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HomeMy WebLinkAboutMiscellaneous - 183 COTUIT STREET 4/30/2018 (2)0 Date./. ".? °-,f7 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . `............r��° .. ......... ?} ...%� has permission to perform .. - . _ -! -�............. • • • plumbin in the buildings of .-.....-..... ........ • . at.. ss,, .�,---- ..... North Andover, Mass. Fee'.--!�,%.. ' . Lic. No.. IQ ..... /Q/ _ 1 ..r- `% U t PLUMBIN,6 IYSPECTOR Check # 7 4 4 6 r Date ..... 7' ... Z. TOWN OF NORTH ANDOVER PERMIT FOR WIRING c This certifies that .......... JAC . L L.. 7"T 0.....;����71 t (— has.... ......... .... has permission to perform. f1o!�-rte ......................................................... wiring in the building of , �' F. #iv q %�. '!Q ............................ ........ .. . 7"U ST orth Andover Mass. at .......�................... ............ , Fee.2. G.X -9 ic. No.aO ................ ELECTRICAL INSPECTOR Check # �+ 7537 so Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. -7 S73 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: -7— cZ 3-07 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)_` 3 C_sC3 null S7— Owner or Tenant 0On i, - i` L %'? Ah 4 A e qhU Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes [ �o❑ (Check Appropriate Box) Purpose of Building %ey imc-AAWAW Utility Authorization No. 4i16 4//-5P Existing Service i00 Amps 120 /"-YC-Volts Overhead Q--'Undgrd ❑ No. of Meters New Service 2W Amps /lc / 2 Vo Volts Overhead [—Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cmmnletion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires /Q No. of CeilSusp. (Paddle) Fans : N o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires /p Pool Above ❑ In [Jo. Swimmin g rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets -3(} No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. InDetection and Initiatin Devices No. of Ranges % No. of Air Cond. Tons Tot No. of Alerting Devices No. of Waste Dis osers P Heat Pump Totals: Number Tons KIWI. No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local ❑ Connection ❑Other No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: r't ,- C/14(G Attach additional detail ij desired, or as required by the inspector of rNrres. Estimated Value of Electrical Work: � (When required by municipal policy.) Work to Start: 7-2o -o�� 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: tel; G?-. 4 A -e IM LIC. NO.: -)0 yd e A Licensee: 1.W GlA cc.A e -JV Signature LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 2W -J,3'4 _ yIV Address: 3 ?- VN C S sera 1n,4 0 /A2 Y Alt. Tel. No.: to't.r•3 6a I *Per M.G.L c. 147, s. 5Y-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 agent. Owner/Agent - Signature Telephone No. PERMIT FEE: R,--, - © /< 5eotlaz- dv-t r-C,t,Lj 0 h CD —5--d—Ib, L In IN The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations k1i 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Orgmization/Individual):-- Address: ry) e A -10 City/State/Zip: C kc- (w. s.i 4-14 Phone.#: %2d'- -LA Yyeo Are you an employer? Check the appropriate box: 1. gI am a employer with lz�L- 4. I am a general contractor and I employees (full and/or part-time).* haYe 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. employees and have workers' [No workers' comp. insurance comp. insurance.: required.] 5. C] We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp, right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' COUP. insurance required.] Type of project required):, 6. ew construction 7. ❑ Remodeling 8. Demolition 9. Building addition 10.0 Electrical repairs or additions I LD Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other t •••.r •rr••w•• �—• --an uu& Fr, muer. also nu out me section below showing their workers compensation policy information. Homeowners who submit this affidavit indicating they aro 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 subcontractors and state whether or not those entities have employees. If the sub-contractons have employees, they must provide their worker' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: %A•e 1�`%� Fy �_{ �7_-„ s (';3 y,;e4 - �= Policy # or Self -ins. Lic. #: %L t�l� l �- Expiration Date: P Ods Job Site Address: rE 3 Cz� T urr ST City/State/Zip: �! -r� 6114 Ve„ 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 fate 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 Investivatinne nfthw Tlyd 1 do hereby under the pains and penaltles of perjury that the information provided above is true and correct JZ 4-r T- 7- 2 ? 0 7 �Pp- a,s-b - 00 Official use only. Do not write in this area, to be completed y city or town offlciaL 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 #: ;LMAS�VkCASETfS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) 4O'cve,- Mass. Date / 19 Permit # � tid r u Building Location A3 5_ Owner's New ❑ Renovation C�_ Replacement ❑ Name C_ S r Type of Occupancy FIXTURES Plans Submitted: Yes El No G Installing Company Name. Check one: Certificate Address y%2 n r�f sem' C ' ❑ Corporation S�vnPlccGvr� %%%2 01� 1?0 ❑ Partnership Business Telephone %/ a 71 - d -y— Irm//Co. Name of Licensed Plumber or Gas Fitter s r�L r� C_t/I C _14-0 INSURANCE COVERAGE: I have a current li bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Y No G If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy,-_,__�Other type of indemnity 0 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, and that my signature on this permit application walves this requirement. Check one: Owner = Agent Signature of Owner or Owner's Agent I herebv certify that all of the details and information I have �ubmined for entered) in the above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for ,his application will be ,n compliance with all pertinent provisions of the ..massachusetts Mate Gas Code and Chapter 142 of the General Laws. 'o /z By i e Lacense.: Plumber ; Title = G titer aster Journeyman Si Signature of Licensed o GGas Z License Number (Q Ciry/Town APPROVED !OFFICE USE ONLY) • • - NI t■■■■■fI ■■■■■■■■■■■■■■■■■■■■■■■■■ BASEMENT ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■ 4th FLOOR Sth FLOOR 6th FLOOR - .. ■ Installing Company Name. Check one: Certificate Address y%2 n r�f sem' C ' ❑ Corporation S�vnPlccGvr� %%%2 01� 1?0 ❑ Partnership Business Telephone %/ a 71 - d -y— Irm//Co. Name of Licensed Plumber or Gas Fitter s r�L r� C_t/I C _14-0 INSURANCE COVERAGE: I have a current li bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Y No G If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy,-_,__�Other type of indemnity 0 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, and that my signature on this permit application walves this requirement. Check one: Owner = Agent Signature of Owner or Owner's Agent I herebv certify that all of the details and information I have �ubmined for entered) in the above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for ,his application will be ,n compliance with all pertinent provisions of the ..massachusetts Mate Gas Code and Chapter 142 of the General Laws. 'o /z By i e Lacense.: Plumber ; Title = G titer aster Journeyman Si Signature of Licensed o GGas Z License Number (Q Ciry/Town APPROVED !OFFICE USE ONLY) f ds v A ae ' a. O x xZr. > � st O Z � O C M O � . L Q ' lz Z f�q O O i v �• G ae ' A O x • 2 � st O Z � O C M O � . L Q ' v Date.....".. ��.... No-,\ TOWN OF NORTH ANDOVER V9PERMIT FOR GAS INSTALLATION 1 This certifies that .- �-" ? ` .' y . .. ``''' ........ • . . has permission for gas installation .... ` in the buildings of .... r .. :=.....r . ................ . at P .:.......................... .. , North Andover, Mass. Fee./r.7.. Lic. No. .44 .......... �y G GAS INSPECTOR Check # 70%% z 6062 'MASSACHUISETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING n/vvt� Masi, ki � Btuding LoaWn rf1.3, i� f owner's Name2cr1 Type of Ocampency e5 f �� 7� Z IN Now ❑ RawvatbR ©' Replacemwd ❑ Plans Sumhted: Yes EI—No Ci FDCT'URES uJ cleft ate:.. C&'Mft% Business Tetephone-ZE a 7 9- d //� —� Cn/Co. Name Of Licensed Piumber 6;1,* e4le 11-p INSURANCE COVERAGE- -I ftame a anrc tilt ja' ilsbft insmince poky+or ft=fib tda1 � which meets No ❑ the tegedten is of MGL Ch. 142. Yes If You have chedmd YZ. plea se indicate the type coverage by checl ft the appropriate boot A IWAIt ►insurance potisy Qd' Otha b e of Mdenuity p Bond ❑ OWNER'S INSURANCE WAIVER: I atn aware 2W the fixnsee does not Crave the insurance coverage requtrod by Chapter 142 of the Mass. General taws, and that my siW atwe on this permit application w81409 this requircma>t Check one: Si�natrrre of Owner a Owner s_Aperrt Owner ❑ Agent ❑ tkbmw r e ow tt#W rapt work ;n�; �'" �mitba wr aderod) in „ On are true Ana seaaats to the best of my Mama Pmmu Of the Massaohuseas State P vrdw the Permit israed tw oft mon WE be in MWWAG with an Ott Coftfpd ChVW 142 of the LmL Tate ' t�from - - Type of Hoarse: Master / t l JouMeyMan p Umm Numbers • C 3 i i t I ac .. �t W • O 1t O 3 . � '!1 ;a j JOHN G. DANIELSON, INC. Architects 19 Winchester Drive Lexington, MA 02420 Telephone 781-862-1590 Fax 781-863-0457 July 27, 2007 Building Inspector Town of North Andover, MA RE: 183 Cotuit Street; Upon making my inspection, in my opinion, all framing using manufactured materials was done according to manufactures' specifications. Respectfully; Edmond J. anielson, Pres. o No. 8943 lip BOSTON MASS. Jyw OF M�`'S�G 07127/2007 13:01 7018630457 JGD INC, PAGE 01 JOHN G. DANIELSON, INC. mem* to*XftM MA 02M - - Imeph" 781.862-1590 F= 781-863-0337 J*21,W Buifthmppew Town ofNa* AWom, MA RE 183 CM* my *edkmk sa MY OPWO". an fr=jmg using manufactured tnalff als was done acct cft to fires' moms govalfift l r ✓!.tit ♦:'.f ��-.rkrr—s.'!'I � <--- �kkI s f lkM10r,--r Location CX Ti) % 1 No. � D Date 3,111A 'L kEG0 F.0 M 111'. tua 13 1992 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ `_oundation Permit Fee $ i Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ ,J.. And0cY 0 011eCt(PTAL Building Inspector _ Div. Public Works IPFik.%fIT NO. 000 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE; 1 MAP 4.406 [SIC/ 5 LOT NO. ` I 2 RECORD OF OWNERSHIP (DATE o OOK PAGE ZONE C SUB DIV. LOT NO.� LOCATION � � /��ry�f� PURPOSE OF BUILDING Di OWNER'S NAME 1/�n/I'C/,�V y/�GLr�J �II�RN/�ARrNQ_ !. f NO. OF STORIES SIZE OWNER'S ADDRESS i,B:,T ca—f�r�' si BASEMENT OR SLAB -- .Jr ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS --- POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES – SIDES / j� REAR / i1 GIRDERS AREA OF LOT �"i t-^Uv.P� `may �C+ FRONTAGE /(/tel" , p� L7.�V J 7C LTJ HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION P46S MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /1/40 IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY F FiF_L�_•1 SlDe' c)C ACK C-;r/;r/c?y ly'd, 00 – 1 IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I 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 SIGNATUVE210f OWNER OR AUTVIZED AGENT \i 11 In A FEE PERMIT GRANTED 7 19 2 r r OWNER TEL. -6S-3I CONTR. LIC. # 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST /1z) 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 'NV1d 101d S30V1d32I SIH1 'a3SOdWIM3df1S '013 'S30VU -VV 'S3H0M0d H11M 'S9NIa11f18 10 SNOISN3WIa 10VX3 ONV S3NM 101 WOUal 30NV1SIa ONV 101dOSNOISN3Wla 10VX3 MOHSiSf1W N01103S SIHl ZL aa0D3b JNlallna I ON11V3H ON _I Pic I tsl DISID313 P"L 1.W.9 110 SWOON dO 'ONSvo L ONINO1110NOJ SIV _ S831jVM OOOM MOdVA SO 11.1.M lOH _ 'SIO:) y 'SW9 13315 MRS 'SIOD T 'SW9 M39W11 'N8f13 81V lOH 03J803 3:)VNdfld SS313dId 1SIOf 000M ONILM l L I ONIWVVI 9 _ S321f11X13 Nd300W ON130OS 11021 _ b3MOHS 11V1S 13AVdO 8 SVl _ JNI9Wflld ON 31V1S )(NIS N3H:)11)1 S30NIHS DOOM I 1'X13 EI H1V9 11 1 dIH I I 319V9 ONIOWf11dOOM 9 L ONWIM kdNOSVW NO 3NO1S 1119 b30N1:) MO ':)NO:) 3WVM3 NO ADM b0013 8 'Sdis OI11V AMNOSVW NO XDIM9 3WVMd NO omnis F AMNOSVW NO O»f11S 3111 'HdSV ONIOIS '1b3A Fol WOD a MOMVH ONIOIS MiS39SV ONIOIS 11VHdSV _ HldV3 S310NIHS DOOM _ 313dDNOD ONIOIS dObO Z I 9 S0dVO9dVlD SM001d 6 II S11VM y N31-IDMI Nb300W WOOS OV3H S3JVld 3d13 1.W 9 ON V3bV DMV 'N13 +/c 1/1 1/1 V3bV .1.W.9 'N13 11(13 V3bV 1N3W3SV9 E N13Nf1 _ 11 VM AMO _ M31SVld SM31d O.MOMVH 3NO1S NO XOIM9 _ _ _ 3NId 'JI.19 313MDNOJ L 9 313MJNOO NSINIA VOIN31NI 8 _ NOI1VONnOd Z NOIlOflN1SN00 S1N3W1MVdV S3DI330 - kllWVJ 'I11nW L o o -n C D c cD r a - C)- °« C) o o m m ogn v �. CD > > 3 -p O 0 (D 3 r: m A ((D 69 69 fig 69 69 69 0 a O z In O OD 2 a z O° m m FOIA U TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADDRESS (ASSIGNED BY D.P.W.)14g-,' STREET APPLICANT PHONE DATE OF APPLICATION 3////67,,- TOWN USE BELOW THIS LINE PLANNING BOARD DATE APPROVED TOWN PLANNER DATE REJECTED ONSERVATION COMMISSION CONSERVATION ADMIN. BOARD OF HEALTH HEALTH SANITARIAN DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS ,NOTICE OF DECISION Any appeal sha!l be filed - within (4 0; after the datt-, Ci'!1;!1' L,Js Notice in thO Office of the Town Clerk. Date .. February . 14.. 19.9 2 ....... Petition No.. .003792 .............. Date of Hearing.. February .11, . 1.9.9 2 Petition of ...Dominic .Mannarino Premises affected ..1.8.3. Cotui.t. Street ........... Referring to the above petition for a variation from the requirements of aw. Section . 7.3. And .Table. 2. of the. Zoning. bylaw 80a8topermit relief of. 3_6 ft.. from -the. side ­$etbA1Zk for. 4. deck. ......................................................................................... After a public hearing given on the above date, the Board of Appeals voted to ..GRANT..... the .... variance ........................ and hereby authorize the Building Inspector to issue a permit to ..Dominic Mannarino for the construction of the above work, based upon the following conditions: Signed Frank Serio, Jr., Chairman ........................................ Walter Soule, Clerk ........................................... Raymond Vivenzio ......................................... John Pallone ...................................... Robert Ford ................................. Board of Appeals '40RTh 9 ao 4�1fD PP��S � ��SSAC NUSEt TOWN OF NORTH ANDOVER MASSACHUSETTS r: BOARD OF APPEALS *************************** * Dominic Mannarino 183 Cotuit Street North Andover, MA 01845 *************************** ,Any app!,a! filed ,within the date of .i -i 1`::;'iice in the Oi'ice of the Town Clerk. Petition #003-92 DECISION The Board of Appeals held a public hearing on February 11, 1992 upon the application of Dominic Mannarino requesting a variance from the requirement of Section 7.3, Table 2 of the Zoning Bylaw so as to permit relief of 3.6 feet from the side setback for construction of a deck on the premises located at 183 Cotuit Street. The following members were present and voting: Frank Serio, Jr., Chairman, Walter Soule,'Clerk, Raymond Vivenzio, John Pallone, Robert Ford and Louis Rissin. The hearing was advertised in the North Andover Citizen on January 29 and February 5, 1992 and all abutters were notified by regular mail. Upon a motion by Mr. Pallone and seconded by Mr. Soule the Board voted,unanimously, to GRANT the variance as requested. The Board finds that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Dated this 14th day of February, 1992. BOARD OF APPEALS Frank Serio, Jf: Chairman L r N/F CORMEY S 51 '42'35" W 200.00' '1 W LOT A k : to , 24,998 SQ FT f 1 STORY WOOD FRAME a o to '1 W Nf,' No. 183 ^ Q, Pf. N A NC PROPOSED r p Lo DECK 12.0' Z Lo C.) R = 92.90' o 26.4 L = 8.91 ' 0 16.0 191.10' -� N 51-42.35'v E � � C � N IPSWICH < 40' WIDE) STREET 1, THE UNDERSIGNED, A LICENSED PROFESSIONAL LAND SURVEYOR IN 7HE COMMONWEAL 7H OF MASSACHUSETTS, DO HEREBY STA 7F, TO THE BEST OF MY KNOWLEDGE, INFORMA77ON AND BELIEF, THAT THIS PLAN CORREC7LY AND ACCURATELY DEPICTS THE RESULT OF ANNIF71ELD SURVEY PERFORMED BY ME OR UNDER MY D/R T. k t-��-� FOR GRE SURVEYING VAs _ 7! i J DA 7E v Nf,' Pf. NC N1 r 9 I --1-- j � I I --+ - a- -+-- - -� I -i -4--1--17-4- I I i t I I , i g` I I I IIi Ii iI i I i Imo_ I - I I-. i -- I N O i I i , O IN p.., 1: (A N W T m T CA m ?t m T 0 m 3 �� m c c c w? c C c n z ° T z N a n o � z T ^ H N N T T !T1 00 p o s V X11 m z m z O Location �% r No. Date NORTH TOWN OF NORTH ANDOVER O F 9 " Certificate of Occupancy $ 4,- + Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ rr1 Check # 1 --'10/1) + j 61 6 Building Insp6c"Or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: r DATE ISSUED: / SIGNATURE: 'PLC - Building Commissioner/I for of BuildingsDate SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Aj� Map Number Parcel Nu er 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ��.x��, /f/j�fvrhri •� l�3 7-&'/ 7� Name (Print) Address for Service: 3 Signature Telephone 2.2 Owner of Record: �/ 3 `' ---C � Name P ' Address for Service: !68 96Z-- - fz_ - �o i re Telephone S TION 3 - CONSTRUCTION SERVICES .1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Ho a Improvement Contractor Not Applicable ❑ Company N ,341<(- 0a Registration Number Address ✓'� /b Z 6�! Expiration Date $TffAre Telephone a 2/ ou rn X Z rn SECTION 4 - WORKERS COMPENSATI (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavitbe completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildi rmit. Signed affidavit Attached Yes .......—fr No ....... ❑ SECTION 5 Descrip tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Mterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I SFCTION 6 - F.STIMATF,D CONSTRUCTION COSTS 1 Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building V (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) (� �y 7 p? 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, &&: as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print N e S ature of er en Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR 17IvIBERS iST 2 ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE w 40 T z a W cd W O ou O w c/)� aAi U) U �' r.� G O w 'Opp O w > r C U G ir; ® E-01 U � O w • q u". O H W U W -C O cG U v cn id w ® U v' Xp0 O a: O w" W A � y r Z M � 2 Y�� cn Q 4! E cn C O Q I -- W W LL H oc W G9 CIO C O N CD C .n fi raw� I �� toll�w d Standards Board of Building Regulations an ONT�cTOR HOME IMpR9VEMENT C 1 Regisfratiori:- 126893 $13120p4 EXptira"tion: y ent Card „ TYIie: Supplem Home Depot At1Home Service's MARK A RIA.QKWY x#26 Cpgg GA��E Administrator '�',( 3200, l 1� ALTANTA, GA ,CORD, CERTIFICATE OF LIABILITY -INSURANCE , .. `'�"°°"Y"0RIiH0-1T-DATJE 1/24/03 PRODUCER - - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ` LTR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Shepard & Scott Corp. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 352 Seventh ?avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. New York NY 10001 Phone:212-631-7440 Fax:212-631-7443 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER,: Evanston Insurance Co. EM Home services Inc. DBA The Home Depot Installed Sales INSURER B: Commerce & Industry Insurance INSURER C: 3200 Cobb Galleria Parkway Atlanta GA 30339 INSURER D INSURER E: 08/20/03 "UVnmA nm THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER DATE (41a;YY) DATE (IAIMIODIYY) LlMn GENERAL LIABLTTY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X❑ OCCUR 030LP1006878 08/20/03 08/20/04 PREMISES (Eaocarence) $50,000 WED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENU AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,000,000 X POLICY PJERCOT- LOC Emp Ben. 1,000,000 AUTOMOBLE LIABILITY ANY AUTO COMBINED SINGLE LIMB $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS N ON.DWNED ANOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLALIABL" EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS'LABLITY ANY PROPRIETORIPARTNEWEXECUTIVE WC9696691 07/01/03 07/01/04 VVU X TORY LIMITS ER ELEACHACCIDENT j$1,000,000 OFFICERIMEMBEREXCLUDED? It yes, describe under E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E L. DISEASE - POLICY LIMIT $ 1, 000 , 000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS VGI� 1IrM1rJ1I G MiLNCR CANCELLATION PawriN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FALURE TO 00 SO SHALL Proof of Insurance IMPOSE NO OBLIGATION OR LIABLITY OF ANY KIND UPON THE NSURER, ITS AGENTS OR REPRESENTATIVES. 25 (2001/08) 0 ACORN CORPORATION IQRR