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Home My WebLink AboutMiscellaneous - 178 BRIDGES LANE 4/30/2018 (2)Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... a ............. 1AV/t/ E-Iee7- ........... /�� .. ................................... _04 4 has permission to perform .......... e�e&.Zd-. ...... 4 wiring in the building of.:.............. . Ma..S.. ...................... r at ..... /..72? .... &.fb� ......................... . North Andover, Mass. Fee... Lic. No. ........... . I ........ ............ ....... ... LECMCAL INSPECTOR Check # 7424 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only �i Permit No. 7 YZZ Occupancy and Fee Checked [Rev. 1/071 (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: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her in/ten-tion to perform the electrical work described below. Location (Street & Number)—/75- e�l'e 41-4 e Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Telephone No. (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and NatureofProposed Electrical Work: 4cG Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Attach additional detail iJ desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such verage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under flee ah and penalties of p�r�ury, ttrat flee informal' on t is application is true and complete.// FIRM NAME- f tS`I0 �r l NLwv� LIC. NO.: Zow'-7 Licensee /t/ LS F rUtc� Signatu LIC. NO.: (Ifapplicable, enter "exempt/" in thelicense nut ber line.) Address: / ( y,0 / 0 ir I p, p 11411d4)y-« 11-uf�4 Bus. Tel. No.Alt. Tel. No.: Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: 1 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. $ wwuuwui u�te may ve waivea vy the fns ector ol Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. o Emergency ig mg rnd. rnd. Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners IVo--.o7 Detection an Initiatine Devices No. of Ranges No. of Air Cond. y ota Tons �_� No. of Alerting Devices No. of Waste Disposers eat Pum um er _ ...._ Tons ................ K No. o Se - ontaened Totals.........._. . Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Mun'c'pa ❑Other Connection No. of Dryers Heating Appliances KW SecuritySystems:* No. Devices No. o Heaters KW ater o. o o. o of or Equivalent Data Wiring: Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: No. of Devices or Eq uivalent OTHER: Attach additional detail iJ desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such verage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under flee ah and penalties of p�r�ury, ttrat flee informal' on t is application is true and complete.// FIRM NAME- f tS`I0 �r l NLwv� LIC. NO.: Zow'-7 Licensee /t/ LS F rUtc� Signatu LIC. NO.: (Ifapplicable, enter "exempt/" in thelicense nut ber line.) Address: / ( y,0 / 0 ir I p, p 11411d4)y-« 11-uf�4 Bus. Tel. No.Alt. Tel. No.: Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: 1 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. $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Information Please Print Name (Business/Organization/Individual): jii,crsl®k- Kwreue� Address: // up/,+A, V 57' City/State/Zip:_ N a A oiat", / Phone #: 9JVl G 9.7- 3 3 Are you an employer? Check the appropriate box: . ❑ I am a employer with 4. ❑ 1 am a general contractor and I 1.0+ oyees (full and/or part-time).* E� I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs l3.❑ Other Any applicant that checks box # 1 must also till out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: /% r,aOje ,C -ice 'City/State/Zip:h)(). /Qncttcl / X4-4-- I Attacha copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under Phone #: 97i�__ — 6 f 57 — 9-.)-,T 3 that the information provided above is true and correct. Date: b �l ® -7 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Location No. Date " 2.j —�cS &ORT#1 TOWN OF NORTH ANDOVER F A + ; : Certificate of Occupancy $ �'�s'••°' E<�' SACHUs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $� x,. Check # ` 18236 L�Elilding Inspec or" TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCr RF.P gnXATh OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUII,DING PERMIT NUMBER: i rDATEUED: SIGNATURE: Building Commissioner/lEgeclor of Building Date SECTION i- SITE INFORMATION ►.1 Ply Adana•,; 1.2 Assessors Map and Parcel Numbs: R Map Number Parcel Number 1.3 Zoning Information: 1.4 Propeity Dimensions: Zonin Di;u— Use Lot Area Fronts 8 1.6 BUILDING SETBACKS tt Front Yard Side Yard Rear Yard Required Provide Required Provided Rewired Provided 1.7 Wrier SupplyNULL.C.40. 34) 1.3. Flood Zoos Iutem=tioa: 1.8 Sewmp Dispoul System: 'Zooe Outside Flood Zeno 0 Muaicipd 0 On Site Disposal System ❑ Public 0 Pcivite ❑ SECTION2-PROPERTYOWNERSHIP/AUTHORIZEDAGENT ai;Ilt; IStf?Ct: 2.1 Owner of Record Leoz Jim 1�N� IU cy l�4Ss * Name (Print) IAddress for Service: �P Signature Telephone r 2.2 Owner of Record: Name Print Address for Service: SiRoature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.11 Licensed Construction Supervisor: Not Applicable ❑EU UeAs W 0I '2L � C' CS Licensed Colistruction Supervisor. _ mc- Ade. l Q 610 v / � �{l�I ��4j� 7 License Number 7 ✓ �e�dnK10 l2 Q1 D%8 7 ! �% �. (7� Expira ' n Datif ;Addms9L e Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ ro C C F N e / 7 / J 3 7 ✓ ompany • Registration Number .-- S,4me- 50 ae- _.- Addmss 3/07 '?Z8 y71 qq z l Expirati Date Sivature 777 Te hone 1 n SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 f 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 it. signed affidavit Attached Yes .......0 No..... kA SECTION S Description of ftogosed Work check amt applkabk New Construction ❑ Existing Building 0 . Repair(s) Alterations(s) 0 Addition 0 UM woobi Accessory Bldg. ❑ Demolition 0 Other Specify Brief Description of Proposed Work: Rerqc 61A nna� t N I Te s(d t.y___ _—�eo►,�-s c,�, , , VIN y �. (ZemQ JC � �� W�n� ow � �e �Ac>P�� ,� �e�✓ /a � � fk Rqo�/ �'% 2 I SRCTION 6 - RSTIMATY.n rnNCTDii!`TinhTrnclre Item Estimated Cost (Dollar) to be Completed b it applicant OMCIAL USE ONLY .. I . Building / 39 G (a) Building Permit Fee Multiplier Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge 2 Electrical (b) Estimated Total Cost of Construction C^Cev O 3 Plumbing Building Permit fee 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 QVr77nV 7. nWMVD . Check Number ---- -- OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1• CoR.f;- Y con 1 , as Owner uthorized A f 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/AUTHORIZED AGENT DECLARATION I. Co(e)( C0 O 1C as Own uthorized A en f 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 C^Cev O Print N S' cure of OwnpfA1jhV1)a NO. OF STORIES SIS BASEMENT OR SLAB SIZE OF FLOOR T vIBF.RS 1bT 2' u 3 SPAN DIMENSIONS OF SILLS A ' ZLicense: CONSTRUCTi01d SUPEi ` I OF s T , �} + NUmber 'CS 0850$4 ` Birthdate 0611411979' y` }: Expires. 06/1412007- Tr. no: 85044 .i Restticted: 00 i COREY S, COOK`_ 105 RIVER POINT WAY4331 L� t LAWRENCE, MA 01.8413 a Administrator /L6 VO�iL�71.6%LI,IJ ��"'"^"LCIOP.(.w Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration. 145373 E tplration 1/1312007 ' jj;6 i4 idual COREY S. COOK ^ t1 COREY COOK 432 MIDDLE RD,... BRENTWOOD, NH 03833 Administrator . `: Steven Daloia 978-804-8219 MA Lic # 085048 Building• Remodeling Work estimate for Jim and Nancy Mastalerz PERMIT: Permit supplied by contractor. EXTERIOR WORK: Total price: $39600.00 Corey Cook 978-479-9979 MA Lic # 085044 178 Bridges Ln. N. Andover Remove old windows and stops, replace with new windows, insulate around and replace original stops. 21 replacement windows, plus 1/2 round window above single unit in family room. All windows are Harvey Ind. majesty wood series, double hung replacement type, except kitchen window to be casement type. Windows are tilt wash, almond aluminum wrapped exterior, unfinished wood interior. Glass is low -e, argon filled, with grilles in glass, and interior snap in grilles. ( paint and/or stain to be done by homeowner) Change existing front door, and 8' slider in family room. Repair any rotted wood. An allowance of $3500.00 is for purchase of the two doors. Install new storm door on front, and new decorative trim molding above. Remove existing masonite siding. Repair and/or replace any rotted plywood. Tyvek whole house before installing new vinyl. Vinyl siding is Monogram double four wood grain with premium color to be decided by homeowner. Wrap existing exterior casings and fascia with aluminum trim. Install 13 pairs of shutters. Install 2 bathroom vents in soffit. Replace existing garage doors with new insulated doors with glass in top panel. Motors, track, and hardware are re -used. Re -frame wall between garage doors, adding a concrete footing. Repair and/or replace any rotted wood around doors. All scrap and old siding, doors, etc. removed from job site by way of 1 dumpster. Any materials, other than construction debris, thrown in dumpster may become an extra charge if container goes over weight. Job site to be clean and free from debris everyday needed. *- -- --------------- Home- er(s) Coractor(s) Steven Daloia 978-804-8219 MA Lic # 085048 i� t Building• Remodeling PAYMENT SCHEDULE First payment is upon signing of contract: $7500.00 -windows ordered Windows delivered to job site: $4000.00 Windows installed: $4000.00 .Siding ordered: $5000.00 Start siding: $5000.00 Siding '/2 complete: $7500.00 Final payment, contract complete $6600.00 Total of all payments: $39600.00 Homeowner *----------------- -- -----/ -I ---- Contractor *--- --- ----- - ------------------ Contractor * ----------- PJ glewlar Corey Cook 978-479-9979 MA Lic # 085044 41M 10S^ Date-------- ------ ---- Date Date-- Zf X17---------- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print y am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Address Citc Phone # Insurance Co. TPA'( I Fly Fl M AAfC/A4 L Policy # LGL o y(,o r y o Company name: Address City: Phone # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,50o.00 and/or one years' imprisonment_as well_as_civil..penaltlesin fhefnrm da -STOP WORK_ORDER and..aflne Of..(.$10O.OD)-aAfty against -me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under th�,pa� ttie perjury that the information provided above is true and correct Signature.4 Date /,P V6O q Print name 022E Y non Phone # / 9 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing []Check if immediate response is required ❑ Building Dept ❑ Licensing Board Contact person: ❑ Selectman's Office Phone A- ❑ Health Department ❑ Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Si to of ermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 14 D O z 1 � C � o . Cr1 a O a CL C A A H O N Ea c ,.. 0 0 z� a o Go EE U a$ `! C `; _ca G NJ C a C=D • � c � x _ m � � � ' o o LU CL old Wf r R �i Z 0 U n :W :Q M PO as ■ Z Q• O y Q c I cm ca O •— caMA Q 'C E mm mineCD3 Q Ca O a cma ca o =� c ev CL 0 G3 c Z tsCD C.3 h cc c W h Q V) cC W ce W N C � O C . Cr1 O G +�+ O N CL C A A m C O N Ea c ,.. 0 0 z� a o Go EE z o a$ `! C `; _ca G NJ C �3h C=D • � c � _ m � Z C old Wf r R �i Z 0 U n :W :Q M PO as ■ Z Q• O y Q c I cm ca O •— caMA Q 'C E mm mineCD3 Q Ca O a cma ca o =� c ev CL 0 G3 c Z tsCD C.3 h cc c W h Q V) cC W ce W N Location No.Date Mme,. TOWN OF NORTH ANDOVER 3� .:. o� � P + ; ; Certificate of Occupancy $ sss •° <� Building/Frame Permit Fee $ /r �►CHusE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #�` "T 182 3 2 ---Building Inspect6r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT EtMI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: �,-- / �� ,5-- L� v SIGNATURE: ./ Building Commissioner/I toi of buildings Date SECTION 1- SITE INFORMATION 1.1 PropertyAddress: 1.2 Assessors Map and Parcel Number:: Map Number Parcel Number A s 1 L� ✓ f �--/� 1...�� c_d� 1.3 Zoning Information: 1.3 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 3 t Ito 1.7 Water S ly M.G.L.C.40. 54) 1.5. Flood Zone Information: Zone Outside Flood Zone 6 1.8 S Disposal System: Mmicipal On Site Disposal System ❑ Public❑ SECTION 2- PROPERTY OWNERSIHP/AUTHORIZEDAGENT iC 'icti'Ct: ��,.�, Fio 2.1 Owner of Record Name (Print Address for Service ID, 13-1 �5-- 1-( L1 Si & tore Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele one SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supegisor. License Number Address y33 Expiration Date nature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number ddress Expiration Date Si nature XL J Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25e(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Fails in the denial of the issuance of the b4Lding permit. Signed affidavit Attached Yes ...... No ....... ❑ SECTION S Description of Pro sed Workcheett as a cable New Construction ❑ Existing Building 0 Repair(s) 0 Alterations(s) ❑ Accessory Bldg. 0 Demolition 0 Other ❑ Specify Brief Description of Proposed Work: I SF.rTION 6 - RNTTMATF.T) VnNCT1D1TrT1rnPJ rnC're 7 4 to provide this affidavit will result Addition Item Estimated Cost (Dollar) to be Completed b permit applicant OFFICIAL USE ONLY 1. Buildinga V � � () Building Permit Fee Multiplier 2 Electrical —�� (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) / Q 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) WWI vv 0 T CV,f''T7nN7.. I%ILW TSD ♦TTTC7ATfirl �.nTw .n Check Number --I av "r %.v1.TLC LL' IEU v7 Iml,I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT �� as Owner/Authorized Agent of subject property Herjpy authorize `�.o�vw� to act on My half, ilk, 1 atters rel ive to work aulhoiVed by this building permit application. (((iature of er Sl 1 U� Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATTON 1, %_1.J ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are Prue and accurate, to the best of my knowledge and belief Signature of Owner/.A e NO. OF STORIES BASEMENT OR SLABSIZE OF OF FLOOR TIlVIBERS 1r.�t D 1Sr SPAN 1,S DMIENSIONS OF SILLS q.— 6 DIIyIENSIONS OF POSTSz Gu DIIv1ENSIONS OF GIRDERS HEIGHT OF FOUNDATION b SIZE OF FOOTING MATERIAL OF CHIMNEY T� 1S BUILDING ON SOLID OR FILLED LAND _ IS BUILDING CONNECTED TO NATURAL GAS LINE 60) Date r, SIZE C-0 THICKNESS ` X -7 .t 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 LOCATION: Assessors Map Number O T SUBDIVISION STREET_ OFFICIAL USE ONL Lei 9 • �d .l �6 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED S COMMENTS TH DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT PHONE PARCEL. -- OL908 LOT (S) ST. NUMBER ZZQ FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 Jm The Commonwealth of Massachusetts Department of Indusbial Accidents ORlce of tnvoWgsft ns Boston, Mass. 02111 Wakens' Cempemdm Insura►ve Afted 1 Nems Please Print lzq ip z v: ss S'�- C,ihr k --Z, Phone S 0 I am a hwwwwner performing all work myself. I am a sole proprietor and have no one working In any capacity 1 a n an employer providing workers' compensation for my employees working on this job. r v Address 1 `t- ��-dl_. Sat-. Cnf: Ins mance Co. Palm s FAre to secrae coverage a required under 3edbn 25A orMOL 152 can Isad to the letposgm of aminal pwftj s d.a fine up to $1,500.00 mWer one yeW Imprbarrnant.m.wd.=.CbA40MOMMID 1 W hM dA STEP VAMORDERind a.foe d.(S1WL -aAW ap ho ma I understand that a copy d this statement may be forwarded to the Ofrbe of Invedga kxv of ft DIA for caverapa vewres&m. 1 db hereby c4rdy un yft pehs and Puke d perjury that the a provided above !e nue and correct Print ram�� Ptlone W-233 Officid use only do not write In this eros to be compkMW by city or town ofrldal' CBy or Town 11 ❑Check i►lmmedk(e n�sponas k nsqulred [3Bl tenS#w Smd 13 Selectmen's 011IF.'e connect person: Phone ►� ❑ Health Department { ❑ Other 11 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: ny-tr� C", (Location Facility) Signature a it Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector A i REFERENCES ESSEX REGISTRY OF DEEDS: DEED BOOK 4263, PAGE 209. DEED BOOK 9092, PAGE 70. PLAN No. 33 ASSESSOR'S MAP 56 LOT 8 TOTAL AREA = 15,777 S.F. 100% EXISTING COVERAGE = 1,236 S.F. 7.8% EXISTING OPEN SPACE = 14,541 S.F. 92.2% PROPOSED COVERAGE = 1,914 S.F. 12.1% PROPOSED OPEN SPACE= 13,863 S.F. 87.9% ZONING: R-4 BRADFORD ENGINEERING CO. 3 WASHINGTON SO. HAVE R H I LL MA. 018-30 SETBACKS: FRONT: 30' MAWN: RG REAR: 30' cHEacm. PLB SIDE: 15' JWB MINIMUM FRONTAGE: 100' FAX' (978) 373-8021 MINIMUM LOT SIZE: 12,500 S.F. N\F PARISH OF ST. PAUL CHURCH 1p\ "m as a-7' DAVIS STREET 4 r7 PLAN OF LAND NORTH ANDOVER., MA. NO. 27 DAVIS STREET 1 s am�y JAMES W. BOUGIOUKAS P.E., R.L.S. DATE PREPARED FOR: JAMES E. DRISCOLL & JACQUELINE DRISCOLL ZONING' R4 PERMIT PLAN °Nm BRM BRADFORD ENGINEERING CO. 3 WASHINGTON SO. HAVE R H I LL MA. 018-30 SHEET 1 of MAWN: RG REVISIONS BY cHEacm. PLB JWB PHONE (978) 373-2396 FAX' (978) 373-8021 lbradford.engr@verizon.net 1" = 30' DATE: FEBRUARY 1, 2005 FlIF NAME. NORTHANDOVER\DWG\27DAVISST.DWG FILE NO: 138136S 0 1 hl S au cn CM C O •- C mcc Mme_ C) o L -- CL cm< Cu M 0.2 Z COO) O a � a O y� � a O �•dC. C M M C . �O Ccc it CD :w m *Allb CL E E m ♦: ,L o� � * � is L COy L CO �' m Z y 7 Go A y • E m _O � c � CL CV r` cm m y � W.f�. .v IS y O Z O Coo Ccm O a Q ` ` m C C = m CL.COD QCQ N F- CO Lil C .'_, ,'CcZ ._.. LL m y... C Z W E �� y o I --- to C mM O� S au cn CM C O •- C mcc Mme_ C) o L -- CL cm< Cu M 0.2 Z COO) c Q O y� �•dC. C M M C . �O Ccc it CD :w m *Allb CL E E m ♦: ,L o� � * � is L COy L CO �' m Z y 7 Go A y • E m _O � c � CL CV r` cm m y =CD C W.f�. .v IS y O Z O Coo Ccm O a Q ` ` m C C = m CL.COD QCQ N F- CO Lil C .'_, ,'CcZ ._.. LL m y... C Z W E �� y o I --- to C mM O� a4- S au cn CM C O •- C mcc Mme_ C) o L -- CL cm< Cu M 0.2 Z COO) Location No. Date K-� I76S' 5057 Div. Public Works a TOWWOF' NORTH ANDOVER op Certificate of Occupancy $ Building/Frame Permit Fee $ 4 S Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ S s� Building ector K-� I76S' 5057 Div. Public Works �$y s .1fiT 1K�J. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. N PAGE 1 MAP d40.1r)� () v��SUBDIV.-LL�OTTN`O. LOT NO. i(�,-il 2 RECORD OF OWNERSHIP iD,A,/TE BOOK PAGES ZONESW �Vla�g g5 a Q I a2 t� LOCATION fT PURPOSE OF BUILDING _ K/ OpM 1l 9` OWNER'S NAME ��'i-%�� fSIO `� ► A N. � \ j `t NO. OF STORIES SIZE e _ �! L / Vtl 1 2XL OWNER'S ADDRESS %1Q%`T BASEMENT OR SLABl0_^loC/� ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST21fX�ND 3RD BUILDER'S NAME A Ai& iFJj4�E � SPAN DIMENSIONS OF SILLS POSTS DISTANCE TO NEAREST BUILDIING^ DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES 50 Pr/ -1 (SMEAR (W r "" GIRDERS AREA OF LOT n, 1 J�� —Ll FRONTAGE I l (M � (✓ tel! IS BUILDING NEW JCC) IS BUILDING ADDITION \I!�^�. ,� rc HEIGHT OF FOUNDATION j'� THICKNESS SIZE OF FOOTING ( I� X4 FT <zm MATERIAL OF CHIMNEY IS BUILDING ALTERATION l�A� I IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAG_ 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILEDAND APPROVED BY BUILDING INSPECTOR DATE FILED jR i Ya lct4 SIGNATURE OF OWNEF(JOR AUTHORIZED b F E E . PERMIT GRANTED I 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST =_(17') EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR //-- OWNERTEL.N 'lS�i)IOOC�Io/ CONTR.TEL.N exon l(1. Lao I CONTR. LIC. # H.I.C. # 6' N BUILDING RECORD i OCCUPANCY 12 SINGLE FAMILY STORIES THIS MULTI. FAMILY SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. W t u , OF, Pop-ce ( (2-K t2-) AW A-KLD 9D (tx$) ,-( I Zx 4) 4-- (((, K (LL) vyo N f2r, L-�c l 51-7 c�tG MAIN I 2-o' PP-o Pa5ET-:�, Rk--p c ACL -79e 7- 41, OFFICES APARTMENTS __ CONSTRUCTION 2 FOUNDATION CONCRETE 8 INTERIOR E PINE HARDW D PLASTER — DRY WALLUNFIN. FINISH 2 I3 —i— CONCRETE BL K. BRICK OR STONE PIERS — 3 BASEMENT AREA FULL FIN. B M AREA 1/1 1/7 1/ FIN. ATTIC AREA NO B MT FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 �_ 3 _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING HARDW D COMMCN VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ 11 BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER ELK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I — I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE GAMBRELMANSARD I I HIP BATH 13 FIX.) TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING 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 7 NO. OF ROOMS GAS O.IL B'M'T 2nd _ 13 rd ELECTRIC NO HEATING W t u , OF, Pop-ce ( (2-K t2-) AW A-KLD 9D (tx$) ,-( I Zx 4) 4-- (((, K (LL) vyo N f2r, L-�c l 51-7 c�tG MAIN I 2-o' PP-o Pa5ET-:�, Rk--p c ACL -79e 7- 41, cn m m D m T z r T z D = CO) 'o C � CA3 CO) Cl) 10 0CD� Z y OO. O n� r n� -v CL co) CD CDO CL c CD mo CD m_ CD �� . SD O CO) O CQ O CD 0 CO) O 'G Z CD O CD O CD W co - N CS oa N O 7 a .o �- O O n C7 CD H a C-3 Z ?-o N +i O� .0.► � ,df CD � T CD 10 CAO2 CD O N o o i CD:� CD a � moo O O LO). O CL o CD CD CD CD C) 0 CD NA � a CD S:v rn.art, CO) C=D n=) N � r� r N a N '� CL N dC (^ CD CO) V 1 l N N CDCD CD .rt N 3 O CD 4 KZ st 00 CD O CD o =W Cn p CD CD s � dNil :+ d o.'o N O_ 1 Cl) o ~" CD OF o mcAa cn O , rn o :; d IV7y w y ?? °� c CD ; � ar- ::r n tz �? w ro oCC r z b n ?? = C7 7� oGc o o. p a7 C z c tz O C CD ^ n E3 o a ?C rD r o x t99ri r 16 H 0 0 c FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: _J �'C�lCiy AAAS-VAZ- Phone 508 -(DkCQ -2s�Ce 1 '1 LOCATION: Assessor's Map Nu: er (��I Parte_ � ZocK u o& 3 Subdivision Lots) I L�-/Ik- Stree= l-7? 15PUDGES uWSt. Nu.:j--er Use Only************************ REC0MMENDATIONS OF TOWN AGENTS: Date Aucroved C;,:a-_o;, Ad-_nistra for Date Re; ectad Cc= en -- Date Arnroved Tcwn Planner Date Re', ected CCMr, en-- Fccd Sept_c Inspectc_-:iea�t:: QV- wcr::s - se.tier,'wa-er connections - driveway per^it Fare Derar-me.n,: Received by Building Inspector Date Arnroved Date Re4ecte_ Date Annrcved Date Rejected l' AUG 2 L iW F!U"C DING l' Town of North Andover BUILDING DEPARTMENT Homeowner License ExesnDtion (Please print) DATE 2 1 j s H4 JOB LOCATION 1-7e) 6gf)678S LA-K�G Number Street Address Sec 1N n or town .,f•,, ,* ,--a„ mJ,l L.. JIM �- bong-Fo�'�O(o( Name Home Phone Work hone P- = MAILING ADDRESS 1��5 6,rJQ&-, City%To�.an State Zip code The current exemption for "homeowners" was extended to include owner -ocC•:pied dwellinr-s of six units or Less and to allow such homeowners to Eae an individual for hire who does not possess a license, provided L.ha,_ the owner acts as supervisor. (State Building Code, Section 109.1.1) DE:=_dI:ION OF HOMEOWNER: 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 to six Family dwElI - ing, attached or detached structures accessory to such use acid/or farm struct::res. A person who constructs more than one home in a two-yE-nr period shall not be considered a homeowner. Such "homeowner" shall-submi_ to the Building Official, on a form acceptable to the Bulding Official, t' -at he/she shall be responsible for all such work. performed ui:dEr the building pernJ t. (Section 109.1.1) -n=^.dei'SignEC "homeowner" assumes responsibility for compliance with �..- -a_c 'Zuildinz Code and other aDDlicabLe codes, by -Laws, rules anal _a __ons. u::ders; :�e� "hemecwner" cer_ifies that he/she understands the 'ic.ti, of Ncr=.. %ndover Building Deoartiment minimum inspection procedures and a%d ti -a_ hE/she will comply with said procedures anu - _C e:e7 d'.Yc:l_n2S ALO Cubic Leer , Or Lar;Gr. Ji_1 Gc pit :te Eui_ding Code Sec.._on 127.0, Cons Q / •Y --��.. o �, . �� N � i i i �. . '�' i _ � � � �� i `{ I ' 1 � �. nv... '` ��, 0 i elRA00:4 �vtrS 16 ,fait sfe4-4' RN 40 .,)aelo le -,w. ted SLT# /j f '7 ,, . d Ad. M or geo S"At M4 EM-OLV-80SIION 131 SNUdl 8nGNU NO3HiAdd:Gl SV:90 176,-6T-snid is r o' I --- -- - . --- . , ..."f 444 -e -V&! , ;,��,-: 0,� , - � : " '� .. I Nlt,,� V", �:' -` - -: ; 1, 4 4t:ff". ., . , i � ... 14 . �� - .�",.��:....�,,�"II,�1-4...�V'�t�.,".4.,�� ", - '111 --,,-� ''. .,�l .. � I , ,� i ! �, - -, , ...'Lo- , , I 4 - -.:' "... 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