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HomeMy WebLinkAboutMiscellaneous - 1601 SALEM STREET 4/30/2018 1601 SALEM STREET 210/106.B-0006-0000.0 1 � \ •P• 4D 4� / EE PLAT 105 p �� Ob A7 alp 41 e of •r • �1°� ,c�Q FV' .•..o» \ i ��cue lee 218 2D4AC. �t y L 117 . 2.0 AC. .8 L7 12 ! N.ER. 219 6 �,•``�. o 20 2AC. 11A, Q -- 1 war NO O f r✓ 1 222 220 `°• ).rr v \� 2.0 AC. (A r x...2.0 IL 3 \t QAC' 4a °r• , Ar :J 2A, 1 sf tiW 221 \ l �. L 2AAC. \� 1.14 A. Ir COG � s � 5 � to \ 1A)a .• " 23 1.11 Aa. 1035 k IFI Aa 51. / tc63 P. ♦01✓ .r1.0� 1.°) •.. S' Nerd. 42 3.61 A� D) \ �s+" Z1 N 1.228AC 1.03Ar 1.82AC. 0 26 \ �A''•' °�� 2.08AC. J3Z0 239L2 240 LZ2 d L +\ 239 E.1 .#12695 LOAI.o AC. \ ¢\m / L 75AC BROOK R p l 236 L ,/• 2AC. L 18 '!2 AG. �e L 17 LOAD L 47.K. 1. 230 G. L4 /.52 AC-�^r•/, 32 . 231 L 12 I'22 A'C. 23 l.07 L14 Lia 229 1.09� L02AC 233 ° L 3A 224 234 L 1/ b, n L 1 I� LSA R1 r ivh !l0 AC. 1 .23AG f.0 AC• 228 226 225 1•4AC L8 L7 227 �` L9 scrs= i-200' 1 I SEE PLAT 106 0, i ��� ��M - � \V �� i .r - - L ✓� INSTRUCTIONS: This form is used to verify that all necessa a ro oafs/permits _. goards and Departments having jurisdiction have been obtained. This!does the applicant and/or.landowner from compliance with any applicable or re es not re►ieve r � I gulrerr�entS. ,. . *APPLICANT FILLS OUT THIS SECTION APPLICANT j� kkeN ��r�o HONE�� LOCATION: Assessor's Map Number PARCEL MA(': 2, w ! SUBDIVISION r �L LOT(S) STREET J b 0 l 1 j6 L,,e ST. NUMBER I 0 **OFFICIAL USE ONLY . RE MIUI'ENDATIONS TOWN AGENTS.- CONSERVATION GENTS:CONSERVATION ADMINI ATOR DATE APPROVED a DATE REJE CTED COMMENTS BV6-hv- rogot' o TOWN PLANNER DATE-APPROVED t DATE REJECTED ' J C014MENTS FOOD INSPECTOR-HEALTH QATE APP--------------- ROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH • DATE APPROVED � DATE REJECTED F} , r U� k K COMMENTS e S1� 1 e PUBLIC Uf/OFIIkS SEWER/WATER CONNECTIONS DRIVEWAY PERMIT � FIRE L3EPARTIVIENT (` RECEIVED SY�k UILDING-INSPECTOR i" DATE ,ed 9197�m Y i Date. ... T NORT/, °`,•`'°:•_'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHusE� This certifies that ..... .........511.5..A................. has permission to perform ....., . wiri.fg in the building of ..... .................................. ../....�c...�P.C,../.......... ...... /4� . ��( e S. ,North Andover as at.....P.... ............ ......... Fee...l� �:. Lic.NQ13.' �............. '.. /.... . .......... , / ELECTRICAL INS ECTOR Check # 4311 Commonwealth of Massachusetts Official Use Only 6 Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC 5247(o 1200 (PLEASE PRINT IN INK OR TY.E IN ORMATION) Date: l _ City or Town of: Al'. To the Inspe for o Wires: By this application the undersigned Aves noti of is or her int tion to perform the electrical work described below. Location(Street&Nu her) mool , Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system ' Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above rnd. ❑ In-rnd. ❑ o.o Emergency Lighting 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 o. Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons f Heat Pump Number TonsKW No.of Self-Contained r No.of Waste Disposers Totals: - Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KWSecurity Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of lectri al Work: T7f (When required by municipal policy.) Work to Start: j Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under t1te pain andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.:. 1 r Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.,• 60.1 594 5928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Li see 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)[3 owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ol Iew Location /"' / No. Date 6^f'y'Q� NORTH TOWN OF NORTH ANDOVER 9 i . , ; , Certificate of Occupancy $ Ett' Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � Check # 56 '_18 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI&RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: C - off C � SIGNATURE: ...� Building Commissioner/Ingwor of Buildings Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ,cs so �s ] /a/0 >,3 G. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Rapired Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record j;aof2;4 57y�-� Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z�q M Signature Tele hone M SECTION 3-CONSTRUCTION SERVICES D0 3.1 Licensed Construction Su rvisor: Not Applicable ❑ Licensed Construction Supervisor:rvisor: Q O License NumberAddressic Expiration Date 1g ture � /� Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ ®®j Company Name 4 m A/ C y D AIA i9/!/`l� Registration Number Address 'O (/� l r., Z—D S Expiration Date lure Telephone tea. SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. -Signed affidavit Attached Yes......ff No.......❑ SECTION 5 Description of Pro osed Work check aR applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: p 7_��dr ZAle 'OF SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building `• �- (a) Building Permit Fee (Q 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 I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION as Gwft Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print N Sdratore o Owner/A t t Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 1 . � A -074 HOtfE INPROVENENT CONTRACTOR Registration: 100020 Expiration: 6/8/02 Type: Private Corporatio NENPRO, INC. _ THONAS FOXON -7�' 4!EeEw 26 Cedar St ADMINISTRATOR Noburn Hp 01801 s . X14 i I BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR.. Number: CS 029090 IBirthdate: 11/i9/1,953 Expires:'11/19/2003 Tr.no: 8383 ; Restricted:"0'0-,- THOMAS 0THOMAS P FOXON .230 WALNUT STS '14EADING, MA 01867 r. Administrator - 77 1 __.W -- May-20-0,2 12 : 39P P.01 UKAr 4L;kw. csR .re I PpooUcsR THIS CERTIFICATE IS =_••- _ RIGHTS UPON THE CERTIFICATE - I - ------ �..� _. uIERTIFICATE DOES y^. ...E.�., .-.�. ,... 122 Quincy Shore•Drive ALTER THE COVERAGE AFFORDED ay North Quincy MA 02171 Phone: 617-770-9000 INSURERS AFFORDING COVERAGE -- INSURED - •- • INSURERA Arbella Protection Ins. Co INsuHtH e: AIM Mutual Ing. Co. Nowpro, Inc. INSURER C PO BOX 2696 INS)IRFkfI: Woburn MA 01801 _. INSURER E. COVERAGES ! 't P' LILIES Of INSURANCE LI$TEO f1ELOW HAVE BEEN ISSUED TO TIIE INSURE,)NAMED ABOVE FOR THE POLICY PERIOD INDICA ItD.NOTWITHSTANDING ;.::'i i ,I)IRFMFNT.I ERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMI:NT WITI I RESPFrT TO WHICH THIS CERT!(ICATE MAY OF ISSUEU OH MAY PERTAIN.TIM INSURANCE AFFORDED BY THE POLICIES DESf,R1RFp HtHEIN!S SUBJECT TO ALL TI IE TFRMS,EXCLUSIONS AND CONDITIONS OF SUCH POLI(:IFS.AGGHEGA TE LIMITS SHOWN MAY IIAVE BEEN REDUCED BY PAID CLAIM!.. INSR!.. ... -. _ I ...... LTR TYPE OF INSURANCE POLICY NUMBER GATE MMIDDIYY E DA7EYMM DDhPCH GENERAL LIABILITY EACH OCCURRENCE Y R $ 1,009,000 A XCOMMERCIAL f,F.NF.RALLIABILITY 850000010649 01/01/02 01/01/03 FIRE DAMAGE(Any nnnl-re) S50L000 CIAWS MAOIE )(�OCCUR MED EXP(Any one per60n) $—5,600 PE14SONAL 6 ADV INJURY $1,000,000. GENERAL AGGREGATE s2,000,000 GENII ACCKtGATE LIMIT APPLIES PER. PRODUC I'S•COMP/OP AGG S2,000,000 POLICY PRO- I ... ,,. JECT r7 LOC AUrOMOB0.E LIABILITY I COMBINED SINCI F I.IMIT ! BI ANY AUTO 81037400001 12/31/01 12/31/02 (Eaaccl08m) 5 500,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per pefw) E XHIRED AUTOS ' Xi NON-0WNFO BODILY INJURY AUTOS (Per acCJCenI) PROPERTY DAMAGE (Per wxA-ml) S GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S ANYAUTO EA ACC g -_ OTHFR THAN AUTO ONLY: AGG I S EXCESS LIA[IILITr EACH OCCURRENCE. S5 000,000 A !X OCCUR L J CLAIMS MADF 4600010709 01101102 1 01/01/03 AGGREGATE g 5,000,OOO OFfXJCIItlLE RETENTION E B �WORKERS COMPENSATION AND X TORY l IMr I$ ER EMPLOYERS'LIABILITY WMZ@003031 05/01/02 i 05/01/03 E.L.EACHACCIUENf 5500,000 F L.UISEASE-EA EMPLOYEE $500,000 OTKER E.L.DISEASE•P01 ICY LIMIT I$ 500,000 I .._ I I =-CRIPTION OF OPERATIONS/LOCATIONSArEKICLEWEXCLUSIONS ADDED BY ENOC RSEMENTISPECIAL PROVISIONS OPERATIONS OF INSURED - s^=ATE HOLDER N ADDITIONAL INSURED:INSURER LETTER: CANCELLATION SPECIW SHOULD ANY OF TME ABOVE DESCniocu ViTuwaS OF-Am4;ELLtfJ e/EFORE iMe txPIRATIO DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1.�OAV S WRITTEN SPECIMEN NQ=& THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO BLIGATION ABILITY Of ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESE ATIVES. AUTHO ,REEP!R'ES TA E A /-y J... .T F i ✓�' i�z�� ACORD 25-S(7197) dr on C_ C)ACORD CORPORATION 1988 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 r Wor'ers'Compensation Insurance Affidavit .x Please Print Name: Location: City Phone = am a homeowner performing all work myself. 01 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. yCompany name: Address ,6 (x'00-�� 57— Phoneme Z8%�.�"Z-� WIED Insuranee Co. mum Genti�anv-name: - �ddress Clty: . . Phone-* Co. Poltcv# Failure to secure coverage as required under section 25A or WIL 152 can feed to dw WrOosition d criminal penames.d a one up to$1.500.00 and/or one years'imprisonment as well as cio penalties in:"form of a STOP MRK OPMM and a fine of $10D.00 t ?a dayme. 1 understand that a.cagainst opy of this statement may tae,..mo-asded to the f3rnce of M of the.DtA for . coverage verification. /do herby certify under the sins and penalties of perfury Mat the awbimatim proviaed above is bue and correct Signature ;UGrJ Date & 6 Print name-..-A e— /�fo�s� ,�p� Phone# Official use only do not write in this area to be completed by city or town official' I] Building Dept OGheck if immediate response is required Building Dept Licensing g Board Contact person: Phone p Selectman's ice #- © Health Department Q Other RM WORKMAN'S COMPENSATION North Andover Building Department Tel: 978-688_9: DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building perrrtil Number is that the debris resulting from this work shall be disposed of in a properly licensed solid.waste disposal facility as defined by MG L c11, S150A. The debris will be disposed of in: (Location of Facility) -nEA Signator of Permit Applicant � HOZ ate NOTE: Demolition permit from t e To wn of North Andover must be obtained for this project through the Office of the Building Inspector 4704 ! MA Reg. #100020 CT Re 3 lam 1"k—las ���0 Reg. #517262 THE REPLACEMENTWINDOWPEOPLE Federal ID #04-2714773 Corporate Headquarters:26 Cedar St.,P.O.Box 2696 Wobum,MA 01888 (781)933-4100 1.800.342-2211 THIS CONTRACT MADE THE. . . . . . f day of f.7Jqk7`a. . . . . . . 200,'?,. between . . . . b . . Y � . . . . . . . . . . . . . . . . (Home Owners) ` i /✓1 (Home Phone) us P o ) of (Address) (State) (Zip Code) the "Owner" and NEWPRO, INC., "NEWPRO". NEWPRO hereby agrees that it will for the consideration hereinafter mentioned, furnish all labor and material necessary to install the following described work at the premises located at (Job Address) 5�i . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL NEWPRO ' Additional Style Qty TOTAL CASH Windows Purchased Work y y PRICE 7 Window Color Specify Slidinq Glass Door DEPOSIT Capping Color Specify Qty Steel Security Door WITH ORDER '�j. Double Hung Leaded Glass Picture Window Obscure Glass TOP BOTTOM BALANCE Stationary Casement — Screens a4=Lp UL DUE AT Casement - Model #'TfilpINSTALLATION 2 Lite/3 Lite Slider NEWPRO' does not do any painting or Ba / Bow Frame staining. CASH Garden Window _ NEWPRO* is not responsible for conditions Balance Paid to or circumstances beyond its control including Installer at Installation Awning condensation resulting from or due to pre- Other existing conditions. FINANCE IBank Completion GRIDS 1, oloni Diamond Grooved Form Signed at Installation DESCRIBE WORK: FA1 NORTH Town o 4over 0 No. I Q C, 0 dover, Mass., C CMCHE-ICK RATED S BOARD OF HEALTH Food/Kitchen PERMIT T Septic System 3 cp.p h J-& S..V -e BUILDING INSPECTOR THISCERTIFIES THAT........................ ................................ ............................................................................................... Foundation has permission to erect & / -- P', (S-/- ........................................ buildings on...1A01.......15..!P....................................................... Rough to be occupied as.......Re PIA C e M e W _�_ W PV D 0 ct.)_S Chimney ......................................................................................................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the I action, Alteration and Construction of Buildings in the Town of North Andover. /0 e. )3 /6 � 'Ys PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELEcTArCAL INSPECTOR. 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. INSTRUCTIONS: This form is used to verify that all necessary a ro als/ er' �u� -Boards and Departments having jurisdiction have been obtained. ry pp 'doesis not mlrel'i v the applicant and/or landowner from compliance with any appl cablehor equ e�eelleve nts APPLICANT FILLS OUT THIS SECTION APPLICANT �y k&\ Neotr HONEt�►n�;1��-!rr�� q g ` iI LOCATION: Assessor's Map Number PARCEL M A : 2 to SUBDIVISION LOT(S) _ STREET DI GjA L V Ak ST. NUMBER !I I OFFICIAL USE ONLY RE MM'ENDATIONS TOWN AGENTS: j. CONSERVATION ADMINI ATOR DATE APPROVED a a DATE REJECTED COMMENTS BoAciq 'BrooK E 0"560c-ICLU V iJ alpp f 'sal 'i i TOWN PLANNER l DaFE.AI'P.ROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE-,REJEGTED 1 . COMMENTS w�a, TiatJ.-> -rI"s Ar- #\J I PUBLIC WORKS-SEWER/WATER CONNECTIONS i DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm 1 . i w'L'�/ILLI - - f° J �• F � -lr74!45'20''.E---�., 297.29' P.T.#t– T.P.#2 ' BENCHMARK: TOP OF SEPTIC,—, a 99.60 (ossumed) �vh i TANK. ELEV. I o / 1000 GALLON "N SEPTIC TANK N m DISTRIBUTION_ p Boz of N f \ r+ fF 0 i• x w tiCi ! co T.P.#3 –G co ,OF SAND MIL POLY .. � 6AR(iIER ASS 9,t.'z '12• TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DA'Z'E ISSUED: W ic SIGNATURE: Building Commissioner/IEEQmtor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: $— D MAP: 210 loT: lo6 /I kA o 1004 S Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: A ^ Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided ReqWred Provided � 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record GAlz A 140-1-- SALEM STKEE-T, N AWDOVE9S Name(Print) Address for Service 2- gn Telephone 2.2 Owner of Record: Name Print Address for Service: O _ M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: 0 License Number Address Expiration Date xP v Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address r Expiration Date ^ Signature Telephone !�I 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 chem applicable) New Construction ❑ Existing Building V Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: -+b Lv awe4e� ktA7,4 15e.A.1551 , I arn��ilA Tb-�5 AIA VO S - be i k544;4�, ATM A4-t_ok e SECTION 6-'F STED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be w 01 FIC�T7SE`O QTLY � � Comp eted by permita licant �€ 3k! sI+-Rsk m ,a> •1 7Tx /su«?S .'n",,.. �Yt,' 1. Building / �1 (a) Building Permit Fee `_1 a v Multiplier 2 Electrical % Q ff (b) Estimated Total Cost of C�w�u Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC A// 5 Fire Protection /V/ 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR.CONTRACTORR APPLIES FOR BUILDING PERMIT I, 1/ERFA/Z A . J Y�D , as Owner/Authorized Agentofsubject property Hereby authorize�5 to act on My behalf,in all ma relative t work authorized by this building permit application. - L�2/2�d y i ature of OZ�,T Dates SECTION 7b OWNER/AUTHOR/IZED AGENT DECLARATION I, FA!Z A • e.' 1 as Owner ct property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief h • 51t Print Name ID Signature of O r/ Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DR ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE eiC3F?'B'k 04 .�no ri��Yn Town of North Andover Building Department 04 27 Charles Street �RAY6o hpS"y.fi7 North Andover, MA. 01845 CV1i9��4 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE �' �" JOB LOCATION eco106Ma /lot Number Street Address p F� 4 Iia a4 L99g qq� "HOMEOWNER Work Phone Na a Home Phone PRESENT MAILING ADDRESSKAN City Town �_7§tate Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL S i 7 Z j t; VV40 01 G3 � 4 (JN ODa vi 1 1 Ou (Nasuas N°2 N 5 /.X-a I NORTHERN ASSGCIATES, INC. 401 SOUTH ©ROADWAY, LAWRENCE MA. 01843-3522 TEL:(978) 837-3335 FAX:(978) 837-3336 MORTGAGOR: .FAIZ � 50PHIA 5YED DEED REF: 1674/255 LOCATION: I GO I SALEM STREET PLAN REF: 5953 CITY,5TATE: N ANDOVER, MA 5CALE: I "=GO' DATE: 1102102 JOB #: 20 1 . 12907 I i i i I i, i I 1 x0.72 LOT 12 i 44,000 5.F.± LOT I I N C1J J N N � � I W I ,W N I •y 5PLIT LEVEL WO.OD6O I 127.79' 23.2/ SALEM STREET CERTIFIED TO: . Flood hazard zone has been determined by scale and is not necessarily accurate.Until definitive Plans are issued by HUD anti/or a vertical control survey is Performed,Precise elevations cannot be determined. NOTE: This mortgage Inspection was prepared �, ..`,; , This mortgage specifically for mortgage purpose only and e�.1,. inspection was prepared in accordance is not to be relied upon as a land or property cJf 1 5• y with the Technical Standards for Mortgage Loan < `-., . Inspections as adopted by the Massachusetts Board of line survey, used jbr recording, preparing deeds i. ,;! Y�;s• > Registration of ProJbssacnal Engineers and Land descriptions, to construction No corners were JOHN Y�y.', Surveyors 250 CMR 605. set. oxBuilding location and offsets are �� - I further state that in m approximately located on ground and �• 1" � y professaornal opinion that '� O 1�N the structures shown conform with the local zoning horizontal are shown specifically for zoning determination i U RUSSELL , dimensional setback requirements at the time of construction or only and are not to be used to establish property q #3871 �s, are exempt under previsions of M.C.L CH. 40—A Sec. 7. lines. The matters shown hereon are based on client—furnished in)brmation and may be subject ti -121. property/House is not in Flood Hazard. to further out—sales, takings, easements and rights M V _ ^ rra of way, and other matters o record araC n: 2. Property/House is in a Flood hazard Area. f preserptive O 3. In rnation is'insu or other rights. Northern Associates, Inc. assumes no f�t Jficent to determine Flood Hazard. responsibility herein to land owner or occupant, �J V v Flood Hazard determined from latest Federal Flood accepts no responsibility for damages resulting from said reliance by anyone other than the said mortgagee and its assigns Insurance Rate Map Pmol in connection with its proposed mortgage financing to said mortgagor. DateZo li ne Ih