�� D
rju 5
r [ } m
�
Q �
121
i G O� lD
Grid Pattern and Location MUST be indicated.
z Color Of
If a single%vindow or mulled windows require multiple grid patterns,indicate location and pattern in the additional spaces prorided. Window 1 Door Wraps
( ,
3 ForCsmts,CPC.Bay or Bay.use"L","R"or"S"(Stationary). For Patio 8 Garden Doors,use"S"(Stationary)or-7C"(Operating).
SAY 1 BOW WINDOW GARDEN WINDOWS
Proieclion Angle: (Bay:3d'-or 45) Top of Window to Soffit(inches} WALL THICKNESS° {inches} O
Bay Window Ftankers-DH 1 Csmt. Width of Overhang +
{inches) SEATBOARD MATERIAL
Sea lboard Material-Birch or Oak if tied to Soffi t,color of Soffit materialm
Specify Birch or Oak Veneer or White Pionite (A
New Interior Casing[BaylBowlGarden/Patio Doors) Construct Roof '{Yes 1 No} Additional charge for wall thickness of 6'or mors. m
(9
Clamshell(CL)or Colonial(CO) a There is no guarantee that new shingles will match existing color. �
N
I have reviewed and agree with ail of the
SPE IA CONSIDERATIONS; -p/Yr� c(j'r,� 6n I k)zf IC jab specifi Ins descri c)above.
- � uI�' `t 2f Y pr, 6 r ' {� Q ` t te. `I 3
Customer r Date
e r.
w
.7
70
WJ DOW SPECIFICATION SHUT - Spec, heAet :VV 2 3 2 2®Q Sheet: �a` f c! 3
Customer-C"----------Job#:,gsoqqs-Consultant:--�j t= ------- date: �� �, T�
Existing Window New Window 3
Measurements Grids Pattern' Pattern1 z Pattern'z Window Hinge Locations 3 <
C "' - �° 8 Glass Misc. Csmt,CPC,tray.Bow.
L Rough Opening o tu C o g
W Location Style metal Style Series a o, o y y �. N Options Items Patio8Gardanlloors
H {Room 1 Floor} "Code" YIN "Code" "Code" U Width Height UI j = �` j = j =° "Code" "Code" (trom outside,Lt to Rt)
04 014 Ghlu '1 S1
R � qS _)v
�Awc _,
X
z
O
B
t} �
m
W
t4 W
Q1
N
S1 U)
12
Grid Pattern and Location MUST be indicated. Color of
Ifa single window or mulled windows require multiple grid patlems.indicate location and pattern in the additional spaces provided. Window 1 Door Wraps �.
3 ForCsmts,CPC,Bay or Bow,use"L","R"or"S"(Stationary). For Patio&Garden tabors,use"S"(Stationary)or"X"(Operating).
BAY 1 BOW WINDOW GARDEN WINDOWS
Projection Angle: IBay:3CP or 45`j Top of Window to Soffit(inches} WALL THICKNESS` (inches) O
0
Bay Window Flankers-DH 1 Csmt. Width of Overhang(inches) SEATSOARD MATERIAL :+
Seatboard Material.Birch or Oak If Ned to Soffit,coforof Soffit material Specify Birch or Oak Veneer or White Pionite O
W
New Interior Casing(Bayli3owlGardenWatio Doors) Construct Roof 3{Yes—IN °Addifional charge for wall thickness of V or more.
Clamshell CL or Colonial
{ } (CO)( } 3 There is no guarantee that new shingles will match existing color_ to
i I have reviewed and agree with all of the
SPECIAL CONSIDERATIONS: �ee- LL-('�_ / ob specificatio scribe ov w
—�
a
f 3
r 1
,
(U
Customer Signatur Gate
5-14,33 SFC'N=VV:
•
/.0-,=;?, q- 'I/
Date. . . . . . .. .. . .. .. .. . .. .
NOtt T
TOWN OF NORTH ANDOVER
0
•
PERMIT FOR GAS INSTALLATION
X
SACHUS
Et
This certifies that . . . . . . . . . . . . . . . . . .
has permission for gas installations,. . . . . . . . . . . . . . . . . . . . . . . . . .
in the bufldiag's of . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . .. North,Andover, Mass.
Fee . . . . . . Lic. N
0.. . . . .e. . . . . . . . . . . . .
Check#
4774
MASSACHUSETTS UNIFORM APPUCATON FOR PERNIIT TO DO GAS FIrrnNG
(Type or print) DateVN'l�
NORTH ANDOVER,MASSACHUSETTS 7
Building Locations $f e g A Permit#
Amount$ � 4�
Owner's Name
New❑ Renovation ❑ Replacement Plans Submitted ❑
00
Cn � H a
w a U
z o w ¢ F a z o z H
Gwwz CA o U a O
C.
H
F O
K7TH . FLOOR
ASEM ENT
BASEMENT
LOOR
L O O R
L O O R
LOOR
L O O R ul
L O O R
LOOR
LOOR
(Print or type) Check one: Certificatg Installing Company
r
Name l�fL -�l p Wd dU Corp.
Address i ' b 7 2, Partner.
c
Business Telep one ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter y"a
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 0 Other type of indemnity 13Bond
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: El
of Owner or Owner's Agent Owner ❑ 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 Massachusett State and Chapter 142 of the General Laws.
Signature of Licensed Plumber Or Gas Fitter
By:
Title Plumber
City/Town Gas Fitter License Number
Master
Journeyman
APPROVED(OFFICE USE ONLY)
;7
Location
No. 3 Date
c
NORTH TOWN OF NORTH ANDOVER
Certificate of Occupancy $
# Building/Frame Permit Fee $
,SSACMUStt� Foundation Permit F�e�e�,.�� $
Other Permit Feev''wf $ 3T
Sewer Connection Fee $ _
Water Connection Fee $
TOTAL $ 30
Building Inspector
ctor
Div. Public Works
PERMIT NO. 342> APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1
MAP 4d0. LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK :PAGE
ZONE SUB DIV. LOT NO.
w LOCATIONr LA
` PURPOSE OF BUILDING / O
OWNER'S NAME / ►+�G u� T p!1 NO. OF STORIES
i OWNER'S ADDRESS �C c..7 BASEMENT OR SLAB
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST /�� 2ND 3RD --
BUILDER'S NAME _ SPAN v
�. DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES—SIDES REAR GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TOR UIREMENTS OF CODE I �� IS BUILDING CONNECTED TO TOWN WATER C�
BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER ® �J
IS BUILDING CONNECTED TO NATURAL GAS LINE/ -�-•✓ �S' "
INSTRUCTIONS
3 PROPERTY fNFORMATION
LAND COST
SEE BOTH SIDES /1 EST. BLDG. COST
PAGE 1 FILL OUT SECTIONS 1 3
,��7 V ttt��•...•��F�F••••• EST. BLDG. COST PER BvQ. FT.
- �
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE JEDND APPROVED BY BUILDING INSPECTOR
DATE FI
BUILDING IN@PBCTOII
8 RE OF OWNE OR AUTHORIZED AGENT
F E E OWNER TEL.k
PERMIT GRANTED CONTR.TEL.N
-7f A
i9 _
CONTR.LIC.1/
211
q3 14 H.I.C.#
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY I KFO
RIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY ICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION —I 8 INTERIOR FINISH
CONCRETE d 1 2 I2
,��°%o/� 4�ria / CCK escts / lv>`
CONCRETE BL K. PINE _
BRICK OR STONE HARDWD
PIERS PLASTER ���!//Oa ✓L �( CS��- �`� �' �j CJ��
_ DRY VJAIL _
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'TAREA
y, 1/2 '/ FIN. ATTIC AREA
NO BMT FIRE PLACES
HEAD ROOM MODERN KITCHEN I�
4 WALLS I 9 FLOORS / c-dD�, Z/
CLAPBOARDS B __L 2 3
DROP SIDING CONCRETE _
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDW D _
ASBESTOS SIDING COM/+ICN
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR I_
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR 1__d POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE I 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 I 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
GAS
7 NO. Of ROOMS, OI L
B'M'T 2nd _ ELECTRIC
1st 13rdI NO HEATING
I
NORT
Town of 4Andover
C, �rt, dower, Mass.,
o
COC MIC ME WICK
ORATED
E BOARD OF HEALTH
Food/Kitchen
PERMIT T D:j Septic System
I
I
BUILDING INSPECTOR
THIS CERTIFIES THAT..................... ..... . ..................................................................................
_ """"""""""""""" Foundation
4 has permission to erect..,t�4� ,................. buildings on.v ......�.RP CW.......Asog. ...................................... ough
to tie Occupied as^����. .... �*`.t4........WSk..... ... . .............. ............ .. ....... ........ Chi ney
I provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings In the Town of North Andover. PLUMBING INSPECTOR
' VIOLATION of the Zoning or Building Regulations Voids this Permit. < Roulb
Fin 1
v• d�`'�' PERMIT EXP 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONS N Roug
.... ....... ........... Service
BUILDING TOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — .Do Not Remove F nalh
No Lathing or Dry Wall To Be Done ,
FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
A
TOWN of NORTH ANDOVER
AFFIDAVIT
H®e 3a¢uvenait Co nttactm law
awlaunt to POMit t%l katiM
M�c. 142 A requires that the ' alt mtian, ran aticn, rqx r, i iratio n, caxmman,
iit¢vvenant, regal, dmnlitian, or cmnstr�rtiaa of an adhtian to any pn-- edstiig bnld-
irg coataurirg at least ane but mt mxe than far daellirg units...or to sbmbxes 4dch are adjacent to
surh residers cr la.nildiug"be dore by rWsGaed arMmcto s, nth orta n e ians, alsrg with Od]Er
reWirmants-
Type of Work: 0aW0 la00 A? 1?r^16461C/ Est. Cost
Address of Work 2,e,9 t W
Owner Name:
Date of Permit Application: ZZ 7
I hereby certify that:
Registration is not required for the following reason(s): For office Use Q�ay
Work excluded by law }lit ND.
Job under $1,000 Date
Building not owner-occupied
—Pr6wmer pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONtRACZQRS_
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRA-
TION PROGRAM OR GUARANTY FUND UNDER MGI, c. 142A.
Sig sed unser penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a permit as the
owner o th above pro er
_ ,
Date Owner Name