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HomeMy WebLinkAboutMiscellaneous - 200 HICKORY HILL ROAD 4/30/2018Location Noy 31 Date TOWN OF NORTH AN OVER Certificate of Occupancy $ U Building/Frame Permit Fee $,12115. ,a y t! Foundation Permit Fee $ / m) - "-v Other Permit Fee Sewer Connection Fee `33 / Water Connection Fee J(eZf3ullding inspector PMD Div. Public Works TOTAL TO 81391 ta:x 'I"Y.••.+"4`:jt ".:A>^�}'s;,:..yE. 7... 1.r Ailgp�c 3 C, No. s Date - o»,„f TOWN OF NORTH ANDOVER s: ?o,,..o •,,�o 0 a . p Certificate of Occupancy $ r AL Building/Frame Permit Fee $ s�CMus `� Foundation Permit Fee $ 1 0 L->=" Other Permit; Fee - Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Ins actor �'- 150.00 (AID '+-Fo 80-8 p0q 1 Div. Public Works vyi f 4 12-W 6931 B,uuildin Inspector, 2,000.00 Div. fub c Works Location Alk •Date No. Z.•- 3-Z- NO oT TOWN OF NORTH ANDOVER Of .• OOL 3? ��', .. - n e Certificate of Occupancy $ °, •' , Buitd'i4g/Frame Permit Fee $ _ "0 SACMUSE Foundation Foundation Permit Fee " $ Other Permit Fee $ . 5 0 N A10 6 37 Sewer Connection Fee $ /45)040 }�,�'C'p D .33/ Water Connection Fee $ °a . 14W TOTAL $�'�', vyi f 4 12-W 6931 B,uuildin Inspector, 2,000.00 Div. fub c Works PERAHT NO. t$2' APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASS. PAGE 1 MAP qJO. /_Z_ LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE I ZONIE 1�� SUB DIV. LOT NO. L�;�i9 t1 , ,` , L a4g1 LOCATION PURPOSE OF of euILDING115., OWNER'S NAME % r NO. OF STORIES vY SIZE% G -!77/ {o OWNER'S ADDRESS BASEMENT OR SLAB -e ARCHITECT'S NAME S �• ARCHITECT'S SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING (/^O - DIMENSIONS OF SILLSA~�--- POSTS - _lI y� DISTANCE FROM STREET /y G..�.y DISTANCE FROM LOT LINES — SIDES _�/ REAR „J� " GIRDERS /i �y �A, AREA OF LOT �� �� -cF FRONTAGE 3�e /,1 7 HEIGHT OF FOUNDATION / THICKNESS /G IS BUILDING NEW SIZE OF FOOTING 21- x 7 IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING_ ALTERATION n� IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Xp �. 1� IS BUILDING CONNECTED TO TOWN WATER •P�� BOARD OF APPEALS ACTION. IF ANY A /J �V✓`f IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE 16 INSTRUCTIONS SEE BOTH SIDES c 'PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 3 PERMIT FOR FOUNDATION ONLY. 3 PROPERTY INFORMATION REGULATED BY PARA. 114.8-S. B.C. LAND COST QCT✓ ��J EST. BLDG. COST C•�.� C /��. - ��--er-- nATr Q,[ C r EST. BLDG. COST PER SQ. FT. OATE C _ �� "/T f Fr. ¢ 1 /O& �' EST. BLDG. COST PER ROOM Z�j,�77�Co✓ SEPTIC PERMIT NO. A, _ 4 APPROVED\BYr. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULA-RERMIT FOR MAR PLANS M,WJST BE FILED AND APPROVED. BY BUILDING INSPECT RR C DATE FILED /"'7 A•• ���. FEE - SIGNATURE OF OWNER OR AAerAORIZED AGENT F E E I Z.I S•, So C C PERMIT GRANTED _7 Fe v re t AMa's 19 OWNER TEL.'�3S" CONTR. TEL. LESS FDA FEE `'•''� mago= panS•So BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN Ck 'b--Ctg BUILDING INSPECTOR --�93a- SINGLE FAM MULTI. 'FAMI 'APARTMENTS OCCUPANCY �FO OES �=ICES CONSTRUCTION 2 FOUNDATION I II 8 INTERIOR FINISH CONCRETE CONCRETE BRICK OR PIERS 3 BASEMENT AREA FULL 14 '/2 1/ NO BMT HEAD ROOM BUILDING RECORD 12 L 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. PINEPLASTER _ HARDW D DRY WALL UNFIN. — FIN. B M T AREA _ , FIN. ATTIC AREA' FIRE PLACES 7 MODERN KITCHEN 4 WALLS I 9 FLOORS 007fiavl. ll 901 YVIR T z Al ', _ - 3Tt,%I CLAPBOARDS TOILET RM. (2 FIX.) WATER CLOSET B _ 1 _2f 3 I_ _ ---{ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING HARDW D COMMON ASPH. TILE VERT. SIDING STUCCO ON MASONRY' STUCCO ON FRAME TILE FLOOR _BRICK=ON MASONRY - 'ATTIC STRS. & FLOOR _ BRICK' ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME ' 'SUPERIOR POOR I - ADEOUATE I --i NONE 5 ROOF GABLE LA I HIP GAMBREL MANSARD FLAT SHED 10 PLUMBING BATH (3 FIX.) TOILET RM. (2 FIX.) WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING ' TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING - WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBE & COLS. STEAM STEEL -M. HOT W T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS ` OIL B'MI 2nd ELECTRIC NO HEATING 1st L•� 3rd 4 ZW­oft-.r.i 1 4 M(; 6pf�r.e.€ DIM l;A9 c>xl �i ' LL S�)5 ; L�l yx 22, aPo avy RIC axe YO -s I -b tfe74-t oz 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT:/�dIG�S ✓./j��r/10 Phone g�7--7-G35-- LOCATION: Assessor's Map Number b G Parcel Subdivision l Lot(s) Street fil St. Number 00 ************************Official Use Only************************ =RECOIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Healt1i Agent Comments Public Works - Date Approved o'Z Date Rejected sewer/water connections �--— - driveway permit Fire Department ILT 4 Received by Building r Inspector f,� `• ��UG 2 � ss� C Z� lq� Date pp ,Opo SE J) S ITE PLA1J DoT 3.8. ! IC Koply HILL Ljo/ 114 qy 0 a C7 0 Z Cl) m m D O z T z D r CO) 10 Z CD O o- r 03 -00 CD O. n� v CL CCD O Q O CcCD CD Cry CD 0 CO! O CO O 0 CO) c 0 C CO) W Cl) CD C7 rf CD CD VF CD CO) 0 0 CD 0 C CD - Balk m m C1, r vY� C O O 0 co O a O ao a Cfl CD ccc o' N 4-- 0. 0 a CO) CO) CD 3 r.: o' mcr a N C CD N CN tC O 0 m N CD . *C3 .� Co .df CD co CL CD CL -M0 = m O O N O C O 'fl O '� Cc7 C* C :Z CD = .: Z5• O N, ay7; 1 a =' o ? qCD CD 71 � • .v1 a CD :T" CD �,�•�' N .�• d y R 90 r. C .�.. � CD _ CCD N A -1 _ a) NCD UM n �o CCD O CD a' 0 _ tri N • -o O i ... CD y 0 9 0 cn cn OZ -, oil S C) Z yIz a` rD o n o o r tz ate- o o' `C C/) rD o CL n ? O tzi 0 �O , • . Ul IL -� SEP Z t CERTIFIED FOUNDA T/ON PLAN -- - —� LOCATED /N _ M.Q. SCALE: /"- 40 DATE 9116194 Scott L. Gi/es RL.S. 50 Deer MeodoW Rood North Andover, Moss. L OT /7 66.3/ LOT 39 92,i O O I H/ CKOR Y HILL DAD / CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE SU/L DING /NSPEC TOR ONLY � t F SHOWN COMPLY AND SUCH USE /S FOR THE WITH THE ZONING DETERMINATION OF ZON/NG 2 SY LAWS OF CONFORMITY OR NON- CONFORMITY Eo N_/�!_,l®, WHEN CONSTRUCTED. WHEN BUIL T. yQ l�Location k6r? No. Date_�y OF NORTH ANDOVER >f Occupancy $ ime Permit Fee $ a PermTpe/ ,, it Fee $ Sewer Connection -Feed $ l Water Connection Fee $ \ TOTAL $ t2 C' Building Inspector 9194 0B ti - 25- 00 PAID + 10 753`0 Div. Public Works . KAREN H.P. NELSON TOWN of �rOP NopTN f Director NORTH ANDOVER BUILDING CONSERVATION s8�`" 5E4 DIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT J CHIMNEY APPLICATION AND PERMIT DATE �7 ,� ) P S LOCATION AM AiLld&u� OWNER'S NAME / [? vv/ - BUILDER'S NAME 0 (zz MASON'S NAME / tI r L "N C 1n rtV / MASON'S ADDRESS D q (?Mie V f b, MASON'S TELEPHONE l 6(, - c, 0-3?j MATERIAL OF CHIMNEY 120 Main Street, 01845 (508) 682-6483 . PERMIT #3P — L INTERIOR CHIMNEY EXTERIOR CHIMNEY /jr�i 1( NUMBER AND SIZE OF . FLUES��/CI [r THICKNESS OF HEARTH Will chimney or fireplace conform to requirements of the code and have rules and regulations been received DATE SIGNATURE OF MASON�i�/�-� CONTR. LIC. EST. CONSTRUCTION COST/CONTRACT PRICE .TSI PERMIT GRANTED ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS FEE ,,► SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES 2 W CL (D 3 c CT 1 w 00 N 0 m mn n m 0 Milm 20 0 0 0 C Z 0 I) Ti C 01 n A Z Z G c s c rD v, CA CD T10 CO) C") 0 D CD c Z CO) p CD o tyyre z D a r n• , = _ CL �• CO) � O � v CD O CD Q = CD O` n CD O CD m z O z cn m Lk z -0 v m DO T D i W CI C CD y� CD CLO y _= I C= CD F v CO O 1 Z CD oCD O C CD IN I- (, C -a 0 Ct 2 d O 4c.® y ECO n ® C) ycino. m z •� �� -'� 0 03 w: mcc =r a ,� a 03 CD -640 CD H C N O =r ® CO O 7 0 y O o� 0' ca ._•• O 'Z f009 Co O ' CL. n CD CL O CCDCD CD s-� O CD J d � 3 it N .�• O H N CD - CCP d Q ` °0 --4, C .c a CO) 9 �° ca a y N N"4 .r O OQ CDn .� �- l „•F t .� �' �. • illi CD o a� -"a o CD ^' ' CD C H o� CD 1 �' O •� v .~ �. Q Co 1 Y M, m H 0 h� r v 9 - c 0 `° ru � C 01 ��.o G c b n• o O O rD CD 58,- 4,A p tyyre EJ M Location q No. � � S� Date Fes,. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Mus t�'• Building/Frame Permit Fee $ 40 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ J&- Check # / C�- 1 6 4 6 1 A/a Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: S/ DATE ISSUED: / _ O,3 �— SIGNATURE: z40CCS" Building Commissioner/I for ot Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: a0® 4-;ckor* 1.2 Assessors Map and Parcel Number: Map Number Parcel Number %11 Q LQ N D 0-1-" dY! Pf 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: AG r '7 F3 Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Le 9 uired 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 OWNERSIIIPJAUTHORIZED AGENT 2.1 Owner of Record Nam Print I Address for Service A q-7 Y�- 65-,7 Sig a re Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SE!; IN 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: P, w 1 6, lav T—C Vt S Licensed Construction Supervisor: 1 a -I i�pg2ry V Y" 'c> 4— II/t? . 7Jiv1>p�� Address r� / f �7�-��(� p 3331 SigYature44 Telephone Not Applicable ❑ e- License Number c. Expiration Date 3.2 Registered Home Improvement Contractor 41V4 CfA ^(A a V{ et >9 yr Not Applicable ❑ 1 a 9 Company Name ,1. 1 F y¢QNV tM �/0 JliYl�O�%t� r p� Registration Number / Address -33 Expiration Date Si aatture Telephone ou M z 0 �J i i 0 Z M 90 0 Mn ic M _r YI 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 .......a No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 1� Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: wok E peGfc w A-ec- L- % t ,.e- Ae' f -Y SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b ermit a licant OCIAL USE ON%Y 1. Building (a) Building Permit Fee Multiplier 2 Electrical J (b) Estimated Total Cost of Construction 2 ✓ 0 3 PlumbinE Building Permit fee (8) 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 I, TA w ,y y A YV L LL ►4 as Owner/Authorized Agent of subject property Hereby authorize to act on My bcalf, i all in ers relative t ork authorized by this building permit application. .5 4 3 Si n t re of Owner Date SEC ION 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 Signature of Owner/A ent Date NO. OF STORIES SIZE r BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2 3 RD SPAN DIMENSIONS OF SILLS DIWNSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHI1vINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 011t 12 EIVI'A P_ G FORM U - LOT RELEASE FORM --�3 - 0 3 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 edv I G• /ivIa'(-tl 004 14vkk s PHONE 977-- 64 - �en�e rMpro�-.oK.ohi� LOCATION: Assessor's Map•Numbbr PARCEL SUBDIVISION LOT (S) —� STREET_ At c4cc.J. d-1 -L- L .R J) ST. NUMBER ol—" �J ************************************OFFICIAL USE ONLY************************** ** REC MENDATI N$ F T W AGENTSI : ONSERVATION ADMINISTR OR DATE APPROVED 6 DATE REJECTED COMMENTS a 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 , DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9W im f5 S1V -r ;• ¢�sl. �l-� ,�%.w �7% ''...6. p,a.. .n Jk; �. .1.�. r r '01 . SEP 2 , � ;:t _. �, , ' CERT/F/EDFOUJVDA T%ON PLAN` dq i 2r L0CATEO /N NO-'AAVDOV f� , 1`" Md s ;z WIN , tk ?Q14- L r 40 DATE 50 Deer'Meodow flood NL?rover, Mass. - v ., 3 F ' a E , mg "T x .vim k %{ �g - i e•s LOT, . 39 �� 5 >r ink P P' 2 t 4 .. t ca •`s '4.. ..r -"`�` ';r,: t�" �� !S� !y W. {`fit Vol 't'S fig, i�` y, i { ��i .� ? a � �,i y � 'it r •t- �.. � 2$ � � ! "� 1 A IV 121 y`vjL - ti.Y4 ��4 �P' f �� :� � a r � Or t �`✓ '«R`'�' � d i 'r�ri.•r. +�•. _ p t is .; tJ 'x"'a t,� �.�:; is i���*��g.��'�����i•. t ¢��' t,:r��x '' a'r� z o -a '� „�'•.. � 1� �:< i%,yF�'fH��s �`. '-�W.:- � �" ,"�� ;����,� •."�• v '3 � � .� 5 a� � � r � ` r � �� 2 " y i 7�?' •. �rz ' � >_ 6 ;sY' � A ''�.a. r{ f:�� 4f, :{x+ 3D`, 4' .� "+'}t {'° ,�' J s '• / 3. `4 �1nI Y a - t p 10 T w tZ t ef6,p .� >a��..: -�o-//�i s '�" •"tea t,.;_, { ,.5 (' 7 �" >•�' i=b��y � i r�} ? �, } � ) :J" �� ' = 1. N n�v 3" i-L'��j � ""!. xTo y t 2> 783 SF. YMP Air ggg xx'}" a J 11;4 � x Y xS' iiy' . s€ •s� iF +. isfily t �� `` < ISM j'. arn�, z` C2 � ,ay `�' � .k-�3. y*t��'�`�t^� ~'S � ,,('�'±�q,� yr ;�;', .�1� ��, //�� ��VI � u �I� l � > ,'# �_. I '�c�' S ^t ;'r ,.yS _;�` +��•�'c ; S' . F' .1•'i "i_ "�' C Y \J � }'p � �v�` S Bi.1��,„Y �'!4d r g � p• ',� .7 a" * �C•�, vw.`c, i'°� r.';r f.rr".;.Y k c ,Q 3'aa7 r� ♦ ,,�r r_S "§� fi ^� .3 �f. ..1a- .`` 'fir ��" �"� (Y �•"5r ,. i'�y+ x+'�°:r. •`�3 s� ��•'� M IAyF F,ts rt �lv J { �t3 _ fi4 _ NOW. r4 fx y +iar1�} r Sii�2� aY °r a + V 2 ,int Q% ­ I I .� .r ?�"`c t,, � - '4iFa+r,s"• may. i .'a4' ty:: /�(] # -"�{ f i. 7. s �„ta�� �,-aa '� '�-� & a�+w yy_5+:. t �a> to of , +�',, 'dry a Q .A`»� y}y •,� '. t Q OR . ? �f °b ,ri x y �, f, m**w;,df t S« . 1751 i�"'S•:.Y ,.[• �"� 'A''>~� �+� Fr •' I,t # �L3 ��u,. ���`�� ig 3�� 9'-' ��. �+ � ai �•• kr•r yx �r ,.r .k. _,.. >�v 3� ,"'"" r-'rr••4 �« ata i,.�, sr 7'H TH�'Z ' LGAI�YS�Oi £ j sla.v I �w4 :toy w'"'�tiraFti F t �'.k% " c' :3 �, " '' ,• -v :rv:K,OHILR Y _r h:a, c �•. �, } tF Ar`�a' t . � xa- � - . •�. p � . `y+`¢ '�'' g �' �.F'° {�. �x i .. . 6 2 c ,. r't, ,"`d+f' #, �oF xrHE ��.4ND'SIJC lot �, _O t ij �. 1_, Pr vvfrciv� c x/1VW.IV, ARE FORuTHE+ USE � � � � `� � 1LrD//1%G 10010'CTOR'TONLY, •� , _ L,rr,.�l�wr �• YY SJB...?�av4:.:+.d:.'Ri�e[dJ±f� S�4{X}II:iSva: lot �, _O t ij �. x/1VW.IV, ARE FORuTHE+ USE � � � � `� � 1LrD//1%G 10010'CTOR'TONLY, •� , T/O/VR©F-ZON/NG02 'STRUCTED.was v,q Vey i3 4.: it I WON j4 t. } f^�.E:< ' t .' X .': �wl 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 a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Faci Signatureof Permit Applicant / / G > Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through, the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: p d+ -v t /-1-v7`r: % (ft --t Location: o lei Gke s kiL L C, /�- City /V 0 7 4N i'l. 0\A,-, , tom M Phone # % 7 T & Fl -3 3 3 I am a homeowner performing all work myself. EiTI 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. Comoanv name: Address City: Phone # Insurance. Co. Policv # 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 $1,5W.00 and/or one years' imprisonment_as_YfeU_as_civat.penaltiesinAbeiArm4aBTOPW-ORK ORDERaW.a.fine.of_($1110.1Z0)-adwagainstim 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Date 5hL 7/0.3 Print name �'� / �` - A 4 ` , s Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/l:icensipg O Building Dept []Check if immediate response is required p licensing Board E] Selectman's Office Contact person: Phone A- E] Health Department Ej Other D m W 00 D C U) m --I 00 0nm m N � r C Z— co m m 0 C: O Fn R BEAM LAYOUT FOR LEVEL 2 CUSTOMER -- 8 & K LOCK DATE 05/27/03 REF Deck03142 JACKSON LUMBER 215 MARKET ST LAWRENCENA. 1-978-686-4141 BEAM BEAM POST POST LABEL LENGTH COUNT SPACING A II' 10 1/2" 2 II' 7" B 5' 5 1/2" 2 4' 1/2" C 6' 9 1/2" 3 2' 8 3/4" D is 4" 2 1' 1/2" E 1' 4" 2 1' 1/2" F 5' 5 1/2" 2 4' 1/2" G 9' S 1/2" 2 9' 2" Post spacing is measured center -to -center. Depth of post -in -concrete footers --- 48 inches. 1' 11 1/2" 1' 2 1/2" 1' 10" 1' 2 1/2" 7 1/2" 1'21/2" 1' 11 1/2" BEAM LAYOUT FOR LEVEL I CUSTOMER -- B & K LOCK DATE 05/27/03 REF Deck03142 JACKSON LUMBER 215 MARKET ST LAWRENCE,MA. 1-978-686-4141 BEAM BEAM POST POST LABEL LENGTH COUNT SPACING A 37' 10 1/2" 5 9' 4 3/4" B 2' 9 1/2" 2 2' 6" C 23' 7 1/2" 3 11' 8" D 11' 4 1/2" 2 E 11' 4 1/2" 2 Post spacing is measured center -to -center. Depth of post -in -concrete footers --- 48 inches. 3' 1/2" 1' S 1/2" 3' 1/2" F S 112' 7k �amrmw • al/ a� �rina�ac�zuee BOARD OF BUILDING REGULATIONS Licnse: CONSTRUCTION SUPERVISOR Number. CS 059105 Birthdate: 05/0511960 '1Expires 05/05//2004 Tr. no: 23896 RAtricted y 00 PAUL G-HUTCHINS,'�f 121 FARNUM Si NORTH ANDOVER,'' MA 01845 Administrator i 1� —', O z m C3 n O O N H CO .9 CD L CL co 0 CD Q CA V CO) C 0 .0 H ui D 0 Cc W crw ui0 U $ w ) a V) O o W2 o a: v U Cd z � F rs: x O W v w w (k: w O O a: c u. W w w z cn o o cf) O O N H CO .9 CD L CL co 0 CD Q CA V CO) C 0 .0 H ui D 0 Cc W crw ui0 c c �m22c • .r (k: = O N ' C O `I: cc m c t o IL o C CD N m »-- dw: m IL+O+ N CM L 2 m 0 N N m �• c 0 � � O y = C NCD W C CM .� coo c a • •: d c y m SOC = ICE O H W 0 L A ocE N O.t = �N Z o cW.3 m c m c g y S O. A m � y ��'� O =s CL, m� O O N H CO .9 CD L CL co 0 CD Q CA V CO) C 0 .0 H ui D 0 Cc W crw ui0