HomeMy WebLinkAboutMiscellaneous - 17 CROSSBOW LANE 4/30/2018 (3) i
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PEKYWIT �
O. /Q LOT NO. , Z RECORD OF OWNERSHIP JDAVE �BOOK PAGE
ZONE SUQ DIV. LOT NO. • � I \�,,
OCATION v. PURPOSE of BUILDING �Q `
OWNER'S NAME NO. OF STORIES SIZE �� �C� �V S"I✓ISS(
OWNER'S ADDRESS BASEMENT OR SLA•
ARCHITECT-f MANE CU SIZE OF FLOOR TIMSERf IST SND i SRD •
BUIIOER'f NAME ) SPAN r
DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES—810Ef REAR ' QIRDERf
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS -
If BUILDING NEW SIZE OF FOOTING x
IS BUILDING ADDITION MATERIAL OF CH1UNEV
If BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE If BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY f f If BUILDING CONNECTED TO TOWN SEWER
If BUILDING CONNECTED TO NATURAL OAS L:MT
f PROPERTY INFORMATION
INSTRUCTIONS
LAND COST
SEE BOTH SIDES - EST. BLDG. COST \1 O
EST. BLDG. COST PER SG. R-
AGE 1 FILL OUT SECTIONS 1 - S
UST. SLOG. COST PER ROOM
PAGE E FILL OUT SECTIONS 1 - 12
BEPTIC PERMIT NO.
ELECTRIC METZ"MUST BE ON OUTSIDE OF BUILDING 4 APrRO�%!D RY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
•*LANG MUST SE FILED AND APPROVED BY BUILDING INSPECTOR
DATZ n 0 ING INSPECTOR -
&GNA RE DF owpwa on AUT710 roto SATPIG
Z- OWNER TEL.f
: RMIT.RA,.+RoCONTRA.TELB -. l/,a-�
H.1 CA
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NORT
Town of
o _ sLAKE
dover, Mass., Z-- 199
'9A;C OCHICHEWIC K
'9_A �R�1 T E p APP
v BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
THIS CERTIFIES THAT2 BUILDING INSPECTOR
�..... .............K <. ...................................................................
has permission to erect....6-L-,rf161 ........... buildings on .......�. �,v S S c.J
( . ..... Foundation
. .,. ..................................... Rough
to be occupied as........................................................ ,, dam"
!4. ............................................................................................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final
Buildings in the Town of North Andover.
VIOLATION of the Zoning or Building Regulations Voids this Permit. PLUMBING INSPECTOR
Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR
.............................. Rough
................................... .. .. .... ... ............ Service
B DING INSPECTOR
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.
Smoke Det.
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF INDUSTRIAL ACCIDENTS
OFFICE OF INVESTIGATION
' 600 Washington Street
Boston, Mass 02111
Workers' Compensation Insurance Affidavit
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name
location cy6 ss'no w ,
city (U Vl&O\rpl J , MA O kY SFS
I am a homeowner performing till work myself
_77I am a sole ro rietor and have no one working in any ca acit
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_I am an employer providing workers compensation for my employees working on this job.
company name
address
city phone#
insurance co. otic #
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_I am a sole roprieto , general contractor, or homeowner(circle one) and have hired the contractors listed
below who have-the following workers'compensation p ice:
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address ( G ackc�
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insurance co. policy#
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insurance co. otic #
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Failure to secure coverage s
g a required under Section 25A of MGL xxxxxxxxxxto 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.
_Lunderstand that a copy of his statement may be forwarded to the Office of Investigations of the DA for coverage verification.
I do hereby certify under a ins and nalti of perjury that the information provided above is true and
correct Signature �iG>!i � Date �' —9 7
Print Name Phone
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
. 1
Building Permit Number 406 Date November 18, 1997
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 66 Settlers Ridge
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.
6°0tio CERTIFICATE ISSUED TO Tara Leigh Dev
04
185 Hickory Hill Rd No. Andover MA 01845
40 ADDRESS
. CNUs� �> >
Building Inspector
" 4
N RT/y L
0" o - _ over
T 'l
No. 4,4o 4- _ � ; * -
* i- _ /1 ,3-19? 7
* s dower, Mass.,
LAXE
CCCNIC EWICK�L�1•
A� r
�s q4 T E
(G BOARD OF HEALTH
Food/Kitchen
Septic SystemPERMIT T
_ f
/ BUILDING INSPECTOR
THIS CERTIFIES THAT..................�/�".k.A............ic—1. ............ .. .-.............................................. Foundation
has permission to erect........................................ buildings on ..... .........�.�..<[... .......... �� Rough d /� ��ci�
lla.�+P
• Chimney
to be occupied as.................................�/.../..�..6..�.:.�...............�����...... ..... .
. . . .. . . . . . ............. ..
provided that the person accepting this permit shall in every respect conform to th erms of the application on file in
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. PLUMBIN9 INsEc�OR
VIOLATION of the Zoning or Building Regulations ulations Voids this Permit. u
PERMIT EXPIRES IN 6 MONTHS '
UNLESS CONSTRUCTION ST TS
UELECTRICAL SPE
o
.............................. .......... .... .... .......
BUILDING INSPECTOR
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
Until Inspected and Approved by the Building Inspector. DEPARTMENT
`O Bumer
Street No. ,
{ a s ` 1 Smoke Det.