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Miscellaneous - 18-20 Belmont Street
m North Andover Board aAssessors Public Access Of No oTH A F > 9 • �q � F i gSSwCHUSE'� Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 North Andover Board Assessors 'Aproperty Record Card Parcel ID :210/018.0-0026-0000.0 FY:2012 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge 71 A r it 20 BELMONT STREET Location: 18 BELMONT STREET Owner Name: SULLIVAN, TIMOTHY R. Owner Address: 18 BELMONT STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5 - 5 Land Area: 0.11 acres Use Code: 104 -TWO -FAM -RES Total Finished Area: 2362 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR al Value: 296,000 302,300 Ming Value: 148,700 155,000 id Value: 147,300 147,300 rket Land Value: 147,300 ipter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=1888021 &town=NandoverPubAcc 7/16/2012 N 0 N } LL H W W Q' F N F Z O J W m O 77 U) U Of 720 00 � J U o d a c O W O F O a0 O J N O O Y U O J m O O O O O w N O O O CD r O O N JI w U Q a 0 N (a a O co 0 6 0 O O to N 0 CD6 o0 N. N ''= U) , P t` ooX:tA�s � U eN i IQ) J'=(VO O '6 -0-0i V '! kyr •. Ymia) 4. m d"0Cj O U: w (�mI�9aOis (n c e —:� C3 > p -, 0 0 mCc)-a�� a�ac;o;N C:,2 w C) ,-s O '" Z{ — w� F.I. a co co �€ ig Q a �T oxC) Z r. O - z.. O La :Z -o...9, _. t° O LL 10 t w ayF z Inc ! p m wooN �W/��� �, p� O 00 °� i Sao€¢ LL Z rl- O wc< r d 3 Z w�¢ V C Z ao (ci ;'U' C ZCD y� 3crI.O Lo vo' JVU, _ }U) a ve ' I 5 � W � > m m � � r- O 01 {4j W� O O O 4 O d i 13 0' ISO (O C e•• i Q E LoO -= LLJ: a° 40 a o (c J 2 ao o Z 1144), �r to r0 U a - iipp yy p g M O fr0` mm fn H a Q r ui i j I N FM I � iNSt� k iQN _ tLl, j UEE mYE (Zia 7 (A rr F— N O._ 6 Q. m LL m fn U QQ r . Yi Co, Co, ^'�•• tv J m Z co r-- �I 11N0,(NO 'c(n SOD L7 ! y Q 33• O (6F C7 O N O d M ;COD r.r N r r Q Q$ Xl�9� + .� . 1- w O Qm�Qa`f°iiQ �''_ �cgad c Q mtc! o E - U- m !O !l z Z c� LL c ati 1 a;U o W mfo- Oar- fl- itt='Im i ��o-�1D w}C7U;ao00 Z O W '7 N 4N „§ I g} Jp pp m 6ti co SEL �'O �L 03p�lV CD ^. O CD a' @gYnL' OO,1O S CS i co i (6 � iw (� .(, D aFOFmmlmt 's L,10 Cc C frl LL Z I— Q } W §O �U . d TE;E, O No-? c6 pXd(d .;X N:U) ti P. X Lu F— COLLSWm,YW a iii m,m ¢ N �. N .,OD LU 0 LLI Ln m V 0 C) €C9 LL Cl) y y0) O o IZ Q Z OZZ E E 4 t= cam {I-- .. J U) m a� m O 0�aoic a E -Q' -g W '.Oxk lo 4 jOQ "StLa;U Y nfn� WlL.L (n 0 N (a a O co 0 6 0 O O to N 0 CD6 972'9 Date ...... ...... ....�5.... �Q TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ i. �:......Ce�?w't.!:fJ...... %/l r has permission to perform 7G-72�-4ii,7� .............. ..... ............... wiringin the building of Svc t/�fc�...................... 8 ....................................... y .. at ........... .......... ............. ., North Andover, Mass. tFee .J.. . !�"..'.... Lic. No. b. 7 .......... E /.. ?-r...... �r.. L CTRicAL INSPECTOR I V / a Check # t ?— t / J 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed forin. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an ' electrical permit shall be issued to the person, firm or corporation stated on the.permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and maybe_deemed.bythe-Inspectorof-Wires abandoned.and_invalid_if he—.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or.the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section M of Clmapter 240 of the Acts of 2010 and extended by Sections -74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending"through August 15, 2012. C Rule 8—Permit/Date Closed: 0 Permit Extension Act — Permit/Date Closed: ** Note: Reapply for new permil�5< Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. %Z 2 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS rRev.9/051 leaveblank) 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 W INK OR TYPE ALL INFORMATION) Date: /-d . s2 2 — ZQ City or Town of: I/- Ad -a iM7 To the Anspector of Wires: By this application the undersigned gives notice o his or her intention t perform the electrical work described below. Location (Street & Number) /3 B4111harn- 5Y Owner or Tenant ,' „ iCe� L42 /'� Telephone No. `� Q yf (f 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 New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ' Uj- Cmmnletinn of the following, table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Sus P (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above ❑ In- ❑ Swimming Pool g rnd. rnd. o. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of OR Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. Detection and Initiating nitiatin Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers P ! Heat Pum Totals: p Number - - TonsJ.KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal ❑ Other Connection Dryers No. of D Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters o. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Deices or Equivalent OTHER: Attach additional detail if desired, or as required by the inspector of wires. Estimated Value of le trical Work (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C RAGE: 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 cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and enaldes ofperjury, that the information on this application is true and complete FIRM NAME: o i P l LIC. NO.: Licensee: G✓, Signature LIC. NO.: 10 (If applicable, enter "exe t in the license number line.) Bus. Tel. No.: %&0 '71 Address: /CAS 4,fhe,?,-e.f1 S -r /%r rb inge- A/11 0/91/-0 Alt. Tel. No.: *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 Elow40r's a nt. Owner/Agent Signature Telephone No. PERMIT EEE: $ c e I� l" W GOLDSTEIN & HERNDON, LLP Attorneys at Law 1244 Boylston.Street, Suite 200 Chestnut Hill, MA 02467-21.16 Bk I I SZ37 P:9309 41-32-792 11-16-2009 a QUITCLAIM DEED MASSACHUSETTS STATE EXCISE TAX Essex North Registry Date: 11-16-200? & 11:rl6at ct IT: 104 DOCAV : 172792 Fee: $IP672.08 Cons: $368,i 00.40 We, Edward J. Sullivan and Maureen C. Sullivan of 18 Belmont Street, North Andover, Massachusetts, for consideration paid, and in full consideration of THREE HUNDRED SIXTY- EIGHT THOUSAND AND 00/100 Dollars (U.S. $368,000.00) do hereby grant to Timothy R. Sullivan, individually, of 18 Belmont Street, North Andover, Massachusetts with quitclaim covenants the following property in Middlesex North registry of Deeds: The land together with the buildings thereon sitauted in said North Andover, North Essex County, being Lot 22 on a Plan of Lands of E.S. Sargent, recorded with the North Essex Registry of Deeds as Plan No. 033, and bounded and described as follows: NORTHERLY fifty (50.0) feet by the southerly line of Belmont Street; EASTERLY one hundred (100.0) feet by Lot 21 as shown on said plan; SOUTHERLY fifty (50.0) feet by Lot 16 as shown on said plan; and WESTERLY one hunfred (100.0) feet by Lot 23 as shown on said plan. Said parcel contains 5,000 square feet of land, more or less, according to said plan. For Grantors title see deed recorded with the Middlesex North Registry of Deeds in Book 5467, at Page 317. Witness our hands and seals this 16th day of November, 2009. e &,,.k n �, 1, � '111-±Lo--�-�� C Edward J. Sullivan Maureen C. Sullivan ASsq( COMMONWEALTH OF MASSACHUSETTS Nmfm, ss. November 16, 2009 On this 16th day of November, 2009, before me, the undersigned notary, public, personally appeared Edward J. Sullivan and Maureen C. Sullivan, proved to me through satisfactory evidence of identification, which were [? Mass. driver's license(s) or. [ ] to be the persons whose names are signed on the preceding or attached document, and acknowledged to me that they. signed it voluntarily for its stated purpose. Notary Public: Kenneth M. Goldstein RECEIPT Printad:06-22-2010 ® 14:31:15 Essex North Registry Robert F. Kelley Register Trans#: 80604 Oper:RICHARDB SCALISE, DOMENIC J., ESQ. 89 MAIN STREET NO. ANDOVER, MA 01845 Book: PL Page: 16263 Ctl#: 226 Rec:6-22=2010 I 2:31:12p DOC DESCRIPTION TRANS AMT PLAN Surcharge CPA $20.00 20.00 5.00 TECH FEE 5.00 Plan recording 50.00 Document Copy -Man 2.00 Total fees: 77.00 ----------------------------------- Book: 12077 Page: 213 Inst#: 15595 Ctl#: 227 Rec:6-22-2010 I 2:31:12p NAND 18-20 BELMONT ST DOC DESCRIPTION --- ----------- TRANS AMT NOTICE --------- Surcharge CPA $20.00 20.00 50.00 recording fee 50.00 5.00 TECH FEE 5.00 Total fees: 75.00 *** Total charges: 152.00 CHECK PM 3872 152.00 _3 COPY I BI--- 112077 P:g213 -lw-:'r 15 5 9 5 G —2-1-2030'a 02%3 -lo 6 ABOVE. FORREGISTRYOF DEEDS USE ONLY COVER SHEET THIS IS THE FIRST PAGE OF THIS DOCUMENT 20NOT REMOVE GRANTOR GRANTEE 7-0 g7L- mo Al ADDRESS OF PROPERTY CITY/TOWN. TYPE OF DOCUMENT MLC ASSIGNMENT DEED 6D TYPE MORTGAGE NOTICE' bE(4SI&Al TYPE DISCHARGE -SUBORDINATION AFFIDAVIT CERT DEC OF HOMESTEAD UCC TYPE TYPE DEC OF TRUST OTHER DESCRIBE Essex North Registry of Deeds Robert F. Kelley, R ' egister 354 Merrimack St. Suite 304 Lawrence, MA 01843 (978) 683-2745 www.lawrence* deeds.com 5 - Albert P. Manzi III, Esq. Chairman Ellen P. McIntyre, Vice -Chairman Richard J. Byers, Esq. Clerk Joseph. D. LaGrasse Richard M. Vaillancourt Associate Members Thomas D. Ippolito Daniel S. Braese, Esq. Michael P. Liporto Town of North Andover ZONING BOARD OF APPEALS Any appeal shall be filed within (20) Notice of Decision days after the date of filing of this Year 2010 notice in the office of the Town Clerk, (r+. .. r.. r Kan n 2010 MAY 23 PM 0 33 TG1' H 0 NORTH MADOVi R MAS 5 ANUWT,rie�stamp :i +.o certify that twenty (20) days ViPSed from date of decision, filed vol filing of ?r ,appeal. Date � Une . l4 o�)Q! d Joyoe ABrads ah w Tnvrn r afle per Mass. Lien. L. ch. 40A, § 17 Property at: 18-20 Behnont Street NAME: Timothy Sullivan HEARING(S): May 18, 2010 ADDRESS: BQQ Bglmont,Street (Map:18,.Parcel PETITION: 2010-005 26)North Andover, MA01845 The North Andover Board of Appeals held a public hearing at The Senior Center, at 120R Main Street, North Andover, MA on Tuesday, May 18 2010 at 7:30 PM on the application of Timothy Sullivan located at 18-20 Belmont Street (Map 18, Parcel 26), North Andover, MA 01845. Petitioner is requesting two (2) Special Permits for alteration or extension into the requiredside side yard for egress, in accordance with Sections 9.2 of this Bylaw within an R4 District Another Special Permit was also requested by the petitioner for the conversion of an existing single family to a two family by the Zoning Board of Appeals, Sections10.3 and 4.122.14.1) of this Bylaw within an R4 District Legal notices were sent to all the certified abutters provided by the Town of North Andover, Assessors Office, and were published in the Eagle -Tribune, a newspaper of general circulation in the Town of North Andover, on May 4, 2010 & May 11, 2010. The following voting members were present: Albert P. Manzi, Ellen P. McIntyre, Richard J. Byers, and Richard M. Vaillancourt. The following Associate members were present: Thomas Ippolito and Daniel S Braese. Upon. a motion by Richard M. Vaillancourt and 2nd by Richard J. 'Byers, the Board voted to GRANT the Special Permit to allow from paragraph 9.2 of the Zoning bylaw for alteration or extension into the required side yard for egress. The following members all voted in favor of the Special Permit Albert P. Manzi, Ellen P. McIntyre, Richard J. Byers, Richard M. Vaillancourt, and Daniel S Braese. The motion was unanimously approved. Upon a motion by Richard M. Vaillancourt and 2nd by Richard J. Byers, the Board voted to GRANT another Special Permit to allow .from paragraph 10.3 and 4.122.14D of the Zoning By law to convert an existing one family dwelling to a two family dwelling. The following members voted in favor of the Special Permit: Albert P. Manzi, Ellen P. McIntyre, Richard J. Byers, Richard M. Vaillancourt, and Daniel S Braese. The motion was unanimously approved. The Board finds that this use, as developed by the building & site plans, will not adversely affect the neighborhood. There will be no nuisance or serious hazard to vehicles or pedestrians since there are provisions for the required off-street parking. Adequate and appropriate facilities are provided to the existing residential dwelling and will be provided for the proper operation of a two (2) family dwelling. The Board finds that the 2 family dwelling will not be substantially more detrimental than the existing Page 1 of 2 single-family dwelling to the neighborhood and that this use, of a 2 family dwelling, will be in harmony with the general purpose and intent of this Bylaw. Site: Sections_ 9.2, alteration or addition into the required side yard for egress. Section 4.122.14D and 10.3 to convert an existing single family dwelling to a two family dwelling. Plan(s) Title: 1) "Plot Plan of Land" Dated April 14, 2010, containing one (1) sheet. Prepared by Larry G. Dasilva, P.L.S. East Taunton, MA 02718 2) Original plans submitted dated Sep 6, 1990 containing five (5) sheets; exterior elevation right side elevation, first floor plan, second floor plan and cross section A plan. Voting in favor: Albert P. Manzi, Ellen P. McIntyre, Richard J. Byers„ Richard M. Vaillancourt, and Daniel S Braese. Voting in the Negative: N/A The Board fords that the applicant has satisfied the provisions of Section 9.2 Sections 10.3 and 4.122.14D of the Zoning Bylaw for 18-20 Belmont Street in anR-4.Zoning District. Notes: 1. This decision shall not be in effect until a copy of this decision is recorded at the Essex County Registry of Deeds, Northern District at the applicant's expense. 2. The granting of the Special Permits) as requested by the applicant does not necessarily ensure the granting of a building permit as the applicant must abide by all applicable local, state, and federal building codes and regulations, prior to the issuance of a building permit as required by the Inspector of Buildings. 3. If the rights authorized by the Special Permit are not exercised within two (2) years of the date of the grant, it shall lapse, and may be re-established only after notice, a new hearing. North ndover Zoning Boa d of App als AlbertP. Manzi III, Esq., Chairman EllenP. McIntyre, Vice Chairman Richard J. Byers, Esq., Clerk Richard M. Vaillancourt Daniel S Braese Decision 2010-005 lql Zoning Summary ' AND STAIR= 60 SF Zorrrig Disidd - R4 0 DensNy Requirements µ EXISTING FOUNDA TION Exist Read Prop Lot Area sf (min) 5000 12500 5000 499" A (max) 32+E- 35 324 FmnbW It (min) 50 100 50 Front Yard tt (min) 11.0 30 11.0 Side Yard ft (min) 6.4 15 6.4 Rear Yard ft (min) 29A 30 27.9 PROPOSED STAIRS 6.4' N o C1400 nnj oe _aoa \�K Z J : A � 0 0 S` (0 O��V ,JS9C' GARY (3, tiN DAS1LVq m 0.474 f n C �UHVt�U tc 6.4' _a--_ 185.56' TO HODGES STREET r N/F JOHN & CAROL YN MEL VIDAS ASSESSORS MAP 18 L 0 T 30 DEED BOOK 966 PAGE 238 r-2.0' 50.00' EXISTING C3 GARAGE N N TWO GARAGE PARKING STALLS NIF EDWARD J. & MAUREEN C. SULLIVAN ASSESSORS MAP 18 LOT 26 DEED BOOK 5467 PAGE 317 5 4' LOT AREA=.5.000 S F. f PROPOSED DECK ' AND STAIR= 60 SF 0 0 NEW ADDITION ON µ EXISTING FOUNDA TION A FOOTPRINT=25 SF 4.2' 2#20 #20 X EXIST. 2—STORY DWELLING; FOOTPRINT __AREA=1, 313 S.F _i� O EXISTING. FOUNDA TION o N r. _. 2> tJ �. i I. _' Cj AD 2.0 �'. � 9.4X27' � V) o � BEZAONT ��' ���s� STREET GRAPHIC SCALE 10 5 0 FEET 10 20 2.5 1.25 0 2.5 5 17.0' x Ln 2 c� 21.2' l U. 2' Andover 1.5' 2Ad0 A X00 v x g PffiGIST Y Or- OMOS N&thernDisuictof Esswex ' X PLM 140 _. Attest: Regis:ee of Deeds '07 of Appeals w10i020 BELMONT STREET TIMOTHY SULLIVAN PLOT PLA 020 9ELMONT STREETN 11ND N,9NAEM ESSEX CQUNIY NO. ANDOVER, MASSACHUSETTS INC"� .._plib LARRY G. DASILVA, P.L.S. 1"10' APRIL 14, 20ao 1 S .84 SLUEJAY LE EAST TAUNTON, MASSACHUSETS 02718 TEL: 774--218-9133 4_ 0 0 . JNA A X qc�Q ()�a Q) O Q: Q V o 2Ad0 A X00 v x g PffiGIST Y Or- OMOS N&thernDisuictof Esswex ' X PLM 140 _. Attest: Regis:ee of Deeds '07 of Appeals w10i020 BELMONT STREET TIMOTHY SULLIVAN PLOT PLA 020 9ELMONT STREETN 11ND N,9NAEM ESSEX CQUNIY NO. ANDOVER, MASSACHUSETTS INC"� .._plib LARRY G. DASILVA, P.L.S. 1"10' APRIL 14, 20ao 1 S .84 SLUEJAY LE EAST TAUNTON, MASSACHUSETS 02718 TEL: 774--218-9133 4_ Town of North Andover Zoning Board of Appeals 1600 Osgood Street North Andover, MA 10845 ATTN: Angela Ciofolo an Dear Angela: DOMENIC J. SCALISE Attorney at Law 89 Main Street North Andover, MA 01845 Telephone (978) 682-4153 Fax (978) 794-2088 Email djs@djscalise.com June 23, 2010 JUN 2 zoo D BOARD OF APPEALS Timothy R. Sullivan — Zoning Board of Appeals 18-20 Belmont Street, North Andover, MA Concerning the above captioned matter, I enclose herewith a copy of the Zoning Board's decision -and plot plan that were recorded in the North District of Essex Registry of Deeds on June 22, 2010, along with a copy of the registry receipt. Kindly file these documents with the Zoning Board and notify the Building Department. If you have any questions, please do not hesitate to contact me. Very truly yours, Domeni ' . Scalise DJS/t CC: T.R. Sullivan Town of North Andover ZONING BOARD OF APPEALS Albert P. Manzi III, Esq. Chairman Ellen P. McIntyre, Vice -Chairman Richard J. Byers, Esq. Clerk Joseph D. LaGrasse Richard M. Vaillancourt Associate Members Thomas D. Ippolito Daniel S. Braese, Esq. Michael P. Liporto Any'appeal shall be filed within (20) days after the date of filing of this notice in the office of the Town Clerk, er Mass. Gen. L. ch. 40A, § 17 Notice of Decision Year 2010. RE Q E IV ED i UL _.E. 3 n°� r�cL. 2010 MAY 28 Pill 4 33 T0WH' 0 M A S S HiwHOKif,4 stamp .:0 to certify that twenty (20) days 1314sed from date of decision, filed without filing ofa�r ,appeal. Date ROU . IS a61 O Joyce A. Brad h w Town Clerk Property at: 18-20 Belmont Street NAME: Timothy Sullivan HEARING(S): May 18, 2010 ADDRESS: 1820Bglmont Street (MApA8, Parcel 26)NorthAndover'MA.,b1845 PETITION: 2010-005 . The North Andover Board of Appeals held a public hearing at The Senior Center, at 120R Main Street, North Andover, MA on Tuesday, May 18 2010 at 7:30 PM on the application of Timothy Sullivan located at 18-20 Belmont Street (Map 18, Parcel 26), North Andover, MA 01845. Petitioner is requesting two (2) Special Permits for alteration or extension into the required. side yard for egress, in accordance with Sections 9.2 of this Bylaw within an R-4 District Another Special Permit was also requested by the petitioner for the conversion of an existing single family to a two family by the Zoning Board of Appeals, Sections10.3 and 4.122.14.1) of this Bylaw within an R-4 District Legal notices were sent to all the certified abutters provided by the Town of North Andover, Assessors Office, and were published in the Eagle -Tribune, a newspaper of general circulation in the Town of North Andover, on May 4, 2010 & May 11, 2010. The following voting members were present: Albert P. Manzi, Ellen P. McIntyre, Richard J. Byers, and Richard M. Vaillancourt. The following Associate members were present: Thomas Ippolito and Daniel S Braese. Upon. a motion by Richard M. Vaillancourt and 2nd by Richard J. Byers, the Board voted to GRANT the Special Permit to allow from paragraph 9.2 of the Zoning bylaw for alteration or extension into the required side yard for egress. The following members all voted in favor of the Special Permit Albert P. Manzi; Ellen P. McIntyre, Richard J. Byers, Richard M. Vaillancourt, and Daniel S Braese. The motion was unanimously approved. Upon a motion by Richard M. Vaillancourt and 2nd by Richard J. Byers, the Board voted to GRANT another Special Permit to allow .from paragraph 10.3 and 4.122.14D of the Zoning By law to convert an existing one family dwelling to a two family dwelling. The following members voted in favor of the Special Permit: Albert P. Manzi, Ellen P. McIntyre, Richard J. Byers, Richard M. Vaillancourt, and Daniel S Braese. The motion was unanimously approved. The Board finds that -this use, as developed by the building & site plans, will not adversely affect the neighborhood. There will be no nuisance or serious hazard to vehicles or pedestrians since there are provisions for the required off-street parking. Adequate and appropriate facilities are provided to the existing residential dwelling and will be provided for the proper operation of a two (2) family dwelling. The Board finds that the 2 family dwelling will not be substantially more detrimental than the existing a� Page 1 of 2 [gle-family dwelling to the neighborhood and that this use, of a 2 family dwelling, will be in harmony th the general purpose and intent of this Bylaw. Site: Sections 9.2, alteration or addition into the required side yard for egress. Section 4.122.14D and 10.3 to convertan existing single family dwelling to a two family dwelling. Plan(s) Title: 1) "Plot Plan of Land" Dated April 14, 2010, containing one (1) sheet. -Prepared by Larry G. Dasilva, P.L.S. East Taunton, MA 02718 2) Original plans submitted dated Sep 6, 1990 containing five (5) sheets; exterior elevation right side elevation, first floor plan, second floor plan and cross section A plan. Voting in favor: Albert P. Manzi, Ellen P. McIntyre, Richard J. Byers„ Richard M. Vaillancourt, and Daniel S Braese. Voting in the Negative: N/A The Board fords that the applicant has satisfied the provisions of Section 9.2 Sections 10.3 and 4.122.14D of the Zoning Bylaw for 18-20 Belmont Street in an R-4 Zoning District. Notes: 1. This decision shall not be in effect until a copy of this decision is recorded at the Essex County Registry of Deeds, Northern District at the applicant's expense. 2. The granting of the Special Permit(s) as requested by the applicant does not necessarily ensure the granting of a building permit as the applicant must abide by all applicable local, state, and federal building codes and regulations, prior to the issuance of a building permit as required by the Inspector of Buildings. 3. If the rights authorized by the Special Permit are not exercised within two (2) years of the date of the grant, it shall lapse, and may be re-established only after notice, d a new hearing. North dove r Zoning Boa d of App als Albert . Manzi III, Esq., Chairman Ellen . McIntyre, Vice Chairman Richard J. Byers, Esq., Clerk Richard M. Vaillancourt Daniel S Braese Decision 2010-005 U 10295 '9, — >, e, —� Date ............................ .. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ h, ...............................ate................. ....................... has permission to perform ........i ` ........ ........... ......... wiring in the building of ......... -7 . ...... ......... at ............... ....... .......... . North Ando r, Masse Fee./.7.(.: .... ;�.�Lic. No/ .. . ....... do �Iv— , �- -/;—� , el ECTRICAL OR Check 4 Commonwealth of Massachusetts Official Use OnIL__— Department of Fire Services Permit No. w Z9.5 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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: 2', Z a — // 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) Ig delMp,uT- S Owner or Tenant %iso fid Sv //1W Al Telephone No. Owner's Address de /w/v.rJ7F <ST Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building T 1'le `wl q Utility Authorization No. // 616 qd y8 Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service o200 Amps I -a / a Yd Volts Overhead 2 Undgrd ❑ No. of Meters o7 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ���4V 6200,1 o2 5,4",4 Completion of the following table 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- Elo. rnd. rnd. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No: of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons .. KW ....................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: 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: (When required by municipal policy.) Work to Start: 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: A�e4l �v 6400 w `A, LIC. NO.: /O 7S -j-.4 Licensee: 6--"0,1"V Signature LIC. NO.: (If applicable, enter "exempt" in the license number line. Bus. Tel. NO.: '778 36 y Address: d/&G 0 Alt. Tel. No.: 3�3/ *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 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 Owner/Agent FPERMITFEE.-$ ,9 - Signature Telephone No.%7 � 2�-%/ �Ov w The Commonwealth of Massachusetts JTB D2 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationPlease Print Legibly Name (Business/Organization/Individual): A�ey, // / ( a—,>_0 J, �y Address: 105 61101,e � sr City/State/Zip: l %eel-,, m e. �,4 0/86 0 Phone #: 9'7, 36 8 �a Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Eq Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f 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: ,rA I/G If /'S IA)s -oxe L Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: / T/ 46G %!o s /i City/State/Zip:, A . ev A/4, 11 Attach a 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. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone #: 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: %0685 43 Oaf poNTvkpl-# \MppRp6 no0\Y ytAl°wash gton St" deskfined; A000 erase is \os nak Luce r board Y or ns� \i this \�c o� plo�essro PWAS-61p0, o° l of eXt p►viston gostpn'M ° is chan9 ope�om i�SegnombeCs Sutte 7��' address shs` �o �ns�r to Y°Ur C�c Geneva\ \ � d ame me or addres r of the 1Y your n \Ways re\koll v"'Ons d Ustn°tseeon y°�r o�er°eW a\ PPQ\s°SUble� to n \ pr vi\e9Ke P th trcen erser P so,aw I\ \ a\ ended. I \s a P er Yh ` as or as$19or P° t am d a (e4Urred by `' person COMM :NyWEALTH OF MASS HUSEI7S . aM ELECTRICIANS AS A R1=G JOURNEYMAN r y ELECTRIIA ISSUES THE ABOVE LICENSE TO KEVIN T GOOD.WIN 105 CHURL H ST MERRTMAC MA. 01860 1529 k' 10 7..45 :. _ B 07/31/13 s ' I 873582 i - _.� ,� .. amu$ �.•... , ..,..:� . : %0685 43 Oaf poNTvkpl-# \MppRp6 no0\Y ytAl°wash gton St" deskfined; A000 erase is \os nak Luce r board Y or ns� \i this \�c o� plo�essro PWAS-61p0, o° l of eXt p►viston gostpn'M ° is chan9 ope�om i�SegnombeCs Sutte 7��' address shs` �o �ns�r to Y°Ur C�c Geneva\ \ � d ame me or addres r of the 1Y your n \Ways re\koll v"'Ons d Ustn°tseeon y°�r o�er°eW a\ PPQ\s°SUble� to n \ pr vi\e9Ke P th trcen erser P so,aw I\ \ a\ ended. I \s a P er Yh ` as or as$19or P° t am d a (e4Urred by `' person 875 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING r This certifies that . . C....% `s........ . has permission to perform ...R'f!� .................. plumbing in the buildings of .. �.� . ........................ at. ...................... . North Andover, Mass. Fee.R Z ..... Lic. No... .................. PL MBING INSPECTOR ;'Check # ��� S FIXTURES MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: M// � 4,1 MA. Date: le' /l2 /d Permit# y Building Location: JO &_j–%ti)L Si Owners Name: % 501- 0 14V Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional Residential ©— r New: ❑ Alteration: Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2'-- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) regarding 1pis application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the pe t isstj6d jbr this applicallon will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chap)er 142jotheffier1fral Layrs. By . Title USE ONL Type of License: Q'T mber Signature of Lice n d Plumber [3'ster ❑Journeyman License Number: G� DEDICATED SYSTEMS LU Zof Z z U W Y W H Vf Q V1 } U 1- V1 W OC GQQC 0 Z pC Z W Z Z _z Q H W QZ V1 Q H UA 0 Z •N h W W 0 °° `^ W ~ Z Cie OC °C a tr Z of W W H S d 0 3 U n i Q Q a Z Z v► Q F- Q F- = Q Q w W 4 Q IR OC Q Q V1 IA O p H Q m m 0 0 U. x x O = O g g rr tn� Q 3 3 H 3 0 0 Q Q = to3 ;SUB BSMT. BASEMENT 1sT FLOOR 2ND FLOOR 3" FLOOR C FLOOR 5TN FLOOR 6T" FLOOR 7T" FLOOR 8T" FLOOR Installing Company Name: Check One Only Certificate # Corporation /� 6[1 Address: ����^� v� �� �lr , l Citwown: �'� ZI A &we 4l State: I ❑Partnership Business Tel: / 7a' c��o %Z 7 Fax: /'2ri Q*irm/Company Name of Licensed Plumber: CL ��tlte_7c. 1,/ INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2'-- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) regarding 1pis application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the pe t isstj6d jbr this applicallon will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chap)er 142jotheffier1fral Layrs. By . Title USE ONL Type of License: Q'T mber Signature of Lice n d Plumber [3'ster ❑Journeyman License Number: G� 7.466 Date. l.% .J 6. //. � ...... . Ofry TOWN OF NORTH ANDOVER'" • PERMIT FOR GAS IN •,t :. .y �9SSACNUSEtt i J j This certifies that ..--�-� < C .` .... p C. (. i .................. . has permission for gas installation .... P. 'Aq.�'...:'- ........... in the buildings of .0 .(. i .4 .lam ......................... . at .. ... . c . C.:- . ......... , North ndover, Mass. Fee 7� ..... Lic. No. J. 7 4'.?. L !:`.......... . G S INSPECTOR Check # IC-)- � < MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING /d Permit# aster City/Town: /Vae/4)4,��� MA. Date: _ City/Town Building Location:' --)o Owners Name: 77-10 7-4 SuLf!(/ .✓ APPRAVFn lnFFICF USF nNLYI Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential . New: ❑ Alteration: Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes f�'No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Lj 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ of Owner or Owner's By checking this box [ , ereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations perijorry�d under th permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Cooe a�9 � apter�42 ;?he General taws. By V1/1/ ` 1 --- v 94 Signature of Lic ed P umber/G2 License Number: I jo 7,7 Ix Title aster City/Town Y APPRAVFn lnFFICF USF nNLYI vi Z D H W it O V x N ~ = W to m O x QQ (7 J W W rn O Z Ix 0H W W W > U) w W Z w m z 0 a I- W W n=. IW- o Q ut W 0 w x x w W > I- V W} a Bt Z W 0 -� J W t— H ag rn x O Z C9 �o z t+- W 0 w i— x W W H Z O o W x� rn Q W Q Q w w to W O Q> O Z O w z z W Q O v o u_ 0 c9 x x .� O a. ow i- >>> SUB BSMT. BASEMENT 1 FLOOR 2 WFLOOR 3RD FLOOR 4 FLOOR e"—FLOOR 6 FLOOR 7 FLOOR 8'" FLOOR 2a � Check One Only Certificate # Installing Company Name: El Corporation Address: � St /Ff '4GC IQ- City/Town: �,// v1 Ile- State: S % Y ��� % 2 6 ? ��� E] Partn Business Tel: Fax: 2rmership /company Name of Licensed Plumber/Gas Fitter: Ite- If Ile q -- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes f�'No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Lj 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ of Owner or Owner's By checking this box [ , ereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations perijorry�d under th permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Cooe a�9 � apter�42 ;?he General taws. By V1/1/ ` 1 --- v 94 Signature of Lic ed P umber/G2 License Number: I jo 7,7 2131umber E�s Fitter Title aster City/Town ❑Joumeyman APPRAVFn lnFFICF USF nNLYI ❑ LP Installer Date . TOWN OF NORTH ANDOVER PERMIT FOR G This certifies that (:7. ... 7-1-A "6 has permission for gas installation .. ./ .................. in the buildings of .... S'. t_. X . (.(...................... at ........... ,q North Andover, Mass. Fee... � a `. Lic. No -:.)('(1&. . .... GASINSPECTOR Check 41 6969 -r MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date V-) NORTH ANDOVER, MASSACHUSETTS Building Locations Permit# Amount It U New ❑ Renovation Owner's Name Replacement ® Plans Submitted (Print or type) Check one: Certificate Installing Company Name El Corp, Address Partner. usmess Telephone 117 S7 S- Ir G y -31 ZZ Finn/Co. Name of Licensed Plumber or Gas Fitter l5A7r/ °5 / r f o r, e- . INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No o If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 1:1 Other type of indemnity E] 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 andhat my sip a on this permit application waives this requirement. Y, 61 S 1-1 Check one: Signature of Owner or er's Agent Owner ® Agent i nereoy certtry mat an or the details and mtormatton 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 Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) h Signature of Licensed Plumber Or Gas Fitter Plumber ,P/- �o'f% Gas Fitter License Number Master ® Journeyman k w o x x H z z o z w G14 oa w W 0 w a, aWCE a FwV dxa OO > F Cw w' > O O w a w H x o x w 3 a c7 a v a > a O w H o SUB -BA SEM ENT BA SEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR LL 8TH. FLOOR (Print or type) Check one: Certificate Installing Company Name El Corp, Address Partner. usmess Telephone 117 S7 S- Ir G y -31 ZZ Finn/Co. Name of Licensed Plumber or Gas Fitter l5A7r/ °5 / r f o r, e- . INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No o If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 1:1 Other type of indemnity E] 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 andhat my sip a on this permit application waives this requirement. Y, 61 S 1-1 Check one: Signature of Owner or er's Agent Owner ® Agent i nereoy certtry mat an or the details and mtormatton 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 Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) h Signature of Licensed Plumber Or Gas Fitter Plumber ,P/- �o'f% Gas Fitter License Number Master ® Journeyman The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations 600 Washington Street Boston, MA -02111 www.massgov/dig Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate bog: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 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.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other appaca n inai cnecrs.00x ;;: MuSt also rni 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: City/State/Zip: Attach a 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 the pains and penalties of perjury that the information provided above is true and correct Signature Date Phone #: . 47 & �;_ 53- 02, '13 5 % 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions � Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, 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, §25C(6) 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, MGL chapter 152, §25C(7) states "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." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability.Partnerships (LLP) with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials, 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. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in . (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.. 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. Tel. # 617-7274900 ext 406 or 1-877-NIASSAFE Fax # 617-72.7-7749 Revised 5-26-05 v,-ww.mass.gov/dia Date 0"",� �' :1�o TOWN OF NORTH ANDOVER a PERMIT FORK UM81NG This certifies that .................. has permission to perform . �t� ............................... plumbing in the buildings of .f9' .................... at .. / . .. l ....`z..7�.............. . North Andover, Mass. Fee.. l! ` .. Lic. No... �?�i!� 3 - ............ ........ PLUMBING INSPE TOR Check # 8267 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS j - Date b- Building Location /Se %m pn 4 5 A- Owners Name � � �/ of �u � f � vim, Permit # 277 � Amount j g# Tyne of Occupant IL�,� e�fi'q j �'� NewRenovation Replacement Plans Submitted Yes No ❑ FIXTUR PS (Print or type) Installing Company Name Address Check one: Certificate ® Corp. 13 Partner. Business Telephone �7 s-� p y 9 '7-7--- Firm/Co. Name of Licensed Plumber: (�/n.v'I �.5 / roy i �.•� cr �/— Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ❑ Other type of indemnity ❑ Bond 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 10 Signature Owner Agent Liai 11 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 lumbin nd Chapter 142 of the General Laws. By: Signature o . jimine Title Type of Plumbing License PL �� _ X City/Town Dun= Numoer Master ❑ Journeyman APPROVED(OFFICE USE ONLY The Commarzwealx°h of Massachusetts kl jt ! Department of Industrial Accidents Office Investigations �' u of 11 iii:. 600 *ashinvton Street ' Boston MA 02111 www -H rssgov/dia . workers'Co Insitrimce Affidavit: Builders/Contractors Aiicant Information /E1ectrici8as/p1amberS • Please Print Leaib Nan a (Businms/orgsniration/Individual): Address: City/State/Zip: Phone #: . youau employer? Cheek.the appropriate box:[Are I am a employer with 4. Type of Project (required): ❑ Iam a general contractor and I employees (full and/or part-time).* . Q'I am .a.sole proprietor or have hired the sub-cottttactors 6. ❑ Naw construction listed paFjner_ . ship and have no employees on the attached sheet. ❑ Remodeling . These std -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. $' Q Demoiman 5. ❑ We are a corporation and its 9. ❑ Building addition required.] . 3. ❑ I am a homeowner doing officers have exercised their 10.0 Electrical repairs or additions all work myself [No•workers' comp. right of exemption per MOL I ! .❑ Plumbing repairs or additions C. I52, § I(4), and -we have no insurance requir4].t .employees. [No workers' 12.❑ Roof repairs comp. insurance required..] 13-0 _Other 'Arry applicant. that checks bottt� I _must also Fitt out the section blow showing their woricarc' oom t Homeowners who submit this atiidavft indicating pensatioe policy information. they arc loin atl worts . r - =Contractors that check this box rtrustatached an additional sheattdtow' end then him outride contmetors must submit a new affidavit indi ° such mg• the name of the sub -contactors and their woric—, an a er tftt� ■ -P r P �' s pravigrw workers �t lrtformadom cern r poli^• irfotmadon rnrnperrsaturn �rrsuranre or f ) calployem Below is the policy avid job site . Insurance Company Name: ' Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: Attach a copy of the work Failure to sers'. compensation policy dechtratiion page (showing /e ppol y number and expiration date ecure coverage as required under Section 25A of M(3L C. 152 can lead to the imposition of criminal fine up to $1,500.00 and/or ane -year imprisonment, as well as civic 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 f forwarded to the Office of Investigations of the DIA for insurance coverage verification. I de hereby certify under the psora and petta/tiet of perjury that the enfn"Won provided above is tr� and rortt d Siture• /' . T7 Date: /0 - (� • /) of osis/ use o)* Do not write in this area zv be confkx, by cxiy or town. offuza[ City or Town:Permit/License # Issuing Aothork (circle one): L Board Of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions - Massachusetts General Laws chapter 152 requires all emp 3 overs to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, - express or implied, oral or wrhtmrL" An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two_ormore of the'fbmgoing engaged in a joint enterprise, and includirig the legal representatives of a deceased employer, br the receiver ortustee•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 dweiling:.house or on the grounds or building appurtenant thereto shall not, because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing ageney shall withhold the issuance or renewal ofa license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has cot produced acceptable evideuce.of compliance with the insurance covera„oe required" Additionally, 40L chapter I52, §25C(7) states "Neither tiie commonwealth nor any of its political subdivisions shall enter im any contract for the perk mance ofpublic work Cantil -acceptable evidence of compliance with the insurmce requirements of this chapter have been presmftd to the contracting authority" . Applicants Please fill out the workers' compensation• affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es). mind phone number(s) along with their eertificate(s) of roar=mi=ce. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not mquiredito carry workers' eornpensation insurance. If -an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Departrnent 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' oompw=tion policy, please -call the Departrnent at the nurmber. listed below. Self it su_red co -yanim- should ent-- thedr self-insurance iieanse Humber or, the'appropriale aim' . City or Town Officials Please be sure that the affidavit is complete and printed tegibiy. 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 permMicense number which v►-iII be used as a reference number. In addition, an applicant that must submit multiple permitAicerm applications in any given year, need only submit one affidavit indicating -current policy information (if necessary) and under "Job Site Address" the appiicartt should write "all locations in (city or town)." A copy of-t6e affidavit that has been officially starnped or marked by the city or town may be provided to the appiicant as proof that a valid affidavit is on file for fiftm permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said pers6n is NO'i' required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, pleasedo.not. hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of lmdustrial Accidents 4fiice of Lnvisti rations 600 Waffi ngton Street Boston, MA 02111 TeL # 617-727-4900 6x t 406 or 1-977-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia 1 Date.U: do TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING b 8 This certifies that , . �......�>!«R.= has permission to perform ..... pi C. 411�:.Q plumbing in the buildings of ................. at ... .............. North Andover, Mass. Fee. Lic. No.. .% 3�} `? 1 ....... J PLUMBING INSPECTOR Check # K -/n r / 5632 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMPING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date '� 3 Building Location /� - G /�j�j Owners Name L SUG L / v� �✓ Permit # A $ k Amount !� Type of Occupancy 5 I V �- New ❑ Renovation ❑ Replacement ® Plans Submitted Yes ® No (Print'or type) Check one: Certificate Installing Company Name 1�� l �1 IL�E�L� Corp. Address el «dvTJ C— ' 7— ❑ Partner. Business Telephone 7 -7� �Fum/Co- Name of Licensed Plumber. z3q /�� J70 -1—Z Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Er Other type of indemnity El Bond 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 Signature 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 Massachu State PI mbin C e an Ch 142 of the General Laws. By: Signature oi 17censeaum r Type of Plumbing License Title�'17 City/Town cense m-6 r� Master jai APPROVED (OFFICE USE ONLY Installing Address ---a v%a, %jussr%innfi ^rrL11.oA1lUN FUR FF_RM11 1U IJU I'LUMILSINU (Pflni or Type) NORTH ANDOVER,o , Mass. Date Bonding 22 Permit 3 39,l Owner's Name �u Ilt 0 nri New Renovation Q Replacement p Plant Submitted: Yes C3 No. C] FIXTURES Business Telephone Name d censeu Plumber INSURANCE COVERAGE: Check one I have a current liability Insurance policy or No substantial equhWanL Yes 0 No 0 It You have checked ySI. please Indlcata the typo covervgo by checking the appropriate box A IlabIlly Insurance 061110 Other type of Indemnity (3 Bond El: OWNER'S INSURANCE WAfVER;. 14 livVire -that the llcens'es does not have the 'kisurance coverage required by Chapter 142 of the Mass. General I.Aws.and,ft( my signature on this permit application- waives _IhI&tequkenWnL—-- Chec*,one: attffo of at Owner 0 Agento---- " of Owner's Aaenf—. I h*'*bY M111Y that all of the delaile and Information I have Vj ! bmthed for ent 04 " an SCCLK knowledge "W thaUall pkimbIng work and 1nJ1A1&t1On8 Wo(mod undw the =WWWL=jPW ct�l��a ar Vpk&tkm at* ttua� d Winen?PF"ZiOnt Of the Massachusetts State Plumbing Code WW Chapter r4�gof ��� b Vnih a. i THIS Cfty/To*n N"YWED (OFFICE USE ONLY) Ucense Number/Z6 ?6 L7 - Type of Plumbing Lkense: Master Journeyman 0 a Z 0 11 Is Is A IN. 0 1 4 0 Is 0 j z OU as ; 0 or • 60 0 : 4 31 4 1 ; Z 4xi 14'0 44 X Id I 06 19 at W t:nz .4 ZOo 2s. 0 44 -0 -0 t � 1 '0 *Ua- , V- BAGRUGHT IST /LOOM .2119 FLOOR 111 ING FLOOR 4TH. FLOOR —T F I'TH FLOOR OTH FLOOR, ITR FLOOR Es Tit FLOOR Business Telephone Name d censeu Plumber INSURANCE COVERAGE: Check one I have a current liability Insurance policy or No substantial equhWanL Yes 0 No 0 It You have checked ySI. please Indlcata the typo covervgo by checking the appropriate box A IlabIlly Insurance 061110 Other type of Indemnity (3 Bond El: OWNER'S INSURANCE WAfVER;. 14 livVire -that the llcens'es does not have the 'kisurance coverage required by Chapter 142 of the Mass. General I.Aws.and,ft( my signature on this permit application- waives _IhI&tequkenWnL—-- Chec*,one: attffo of at Owner 0 Agento---- " of Owner's Aaenf—. I h*'*bY M111Y that all of the delaile and Information I have Vj ! bmthed for ent 04 " an SCCLK knowledge "W thaUall pkimbIng work and 1nJ1A1&t1On8 Wo(mod undw the =WWWL=jPW ct�l��a ar Vpk&tkm at* ttua� d Winen?PF"ZiOnt Of the Massachusetts State Plumbing Code WW Chapter r4�gof ��� b Vnih a. i THIS Cfty/To*n N"YWED (OFFICE USE ONLY) Ucense Number/Z6 ?6 L7 - Type of Plumbing Lkense: Master Journeyman 0 5, �,:,, °';. •� -.�tio TOWN OF NORTH ANDOVER . k`" PERMIT FOR PLUMBING Ss CHUS� This certifies that t? ./. •/.�..4..... c?�..!................ permission has P to perform ... R r, ... J............... plum.b'ing in the buildings of ................... S. at ../� ..Bc ................ . Neth Andover, Mass. Fee.?. Lic. No.. j/ p.3 d./ ........ 4 ....'`'OYy...... . P MBING INSPECTOR 07/07/97 12:23 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Location �O s'o S No. 02 Date ��- 6 — TOWN OF NORTH ANDOVER Check #� 1 51 71 Building Inspector Certificate of Occupancy $ us s'•<�' swMs C Building/Frame Permit Fee $ Foundation Permit Fee $ .rpt 6 0 0 Other Permit Fee s�oVr c2 �- $ TOTAL $ Check #� 1 51 71 Building Inspector TOWN OF NORTOANDOYER BUILDING DEPARTAMNT PPI ICATION TQ.MNSTRUCr..RE MNLOVATE, OR DEMOLISH A ONEDR TWO FAMILY DWELLING 3UILDING PERMIT NUMBER-. DATE ISSUED: SIGNATURE: f . Ta_ilAi for of Buildings Date I i 3ECTION. I- SITE 1"ORMATION A Property Address: 1.2 Assessors Map and Parcel Number: aJ o) 0) ap Number "-Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ?oning.District a 1.6 rBUMMING SMACKS (ft) Front Yard Side,Yard Rear Yard r': Provided R red Provided Reg1jived Provideed 1.9 Sewerage Disposal System! A.7 Water Supply 1%CG.L_C.40.. 54) j'5. Flood Zone Information: Zone outside Flood Zone 0 municipal 0 On Site Disr."; .Dublic 0 Private 0 L ---- 7-- AGLNT SECTION 2 - PROPERT)y 2.1 Owner of Record K �P 3/ C,� /—n A _D (Print) Address for Service: -Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature SECTYnN.3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: C License Number X, 4 777777 Address Expiration Date Signature Telephone egg 3.2 Register . ed Home Improvement Contractor Not Applicable 0 Company Name n Registration Number r r Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION MG -1- C 132 § 35r(6) Workers Compensation Insurance affidavit must be completed and submAttMd with this application. Failure: to provide this affidavit will result in the dental of the issuance of the buildingpermit. Signed atdavit Attached yes ... .,❑ . ,;No.,......Q . SECTION'S tion of. Pro osed Work;' check all a . licabie: New Construction ❑ Existing Building d Repair(s) Alteratioris(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 1 r-/ 5 T 4 e- N[ C, I� � � c> a,✓ o o T-> 5 4UTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Com leted:by permit a licant 1. Building (a) "Building Perrriif Fear Multi liar 2 Electrical (b� Esrimated 1C, okof Co 3 ction Plumbzui B.uilding,Pernut fee-(a).x (b) 4 .: Mechanical , HVAC: LE 5 Fire Protection 6 Total 52. Check: ui9ibet SECTION 72i OWNER AUTHORIZATIONTO 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.' Signature of Owner Date i SECTION 7b OWNER/AUTI30RIZED AGENT DECLARATION f property ,as Owner/Authorized Agent of subject Hereby declare that the statements and information on the foregoing .applicat'onare true.and;accurate., to the best of my knowledge and belief i! Print Name Si iature of UWner/A ent NQ OF STORIES BASEMENT OR SLAB SIZE OF FLOOR TR\,1BERS SPAN DIMENSIONS .OF SILLS DIIMIENSIONS OF POSTS DMENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CHWINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS E Date THICKNESS X e r - m cnm 0 m K CA CD a Z CD O ar C!7 d CZ n� -o -o 0 O v CL V CD O CZ O CD CO) CD sz O n Nf O CO) C O C CO) d c� CD O �F CD CD y CD CO) O CD 0 CD -',, Q = do m CO) »m 0 m C3 C H c7 d 0 T Z m 0-C co) col CD ..a =r d °'► d O T CD m 0 ®y 0 ti N O?m 2 �: _ = O CO) O - U2 CD O Z �• CO! O N CD n320 J D. S ��-�•yy I ,.ter .•r VJ A CD O N F C/)m 1 0 CD ^ d � c_ a m . N .' O p� I _ - e cn o � 'ca n ems• / ' / /� ® N = m O yCDo c CD a z a �G ^ cn z N � O �m o C* m • cn V/ W N dCD a� C* �Z CD N Cn cn w 'v -x 'r1 PCI h7 n Pi "r7 Cn al or* M 0 p D rte~ d w A COD P- gi 09�% •S C" = QQ ��„ Z 0 w � oCa O w 0• G51 z C rD r' y O xto tJ y d o x t .. WOOD STOVE INSTL�.i I(t`#t�dEGt�LIST Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove (•_� A. New �/` Used. B. Type/radiant `4 01A P4 r Circulating C. Manufacturer Verm s Ln s _Lab. No. 5e U WARM OGI< �s,Rc y Name/Model No. b e{l ea w,f �i > o Collar size it `' If Dimensions/Height _Length lcJ'`i _Width Z 3 Chimney A. New V Existing B. Size (flue area)_ C. Other appliances attached to flue (Number and flue size) D. Prefab(Manufacturer=name and type)lia-i ,e �5__,h� e( S's yl Chrmne S stem lyre 14 T' 3/(,K /2K E. Masonry/Lined _ _.Flue liner __ _ Unlined type 3 minulhcturer) F. Height (refer to diagrams) ' cap 9 T I 0"to to CHIMNEY HEIGHT Hearth (non-combustible) A. Materials B. Sub -floor construction C. Minimum dimensions (refer to diagram) Clearances and Wall Protection (see stove installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE COR!"IER HEARTH WALL/CENTER CHIMNEY HEIGHT Hearth (non-combustible) A. Materials B. Sub -floor construction C. Minimum dimensions (refer to diagram) Clearances and Wall Protection (see stove installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE COR!"IER HEARTH WALL/CENTER r, Location - / No. .�.p . Date • o ,,tio TOWN OF NORTH ANDOVER p Certificate of Occupancy $ 13'0 y a • Building/Frame Permit Fee $ cMrsm�``� Foundation Permit Fee $ Other Permit Fee $, /--50,y"e �G©,nnection Fee $ Z�• Water Connection Fee $ o ®8 yg TAL $ Roo, Vo - tor o -tor f b6fiding Inspector Div. Public Works PERMIT NO. r APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. XY� PAGE 1 MAP KVO. LOT NO. C. 2 RECORD OF OWNERSHIP DAT BOOK 'PAGE 7_'ONE SUB DIV. LOT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING LOCATION � c�i o �L p ®� , Si`, PURPOSE OF BUILDING r 4 �� � � /� y� - / � Y OWNER'S NAME .09-6/,vIA �.JC�Q..LI VA N NO. OF STORIES l SIZE OWNER'S ADDRESS��.y n 6L� tj Tn) _ A r PTgrygagi BASEMENT OR SLAB 1 -f,lS" I SIGNATURE OF OW OR AUTHORIZED AGENT ARCHITECT'S NAMEBAARY 1>jooIS Vy'keo'lC$P8S/V SIZE OF FLOOR TIMBERS ISST tT y k 2ND �/ 3RD 7 BUILDER'S NAME .0 f� LLV A_J M1 SPAN F E E DISTANCE TO NEAREST BUILDING V' S O DIMENSIONS OF SILLS CONTR. LIC. # DISTANCE FROM STREETE •' POSTS DISTANCE FROM LOT LINES - SIDES 6 D i/q s y)REAR ` 36 ° GIRDERS AREA OF LOT S`©00 FRONTAGE HEIGHT OF FOUNDATION •� D THICKNESS N IS BUILDING NEW Al 0 SIZE OF FOOTING "-1 d� D DD X IS BUILDING ADDITION NO MATER:AL OF CHIMNEY 13 i R 1 IS BUILDING ALTERATION ai G� IS BUILDING ON SOLID OR FILLED LAND OL WILL BUILDING CONFORM T6 REQUIREMENTS OF CODE 69 IS BUILDING CONNECTED TO TOWN WATER yes BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER s IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 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 FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OF OW OR AUTHORIZED AGENT 6®S #60St 0 F E E WTI CONTR. LIC. # PERMIT -GR ED 19 �_ h 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST `©r DWS EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN I a ONIIV3HON V . JI81J313,rI- PAZ 1.W.9 I a ONIIV3HON Pic ' ?sl I JI81J313,rI- PAZ 1.W.9 110 SWO01 d0 SVO S831V3H IINfl O.1.H INVIOVB ONINOIDONOJ MIV aOdVA 80 8.I.M IOH _ S831jV8 DOOM i ' ' 'S10D 18 'SW9 1331S WV31S 'Ndni 8IV IOH (33J80j 3JVN8flj SS313dId _ 'S10J R 'SW8 839W11 1SIOf OOOM ONIMH l I ONIWVmd 9 ` OOVO 3111 :81JOld 3141 _ S38f11X13 N8300W `JNId008 1108 _ _ 83MOHS 1•1V1S `JNI9Wtlld ON 13AVdO 8 8V1 31V1S _ NNIS N3HJ11X S3ONIHS DOOM kdOiVAVI S310NIHS 11VHdSV _ `-� 13SO1J 831VM 03HS IVI4 13a3WVO T31 1-0 1'Xlj ZIXIJB 08 VSNdIH ") H1V9 4 19VO ONIHWf11d O L doom 5 3NON800d 38�183df1S �I ' ONIMIM 3WV8j NO 3NO1S ABNOSVW NO 3NO1S '_X19 830NIJ 80 'JNOJ 3WV8j NO XJI89 —I' 80013 V 'SBIS JIIIV ABNOSVW NO X0I89 —� __ _ _ E Z _ l _ 9 3111'HdSV NOV'IWOJ 3WV8j NO OJJt11S ABNOSVW NO OJJf11S ONIOIS 'MA ONI01S SOIS39SV ON101S 1lVHdSV O.M(JdVH H18V3 S3IONIHS DOOM 3138JNOJ ONIOIS dObO S08V09dV1J Mold 6 I S1lVM -V N3HJ1'IXI N8300.W W008 OV3H 'MVld3814 ` 1;W.9 ON V38V JIIIV 'NH '/r 1/1 - 71 V38V .1.W.9 'Nil 11t1j V38V 1N3W3SV8 £ _ N13Nn 11VM A80 831SV1d S831d O.MOBVH 3NO1S 80 XJI89 3NId 'X.19 3138JNOJ 3138JNOJ HSINId`mOIM31Nl 8 NOIIVaNOOi Z' NOu:)nH1SNOO S1N3W18VdV S3JIdj0 � ., AIIWVd 'Iilnw 53180!S AIIWVJ 310NIS JIONVdn000 : L • (Please print) DATE 2//3/7/ JOB LOCATION Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption sr umber Street Address .''HOMEOWNER" VJA41N ]A Name ome Phone 6S io%-1M % 0"'1.,i ection of town ork Phone PRESENT MAILING ADDRESS / g' Q -41y%0 1.4 7- S T _abKTis IU 4 Clty Town State Zip code The current exemption for "homeowners" was extended to include owner ,-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided ethat the owner acts as supervisor. (State Building Code, Section 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns aipa.rcel 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 dwell- ing, attached or detached structures accessory to such use and/or farm ,structures. A person who constructs more than one home in a two-year period shall not be coris:idered a homeowner. Such "homeowner" shall submit .to the Building Official, on a form acceptable to the Bulding Official, '.that he/she shall be,responsible for all such work performed under the `building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and 'regulations. i r' The undersigned "homeowner" certifies that he/she understands the Town of North 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 'Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. W to Cd ce O UP of i •tip �1 zz-++ 0Cie jW W to Cd E 4. O o ce O � of i Q ~ t.i WW 0Cie O W W d d � U. Z. Z Z W d 6�Y D Z W- Z Z V f oC p� Q QO c m h MOO m. T 4 47 T � � .3 m L C E ftl J L a j Rf J L U W L m W Y O OC U LL ¢ ti cc cn LL cc U. m N E 4. O o U i H • Z •z u V :a c .a � c ` a% L V CQ •c f v E QO c E" MOO C 4 47 T � � .3 E 4. O o U ° H • Z •z u V :a c .a � c ` H F s O V SRI ° AA� N C6 c a% L V CQ •c O v E QO c E" MOO C .3 SRI z AA� a% L 4 L C i� O u �- u a. c a C C O O C 04 u Z •c a O ar- m o V � C cc a o0 rA • _ C ® • _ 10 J z 0 0 oe 0 < LU 0 LU LL. uj LU LU CC 0 cc r- c rn E 00 Lu O 0 CD 0 C: 0 U- a: co u- CC m co co uj ZD ZD 0 O Z 00 O W V 0 O. c cc CL CL. to 40 ci E cc O W V cc CL to