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HomeMy WebLinkAboutMiscellaneous - 20 FERNCROFT CIRCLE 4/30/2018 (2) 20 FERNCROFT CIRCLE 210/103.0-0100-0000.0 ® The Commerce Insurance Company1m MAPFRE Citation Insurance Companysm 11 Gore Road,Webster,Massachusetts 01570 INSURANCE 508.949.15001 www.mapfreinsurance.com July 21, 2016 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: JONATHAN LAFLAMME/KAILEY LAFLAMME Property Address: 20 FERNCROFT CIRCLE Policyk BGDTWP Date of Loss: 07/21/2016 Filek MPKK21-KHWJJ9 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. KELLY CHAUSSE Telephone: (508)949-1500 Ext: 15830 Claim Representative I, Property Toll Free: 1-800-221-1605, Ext: 15830 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. July 21, 2016 CIC 254 (Rev.4/95) MAIL V93 Date d1v..v.. ........i .................. TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ...... .. .... (f ...... ................................ ..........................(�............................ has permission to perform .........&.4 Wk r—ot" .............. wiring in the building of......;.Ul ..........(..m.. .................................................... at ........... .......61(L' rth Andover,Mass. ................................AIF ,I 1)�Ae-e Lic.No. ...... .. ......... .......... ............................ .. ......... ELECTRICAL INSPECTOR -Check# r i Commonwealth of Massachusetts Official Use Qnly Department of Fire Services Permit No. I Occupancy and Fee Checked • BOARD OF FIRE PREVENTION REGULATIONS [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 ININK OR TYPE ALL.INFORMATIOl 9 Date: a 14 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) 1P,2f n G c© C� G l Owner or Tenant s Lot vd % (-at v Telephone No. Owner's Address a ir)C ro(k- C cd-e_- Is this permit in conjunction with a building permit? Yes .9 No ❑ (Check Appropriate Box) Purpose of Building &M m/M Utility Authorization No. A41 Ile—, Existing Service,�-O0 Amps /'d 0 / ;7 VO Volts Overhead,] Undgrd❑ No.of Meters New Service ! 19 Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical W rk: W l r-i n c,-/S Aec,-/ sPX AN Vj f rr"H .fid i!'C 1, (3 Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed LuminairesN No.of Cell:Susp.(Paddle)Fans No.of Total �A Transformers KVA No.of Luminaire Outlets / No.of Hot Tubs Generators KVA • No.of Luminaires N�'a Swimming Pool Above ❑ In- ❑ o.o mergency Lighting rnd. r d. Batter Units No.of Receptacle Outlets No.of Oil Bur�ers / FIRE ALARMS No. f Zo es No.of Switches No.of Gas Burnrs No.of Detection and Initiating Devices Tot No.of RangesNo.of Air Cond. Tons No.of Alerting Devices W No.of Waste Disposers Heat Pump Numbe 'ions KNo.ofSelf-Contained osers ' \ p Totals: ......... Detection/Alerting Devices No.of Dishwashers Space/Area Heati Local ElMunicipalConnection [I Other No.of Dryers Heating Applies KW SecN.o De ice a cs or Equivalent No.of Water KW No.of / No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: �( Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: 'y/ 00 (When required by municipal policy.) _ Work to Start: a I-S ( 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 91 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: . oS ti D. 04ry EICcL LIC.NO.: i�7/g Licensee: ,1kr rCt,rV Signature LTC.NO.: (If applicable,enter "exempt"in the license nmber line.) Bus.Tel.No.: Address: P/ ,��nfe-4- �rC1I-twkY 144- Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of PubliSafety"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 PERMIT FEE:$ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the ` notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he f or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Ed Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: + Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass EM Failed Re-Inspection Required($.) ❑ Inspectors Comment : I / Inspectors Signature: V Date: FINAL INSPE T Pass 0 Failed ❑' Re-Inspection Required($.) ❑ Inspectors Comme s: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustriqlAccidihts Office of Investigations kqjp 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information II / Please Print Legibly Name(Business/Organization/Individual): J-,)5�c Address: / SvnSe f C( cc t-e City/State/Zip: Tees jfSbLj.y 111 fi • Phone#: 5 Ub=-ra`17 0A/ Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have Hired the sub-contractors 2m a sole proprietor or partner- listed on the attached sheet.t �• E]Remodeling ,�!a ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions ymyself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name 0 40*%�►�tV&e. L ,S.1)-Ct ec e_ Policy#or Self--ins.Lie.#: � ��r7�-- Expiration Date: 10- %q Job Site Address: qU ' ertyCro Ff e 1 d'c City/State/Zip: ��r �n�c�•+�-s� Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine a of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. Ido 1zereby certify rider thepains andpenalties ofperjury that the information provided above is true and correct Signature: Date: --N' u Phone#• S0&-5-0(e 7 a A j Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: r Information and Instructions , Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the ' members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The ComMoawealth of Massachusetts Depattmeat of Industrial Accidents, Office.ofInvestiigations 600 Washin&n Street Boston,M.A.02111 TO.#617-727-4900 exit 406 or 1-87T MASSAFB Revised 5-26-05 Fax#617-727;7749 wvc wmass,govfdia COMMONWEALTH OF MASSACHUSETTS ELECTRICIANS AS A REG JOURNEYMAN ELECTRICIAN ISSUES THE ABOVE LICENSE TO: .JOSEPH D CARY C 11 SUNSET CIRCLE � . TEWKSBURY MA- 01876-2220 37198 E 07/31/13 929243 Fold,Then Detach Along All Perforations CHUSETT DRIVER'S-LICENSE,50M5 �� R NUBE 720278 EXP Dos 06-02-2014 06-02-1970 g¢g� CLASS REST MGT .SEX D 5.09 M CARY t m JOSEPH D VAtTSETTS 11 SUNSET CIRCLE TEWKSBURY,MA 01876-2220 Date.... TOWN OF NORTH ANDOVER 10 PERMIT FOR PLUMBING This certifies that.... .................... ....... .................................... has permission to perform............. ....................................... plumbing in the buildings of. ........................................ at 7 North Andover, Mass............................................................................. Fee..v7c cv....Lic. No. JY,4............................................................... PLUMBING INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE /� o PERMIT# JOBSITE ADDRESS a,pT>`'1'C► C,IG (�/1 cI� OWNER'S NAME r POWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL�f PRINT CLEARLY NEW RENOVATION:® REPLACEMENT:Q PLANS SUBMITTED: YES 0 NO® FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM _ __ _.___i DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) ---F- KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL _—___f ___j --i .__-...-1 __---f ---i SERVICE/MOP SINK __ _l _ I f f I ._.__f _ I _ f _.� _ f TOILET URINAL WASHING MACHINE CONNECTION ! f _.._ _ I _..�I ____j WATER HEATER ALL TYPES WAa ER PIPING _ f _f __-- . ( _ ' _. ..._.. _...__ _# _- _ ___.- f OTHER _.-_.__ -_.-_. F-77-11E-771__...._.. =F INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES'A NO DJ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW l� LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 01 BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER —f AGENT 10 SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and curate to the best of my knowledge _\ and that all plumbing work and installations performed under the permit issued for this application will be in lian th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMEpne7 ! � _ IILICENSE# NA URE MPO JP' CORPORATION EI# PARTNERSHIP# I LLC�#I = COMPANY NAME AAA I ADDRESS CITY , aq _..-----_._.___I STATE �ZIP 1�7 TEL FAXI gl�I CELL� EMAIL _-- ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL WSPECTION TES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 1 r The Commonwealth of Massachusetts - Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/Organization/Individual): (,1iWL Address: City/State/Zip: I Phone#: Are you an employer?Check a appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.# 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g. E]Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert' rider t p ns an Vpenalfies of perjury Aat the information provided above is true and correct. Si ature: 6Date: Phone#: j Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,. express or implied,oral or written." An em �° . ployer is defined as an individual,partnership,association,corporation or other legal enti or an o rp g ty, y two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CoMT40RWeajth O£'Massa buS, s Department ofIndustrial Accidents Office of Investigations 600 Washington.Street Boston}1A 02111 Tel,#617-727,4900 at 406 or 1-877-.lYJASS.AFE Revised 5-26-05 Fax#617-727-7749 WWW-Mass,govaa. COMMONIIVEALTH OF IVIASSAOHUS.E rtTS..?" PLUMBERS ANO GASFITTERS I�2 LICENSED AS A JONEYMAN RL'UMBER E ISSUES THE ABOVE LICENSE T03 E C0-(BEY CATALFAMO 945 RIVERSIDE DR X. METH UE.N MA L 8.44-e,740- 25;294:. , 05/01/14 168297 JI' a0 h , o• ° q v .• tib kZ OlC©�-- it • - 5 g6 399' j T -- O C r c L`e- CERTIFIED T0: SCALE: 1 ITS SUCCESSORS AND/OR ASSIGNS -11A OF I CERTIFY THAT THE STRUCTURE SHOWN EITHER CONFORMED TO THE DIMENSIONAL REQUIREMENTS OF THE ZONING BYLAWS OF THE TOWN OF—,VCFW .�.vdav�.e ED0 �� WHEN CONSTRUCTED OR IS NOT SUBJECT TO ZONING ENFORCEMENT ACTION MA., UNDER C. ' M.G.L. TITLE VII, CH. 40A, SEC. 7 AND IS NOT LOCATED WITHIN A FLOOD HAZARD AREA HELM S,JR. AS SHOWN ON FLOOD INSURANCE RATE MAPS OF THE FEDERAL f' # No.3773 ti MANAGEMENT AGENCY. 1 EMERGENCY 'O COMMUNITY-PANEL NO. ,Araa qS A AND 8 ars MQRTGArF TNCDtPnmTn,►T ' Location �--- t No. 1/ Date NORTM TOWN OF NORTH ANDOVER 0 a OR 9 Certificate of Occupancy $ +t•�s'"'°''tom Building/Frame/Frame Permit Fee $ s�cMuat 9 Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ s Check # 15911 -- . Building Inspect TOWN NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .... sb ,�.:awy 4ryy ab.•,'x� * taj � o 22,.. •2 BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: —AAA) r Building Commissioner for of Buildings Date 16f— -tO SECTION 1-SITE INFORMATION 1.1 Property A ess: a 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 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 R 'red Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Criao)e-s w �ame(Print) Address for Service: w `M� �EL� Signature Telepho e 2.2 Owner of Record: Name Print Address for Service: 9® b Si nature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone P 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number P Address Expiration Date A Signature Telephone !�/ SECTION 4-WORKERS COMPENSATION(M.G.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.......El No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Tlte rations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ' Ce'v,OUOA (�C(J'�aOe MC O �1Jiv\�QWS SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFF"ICIAL;USE.ONLY Completed by permit applicant 1. Building (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 p *_J Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. I, Qo ( \�P W MCS 1\,S�k t' J 0 ,as Owner/Authorized Age of subject property ereby authorize to act on M eh f,in all matter ti t ork authorized by this building pennit application. -Signature of Ovnier - Date SECTION 7b OWNEPJAUTHORT7,10.D 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 Name Signature of Owner/A ent Date UAW27r, 77,777-M-7 77, NO. OF STORIES SIZE BASEMENT OR SLAB FT RD SIZE OF FLOOR TINIBERS I 2 3 SPAN DDAENSIONS 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 Town of North Andover Building Uepartmt?nt � cr .. 27 Charles Street : North Andover, MA. 01.845 4 4 D. Robert Nicetta } Building Commissioner (978) 688-9545 .:(978) 688-9542 Fax HOMEOWNER UCJ=NSE EXEMp-►IpN Please print DATE Q - I — C1-�J, 108 LOCATION Number Street Address Map/lot IOMEOWNER hoc►Q.s w Q Name Home Phone Work Phone ESENT MAILING ADDRESS P City Town State Zip Code s The current exemption for"homeowners"was extended to include owner of two units or less and to allow such homeowners to en �uW�dwelGrigs not possess a license gage an indiv►dual�himwho does . provideii that the owner acts as supervisor (State 8ur7c6hg Code 1-08.3.5.t) DEFINITION OF HOMEWC)WNER: Person(s)who owns a Marcel of land on which he/she resides or intends to there is, or is intended to be, a one or two reside, c which cessory to such use and/or farm'dwelling, attached or detached 5 +fires. .A person wiw,� res ac- two-year pOiod shalt not be'considered a Melt"►ane home in a ho�ea�wner, The undersigned'homeowner, responsibility for co APpt�abte codes, by-ta%lvs, rules and reguk tions, mPhance with theState Building Code and other The underlsigned "homeowner"certifies that he/she Building Department minimum ins understands the Town d No-Anker on procedures and requirements and that he/she vitt ' �OmPty With said procedures a req irements- IOMEOWNER'S SIGNATURE 'PROVAL OF BUILDING OFFICIAL ' NvR ED Town ofover... Ow rw.ww �4 ,�_ 0% No. /9 - AOL ' Q h o�A �o��,� �y dover, Mass., A?fU ORATED S H � - BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............. """"""' ...... Foundation has permission to erect............................ .......... buildings on ICA.4 ........... .. ....................... .... ...... Rough t0 b8 OCCUpled a Chimney ...................................... .................................. provided that the person cepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the pr isions 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 CONSTRUCTION T TS ELECTRICAL INSPECTOR Rough ............................................... Service UILDING 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 7 _ Street No. SEE REVERSE SIDE Smoke Det. Location © Fey- K C.ro f� C,' r No. 109 Date 06 - �7—p;. Ij,=� MCoTN, TOWN OF NORTH ANDOVER •."o a? • • Os a . 1 . Certificate of Occupancy $ sACM�s<� Building/Frame Permit Fee $ a� . Dl) Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ate D► DO Check # L.- 15817 Building Inspector r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. ® � W 10710/ or a® SIGNATURE: "OON**top* Building Commissionerfl for of Buildings Date z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ,Po FCS tiIC 2y�1 CCKe-CC ©-S (� Al /6 . A-0 _ 'b6J(�� /I Map Number Parcel Number 1..3�Zoning /Informaormation: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BURRING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Reqaired Provided 1.7 Water Supply M.GL.C.40. 34)~F`° 1.5. Flood Zone infonnation: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Y -y Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(Print) Address for Service: Signature Telephone x°7 S- ?q29 2.2 Owner ecord: Name Print Address for Service: z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone t 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number ro Address Expiration Date G) Signature Telephone � 1 SECTION 4-WORKERS COMPENSATION(M.G.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.......11 No.......❑ SECTION 5 Description of Proposed Work check au applicablel New Construction„❑ Exi B ❑ Repair(s) ❑ Alteratio Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Spec Brief Description of Proposed Work: f( , C.�-C,� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be O +`ICIAL"USE ONLY Completed by permit a licant ], I. Building Oa (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 0 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 1 f as Owner/Authorized Agent of subject property /Hereby authorize to act on My behalf,in all matters relative to work authorized by this building pennit application. 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 Print Name Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 1ST2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUII,DING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE • FORM U - LOT RELEASE FORM 9-a-C(•-o :L- 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 _;4-W CS i0Xk&1&hE Y PHONE 917-15 7gz;g LOCATION: Assessor's Map Number PARCEL_ SUBDIVISION LOT LOT (S) STREET ST. NUMBER ************************************OFFICIAL USE RECOM D TIONS F OWN AGENTS: CONSER ATION ADM ISTRATOR DATE APPROVED 2 DATE REJECTED COMMENTS_ W PLANNti DATE APPROVED DATE REJECTED COMMENTS 411,ze FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT _ FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm i f) cwt C1tv+ az;7 x,4t v} NQRTF/ Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta s�<Hus¢t Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATION Number Street Address Map/lot ..HOMEOWNER J0 "`I15F.S � !/� Y <, — ! e(Z�9 Name Home Phone Work Phone PRESENT MAILING ADDRESS C City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of 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 80ding Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, of is5ntended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs rnore than one home in a two-year period shall not be,considered a homeowner 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. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL , _.r w �_ ��_ i - - - °a zL�-� .."I" p _ , � � J 1 f I 1 1 '� � r1 • � + C to .v Z J Q ` X %j J Q , ct�if � O ®O WEn 1 �' I A o O l�•, W �/ .�if/.a�.C.CevvT ,•� �� O o .1r LLl `V Z I ate4 1 J Z 0 (A O �i Ll `• �=u aui s s cit I� `• f o 44 cn ' a w Z CERTIFIED T0: SCALE: 1" =—,Ir4 ITS SUCCESSORS AND/OR ASSIGNS I CERTIFY THAT THE STRUCTURE SHOWN EITHER CONFORMED TO THE DIMENSIONAL tHOFMAS REQUIREMENTS OF THE ZONING BYLAWS OF THE TOWN OF,*Vrr2. V ,4.voarC , MA., � 1 WHEN CONSTRUCTED OR 1S NOT SUBJECT 'TO ZON!!,'C Ff ;'CI'CEI•'i r f i Ar--"iC: iJi-40ER EDi�fARU �� M.G.L. TITLE Vii, CH. 40A, SEC. '7 AND IS NOT LOCATED WITHIN A FLOOD HAZARD AREA % C. AS SHOWN ON FLOOD INSURANCE RATE MAPS OF THE FEDERAL EMERGENCY Qu HELMES,A. ca MANAGEMENT AGENCY. No.3773 f'oo 4 ,e COMMUNITY-PANEL N0. ca 9H� ?bio .Fd J-eµ,•10 pJ 1993 Ffs� A ANO S�� ,9S G fso,elf 1.9-41f PROMSSOOL L" sup ray M TGAGE INSPECTION PLAN T/y �gv.,�Di/.Fif!�oy.��31IL�iS/UJ.fl7S DIVERSIFIED CIVIL ENGINEERING PREPARED FOR 359 LITTLETON ROAD, WESTFORD, MA 236 PLEASANT ST., METHUI?N, MA DWG. Jam. i Nv rc � fy Town ® E over 0 No. A0 9 y0�3 aao o COCH,C D dover, Mass., ADRATED P', 5 BOARD OF HEALTH ERMIT T Food/Kitchen Septic System BUILDING INSPECTOR � M 4•s tip+ THIS CERTIFIES THAT................ ....................................p..... ............... .. ................................. ....... ................ Foundation has permission to erect..Y.K.90 ..... buildings on o.... F'!�'NC I � I�"CIti Rough ............... .............. ..................................................... ..... .. ... to be occu ied as P ?C. Pa.; K R epr�4C � N� Chimney p' ..................................................................................... provided that the person accepting this permit shall in every respect 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, Iteration and Construction of Buildings in the Town of North Andover. r / 63//* * D . PLUMBING INSPECTOR �FlVIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR L 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 Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. : SEE REVERSE SIDE Smoke Det. 1 'Location No. � 7 �� Date / T u ,.ORTN TOWN OF NORTH ANDOVER. 1 .00` p Certificate of Occupancy $ Building/Frame Permit Fee $ �' b'••°•'�� Foundation Permit Fee $ ,SJACHUSEt Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ 21 ` TOTAL $ s7 Building Inspector Div. Public Works 1 PEI2NIIT NO. �APPLICATION FOR PERMIT O 13UILI)********NORTH ANDOVER, MA NI%P NO. O 1.01'.NO. u 2. RyA�E,CORRD(\OF OWN/ER�S11il' ` D/jA�jT�.E� BOOK PAGE 59 GONE SUB DIV. '\� �J Q l�ly(`C '�f���cfj 1u/_( ." �1 Yf LO(:A MON PURPOSE OF BIJII DING NO.OfsroRIES r SIZE i OWNER'S ADDRESS tf ✓� BASEMENT OR SI.AB ARCI IITEC1'S NAME CUP[ e- SIZE OF FI.00R TIMBERS �Z�G� I 2 ND 3 RD o Will DLR'S NAME - � SPAN DISI ANCI:.1 O NEAREST BUIHANG DIMENSIONS OF SILLS DIS 1'ANCE mom STREE f DIMENSIONS Cx:POS-I S (- DIS I'ANCE FROM I..OT LINES-SIDES �� REAR DIMENSIONS OF GIRDERS v AREA of=Lor FRONTAGE IIEIGIfr OF FOUNDATION THICKNESS IS BUILDING NEW �v SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL.OF CIIIMNEY IS BIJII.DING ALTERATION IS BUIl1)ING ON SOLID M FILLED LAND �L A'iry1.BUILDINGCONFORM TOREQUII-RLEMENTSOFCODE �. ISBIJII.DINGCONNECTEDTOTOWNWAI'ER BOARD ON APPEALS ACTION, IF ANY IS BUILDING CONNECT ED TOTOWN SEWER IS BUILDING CONNECrEDTO NATURAL GAS LINE INSTIICTIONS 3. PROPERTY INFOR111A'f1ON E.ANDCOST - --_~ EST. BL.fX;.COST PAGE: I FII.I.OxI'rSECTIONS 1-3 EST. BI-DO.COST PER SQ. FT. ES-1. BLIX i.COST PER R(x)M El K"TRIC METERS MUST BE ON Ox1TSIDE OF BUILDING SEPTIC PERMIT NO. n Al-I ACI IED GARAGES MUST C(INFORM TO STATE FIRE REGIII.A rIONIS 4 APPROVED B1 PLANS MUST BE FILED AND APPROVED BY BUR.DING INSPECTOR B11,11I.DING INSPECTOR • OWNERS'1'EI.Dr� 7 � s✓�C DA fE FII.FD CONE rR.TEI.a'1 CONTRA 1('4 SIGN. I IRI: V OWNFR OR AI l i 11 1RIZ:D AGENT r U.LC.# IIi � — I'I RNII f GR.ANI I1) 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 : 1 i L S Qb` �`-C� I PHONE ���� �7��-T-7 sorcfZg LOCATION: Assess Map Number �` PARCEL_ SUBDIVISION LOT (S) STREET 'ST, NUMBER' *„,*,. *************OFFICIAL USE ONLY*** *** *' *'* RECO EN TI S F OWN AGENTS: - J ONSERVAT ON ADMI I RATOR DATE APPROVED DATE REJECTED COMMENTS K,, " \� k lit Z � ,. TOWN PLANNER I„ � DAk �{PPROVED REJECTED r COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED ` COMMENTS r; PUBLIC WORKS - SEWERIWATER CONNECTIONS DRJVEWAY PERMIT FIRE DEPARTMENT g RECEIVED BY BUILDING INSPECTOR DATE Y FORM U - LOT tRELF-ASE FORM r" 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 PHONE LOCATION: Assessor's Map Number PARCEL -�� SUBDIVISION LOT (S) STREET ST. NUMBER ..., ...*-********"*********************OFFICIAL USE ONLY****'"*"" RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR 'DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED j DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRJVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE r►ORT s! To, Of, _ _ 9Andover O I swo * dover, Mass.,—/ O s LAKE `� A -COCHICMEWICK BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.. l�.. ..�5..............� N • Foundation has permission to erect... A C� •...-.... buildings on ......a. .........F �N.c.r 0. .. Rough to be occupied as !...a. '. ..�. �..�.' Chimney �c... .. o �`.�Y.c......... y provided that the person accepting this permit shall in every respect 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT I S TS r " Rough Service BUILD G 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 Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. O _ V N 4 W z _ J � _ x � J / m n� .SP.E. vooE�Q W - 0 o �p W ;• �• D Q s. i Ld z ••� F Z f as I•� _•'' �. -��- - f 2� LLj Z 100` J Z O N W Ar 5b- Ll a s W It i a L✓iG,EJ elAF eA Z CERTIFIED TO: .y�.P7��Q.E Coefl SCALE: 1" =jrG ITS SUCCESSORS AND/OR ASSIGNS I CERTIFY THAT THE STRUCTURE SHOWN EITHER CONFORMED TO THE DIMENSIONAL ,jHQFA(gs� REQUIREMENTS OF THE ZONING BYLAWS OF THE TOWN OFNsoerH .4.vooA',gFoC • MA.. �v WHEN CONSTRUCTED OR IS NOT SUBJECT TO ZONING ENFORCEMENT ACTION UNDER EDWARD �G M.G.L. TITLE VII, CH. 40A• SEC. 7 AND IS NOT LOCATED WITHIN A FLOOD HAZARD AREA ! C. AS SHOWN ON FLOOD INSURANCE RATE MAPS OF THE FEDERAL EMERGENCY L----� 3 HEL 3Er3 R• MANAGEMENT AGENCY. A No. COMMUNITY-PANEL NO. e•SOO.V vivr,4a '? ,oma AF ��a Ff�/ A ANo 4�a g,9� �YisPf/P f/,990 CANMiTGAGE INSPECTION PLAN .e�.�•P.vGriPoc'T C/�C.c.t� • 77f/ ,gv�or.FiC�•yi+v. ��'�/vsc>rS DIVERSIFIED CIVIL ENGINEERING 359 LITTLETON ROAD, WESTFORD, MA PREPARED FOR 236 PLEASANT ST., METHUEN, MA J"�9�f.F.'l �!, AiVl� .a/SA iS►! .'✓i5/iivME'Y ' �o�oa�� .2,E.�•,cG.vo eo 800.E,2i.�� .�.v4•er �' ywse?B i>9g DWG. NO.R174 i i d'