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HomeMy WebLinkAboutMiscellaneous - 191 KARA DRIVE 4/30/2018N O to D o � 00 o 22 0 m 0 6233 Date ........ ..................... 4 t o TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... kmfto ........ 10 ......................... has permission to perform ...... &�K .... C(V.-WeAlf 4�j .............................. wiring in the building of ..... ........ ......................... L4 at ....... 19 ... ........ b4 ............................... . North Andover, Mass. . A . ....... e\Fee..3:�� ... Lic. NA6.;941 ............ e. �—Jo ............. .............. !—T' ELECTRICAL INSPE*croi V Check# DE0UU IW0FPUKIB;3V= Permit No. Z. 3 BOARDOFFDREPREVEWMR GVLA711011 527adR12i Occupancy 3 Feer Clicked �.•i A.PPUCA71ONFOR PERMIT TO PERFORMELECTRIC,AL WORK � ALL WORK TO BE PERFORMED IN ACCORDANCE WrrH THE MASSACHUSSTS PJ.E(. MICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street d: Number) Ne) t j p_ Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: YesU No Lj (Check Appropriate lib„) Purpose of Building Zp Pye s> cPa,n C Ertisting Service ?—.00 Ampa 19 Wd Volts Overhead n Underground r New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Utility Authorization No. No. of Lighting Oudds No. of Hot Tube No. of Tnaafbnw TOW No. of Lighting Ffsttoea Swriroadng Pool. Above&m KVA owid KVA No. of Receptacle Outlets No. of On Burnes No. of Earrrgeooy Lighting Battery Udo No. of Switch Outlet. 3 No. of Ou Homers FIRE ALARMS � No. of Tones No, of Rangy No. of Air Coad Told Taos No. of Domino sad No. of Dispoub No. of Hat TOW TOW Pump Ton KW Initialing Devices No. of Sounding D.W. No. of Dishwashers Spsce Area Haling KW No. of Self Contained � � unici Murdcfpal Other No. of Dryers Hosting Devices KW connections � No. of Water Neaten KW No. of No. of sign Hsileds No. Hydro Massage Tubs Na of Mown Told HP Ihmestb7 tedv&pmfdf mt;tofte0ft YM El Ea MliAIKB am [3 Om [3 rm** wodcusmrc/—a� _ Daft 5'igleduttdrr Ptile>daofpe�ji>tyr. � on {� Lt! �Q FMMNAME 1) � &,6j I;o n,bolm a b e -C / CC Sag, M YES 1 -Vi NO 1<youtrwdbdoedYB4 PhWkdrarethetypeofa r lrledvalzdEhmwwcak S � f1fid G U .ser [> Limalloo etta C- 7 7 BttdrtmsTeLNa 97— OVVI�hR�sIIVSCJRAI�wANFR;IarnawaeQretihellaQee AtT�Na � � 33 7 dd=nW dreiaaaneo°`°'� at&kftriiegt'vdetasre9i ilyMaassdsimc Dal m a rdillinvsipanc ift-1 nitappla�vii�eshirequww” se (Pleacheck one) Owner Q Agent Telephone No. Pmtwr F13B t-- We No. — t, 1-, 3,;" my R Rea Checked APPUCA71ONFOR PERWTO PERFORMELECMCAL WORK ALL WORK TO BE PERFORMED tN ACCORDANCE WrrH nM MASSACHUSSTS EIECiMXAL CODE, 527 CMB: 12:00 (PLEASE PRINT IN INK OR TYPE ALL NFORMATION) Date/�' Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number)/Cl �`� J Owner or Tenant Me , N Pa L L - Owner's Address C--' Is this permit in conjunction with s budding permit;11 Yes No 1:3 (Check Appropriate Box) Purpose of Building S 1 t (� le / L s e- I C Faristinj Service Z�� Amps / /U /ZZ volts Utility Authorization No. Over Underground No. of Meters New Service Ampr�/ yoly Over Un&erground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 7A-- e No. of Receptacle Oudeft / No. of Switeb Oudeb - (�•� No. of Rama@ No. of Dlspouls QNo. of Dishwashen No. of Dryma No. of Water Herten .r No. Hydro Musge Tuba Yrr�dmopociafonDfleo t Ym �k�!g EY�' Bcm am ^ rrr RMNAME H G cl 0,'1 A Lc(' U S C; c. c /rte I Gic' Of e C r 0 -------�-•--..•.•.�,..�,�.ua,.,.eaaazucasea,�,�gi� id plat RO' � on dfr pmrit appic�t fie! � � Please check one) Owner Apar I ID Above n tteb. t"1 Osttmatota of EmerV1C t .brim Battery PIRG ALARMS W of Zones Na of Detacdea and raidadea DwicaaNO- of SOuNNN Devlcea No. of `ocdoa oaz commcdom n"mirC_aJ �faoDrb Ra*E�tita�dVailredEbc"Wc* S Sri find / v LicirwNa Ae-- a Li mbb 7 2e L� i// Budnw liNa y ,� 3,�I- � ? S wicu W.1 AkTeLNa`>71 .53 7 -- Telephone No, PER1bRI' FEB 3 ok- IZ-�1-- po-n 0 0 Location "No.�% � Date/© NORTH TOWN OF NORTH ANDOVER p? •' • 0 VP Y F A Certificate of Occupancy $ s'•"° • Mus Eta' Building/Frame Permit Fee $ ncv. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 18715 Building Inspector I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING . ... .:.: .... BUILDING PERMIT NUMBER DATE ISSUED: SIGNATURE• Buildin Commissioner rofBuildin SECTION 1- SITE INFORMATION 1.1 Property Address: 1 5 v 1.2 Assessors'% d PAM4 Number. Map Number Parcel \'umber �Y0Qu�e r ,,tuck O N -4'S 1.3 Zoninglafomutiow Zonis Distrid hqwcd Use 1.4 Property Dimensions: Lot Area it 1.6 BUU.DING SETBACKS it -frontage Front Yard Side Yard Rear Yard Required Provide Rapired Provided ReqWred Provided 1.7fter SvM1yM.QLC.40. 54) 1.5. Flood ZomInfomution: 1.8 SewcrvVDis"lSystem: Pablie 11P"e, 11 Zone Outside Float Zone 0 Muokw 0 On Site MpmW System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record - IAwo � QI-� Name (Print) DO I ��� para eye Address for Service: b Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Si cure Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Licensed Construction Supervisor Address Signature Telephone Not Applicabl % License Expiration Date 3.2 Registered Home Improvement Co`ntr_actor,�j Tyk Not Applicable 0 Company Name Registration Number Address Expiration Date Si nature Te ne m X 9 04 z O LN z M 90 O M r r z 0 SECTION 4 - WORKERS COMPENSATION (11'LG:L C 152 6 2546) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes .......0 No ...... 13 SECTION 5 Desert tion of Pmoosed Work dww& V=Ne New Construction • ❑ Existing Building ❑ Repair(s) © Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Descrip ' of Proposed Work: 31-6 Ca r rQ SECTION 6 - ESTIMATED CONSTRUCTION COSTS , Item Estimated Cost (Dollar) to be WM41tt4a OIIGIAI.USEO�]LY 4& - Completed by permit appi cant 1. Building (a) Building Permit Fee Multitier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Pctmit fee (a) x- (b) 4 Mechanical (FIVAC 5 Fire Protection 6 Total 1+2+3+4+5 ® , o Check Number SEC'T'ION 7a OWNER AUTHORIZA ON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT HQ i as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matt five to work autgozedthis tl ' permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject prop�Y Hereby deq that the statements and information on the foregoing application are truce and accutr4te, to the best of my knowledge and belief Print Name Si azure of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 No 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 FELLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ■■ soon f■ ■■ ■■■■ ►■i 01001111 l IM7 ........ SUNROOM Open Storage Area 24-0" 14' 0" CURRENT VIEW 0 Lolly Column Support Pete & Darn Hall 191 Dara Drive North Andover, Ma. date: October 9, 2005 t , E-11 tj SUNROOM mim 3 Dc10 certyig Seem Open Storepe Area CURRENT FRONT VIEW Pete & Dawn Hall 191 Kara Drive North Andover, Ma. date: October 9, 2005 lolly column support CURRENT BACK VIEW Sunroom Florr Layout Sunroom backwall plan u 0 1 u SUNROONI (kderlor fmisM A fie rated Ametrock 2x12 Header Enclosed Garage � 2x8 canswcdon �o 14T' a'—�I Frost W8 PROPOSED FRONT VIEW Pete & Dawn Hall 191 Kara Drive North Andover, Ma. date: October 9, 2005 it, . K-- 6 cr—A FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION**.********************* APPLICANT_LQ_Wn PHONE c : 'baa ' I y1 b LOCATION: Assessor's Map Number PARCE&—' SUBDIVISION LOT (S) STREET YOA&)A ST. NUMBER I ************************************OFFICIAL USE ONLY*********************************** 29M. TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS Town of North Andover Building Department 400 Osgood Street North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE to - 12- - C) NORTN q ti 9 9SSACHUSF� JOB LOCATION ch RY-,6 IJ`(1U-P,_ Number Street Address n Section of Town "HOMEOWNER lq 1 KAY -6, )?VZ" Q -(0 E2 - 191 b Number I / Home Phone Work Phone PRESENT MAILING ADDRESS I �l I KCi rcL-0 rr %\-, e_ `Jo- ACA, lel City 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 that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building 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, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Di HOMEOWNER'S SIGNATURE .— e` 1.7-C�SL11 APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. if ccc 7 �-_ 4rDrE " s -•��-� � � _ �..� .�-� � c=am s:a� ==r;� ..�� mea -�„Gb �--- e^•�.Y ��" i= � .��^� ___ - @� �5''� �.e. cls: f� Y--te . -.: r.= -_-:caw. X03 ai s `.c e— e tx s _t ...� age. r Fs. _ _ � F A� In _ m - = F}sTrR Se'Sk,.,.%JkV tz r� s %Pm �s F. rr:'t�x z�iw3�� eati s6'1 �a€ r -Mt lo- u `&ri UK&�`� _ �s c 51 e t U E _ Y_ T VY ROYAL Saa b, WWRENICE, MA; 01841 Tek 0iF.�1rUf ase e �� --mr-a i C7 m -m Ivan spa 6� as€c¢r r. F'SEy'.ur-%seesA� O L 6a96eL-�E; CE+ BFalp�T�eE�v cK-Y F9€� xEF.6-�6 t 4 A if ccc 7 �-_ 4rDrE " s -•��-� � � _ �..� .�-� � c=am s:a� ==r;� ..�� mea -�„Gb �--- e^•�.Y ��" i= � .��^� ___ - @� �5''� �.e. cls: f� Y--te . -.: r.= -_-:caw. X03 ai s `.c e— e tx s _t ...� age. r Fs. _ _ � F A� In _ m - = F}sTrR Se'Sk,.,.%JkV tz r� s %Pm �s F. rr:'t�x z�iw3�� eati s6'1 �a€ r -Mt lo- u `&ri UK&�`� _ �s c e T if ccc 7 �-_ 4rDrE " s -•��-� � � _ �..� .�-� � c=am s:a� ==r;� ..�� mea -�„Gb �--- e^•�.Y ��" i= � .��^� ___ - @� �5''� �.e. cls: f� Y--te . -.: r.= -_-:caw. X03 ai s `.c e— e tx s _t ...� age. r Fs. _ _ � F A� In _ m - = F}sTrR Se'Sk,.,.%JkV tz r� s %Pm �s F. rr:'t�x z�iw3�� eati s6'1 �a€ r -Mt lo- u `&ri UK&�`� _ �s c 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: "ct '6n,fA 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 I OA. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date 3 5 24' Date .. err...... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION I� / This certifies that :. ......... ......... _ :. has permission for gas installation .......... in the buildings of ..�,�� /�,��- � � ............ ............. . at / 1! .. �!-.' ' ......... North Andover, Mass. Fee..:..... Lic. Nof�,...%�......... GAS INSPECTOR• WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Priv or Type) 1 N nC� Mass. Date Permit # _ Building Location��(!�q_ D D Own s Name e"" ype of Occupancy G New ❑ Renovation O O Plans Submitted: Yes❑ No ❑ Installing C/omppz Name .}- 4 IM II Address % (o f Business Telephone 7OP-1' -i.>70 Check one: ❑ Corporation �artnership ❑ Firm/ Certificate Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a curre t li y insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked res, please indic e type coverage b checking the Yp g Y 9 appropriate box. A liability insurance policy Other type of indemnity ❑ Bond n 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 waives this requirement. Check one: Signature of Owner or Owners Agent Owner:] Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in abov pplication are t a d ac r o the best of my knowledge and that all plumbing work and installations performed under the permit iss or this a plic on e o liance wit I pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the G I laws. EBY Type of License. Title 1 Plumber Signature of Vicen Gasfitter mbar or Gas Fitter City/Town Master License Number [ APPROVED 0 FIC US NLY Journeyman r N _ N ¢ W�q N frf ¢ Ln H ¢ Y V Z X. ¢ } to T V 6.1 Uj J N W Q m ~ Q Lj~ F Q Q ¢ > ¢ = O Z O r C W ¢ N m N O W l'- < W 2 = O �- � , a O C ` q F R �) W W N J Z Q LLJ y ¢ 2 W Q W H W . w S C7 Z !- a Z W J F' Z F W W O > Z W O ?-- U J tN, W Q ¢ W> 2 0 ¢ c7 W 2 ti M Q 3 ¢< a O m e Z > c O N h- S p a O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR I 4TH FLOOR 5TH FLOOR 6TH FLOOR 7THFLOOR 8TH FLOOR Installing C/omppz Name .}- 4 IM II Address % (o f Business Telephone 7OP-1' -i.>70 Check one: ❑ Corporation �artnership ❑ Firm/ Certificate Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a curre t li y insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked res, please indic e type coverage b checking the Yp g Y 9 appropriate box. A liability insurance policy Other type of indemnity ❑ Bond n 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 waives this requirement. Check one: Signature of Owner or Owners Agent Owner:] Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in abov pplication are t a d ac r o the best of my knowledge and that all plumbing work and installations performed under the permit iss or this a plic on e o liance wit I pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the G I laws. EBY Type of License. Title 1 Plumber Signature of Vicen Gasfitter mbar or Gas Fitter City/Town Master License Number [ APPROVED 0 FIC US NLY Journeyman r Location / ?/ 16 h A D /� No. 3s(- Date N�RTh TOWN OF NORTH ANDOVER _ O F � 9 � y _ Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ d s�cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check # P i f v 1 wilding Inspector 7-10101.9'.q-61JoT0600-� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING h. u,.�. _ '`": .,,fie Y5 -. ,.>,...,. ,..,'; an�+ =„ y ,:: - .. ✓:� x,. r :. �"S ��:+, ..'�ctx ;�, a%�T •.:u` BUILDING PERMIT NUMBER: DATE ISSUED: (!� SIGNATURE: AN) Building Commissi ner/Ifor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1 � 6+44 I>A OF- 1.2 Assessors Map and Parcel Number: q94- 10 Map Number Parcel Number p * �Jt dDa L, /'�/? �I � (Zoning 1.3 Information: Zoning District Proposed Use 1.4 Property Dimensions: -1 Ed 5r— Lot Ar s 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 ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: h—, D� w Licensed{Construction Supervisor: V�,Q ����, �'�� Addre s t §,ign'aturt Telephone Not Applicable ❑ � ®�Z 3 z_ License Number V / +/zo0�' Expiration Date 3.2 Registered Home Improvement Contractor �%GI13L4 Not Applicable ❑ / Company Name Registration Number Ad ss �tD ExpiratiA Da Si ature Telephone 09 M X O Z M 90 O Mn r v M r r_ Z Y/ SECTION 4 - WORKERS COMPENSATION (AG.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 ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: ` jq ^' , —0'4, f ' (ffoo V- Pkl�0 V���G� J l (56L<> nn 1::w SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed bypermit applicant OFFICIAL iTE" ONLY _.2it 1. Building (a) ingermFee Multiplier 2 Electrical/; �UV (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (8) X tbl 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Z$ Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN -T OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH DING 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 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 ++__ __ �� r" 7 Print N�a;� -71-24 D4 Si ature of caner/A ent Date NO. OF STORIES SIZE ' BASEMENT OR SLAB SIZE OF FLOOR TIMBERS in 2ND 3 RD 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations , Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone F7am a homeowner performing all work myself. F7I am a sole proprietor and have no one working in any capacity (lam an employer providing workers' compensation for my employees working on this job. Company name: A2 VEIE5 Vz!�S LGi4A �jGc l� . leiC _ Address t&rM0tA + Phone #: Insurance Co. tC� �`�'Dr'�it Policy # Je6G D 024") Company name: Address City: Phone#: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Z Si nd correct Date Z27 �G Print name Phone # Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A- ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION x BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR } Number: CS 068232 Birthdate: 02/14/1962 Expires: 02/14/2002 Tr. n0: 17701 rw �u oc.tcd T0: 00 STEPHEN D HOWELL 15 MT VERNON RD BOXFORD, MA 01921 Administrator -6174, c na rt�f a�qs uie✓I i I HOME IMPROVEMENT CONTRACTOR Re,zstration 123,137 Type - OBA EXPiratWn 01/10/01 HOWELL DESIGN & BUILD T HEN 0. HOWELL i ADMINISTRATOR MT • VERNON RD I BOJ(EORD NA 01921 I `-E1E FO1LL : II1d1E P. 1%1 Jun_24 '94 10:9B Uk:- SPFAX?00 soriQs P. 4 1 OATGAGE PLOT PLAN EK SURVEY 17 ROYAL STREET; LAWRENCE, MA. 01941 Tel. 508--875-1413 MORTOACOR DEED REF. 29x7 PG, x rz ADDRESS OF PRI40PLE WILDING PLAN REF. /Z JTJ DATE OF INSPECTION & I -or 7 s 4, N� I— or z A 9 yg.sdl' Mve . . NOIlrr ThL rnertgope hspno clilcAly form vas pr rid :h 1 FSAIYi" 9AIE THAT IN MY PR ONAL 1ON 1M pogo purlwand be toned up�on ON d on")% no! to EK SUW&y e"tv �' pNn 1 trvopx% and ancarrory nu et eutbul141npy �ONfBt M urno of 1MIIof1C41by lIftydn) is ether �j Y Ya+ and Itti tv eawvaq tM I mat a Nth Ltd �aep with Me Whack rrquktmmth of t' :antnp ardnotoay and Ilwt no t S Niamwjm morlpept Mv�elnp to sold e+ipoper. 613.0 of r uq- improwmanto olthoe tto oa000 NM 1�ao�a property Itnes wompt an w6o"% y t:lNT1fICATtON 70; , .f1�s b lhir cyrtlfleetlen N bawd o ...�,VAI rl. ?top" go' not In a Flood lkmm Area. Ar+a. the Iocal;lon of � Inmkera O& Inf"OtIon ropwtj is b hrufAddonl v1 aihonr, and dear net .•froetr Chown on not to br tod .hood Hosard t a prop.rly v*")L therefore flood Ik=rd dewminod *Im ver flowvd" Flood hood ta;iho �+1abll►Aft+Kr! of pre4Nly Ilh�r. Inouronca Rdto Wap Panol f 2.'J'pp90 - OtAw#6 93 cl N rc CY) of O c� a cr uj > F- ��� � mLLLL.. wox0 Q LO x T I3 J 3 i i 15�MOUN. Ty'E �1O D �B�CFR6; 169 - - -- -- - Ij I I I tij 1 � U y, rr 2 .� �f0 r. 1 �¢ x W4 A w° a cn 0 w z w° wp' :C U m a x 0 w ap' is G w a ° u W cn m G t=. U � GO z p G ir. H w A C cA W p cn sol C v o � C _O HC V V d C ev � �= O • y-' y.r m cc Ear m C� o n y C _ ItCO +• C 3 O. = L. mcg, m co O ,: N h vs �3 — m �Cc : C CA O OC `Ian` 75m N m `Oj cc 1.=z O cm H O c"5 m I; i.i y O c•CZ o cc o o c CL H m h O C C C. ♦O.. y m�O,~ m Z W O y.. C H. M CL Z � p , m y . O L) .m o m c S V� O� CL O� = A a c y 0 O Z .0 CL= m R' O cm H H caO m r.7 COD 0 O V 'd. CO3 O cc C _cc d CO2 L v CD C. CO) C CO CM G O •C D � m m 0 U) w w ccw U) ..,rte.. �. ,��. �..:. y."r.,,,a s��r„ti _ • � r. _. _ �. _ � _ __.__� Po _ � X.. y Location/ x. �No. aDate `� 6 NORTH TOWN OF NORTH ANDOVER V O:t6IO O� • ' - e �? Certificate`orf Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ SACMUS� 4. N,JW a 5As Permit Fee $ . Sewer Connection Fee $ t Water Connection Fee $ TOTAL12 c' Building Inspector 2 7223 Div. Public Works !q - _. ..�,�,r•---.,-. -�.-. _.._� r �----rsr..-l- � -ti's.... -.s-�-.-w. rY v.-- . v--..... - ti w-....-� - --'� a.-.. I- Location No. Date ba /W F ^`- 7076 :x TOWN OF NORTH ANDOVER Certificate of Occupancy $ 3 /7 19y{ Building/Frame Permit Fee $ry, 5 .+'�3 1folo Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ 3 1 9V Water Connection Fee $ k► TOTAL ,Building Inspector f Div. Public. Works �,.4 msµ,- i• �_ 1 Loca :No Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ c -)I - U C,) Building/Frame Permit Fee $ Foundation Permit Fee * Other Permit Fee •-Sewer Connection Fee .Water Connection Fee TOTAL $ `Q . Building Inspector Div. Public Works ti Location No. Date IZ--1 43 Nom,. T0W�V OF NORTH ANDOVER Certificate of Occu $ Buildirm 1 ermit .Fee $ Foundat,erfnit Fee $ I Other Permit Fee $ Sewer Connection Fee $ ./M2 Water Connection Fee $ 490 TOTAL $ G _ B Insp pttor� Div. fubl)c Works 'PER3IIT rJO.�T`� APPLICATION FOR PERMIT TO BUILD —NORTH ANDOVER, MASS., �`, �j G� I t PAGE 1 X MAP iJO. I LOT NO.-� 2 RECORD OF OWNERSHIP iDATE (BOOK 'PAGE ZONE SUB DIV. LOT NO LoCAT16N N PURPOSE OF BUILDING to use OWNER'S NAM NO. OF STORIES SIZE S OWNER'S ADDRESS u BASEMENT R SLAB . ARCH ITECT'SLNAME �C. SIZE OF FLOOR TIMBERS IST r_)Q 2ND �< lo 8RD !! ll BUILDER -S NAME SPAN j DISTANCE TO NEAREST BUILDING ,pe( f 42 ` DIMENSIONS OF SILLS DISTANCE FROM STREET - M 5A / (21 " POSTS A %� f7"/l0 DISTANCE FROM LOT LINES - SIDES ��REAR GIRDERS AREA OF LOT C)�/ �'1 + FRONTAGE HEIGHT OF FOUNDATION /i �( THICKNESS `Q Ti IS BUILDING NEW >�l� / Y` SIZE OF FOOTING f X IS BUILDING ADDITION �I� �./E MATERIAL OF CHIMNEY tt IS BUILDING ALTERATION If� IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER i /� L' BOARD OF APPEALS ACTION. IF ANY p�� ,y-- VVl►� IS BUILDING CONNECTED TO TOWN SEWER r S i f IS BUILDING CONNECTED TO NATURAL GAS LINE f . /es INSTRUCTIONS SEE BOTH SIDES ��}��#� PAGE 1 FILL OUT SECTIONS 1 - 3 {mor PAGE 2 FILL OUT SECTIONS 1 - 12 IDMi MME PERMIT. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING u,� i1iH/�liGf�1 D /� ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR FEE4w, PERMIT GRANTED f _ 19 r f , FEB 2 8 1 J` i I" 0iNJG©EPARTMEN s PROPERTY INFORMATION LAND COST EST. BLDG. COSTO) lid / EST. BLDG. COST PE i SQ. FT. f� EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN Zy/ �V�W�nV �lrir6(r`fOR 1 OCCUPANCY SINGLE FAMILY I S"OR IES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE IZ�l__ la I' UNFIN. 3 BASEMENT AREA FULL N. B'M'TAREA _ 1/1 1/1 1/. -1I FIN. ATTIC AREA t • ,1 0 � f BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT- AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. NO BMT FIRE PLACES / HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 �_ 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW0 _ ASBESTOS SIDING _ COMbAC;N VERT. SIDING ASPH. TIL STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR BRICK ON FRAME CONN. OR CINDERw.+ '""""" A �#i� STONE ON MASONRYY WIRING • • -+ w w. s .� +� STONE ON FRAME _ -Ft• q at '4td4 Ric SUPERIOR POOR111`,1' ADEQUATE NONE I� 5 ROOF 10 PLUMBING GABLE GAMBREL � MANSARD �I TOILET3RMx 12 FIX.) I� R TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPE LESS FURNACE _ FORCED HOT AIR FUI TIMBER BMS. 6 COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPO WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T I 2nd _ ELECTRIC 1st 13rd I NO HEATING FORM U - LOT RELEASE FORM ' INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departmelts having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state lav, regulations or requirements. ****************Applican,,t, fills out this section***************** APPLICANT: D c. - /Ex[ Phone L/ 70/09 LOCATION: Assessor's Map Number Parcel Subdivision Lots) Street Kk aite - St. Number 1 / ************************Official use Only************************ RECO2UMNDATIONS OF TOWN AGENTS: Data Approved2 Adm - Conservation inistrator Date Rejected 4 Comments 41fil f n Data Approved To Planner Data Rejected Comments �f Data Approved �1 /ZZ/ - Healt:� Agent Date Rejected Comments Public Worcs - sewer/water connections - driveway pe=it L 551/. Z I Fire Department'/L' Received by Building Inspector Date i 41 _o v, o �1 o � ,89'LL 6.Si S I � � Z �2 �o y Aw o` �o I�o 2 O ��s s 2 O i 41 _o v, o �1 o � ,89'LL 6.Si S I Is 93063003 L 0 T 1 ■ s �2 �o y Aw o` �o I�o 2 CAR �l" A wre b' O Is 93063003 L 0 T 1 ■ s 4N w w A 0 x o r ° v n cn o w � z z A w° `y0= m= 3 c U `° c w w z � °a° C4 M x a w7 a � w W °�° o 0� > v cn ro X x 0 w a � n7n o c4 m r w z W A G r� °' cn o cn rb W M CD uj 0.z z A 5 co 0 o a m `y0= m= 3 x H m N m W O+=+�.0 c L O •N intC W •E = 4- f3 -.p v o, ES m ooc CIO n Go m O m F- cc s S n m' 5 J z LL z 0 a W U) z 0 U of oc W F- 2-7 LU a W 0 J z w W U) co 0 E L O C3 Z COCL ._,CIO G C C_ C CO) O CO2 c C U �E m m OCS o w O. CL I.- CD O L CL) �4)CDO ►-�r Q �..� 3 C d CL cmQ CO2 C a� c 4-0 cc� C 'a o W Z CO O d U 0 CD CO) c C O CO2 0 J z LL z 0 a W U) z 0 U of oc W F- 2-7 LU a W 0 J z w W U) 111111.1)ING (:()N I :I (VA'1'1()N I I I ii\ 1: I'I 1 Town of N01UlI A N1)0VE 111VViI11N 111� 1'1.i1,NN1N(;. & (;t) ir%ll!Nl'1'1' 1)1;1'1;I.Ul'l111?N'1' 'ATE )CATION I:: HWN' I I.P. NI :I tiON. I )Il tl :(: I (M CHIAINCY APDL I CA f I ON ANO 1113111* 1.,!i I Moil I `:llui •1 hl. ��;�c ii Fri ��,� •}I': � I l }1.1 0 It UNER'S NAME: j 1ILDER'S NAME: ' ' ' 0OC-06-e iSON' S NAME: kSON'S ADDRESS: 47-1;&N.9d.cJ D � �, t6Y ©3O79 tSON'S TELEPHONE: e? 3 TERIAL OF CHIMNEY: ,8k/CK irERIOR CHIMNEY: �R (CK EXIERIOR CHIMNEY: 6,eIc l< II�IBER AND SIZE OF FLUES: II CKNESS OF HEARTH: : U chini >.ey OIL 6i,%epeaee ean(loAm to Vie AC(iU.V10110143 U( -0LC CVdV- a11d IWVC -u}CC.3 (lied :gu,eati.om been ucebed: yC5. -- -- .TE: ' 7-1/v ' .GNATURE OF MASON: i :Rh1IT GRANTED: 'BERT NICETTA ILDING INSPECTOR FE E :SPECTEU: :A44RKS: _ SOLill BLOCK HQUIREA) THIS PERMIT I,ILISF GE VISPLAVLO 014 ME I'KH11sLs CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 040 THIS CERTIFIES THAT IFIMMINWOMW. THE BUILDING LOCATED ON Lot #1 KAM DRIVE (1191) MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR GARAGE. IN ACCORDANCE WITH. THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Oak Trust 401 Andover St. ADDRESS Building Inspector O/ !z �Q P U' H O U W uml O ..z . CD O Co 0 Z O 0 y LA .E Q O V _Q CL y O O V .CL C4 C O !d cc CIO 0 El cc U.j Z ~L o R � L co Q O r' Q. cma Q *"c C J cc Z �\Q CO) C z z z J F- 77 w 00 x O fc z3 z �zz� z w`r pw i �4 -10 " d 7 G \ ~ f9 W> io r C O O v �O U O G O y O a cn t% O 0 aj 7 cc cn cn !z �Q P U' H O U W uml O ..z . CD O Co 0 Z O 0 y LA .E Q O V _Q CL y O O V .CL C4 C O !d cc CIO 0 El cc U.j Z ~L o R � L co Q O r' Q. cma Q *"c C J cc Z �\Q CO) C z z z J F- 77 w i n �.n- -1 t �yyC v1 11 2or0 ?RtZ�2�� yyrlto�� t` X02 00 �y�� Op�r j C O � a Cn 2Z�+a � 2 O"I C7 may ��yz Zayn N rnitCO nynHyy �a y rzZZ2Z�:,dT OCN50 2r_y to O y a 'Mn U) 50 0 2 a 0 w� 04fLn '�o� °�o oa p o�oZ �Kl s: C) `+° `' <z 14 —rvl Cz O rn p� �`a0�O0 :kD'_VjZC Z o o aN to 50 N c�(4'�' oZz°z Y " � YN. F yC` •O' `:`�®'ten : �yn�� �► � C. 3s 11 0 O �.y � n 0 O r 0 O Z m r DWG .NO. -93063008- 7 .. ; s -: a a. •s j' ..p. i n �.n- -1 t �yyC v1 11 2or0 ?RtZ�2�� yyrlto�� t` X02 00 �y�� Op�r j C O � a Cn 2Z�+a � 2 O"I C7 may ��yz Zayn N rnitCO nynHyy �a y rzZZ2Z�:,dT OCN50 2r_y to O y a 'Mn U) 50 0 2 a 0 w� 04fLn '�o� °�o oa p o�oZ �Kl s: C) `+° `' <z 14 —rvl Cz O rn p� �`a0�O0 :kD'_VjZC Z o o aN to 50 N c�(4'�' oZz°z Y " � YN. F yC` •O' `:`�®'ten : �yn�� �► � C. 3s 11 0 O �.y � n 0 O r 0 O Z m r DWG .NO. -93063008- Date ......... �'....... Q. 5.. •4 _ t M TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....:> P' � .:.... � '(,t� C C .. ....................................... has permission to perform .....'.(. S ` �,A S �14t �c . ............................................................ wiring in the building of ......T'(` p� N U /S it .................................................................. . KA d .................. . North Andover, Mass. ..... Lic. No. ..... r� u #� ..`� . c (c v L --.- Check , . Fee ............. ............. ................. : p ........................ _ ELECTRICAL INSPECTOR Check # � '� � `r 5746 I rM WIVEVIUIv YYL'.l" n vr iY&u3 arxt,nv.u.� -� �- �• , DEPARTY ENTOFPUBMSAFEIY permit No. BOARDOFFIREPREV&M0NRHX3ULAT70NSR7(.fiaIle12.OID JOccupancy & Fees Checked APPLICATTONFOR PERMITTO P (S2STSMELECTRIC U WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSA ECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the Location (Street & Number) / / / Owner or Tenant t' Ce s -6 A) 1 z, Owner's Address 2 Is this permit in conjunction with a building permit: Purpose of Building S, ;L Existing Service .� Amps//0 Volts New Service I Amps Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work work d6scribed below. es No a To the Inspector of Wires: (Check Appropriate Box) Utility Authorization No. 04rhead [D Underground M No. of Meters Overhead ED Underground Im No. of Meters No. of Lighting Outlets j No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets /_5 No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets _ - No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total . Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis *No. Hydro Massage Tubs No. of Motors Total HP COTHER- hmattanoeCoverage. Pu[Mt1Ddr gtmema0ofMassachuseflsGmaalLaws IhaNeaa=tLmbkykt%=oeR)kyoxWmCaq)i* C.omWcrzmbstatia cWzyaiart YES NO Ifinest t nbadvafidptoofal=wlDtheOliice YES j�� rycuhawdrd®dYES,pleasedtegp ofcoYeaFby cheddrglheapptu INSURANCE BOND 0111ER ( y) F�aiolbcrtDale Es=abdVairdE1XhJcal Wdk $ WodcbStatt kWecfimDa*Req-,,d >� Fitlal Stgwurldar cRnaltimofti FIRMNAME !i t�M BGG% e� e (G.� U IloaneNa G o2 02 4 Licanee e /7 L1% ,y /�_P C� e_G G Sim !U Limw?go 7,' U � / / Busk=Td Na �l /S l3cGc-A-10 n) �P lV9-tie^41// /,W- C2 / i.34 AIL TdNo. ONVT,WSINSURANCEWAIVER;IamawarethattheLin wdoesTrothavethem ummcoveragecritsabsulWegtuvalentasl g=DdbyMasmdlu =GataalLaws andthatmyagrranernftparmgplicabmwaivesdaisopi a mai (Please check one) Owner � Agent El 1 Telephone No. PERMIT FEE $ signature of Owner Of gen r Location I 7e%.t ffA P,4 >?. No. 6 / 6 Date 6- e�5- ^9:D 5- No�Th TOWN OF NORTH ANDOVER L • Certificate of Occupancy $ t Building/Frame Permit Fee $ l S cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1 8 1 8 5 Building ITspector JIM t ULVILVIUIV VVrMAJ 17 Ur lY/liah]t1ti.LivJLiL i � �•• w -,/� •/ DF.PAR1Y EWOFPUBIICSAFEIY Permit No. ✓� 7 b BOARDOFFIREPREVFIMONRE(3ULA770NSS17a&120 JOccupancy & Fees Checked APPUCATION FOR PERMUTO PERFORMELECTRIC.AL WORK 0ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 �J Y j (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �Q Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 19 /� �j�� Oe. 1y� •- ,"*. Owner or Tenant re � q Owner's Address 9 Is this permit in conjunction with a building permit: Purpose of Building Si r7 JP _ ' L Existing Service : U Amps Yes No (Check Appropriate Box) t e. / Utility Authorization No. Volts 0 erhead a Underground [D No. of Meters New Service Amps t -Volts Overhead L_J Underground L_J No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets j No. of Hot Tubs No. of Transformers Total TVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No. of Receptacle Outlets /5 No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons Jo. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis �No. Hydro Massage Tubs No. of Motors Total HP PUmnoo dle i:rri a�dpvWpMdcf=W10 heOffica YES C p 4NCE La BOM EJ alli R rJ Start �` 7 – US hspec�mDaleRet}le�d )\\lp a,4Gcl 1/ 6e6i ' 1J -f'_ Ci c.-;. C. Signa lm alait . YES M NO M IfymhavedodWYES,pleas nicmdry x(lfw, gby I• `;;r,� Estirn*dValueofElmftxal W(jk $ Rough Furl C> G Limw% /7 G oZ 4 Gu L;�erlo 1BusmessTbl Na 17 3 ADZ cF' 7 S /�S G`GL kff�,iy a %%/V- C2 % j.34 ALTUNo. R'SINSURANCEWANIIRIandawarethattheLmmdoesnahavetheinamneavuWcritsmb9altialegivW=astepWby >seltsGenWIaws my signalute on this panic application waives this tegtmarlat check one) Owner 1:3 Agent Telephone No. PERMIT FEE $ k&to g,c.! B 6c S la- d7 i� 0 0 0 Office Use Only 3 Obi l':IIIItmuntUEttlo lif Permit No. y + Occupancy A Fee Checked fif' 3/90 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (X* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permittoperform the electrical work described below. Location (Street & Number) l 7 IZ4R—A Owner or Tenant 000(( 14'6--� C -,ON sT . Owner's Address y0 ���Of/� 57 Is this permit in conjunction with a building permit Purpose of Buiidino Existing Service Amos Volts New Service Amps _I Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Hot Tubs Yes C No ❑ (Check Appropriate Box) Utility Authorization No. Overhead U Undgrnd El No. of Meters Overhead E, Undgrnd C No. of Meters Above— In - Swimming Pool r,rnri I ornd. r Total No. of Transformers KVA Generators KVA OTHER: INSURANCE CCVERAGE: Pursuant to the requirements of Massachusetts general Laws YES _ NO I have a current Liability Insurance Policy including Comoieted Operations Coverage or its substantial eauivaient. _ I have submitted valid proof of same to the Office. YES _ NO _ If you have checKed YES, please indicate the type of coverage by checking the apprr late box. INSURANCE ? BCND - OTHER __ (Please Sceca`/) (Expiration Date) 2 Estimated Value of Elect I Work 5 Qom, / Final WorK to Start % Inspection Date R.ecuested: Rough Signed under the Penalties of perjury: , Y C A n r�� j / C_ AX0K c/W1 C- U i yy ""__ , 11 09 tic. NO. FIRM NAME t� D Licensee c� � STvi/TSR r/Csw � , Signature LIC. NO. s. Tel. No. Alt. Tel. No. Address OWNER'S INSURANCE WAIVER: I am aware that the Licensee toes not have the insurance coverage or its substantial eduivalent as re- ouired by Massachusetts General Laws. and that my signature on this permit application waives this reautrement. Owner (—� Agent (Please checK one) Telephone No. PERMIT FEE S (Signature of owner or Adentl X_65A No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Ranges Total No. of Air Cond. tons Heat Total Total No. of Disoosals No.of Pumos Tons KW No. of Self Contained No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices Munic:oai r--� Other Local Connection _ No. of Dryers Heating Devices KW Low Voltage wiring • S� No. of Water Heaters KW No. of No. of I Signs Sailasts No. Hvdro Massage Tubs No. of Motors Total HP OTHER: INSURANCE CCVERAGE: Pursuant to the requirements of Massachusetts general Laws YES _ NO I have a current Liability Insurance Policy including Comoieted Operations Coverage or its substantial eauivaient. _ I have submitted valid proof of same to the Office. YES _ NO _ If you have checKed YES, please indicate the type of coverage by checking the apprr late box. INSURANCE ? BCND - OTHER __ (Please Sceca`/) (Expiration Date) 2 Estimated Value of Elect I Work 5 Qom, / Final WorK to Start % Inspection Date R.ecuested: Rough Signed under the Penalties of perjury: , Y C A n r�� j / C_ AX0K c/W1 C- U i yy ""__ , 11 09 tic. NO. FIRM NAME t� D Licensee c� � STvi/TSR r/Csw � , Signature LIC. NO. s. Tel. No. Alt. Tel. No. Address OWNER'S INSURANCE WAIVER: I am aware that the Licensee toes not have the insurance coverage or its substantial eduivalent as re- ouired by Massachusetts General Laws. and that my signature on this permit application waives this reautrement. Owner (—� Agent (Please checK one) Telephone No. PERMIT FEE S (Signature of owner or Adentl X_65A Date. %`... fM ... . TOWN OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION This certifies that .. a .................... . has permission for gas installation in the buildings, of... ..... ............................. at North Andover, Mass. Fee?. Lic. No.A6_11.. _...��PEe ...... •` Check #�— v 5116 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FTMNG 10 (Type or print) Date � V NORTH ANDOVER, MASSACHUSETTS Building Locations L Ae- 71e, 4- bq L/-/ /v Abtl- ow New 0 Renovation �� Replacement Plans Submitted ❑ Permit # v �� Amount $ (Print or type) Name Address t 3 smess Telephone �3 6 Name of Licensed Plumb as Fitter !s/ Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate a type coverage by checking the appropriate box. ❑ Liability insurance policy � 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and mtormatton i nave suomrrreo for enrcrcu) in avvvc app l—LIv„ axc uuc ax— --- L„ Ll - 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) Si ure of 1 fflu ber as Fitter aster 1-1 _Journeyman •AST. ' FL60R =7TH. ������������������� r M ,5TH. FLOOR OR (Print or type) Name Address t 3 smess Telephone �3 6 Name of Licensed Plumb as Fitter !s/ Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate a type coverage by checking the appropriate box. ❑ Liability insurance policy � 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and mtormatton i nave suomrrreo for enrcrcu) in avvvc app l—LIv„ axc uuc ax— --- L„ Ll - 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) Si ure of 1 fflu ber as Fitter aster 1-1 _Journeyman Date ..... ...............:............... a �0- TOWN OF NORTH ANDOVER p PERMIT FOR WIRING Thiscertifies that.................:...............................................:........................... has permission to perform ......................, r h !..r..:. ,......................... j t wiring in the building of f 1 r r at ........1. ..... ......::. tNorth Andover Mass. i................................ , � r Fee:.:....:.... ''" ... Lic. No..:..:..................................................................... j s�� ELECTRICAL INSPECTOR 02/01/9514:16 20.00 PAID WRITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File ;, A TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,w BUILDING PERMIT NUMBER: / / DATE ISSUED: SIGNATURE: C� Building Commissioner/I for of Buildings Date ,lN CTIUN I- Jl 1 E IN VOR MA I JUN 1.1 Property Address: 1.2 Assessors Map and Parcel Number C?PD 4 y� Map Number Parcel Number K U 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronto ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReclWred Provided 1.7 Water SupplyM.G.L.C.40. 54) Pablk 0 Primate 0 Zone 1.3. Flood Zane Information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSE IP/AUTHORIZED AGENT n %� {: �iSti jCt; fir. 2.1 Owner of Record N t) Address for Service ig ature Telephone 2.2 Owner of Record: AJ Name Print Address for /Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 R'3egistered Home Improvement Contractor .i Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (KG.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. Si ed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proosed Work check ad applicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Rion 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: I QFCTION 6 - F.STTMATF.D CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY , 1. Building 1t� /t9 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 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 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 ot'Owner SECTION 7b OWNER/, , Date 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 Print Name of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2qu 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHD NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f NaRTH , TOWN OF NORTH ANDOVER OFFICE OF p BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 D. Robert Nicetta, Building Commissioner HOMEOWNER LICENSE EXEMPTION Please print DATE: Telephone (978) 688-95454 Fax (978)688-9542 JOB LOCATION: 1 � 1 jAu n, - r► ve— Number Street Address Map/Lot HOMEOWNER D Q wY l -�'� (e 6 bIl 1-� LL � . - r y l � 4 - (�9/ 3 �D D Name Home Phone Work Phone PRESENT MAILING ADDRESS 11 9) KQ ra. _D Y I\/C- dor- -�A_ A co ov k_ t Ct. O 1 Ns - City s - City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. 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. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL II0.%RDOF. UTEALS6X8-9541 CONSERVATION 98-9530 IIF:.V:f1I68X-9540 PLANNING 689-9535 4 W ® c O a ' O �. All n'o d C O W V= s 4D ` �E`Q om� W. O O �mc E N W � L. IE ycp Zz. z y ;�3 m y :Z cc y O y O� m 0 ao CD �A ymm aC •z w.'oo cm CO3 m CO3 C3 Z o cm co C c a c C mc c = m :ago Nc COD y m8~ _ cw, a' pyO Hm�1A Ct�== d.=..m > Q M� w P1 E z 0 y co MA E a) O v ev a h O to CA 0 cc C CL. (A CM C CDm 3� �+ CD o` CL o a C Q gyp=••• C J cc 'C Ci z s CDCLy C LLI Y/ LU 0 C9 W W C9 W U) o w a a w w a � ) U w a°' w pG w ex w rA A cn W ® c O a ' O �. All n'o d C O W V= s 4D ` �E`Q om� W. O O �mc E N W � L. IE ycp Zz. z y ;�3 m y :Z cc y O y O� m 0 ao CD �A ymm aC •z w.'oo cm CO3 m CO3 C3 Z o cm co C c a c C mc c = m :ago Nc COD y m8~ _ cw, a' pyO Hm�1A Ct�== d.=..m > Q M� w P1 E z 0 y co MA E a) O v ev a h O to CA 0 cc C CL. (A CM C CDm 3� �+ CD o` CL o a C Q gyp=••• C J cc 'C Ci z s CDCLy C LLI Y/ LU 0 C9 W W C9 W U) TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... FA. �.... P.4l ►.S ......... has permission to perform ..... fkc&. v9 f rt `: plumbing in the buildings of..1 tom?!. �......................... at !'............ , North Andover, Mass. 1.} Fee ... %. i �.. Lic. No..�/..)�/i . •tiu���....... . P UMBING INSPECTOR Check # g6 1 6451 W Building MASSACHUSETTS UNIFORM of New 1:1 Renovation 1:1 Replacement FIXTURES CATION FOR PERMIT TO DO PLUMBING Date Permit Amount S"7 e.5. Plans Submitted Yes 11 No (Print or type) Q , Check one: Certificate Installing Company Name I JU /"f7/t' / ��j l Corp. Address /�-�C/T f/�d C�� C� Partner. Business Telephone �� (� 3 3613 Q 97 Firm/Co. Name of Licensed Plumber: )qy p A?9 te ! s 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 Signature IOwner 11 Agent M 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 Massachuse St to P bing Chapter 142 of the General Laws. By: Signature icense a Flurnoor Title Type of Plumbing License City/TownPPRO License NumDer Master [?],--/Journeyman PROVED (OFFICE USE ONLY