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HomeMy WebLinkAboutMiscellaneous - 19 JOHNSON STREET 4/30/2018 0-7 Date...l.�.....2g.. NORTH °ft °:•'"° TOWN OF NORTH ANDOVER 3? �� •• OL o p a PERMIT FOR WIRING • ,S$�CMUSEt This certifies that .............. !�,...kw.(E?4. ....... ..till.. has permission to perform ...3 .......... wiringinccthe building of................................................................................... at.......1...l..........�J � `�O K' S ,North Andover,Mass. Fee... . .,_ . Lic.No. /.1........... .. � .�!/i1 ° ELEcr ICALINSPECTOR v Check # � �D r 7934 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. , 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 1 .00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:-- ) Z 1 Z-2 to 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) I Cl Z-0ti� Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Ute. Undgrd❑ No.of Meters New Service �C Amps /Zo / yc Volts Overhead❑ Undgrd No.of Meters f Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: E— FEE I> DEL �otGM.d o t L + S� Completion o the followingtable 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 El ❑ o.o mergency ig ing rnd. rnd. Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.o Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number ITons .KW No.of el- ontained Totals: ""' Detection/Alertin g Devices No.of Dishwashers Space/Area Heating KW Local El Muni ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No. o WHeaters KW ater No.o No.Ballasts Data Wiring: Signs BallasNo.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: a No.of Devices or Equivalent y' OTHER: G 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 9— BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 4- T LIC.NO.: 6 C( Licensee: �fi�K�h t,.� � NGro(nz Signature LIC.NO. �` (If applicable,enter`exempt"in the license numb rline.) Bus.Tel.No. �7 7 Address: 10(5 W�ri� In _S {�j�- �Y`�_t A1t.Te1.No.: /- 6 *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 a ent. Owner/Agent Signature Telephone No. [PER"MIT.FIEE: $ I -T- y y v dt 0 SirSe Location No. Date �OR,M TOWN OF NORTH ANDOVER � a ` Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee 1r�� $ OD TOTAL $ Check # �'! 18888 Building Inspector �� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: W7, DATE ISSUED: SIGNATURE: Buildi Commissioner/I r of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number *1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided RegWred Provided' v 1.7 Water Supply M.QLC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT Historic District: Yes_ No_ rn 2. weer of Reco d 1'e- "A�.504re- -') ---IV e N e( t) Address for Service -- � ♦ 1-7 1 ; Si atureT ephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone rn SECTION 3-CONSTRUCTION SERVICES 11 LicensednstructionSupervisor: Not Applicable ❑ Licensed Construction Superviso. ® 273J-1 O k ? Nie—d 4 /. s License Number Mn d D 2 Y�f Expiration Date igna Telephone 3D6,-404D .22 Registered Home Improvement Contractor Not Applicable ❑ v D6,-c0o D t-C" t f 0 Company Name o , Registration Number rn M Idss �'WLl Lb� Expiration Date Telephone G SECTION 4-WORKERS COMPENSATION(1VLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. " Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction 0 Existing Building ❑ Repair(s) Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: G6 4- � cxv z l/!s"�c . SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be QFF'ICIAL USE'4NLY „ ., Completed by permit applicant 1. Building • ...,,.....: J (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) oz� Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _ T 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. rZ - &-05T Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 .j Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DB/IENSIONS OF POSTS DIlVIENSIONS 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 NORTty F Town 0 t over 0 No. y Z ti dover, Mass.j� ' O 2 COC HICHE.CK �ADRArED P" '9S E BOARD OF HEALTH Food/Kitchen T T Septic System PERMI D t BUILDING INSPECTOR THIS CERTIFIES THAT........a..........s........... ..........7na .............. .....94.4 ...... ................................... ................. Foundation go M has permission to erect...................... ................ buon ....�...... ................................ .................... Rough to be occupiedChimney . . . . .. . . . .. ....................................................... ..... ............................................................. provided that the person accepti this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions f the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION ��T, Rough ELECTRICAL INSPECTOR � Q W.�� .............................................................. ................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. O Smoke Det. SEE REVERSE SIDE a if NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws:Chapter 148 Section . 10A. The debris will be disposed of in: CkeZ #4Y (Location acility �iF s z Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date l� The Commonwealth of Massachusetts 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 Information (� Please Print Legibly Natne (131[sincss/()r"Ianiiation/lndiv;clu;tl): Address: 7 Lje—'r 1-t iM JU City/State/Zip: /7�w-rr�e,.�-( OL>=�... ries.3 sZ Phone #: 12f' 2 7& y s AFl an employer?Check the appropriate box: Type of project(required): I. m a employer with / 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 7. 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. '+ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. [1 We are a corporation and its officers have exercised their 10.El Electrical repairs or additions required.] 3.❑ i am a homeowner doing all work right of exemption per MGL I I.[] PRUmbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 1'2.IrjlJ,/Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp, insurance required.] 'Any applicant that checks box d I must also till out the section below showing their workers'compensation policy information. +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. lam an employer that is providing workers'compensation insurance fi r my employees. Below is the policy and job site information. ` Insurance Company Name: / re–✓�/�I'$ 22• _J2: 'C.,.-=..�� Policy ,,4 or Self-ins. Lic. #: �j�l t-1 ',�J� & 1/0 015— Expiration Date: ` D Job Site Address: f / J-6/1 14 cJ City/State/Zip:/1L, 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 tine 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 tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investig tin of the DIA for insurance co erage verification. 1 do he c•er 'y t der t e pains ind nalties of perjury that the information provided above is true and correct Si gnattire: ' Date: Phone 't: OJlicial use only. Do not write in this area,to be completed hp city or town ollic•inl. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: - ry The Commonwealth of Massachusetts Department of Fire Services • Office of the State Fire Marshal P.O.Box 1025 State Road,Stow,MA 01775 PERMIT Date: North Andover permit No (City of Town) (If Applicable) Dig Safe Number In accordance with the provisions of M.G.L.14 8 Chapters s provided in section 997 C;MR 34 Start Date This Permit is granted to: LLQ Full name of person,Finn or Corporation Permissionto locate dumpster for construction/renovation/demolition of building Comments: dumpster must be 25 ' from structure if unable to place with required Restrictions:clearance dumpster must be covered with plywood or tarp end of work day at � l � (Give location by street and no.,or describe in such manner as to provied adequate identification of location) Fee Paid$ 50.00 � — �� � Fire Chief This Permit will expire - —�? (Signature of offical granting permit) Offical granting pemut` (Title) ��� TWIC PERMIT MI ICT RF rrwgPir i Irl1 ICI V Pr1CTi=n I IPr1N TNF PRI=MICFC �� t , NQ FD 4.1 10 i Date • NOaTH q - TOWN OF NORTH ANDOVER - '�'� RECEIPT S SSACHUS� I y� I This certifies that 4'./Y.7-i.`. °/?............. i haspaid... "- %.. ?....................................................................... for � iC ..vim ?. .r...............................:.... i Received by.."L...... .. ... .�?�'? ........... Department........., f� ............ ................................... WHITE: Applicant CANARY:Department PINK:Treasurer I ACORDM CERTIFICATE OF LIABILITY INSURANCE0712012005 DATE /DDIYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cowan Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 359 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Haverhill MA 01830 INSURERS AFFORDING COVERAGE NAIC# INSURED David Langlois INSURER A: First Financial Insurance Company 567 Washington Street INSURER B: Hanover INSURER C: Haverhill MA 01832 INSURER D: INSURER E: COVERAGES 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. INSR 0613131 POLICY NUMBER POLICY EFFECTIVE POLIITP MRRr TYPE OF INSURANCr CY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY 553F000132 0410112005 0410112006 DAMAGE TO RENTED $50,000 CLAIMS MADE I X i OCCUR MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $1,000 000 XPOLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO AMN718408700 0410912005 0410912006 (Ea accident) $ ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $100,000 HIRED AUTOS BODILY INJURY $300,000 NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $100,000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND OR I IMIT OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT I$ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Attention Michael McGuire (978)688-9542 Carpentry contractor. The worker's compensation insurance certificate will be issued directly by the company(Travelers). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 400 Osgood Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGAT OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR North Andover,MA 01845 REPRESENTATIV T D ESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 ' �/l/�.' � ��� �-�, ����_ ' ✓�ie60 �����1�`12���fl'C7S,�IUNS " License: CONSTRUCTION SUPERVISOR Number: CS 077351 Birthdate Q611511966 ..Expires:+0611512006 Tr.no: 25631 Restricted: 00 DAVID W LANGLOIS. 567 WASHINGTON ST HAVERHILL, MA 01832 Commissioner , ,p�� �✓ff���o�rnmzoouuea� \ ard ot.Building Regulatiyns and Standards Bo HOME.IMPROVEMENT CONTRACTOR Registration, 138583 piratwn 411.5/2007 ' t dvidual 1111 T; 7 , DAVID'W•LANGLOI `r I DAVID_'LANGLOI � { �'ff 1 567 WASHINGTON ST >i HAVERHILL,MA 01832 Administrator 1 D-mvid W. L-anglo-i-s- 11- t i ESS Ms-I Vviashington Si. M LYPS,9 Havemill F01a.CA 8-12 watt-- A Pc HONE D ' —11 1�U 1-i-ULB N-z" iSTREET 13TREET IfA19(VAI S ici Ty IC,Ty LISTA T E 11-AAD(f jGTA-TE 1.1-7c herebN,sik-rnit specilf-iCaflons anndi estimate for: and reroof entire bullu-ina. 1 Instal!newinp edge and ice Pnl viater Shiel Pround r-idge of rom-,and a dou lNee r of ic--- nd wate Shield on-right sirl of`fix. roof felt will be used per manufacturers recomiondation usual! none is required nn.,er nin I shingles will be l.K.O.shin,-les"th a 25 year life e-pe c-Itancy and are t;!,m deb from':sii- o this includes up h)2 of a` i;=-Yars vvill lbiz an add;iorial charge approx 55-BUIO p¢:-Pdditi.n-'laver. WrEen shn-a-hing is noi included. t. --se s r- d m -vvil- Ifle abo-ve spukcallcafi as 'ON; r0FU- RHUIS-1 DO A F9, her p, to r la r af, h Mr,v S Ll UI si-. Qen thousaand dollars 00ivoio a%;fblio-ws: 8000.00 dow-rY80U01,00'wheri finirhed All material is guarinteced In be as specific All vyod- to completed in -wor'-manlike mjnn�,r according to, standard practices. Artyll-Itrition or Spe-C-ificatiolls ifivol-Imitit cxAna C'k-'S!Sr W'-i bu, OWA�utull (.qlll- ufvi-mi wiifl-i urdel-S, wid will ua chw-tc uvct Ltid above ihe. 'Iffeeilleras Contin ae-lit in-vii strr:k-eS, neindenit, or May -bi�yunel imir o trint 3 "K !T -9 SUN— M Litreafte:r at.Ghe opumn offfie mdtTsi lgrle-u. A fl- -7 d S at L-I 1= b r _ O Iave Ce :iii, M -- lk as as outll-;ned ahov . ACCEPTED: D.A:7-- at- Location /1 Sjeeet / No. } Date -/6- 93 Of i' NORTM TOWN OF NORTH ANDOVER L p Certificate of Occupancy $ `t Building/Frame Permit Fee $ 11�oundation Permit Fee $ s�cMus • Other Permit Fee $ Sewer Connection Fee $ Q erg-Connection Fee $ TOfAL $ U5 �. .f,�J Building Inspect6r 6357 Div. Public Works o APPLICATIOn.., • MAP 4q O. LOT NO. ZONE I SUB DIV. LOT NO. F—I j LOCATION j PURPOSE OF BUILDING ?h��� I �/t 1l SQ lY 5 �' _ • ✓2GN b + OWNER'S NAMECG Ga „r e ��r` /Q !„ _ 7 ie 1q NO. OF STORIES SIZE OWNER'S ADDRESS h[ WI 1 (► d(/ BASEMENT OR SLAB _- ARCHITECT'S NAME S ZrE--GF F- nna TA)ABERS 1ST 2ND 3RD BUILDER'S NAME SP7lR'7 DISTANCE TO NEAREST BUILDING DIME � S DISTANCE FROM STREET �(fG GI �Kq,Q �.OGiC (��t( ��IV. �• feet n�l�/S DISTANCE FROM LOT LINES-tVSIDESVl1/. REAR 46 '• 7 1 (C 1 AREA OF LOT QQcls S �U FRONTAGE 00 G HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW !l 7 SIZE OF FOOTING iii _[�ZN� X ((I! IS BUILDING ADDITION �S MATERIAL OF CHIMNEY IS BUILDING ALTERATION S- IS BUILDING ON SOLID OR FILLED LAND S� WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Pis IS BUILDING CONNECTED TO TOWN WATER •7 BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COS /0 �r�Tt� �_ PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY f ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS r PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR 6 DATE FILED l3 BOARD OF HEALTH SIGN TURE OF OWNER AR AUTHORIZED AGENT FEE PERMIT GRANTED OWNER TEL.0 '33 33 PLANNING BOARD t9 X13 CONTR.TEL.#-6,% Y7Y - CONTR.LIC. 4 6 _a 7 i BOARD OF SELECTMEN —4 3!7— BUILDING INSPECTOR -f � r BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF. BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. --- 111 PINE BRICK OR STONE HARDw D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEM-77-771 ENT AREA FULL FIN. B M AREA _ '/, V2 V, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 11-9__.._ FLOORS CLAPBOARDS B 1 22 J 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D ASBESTOS SIDING _ COMRACN _ VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I-I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING i GABLEHIP BATH (3 FIX.) _ GAMBQEL MANSARD TOILET RM. (2 FIX.) t FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO a 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 8 COLS. STEAM STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR _ 1 WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL i B'M'T 2nd _ ELECTRIC _ 1st 13rd` NO HEATING NORTH 0 O Andover 0 � o ��4 dower, Mass.,_A*&. 16 19?3 �J COCMIC E i n '7 ADRATED FPV.\I-� 0 '9S H 5�� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT .,. N M "'�""""•'• Foundation has permission to erect......:.......... .................. on ........ . e............... Rough ....... . .. . . ....... Chimney y to be occupied as..... � 1... provided that the person accepting this permit shall in every resp e conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI STAR•r ELECTRICAL INSPECTOR Rough �....... . .............................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Wall To Be Done Dry Div FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. CMAIM /IAIATPR FINAI DRIVEWAY ENTRY PERMIT __