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Miscellaneous - 20 WALNUT AVENUE 4/30/2018
N O O r I Date . ..�'-). ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING f This certifies that has permission to perform .... ....' ' .-............... U ...... ..:....:..:. :.................. wiring in the building of .... ''..... ��y.•.............................................................. at .......... .............................. . North Andover, Mass. Fee.. /115.....r..?... L1C. No .............. ... ..... .. ............................... f� ELECTRICAL INSPECTOR Check # 47'11 THECOMMONWEALTHOFMASSACHUSETTS Office Use only DEPARTA&W0FPUX1CS4FE7Y Permit No.���� BOARD OFFIREPREVEAW0NRE 7MH0NS527CW 12.00 /G � -6-11, Occupancy &Fees Checked APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspecor of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street � Owner or Tenant Owner's Address Is this permit in conjunction with na building permit: Yes ® No (Check Appropriate Box) Purpose of Building r � tt &C E Utility Authorization No. Existing Service Amps / Volts Overhead 1-3 Underground El No. of Meters New Service Amps_ Volts Overhead M Underground 1:3 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work_Oyq 1.c3 1u�t 1V t icatz No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above M Below Generators KVA round round No. of Receptacle Outlets 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. ofpisposals No. of Heat Total Total 1 Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained j Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections t+ No. of Water Heaters KW No. of No. of Signs Bailasis o No. Hydro Massage Tubs No. of Motors Total HP OTHER• I MMtIoeCovaage RmwttoftWmerrtentsofMassachuseltsGmalLaws IhaveawnuiLmbilkyltwat=PblicymchxlmgComplelo Cove�woritsabs=alequivalat YES ED NO D IhaNeAt maedvalidptoofofsametotheOffioe YES rq) ffytiuhaveclleckedYES, p1mwindic*drtypeofcovaageby lNSURANCE�FZ7[ BOND r7 OTHER Wotktostatt , 9-g-03 kgedionD&Rmpeod SignedundffTePenAesoftpajuty: -_, N i,,, f ' f IRR I CA, (Plea9eSpecify) Expiration Date Q Estknated VakrofFl tl Wolk $ Rough 7 -// -0 3 1 Final _ IimwNo. A w $-,5e> aaiswA ,A�✓ t 5 �� UZN �N6- SiV=0 ( / /��-•-t Li seNo �-�%� t/ i / r / BusiressTeiNo. 71x1- Xq`f -7T8`t Addtea� L L ~ 5 i` X e i, S P 61t 7� Alt Tel No. OWNER'SWSURANCEWAAUII Iamaware that duI-ioemdoes nethavethe im ancecomageoritsakswtialequivalartasrigm»dbyMassachusdlsCkrualiaws andthat mysignahmonthis pemvtapplic ahm waivesthisregttitenlatt (Please check one) Owner Agent "Pe Telephone No. PERMIT FEE $ ��, signature ot Uwner or Agent r Date ....... T3 14- H19 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that CII/�/ sk , " S. ....... has permission to perform ..... ....... 5-1.5.1 ...................... wiring in the building of ..........✓ c 4 ..................................................... at ...... A-() ...... North;Andove Fei.��-� ........... Lic. No. . ............. -:>Z-- ..... / ELECTRICAL INSPECTOR 08/14/97 I1.57 35.0o PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasuter p- The Commonwealth of Massachusetts " u'lY M1.ro It Cn. Department of Public Sofcty OCC-1—cl S fee Oleeked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 ,l.a.e blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK NI Work to be performed In accordance With the Mauachusetu Electrical Code. S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL ItrFORHATION) Date—�-97 City or Town of AloeT11 AVDOeEe To the Inspector of Wires: The undersigned applies for a permit to perforo the electrical work described below. Location (Street 6 Number) 020 G(J<%LNUT oS�2EE7— Oumer or Tenant L.0RENL''-- 2�c/,vDE/1/ Owner's Address SAME SO$) 4 -.3 - ,3249 _ Is this permit in conjunction with a building permit: Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization 140._ Existing Service Amps / Volts Overhead ❑ Undgrdl t No New Service Amps / Volts Overhead ❑ Undgrd ❑ Ito of Meters of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation of Alarm System No. of Lighting Outlets No. of Hot Tubs ' No. of Transformers Total No. of Lighting Fixtures Swimming Pool Above In- rn ❑ grnd. grnd. 1:1 Generators KVA No. of Receptacle Outlets No. of Oil Burners , Batter EmerUnigency Lighting No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices g No. of Self Contained Detection/Sounding Devices Local Municipal 11 ❑ Other Connection No. of Ranges g Total No. of Air Cond. tons No. of Disposals No. of Heat s Total Total Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW SignsBalNo. of lastsBallasts WirinoltageQ No. Hydro Massage Tubs No. of Motors Total HP OTHER: CA) SMOKE 'D ETEC7'0 2S INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO E] I have submitted valid proof of same to this office. YES ❑ NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE [J BOND [] OTHER( (Please Specify) Estimated Value of Electrical Work S /a /e3 00 Work to Start $- 5 - 97 Inspection Date Requested: Signed under the penalties of perjury: Rough Expiration ate Final FIRM NAME A.D.T. SECURITY -SYSTEMS NORTHEAST INC. LIC. NO. 1231C Licensee DONALD A BROOKS Signata I An i.TC_ N0, 1231C Address 60 William Street, Wellesley, JfOnT8f' '96• rel. No. 413-732-4400 Alt. Tel. No.617-431-5831 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. Signature of Owner or Agent G�ft- OK1 � PERMIT FEE S -25 o c Location b No. Date �ORTM TOWN OF NORTH ANDOVER O? • , OR - I Certificate of Occupancy $ CHUS Building/Frame /Frame Permit Fee $ s�cHusE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Sr Check # 14-33 / Building Inspector 1.1 Property Address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re(pired Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record —11) U/ S) iqlllyll-zler X/"". Awle,�Ief^ Nam Tint) Address for Sernce : 2.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: z Licensed Construction Supervisor: Address Signature 3.2 Registered Home Improv 1 �-A ")6 1- Company Name 1 Contractor Telephone t« Address for Service: Not Applicable ❑ License Number Expiration Date Not Anolicable ❑ Registration Number Expiration Date 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 buildin rmit. Si ned affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work.- ork:n VInYL R,,e ol GQ on f r7 -r- T7 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant k OF ICTAL USE*QNLY 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 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGVT OR CONTRACTOR AP FOR BUILDING PERMIT I, as Owne/Authorized Agent of subject p operty Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name r Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST 2ND 3 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 Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978)688-9545 Fax(978)688-9542 DEBRIS DISPOSAL FORM f tAORTH O tOLKICKIwK K �4A0 p�N A - R4TED In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in /at: r Facility location Signature of Applicant // i o Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I HV UL1IIIlllVIIVVCdiIII UI IVId01)dI.I/U3C11J Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print 0 f , 9 A am a homeowner performing all work myself j�I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance Co. Policy.9 Company name: Address City: Phone # Insurance Co. Policv # 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. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under t pains and penalties of perjuryat th information provided above is true and correct Signature Date Print name Phone f Official use only do not write in this area to be completed by city or town official' F-1 . Building Dept []Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person:_ Phone #.• ❑ Health Department 0 Other FORM WORKMAN'S COMPENSATION NOME IHRROVFMFHT CONTRACTOR R,egistratien 100633 Expiration 06/2.4/2002 Type, DBA THOMAS ROBIl1ARD SIDING tg�as Robillard 1t Filbert St ADMINISTRATOR Methuen MA 01644 0 M ERS oAr. co o : a U -� b r.C v o v x u r U � a o w r w W 'W1 W w cn ti. a0 U bo w w W w COC/) Q o rA CD C �✓ O y C O O •� V V p, C ev m m c • r r S E =CA it 'd v> 3 m LUo :4- ;u Q 3 �: Y d o o '400: E c �.. ,NG :a3 O *r O. j "'F'f 0 ` CM m E o,;:. C o 3EmsCI yJ'O :cm • � y m C 0 m c c y a �_ ac'� S cit ® c 'y O L c-�co Z o c ` o c H- y d C C a m _ :mho N o ymoI- m ` _ W p � rte... i.- •y cc a=,,, z ui= .E vZv� O • C2 m O m :� C_ 0 CL H CL m O 'O _ cc O y '� O 0 d0 O w I a O I =cm y � � M E m m �3 � � L � O � CMCC -*-a C Cc 0 CD c v J •0 C Z co CL � C C cc COD 0 LLJ U) M W crW LU vJ O z xx F� O a z GG w O E� z w A W o w ci v cn r o w o w v C U G x a oco a: w" U w x o r� cn G w d o w u. w w v o z cn Q x o cn 1 50 •m c c 24 o � CA c ` •c•fl p• c 3 cc 2 c .�o mono: O' y = E< qw :� c r c o :0'3 ,Em M o c E :ate m ®i z y :c _ m • a • y C C m o V E y •c .mo o•v � m :s: $moo cm CAL roQ act •o 3:0 Z •� o o cm r o do c Q � m C •O COD •. W _ O L C +-� W O •fl � C � .� 1-.- . a= y C o W .E w� v•y O L.1 m O C H CL o� oF. � 2 c � OM= O Fo .. CL � O 4U O :a P 0 0 E OoC z O y O Ma E CDCL O O O v CL H 0 .V CLCOD O V !O C CO cm 3 .o O � O O CL. cmQ G J .O O O Z s CDCLCA G 0 U) U) w W Irw vJ Location 26 U,)4 -wt ST No. Date 4�5� O:TH TOWN OF NORTH ANDOVER C?t�a° ,a.ehOOA „ Certificate of Occupancy $ i Building/Frame Permit Fee $ SA UFoundation Permit ee $ CMs � _ Other Permit Fee em $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ (0 �O Building Inspector 09/28/95 13:14 25.00 PAID 8849 Div. Public Works PERJtrr NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE I MAP 4J0. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE t SUB DIV. LOT O. 1I LOCATION /�� �J PURPOSE OF BUILDING "t&4 0—tetyAgI&CA OWNER'S NAME t NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 4- SPAN DISTANCE TO NEAREST BUILDING -- DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILE AND APPF t�VED BY BUILDING INSPECTOR DATE FILED i PERMIT GRANTED 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COSTf EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY )f tl� SUILDING INSPtCToR OWNER TEL. # C7 CONTR. TEL. N CONTR. LIC. N Q Z d H.I.C. # ,Zd 2317 4884` CA-& 0 L � BUILDING RECORD 1 OCCUPANCY 12 1 SINGLE FAMILY SiOR1ES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE IN HARDW D d t 2 13 CONCRETE 8L K. BRICK OR STONE PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL 1/1 1/7 FIN. B M'TAREA FIN. ATTIC AREA _ _ N_O B M T HEAD ROOM FIRE PLACES MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS DROP SIDING B _ 1 2 3 �_ _ _ CONCRETE WOOD SHINGLES EARTH HARDW D COMMON ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I I POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) LAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL ALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. S COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ to 13rd ELECTRIC NO HEATING 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. t 14 ce w iw H w w O A O m s o O r� cn UC: n v C/) o i- w a z c� z Q a m o cz O U2 O c2 T c U G w 0 R W 0 z C� z O c.4 C x a o a v, z a ¢ a U W W O rx > cn C w a w z C¢7 O C' C u, z a ¢ w a G4 "4 7 as o z cin a, ''e O cn -14 100 uj r IRV- O am z 0 CD O W L _O O V Z � Q O y D � � c CM caco 0 MM .MM •� W W O i O Oci O !C O Q M =a y O O 4-W C ccG C.3 .� O c 03 O CL C R y J Q z LL - 0 �i c� o m c c � O ` C N O C �v .Q� C • C R � C m O L m Q E o Q N 3. 0 0 �c m� C N O i :cocc3 N t m J N C N O C m co o cmc fl-C� i m NPalm :moa Q O V y C m 2 C N C O C C m 4 N o O. r N m rO. Cc CD L A NaCD C Z W v v c O -0 VO C' m O : 2 H O 2 cyp a. m � 0 CD O W L _O O V Z � Q O y D � � c CM caco 0 MM .MM •� W W O i O Oci O !C O Q M =a y O O 4-W C ccG C.3 .� O c 03 O CL C R y J Q z LL - 0 �i 9 S r? Date. . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �SgACMUSf � �� r � i This certifies that . (: r'Q' ^r" ! .'............... • • ....... • • • • • • has permission to perform .................................... . plumbing in the buildings of ............. • • • • • • at .....'............. ,North Andover, Mass. t� r. Fe`e .. •�.... Lic. No.. %`? . ..... !�......... ...... . lPL1IMBI ��NVSI OR Check # S `lO 57u7 111 I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO ®O PLUMBING (Print or Type) �=----AAL �1 -dam L9 Permit # _ Mass. Date A- - / zll Building Locatiorl�� Gy,,vu� Owner's Name F .� -��n4 I: _ Type of Occupancy_, <`y;: New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No J FIXTURES -3 Installing Company Name Crane's Plumbing & Heating Check one: Certificate Address 70 Doug'— Street ❑ Corporation Haverhill MA 01830 ❑ Partnership Business Telephone (978) 373-4001 ❑ Name of Licensed Plumber Peter J. Crane — INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes R No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy LX 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: Owner ❑ Agent:.'-. Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted for entered) in the above application are true and accurate to the best of my knowledge and that 1!1 piumh6;g .i-nrk and installations performed under the permit issued for this application will bei pliance i all pertinent provisions of the Massachusetts State Plurnhing Code and Chapo Chapter t-�_' of ;h General Laws. _ By Signature of Licensed Plumber oun Title Type of License: h1asters lx r City/Town License Number' APPROVED (OFFICE USE ONLY) t ■■■■■■■■■■■■■■■■■■■■■■■■■ n■uc�■■■■■■■■■■■■■■■■■■■■■ rBASEMENT .. ■■■■■■■■■■■■■■■■■■■■■■■■■ WPM ■■■■■■■■■■■■■■6th ■■■■■■■■■■■ .. FLOOR 8th FLOOR Installing Company Name Crane's Plumbing & Heating Check one: Certificate Address 70 Doug'— Street ❑ Corporation Haverhill MA 01830 ❑ Partnership Business Telephone (978) 373-4001 ❑ Name of Licensed Plumber Peter J. Crane — INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes R No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy LX 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: Owner ❑ Agent:.'-. Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted for entered) in the above application are true and accurate to the best of my knowledge and that 1!1 piumh6;g .i-nrk and installations performed under the permit issued for this application will bei pliance i all pertinent provisions of the Massachusetts State Plurnhing Code and Chapo Chapter t-�_' of ;h General Laws. _ By Signature of Licensed Plumber oun Title Type of License: h1asters lx r City/Town License Number' APPROVED (OFFICE USE ONLY) t c 3 cr VI V m n t rm T v � C) z 4 m v a T a L� 04 O 0 z 3 � N � ;a z t rm T v � C) z 4 m v a T r n a O z O ;a z V O T 3 �1 �1 O v O c 3 W z C) mm rm rm _T z a z N T T n 0 z w rm r— O z e O C) x M N rmN Z rm O z *#z 4 N Location r, WA r U f Ivo. 15-6 Date L/- 0 3 ' NORTM TOWN OF NORTH ANDOVER F w P M � • i ; , sACNUSEt�' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Id U .- i �1 ©` S o Check # '16675 iv..ii('_ Building Inspector M TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING _✓� 4 Ste"^' c« i f K1� ah`b�`� r� ✓ani � kcR;a..Z.�' A�; R . .�'« C^'fi.«� cess '3+ ' .r➢,nom �^' � ' p� �, �, "'"'��Y`n°iPtHa$�A.. R. � BUILDING PERMIT NUMBER: �..� DATE ISSUED: 9e._ SIGNATURE:Ilk Building Commissioner/InEe2stor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: �? o Wo, (nU+ �ftur 1.2 Assessors Map and Parcel Number: 33 33 Map Number Parcel Number / t/ � l o (I k _ w r ,j /► /� �V �- 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot e. (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ame (Print) Address for Service : Signature Telephone 2.2 Owner of Record: Name Print Address for Service: s Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 License$ Construction Supervisor: Licensed Construction Supervisor: Address Signature , Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 89 M X z z M go O aanr M r r z ^^ Q SECTION 4 - WORKERS COMPENSATION (XG.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 it. Si ned affidavit Attached Yes .......0 No ....... 0 SECTION 5 Descri tion of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ]l(/ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: rear MQr o� halms SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b permit a licant` QFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) �D® J 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 __T as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. —Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property t Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge ; and belief r Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlVIBERS iST2ND 3 SPAN DEMENSIONS OF SILLS DEMENSIONS 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 I 12/10/2002 11:50 FROM Corey & Donahue, Inc TO M & M P.01/01 J08 NO; 2277 13 LfT AN& y. ENT] FIFT) THIS MORTGAGE INSPECTION VAS- PREPARED MORI-CAGE LOAN' UORtAtE PURPOSES AND: I SPECIFICALLYFOR - S : .. -... 'NOT TO BE RELIED UPON ..AS. A.. SURV-E)% Nbo is THIS PLAN TO BE USED To OBTAINBUILDING LOCATION 20 --M. 1 Uid-JA PERMITS. VARIANCESORI�HE.LIKE CERTIFY THAT.. THE STRUCRJkEL5_-_SHOWN NON H -1 aN', - THIS PLAN .8RF IN C(INF<)RMANCE WITH i.?jn '-FIE LOCAL ZONING SETBACKS IN EFFECT AT THE SCALE -11ME OF CONSTRUCTION OR. IS EXEMPT FROM V"TION ENFORCEMENT ACTIoN'uNDM MASS. G.L. t. REGISTRY TITLE Mi. CHAPTER 40A SECTION 7. -1 CWFY THAT THE PARCEL SHOWN FLOOD HAZARD AREA' TITLE REFERENCE ISkLU.LLOCATED WITHIN A AS DEPICTED ON FEMA FLPOU MWEANCE RATE PLAN REFERENCE WAPS FO C MMUNITY DATED FLOOD HAZARD AREA HAS BEEN COREY & DONAHUE., INC.' :DMRMINED BY SCALE- ACCURATE DETERMINATION ENGINEERS & LAND SLIRVENnRS CANNOT BE MADE UNLESS A.VERTICAL CONTROL 198 CAMBRIDGE RD_ WOBURN.- VAA. Olep 'SURVEY IS PERFORMED. i Tel: 978-688=9545 Town of North Andover Building Department 27 Charles Street North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. c DATE (� JOB LOCATION a t-A-ln yr Arl Number Street Address Section of Town "HOMEOWNER Number Home Phone Work Phone PRESENT MAILING ADDRESS 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 requiremenip,,, _ HOMEOWNER'S SIGNA �k APPROVAL OF BUILDING OFFICI Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. I a a 4 �e 0 I a a 8� h fay ��aM aaY7 ll�° -7,Dvyl 1, ovIl / 1 , � D IN Eo----------- wo� -C asoP°�� )ir'o ,& -� A No -f - 5 - roll r°°l ,ddwd ri A` A 0 cn S qN O 0 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 Number is that the debris resulting from this work shall be disposed of in properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: �t7r (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i `? o U v w a a U W w a lz 0 cn cn uj z CL aC c o 0 CD c ° V :;Q Z O. vs cm 0 CL o Q4 10z •�mm c� CD y 0 p a�= c+ i \10 V 4O C N L O M �` v O G O .s CO M o C/)Q i� L. C. 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