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HomeMy WebLinkAboutMiscellaneous - 21 PERIWINKLE WAY 4/30/2018u I North Andover Board of Assessors Public Access f NORTH • i SSwcMus� Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 North Andover Board of Assessors roperty Record Card Parcel ID :210/038.0-0279-0000.0 FY:2012 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to 21 PERIWINKLE WAY Location: 21 PERIWINKLE WAY Owner Name: BRAESE, CHRISTINE, P. Owner Address: 21 PERIWINKLE WAY City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 10 -1.0 Land Area: 0.58 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3216 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 708,000 708,000 Building Value: 415,400 415,400 Land Value: 292,600 292,600 Market Land Value: 292,600 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkId=1889944&town=NandoverPubAcc 5/17/2012 N 0 N LL C4 N O Y U 0 m O O O O O O N O O O M O O N �I w U Q a i� J OlrOG E 00 OO 4 0 j LOi ni a ` aN! CO Cfl N N W N N o�o�x NF y o a a N£ Ca 8_0 m dry c c Y Y ❑',mo��' C)FV'\ ,; a U 30 l<C N O�N N N C ��N OO a; m — a N a c0 COO ,LU U oZ CY)N N i a e€ In Z N N E w c O = c 2N 2�o i �00 O LL J O Q�LqO 00 ZOO H'C m LLO E O (LINO �� y Z r —) O * N t ¢¢ C Z fn t0 O _ ~ ,t, a f as v)N JJ ..I rnO N'�' U) O O i Z [ h Z� v! .. ro m d00 �o 00 00 Y,Nj�I t O r V r0 I Q 0, C6 a N f o LJJ r, 0 0 N C U Ha O cl) = o O N W O mdS a 7 U = a "qt C- @ ? 9, CO i ` CO :2 O ° Cn f 10 N Ny N N C Vl VJv/()V F 041Y f61 f6 f0 `.O O !� f +O+ Ct a cN �� ,. r HlM O ;:. i v E•+°o Eq Z rv, U.m p m U)C V1' ,U.`-Y.O O[ -;:O -a QmtLm ��Un:UQQ� N` co O s ;O' O O, N Cn��QZ 'O CnQ.Oi a m .,5, O rk O O O`, V t0 O, 04 O O- W r=tea ,M. �NN>>r= O 00 ----- - cu RE CD. E (x6 I— i X CU ' i' f +� w 13� Q CPQ N Q: y3a al. {.Cgfl-a LL W.0€c <rC� m m �'E H Z cLLLL cti, $}`0 m10. 0+cip 4=I01210T CD Q H w W +>- U` U is o h 2 ae Z Z ' 16 oDelN�rN��r2 M 3 N L jrn a E E04 »��� Z4�'c `myco a N p `o N U U', t1 O -0 U'd "V_' E ZLL aa, O N 7 CU X F Cp _ 1 X 3 (0 2 V) z f-miL26WmYWj mCQ m W J> J`o ,m6 Z}+ 2 Y U N 2 LL 'Ci} IQL 15�N if Z Lu Q ado aim dV N 2 fn 2 L_< Cna 2 N @� _ =°a ��� U.L s r �@ W m N Z 3 �jU � o'o L ami o,X o �._$NI O> ,2 Y U—) LLI 0901 Town of North Andover D.B.A. — Zoning Compliance Form 474° �`��� 978-688-9545 This form must be reviewed with the Inspector of Buildings. Office Hours are Monday -Friday 8-10 am, and 1-2 pm .Monday -Thursday. A hcant Name: Af-6'U Name of Business: 5.�`C,� ,A i-�'c��►i z�'t-� Address of Business: 21 F7e� i wit' vs l-( G W4 u Zoning District: Map Df)'� Lot 3 21 q Phone: ( �? — C� Email L:�C-1 C' t.l -'z'itt C3 Ct �-a iZ� GCO im ( m t Nature of Business: Do you own this property? Yes V No If no, written permission .is required from your landlord. / Will you have clients coming to this property? Yes No '✓ Will you have any employees? Yes No +/ Will you have any major deliveries? Yes No 'tl� Description of Business Activity (Must be Completed) S0 t—Kj— — Z�.�—�f 4x -'d' -1A 4�. Signature of Applicant - For Signage :Refer to North Andover oning Bylaw Section 6 The prop us is w se in s zoning district, Issued By .� _ ,��-- J� 2.40 Home Occupation (1989/32) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use of the building for living purposes. Home occupations shall include, but not limited to the following uses; personal services such as furnished by and artist or instructor but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacturing of goods, which impacts the residential nature of the neighborhood. 4. For use of a dwelling in any residential district or multi -family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the owner of the home occupation and residing in said dwelling. b. The use is carried on strictly within the principal building; c. There shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings; d. Not more than twenty five (25) percent of the existing gross floor area of the dwelling unit so used, not to exceed one thousand (1000) square feet, is devoted to such use. In connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible from the street; f. The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, omission of odor, gas,_ smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of design not customarily in buildings for residential use. -3 Signature Date North Andover MIMAP March 22, 2017 1038:0=0286 I, ._ .._.. ••• 15 Nutmeg. L'a n •. 038.0-0282 -_: u��lt.� ,. r,, . . ` 61, 1p8 NUTMEG LN 039;64)2 10 PERIWINKLE WAY I03,p 8?00-276}' 'SOrNUTMEG?LN 038 00277 cow t. 038, 0 $0278 Ipg 038.0=0280 22 PERIWINKLE WAY ::�au 9�PE_RIWINKLEIINAY 21 PERIWINKLE`WAY 038.0-0279 065.0-0052 ..._._.. . a. • ` ` `�.�.`• • •?''_�.r.•'' �\tt�`_ -_ _. •��,.- ''�`` ...-llfkltt�:.._.. _:.: 1J�.4C .._._. - . ��11..._._. .. .._..' '�Ct::;.?:_':a\;C.::1:_'-_. .. 71�i1.. l.Ltk'.::::'_.::.�:L �.G!'.::__..-.13.�1.1.'.1: •=�S.tl. _::. _ ',.:'+ '�;:. 1�.��:::_. __ ::::- tl% . • .... Si� 7itU.l. •• �.._. ;jt�j(- •._.__ ' &.... =•1k�t;F. .:•, .: �' aitcl •. yl�tl. - �''1"'Cl....__ .._. "c",✓'.::. JJ .:_: 1��{!. I _: ' I L 411 _:d, `!. -..... �fl.' •aL... Sall.:::.:: .._ � :.,.;SSG!....... ..V�e`! . .::,?.tti. ' •- 038.0=0087 _ . ..... '...... r....... 065.0-0090 1121' ABB gTDT Tf' 101 ABBOTTI§T [j MVPC Bo Zoning Overlay Zoning E3 Municipal Boundary 0 Adult Entertainment Distric Businei 0 Machine Shop Village Ove 31 Businei s 1 District s 2 District ' Horizontal Datum: MA Stateplane Coordinate System, Datum NAO83, - Rail Line Interstates = Interstate 2 Watershed Protection Dist M Busine 0 Historic Mill Area O Busine 0 Medical Marijuana O Genera s 3 District s 4 District Business District AORTII Ot ,,G o ,�H Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of -Major Road 0 Downtown Overlay District tR Planne 0 Historic District Corid Commercial Det Development Dist t< a O + O4 Environmental Affairs/MassGIS. The information depicted on this map is legal boundary - Roads i r Easements : Osgood Smart Growth (40 R Cortido -l: Hydrographic Features Q Conido Industri Development Dist Development. Dist I 1 District 3= _ O --- • •'0 9 * - * for planning purposes only. it may not be adequate for definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY ❑ Parcels SVeams IndusM 12 Distrix * s ♦ OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT Wetlands ®Industri 13 District K. o� f ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Indus"i1 Exempt Lands Reside S District ce 1 District 4 ��' 1l•,, +O��ra° -to °� THIS INFORMATION Reside 'a2 District SSACNUSE ., R-ide ce 3 District de V = 68 ft de ce 4 District ce 5 District de ce 6 District .,,,,ge esidential District .ATE OF USE & OCCUPANCY own of North Andover :r11C3 Date / — —a O / THIS CERTIFIES TH TED ON %� / 8 ?�% ►S SJN `e' IN ACCORDANCE KS OF THE MASSACHUSETTS ATIONS AS MAY AP LY. 30 5, 3 344 u tie r- ,gh604 D10- cl/- c01- /10 Dc/ s� Building Inspector CERTIFICATE ISSUED TO ADDRESS STATE BUILDING CODE AND w.. -,J , h Cl) m m m VJ 0 CO) 'O .00•r• Z CD O Cir Q =■ n� o p a� cr CD O CO) CD Cl) O to �l i - c13 CD O CD 3, CO) CO)CD I O O CD 0 CD ic rn ic R cn cn V ® ® � O . cn cn d ►O►�y . Ir W C 0 w5$o 5.wocr = __4 S a Gd a cn 7C w y 0 o S. 0 y z .� iOa a ®o ® nm Z t S � .w H o T �� �n�nO m y C CD g C C3 0 %0=. C2 .-. A O C2 H OZ ao c � c o n= L C �it l �. D n7o o S 49j: OR arMW C M.s y.00 d � W— Q a y w�CD CD N H Q CD � ll ?, Q CD su 0 C i-16 " " CR :♦ c 1 G C=2 0 CD: '3 � d o .... a Gd a cn 7C w 0 cn ,Y n z v AZ t �� C C> CY .N 1 1 0 0 z O � p �9s°••�,o :�L��h TOWN OF NORTH ANDOVER APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION n , ADDRESS/LOCATION OF PROPERTY: plfrI 4 DATE REQUESTED FILED/READY FOR INSPECTION �� $ CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND PERMIT SIGN -OFFS MUST BE :COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY DOLLARD $20..00) .WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES', SIGNED ROUTING CONSERVATION PLANNING _ �25 (b 1 DPW - WATER METER NOTE: DPW MUST INDICATE THAT WATER METER HAS BEEX1 INSTALLED, PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW Signature Date...... .. ........ ..... N2 2/066 ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.......... ........ /�7 ...................... .............. has permission to perform ...... ......... .............. wiring in the building of ........... ........... ...................... at.4 ...... �t-y ............ ,earth Awd77over, F�.... Lic. No.111?( ................ .1 ....... / . �LECTRICALINSPECfOR Check WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Use only Permit No. Occupancy and Fee Checked Zev. 11/991 (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 INWK ORTYPE ALAndn NFORMATIONJ Date: 3-- ( � City or Town of: 0 • fir- To the Inspector of Wires: By this application the undersigned gtvehnobce of his or her intention to perfonn the electrical work described below. Location (Street & Number) No. of Cei1-Susp. (Paddle) Fans INo. of Total Transformers KVA Na of Lighting Outlets Owner or Tenant ' of n ratan tan KVA No. of Li;lhting Fixtures Telephone No. Owner's Address No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Bos) Purpose of Building Utility Authorization No. Existing Sen•ice Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New SerN ice Amps / Volts Overhead ❑ Undard ❑ No. of Meters Number of Feeders and Ampacity Local 0 Municipal ❑ Other Connection No. of Dryers Heating Appliances KW *Location and Nature of Proposed Electrical Work: , /f A 07/ fold i/ A 1,4,4 M r � Completion orthe rnllnwinv ruble mm, by u.n;unrl h„ it,, rn cnonfn. / ri r37&o& No. of Recessed Fixtures No. of Cei1-Susp. (Paddle) Fans INo. of Total Transformers KVA Na of Lighting Outlets No. of Hot TubsGenerators KVA No. of Li;lhting Fixtures Swimming Pool o bove ❑ n- ❑ „rnd. ornd. o. o mergency Lighting Batter• Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Snitches No. of Gas Burners INo, -o f Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices e No. of Waste Disposers (Heat Pump Totals: Number Tons KW INo. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating K'W . Local 0 Municipal ❑ Other Connection No. of Dryers Heating Appliances KW SecuritySystems: Na of Devices or Equivalent No. of Water K.W Heaters No. o a o Signs Ballasts (Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: Na of Devices or Equivalent OTHER Attach additional detoil if desired, or as required by the Inspector of JVires. 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 undersimed certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) J� (Expiration Date) Estimated Value of Electrical Work-. � � � v (When required by municipal policy.) Work to Start " -0' Inspections. to be requested in accordance with NEC Rule 10, and upon completion. I cert &, under the pains and penalties of perjury, that the information on this"application is true and complete. FMM NAME: ADT Securitv Services I II Morse Street, Normo((„ MA 02062 LIC. NO.: 1533C Licensee: John S. Bassett Si - LIC. NO.: 1533C (If applicable, enter ••exempt'• in the license number line.) f / Bus. Tel. No.- - - 1 Address: I Alt Tel. No.: 603-594-5q28 resi OWNER'S INSUFLANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally ONLY required by law. By my signature bolo«•. I hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature, Telephone No. PERMIT FEE: SJ5.001 Location 4/0 C�,)/ /"' No. _ Date NORTH TOWN OF NORTH ANDOVER L .. 9 Certificate of Occupancy $ -6 ssHusCUS Building /Frame Buildin /Frame Permit Fee $ e Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �5 Check # 14093 % Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: �„/ DATE ISSUED: 7 6/ e - SIGNATURE: Building Commissioner/IEEextor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1 Pe ri ti,\Ie- wa. y 39, '79 Q + t4= 3 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: k`3 FaM1 IY a510toto Zoning District Proposed UsY Lot Areas Frontage ft 1.6 WELDING SETBACKS ft Front Yard Side Yard Rear Yard Reqtlired Provide Required Provided R aired Provided O ` 146'r AO SAO 4 1- 0+ 1.7 Water S M.G.L.C.40. 54) 1.5. Flood Zone Information: / Zone Outside I's Sewerage Disposal System: Ne***' Public Private ❑ Flood Zone Ne* Municipal (4/ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record A bboit- OerJrne1. +- Coro (b �q Tc,r-r-% 01 K e S+r ND. An46.w Nam e (Print) Address for Service: S' ature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ W t %\ i oary-, Ga, re- Licensel Construction Supervisor: CS os,2 a 14 1 License Number Addr� 97-19;;k3 Expiration Date ignature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 1i 0 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 ....... V No ....... ❑ SECTION 5 Descri tin of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description ofProposed Work: /� CJS_ Ouie 16\0 w i ik a 3 C a/- -T a C. e -CA-9 e rend e.- SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit ap2licant OCIAO. USE -ONLY 1. Building �1 Oc Ho oco (a) Building Permit Fee Multiplier / . (� 2 Electrical g 000 (b) Estimated Total Cost of�� Construction / 3 Plumbin Building Permit fee (e) X (b) / 6 / s 4 Mechanical HVAC ( 00 0 5 Fire Protection N A 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, &AA invot 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, Wi l l i a v►, 64 rfe t - PrtSiAcA`k- a Abba 1+ Oc v COf a ,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 .� W I %1�carr.' 6a..rrCA* Print Napoo G Si at e of Owner/A ent NO. OF STOWS -7/17/00 Date SIZE BASEMENT OIZ SLAB @M,C SIZE OF FLOOR TIMBERS 1 2 al art0 3 D a X SPAN 114' DIMENSIONS OF SILLS k DIMENSIONS OF POSTS ii Yip DIMENSIONS OF GIRDERS — RX C HEIGHT OF FOUNDATION g' THICKNESS SIZE OF FOOTING l b " ar a L" X MATERIAL OF CHIMNEY OrXL4 IS BUILDING ON SOLID OR FILLED LAND SO IS BUILDING CONNECTED TO NATURAL GAS LINE eS MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 7-14-2000 or 2 family, detached Other (Non -Electric Resistance) DATE OF PLANS: MAY 18, 1998 TITLE: PROJECT INFORMATION: 21 Periwinkle Way LOT - 8 NORTH ANDOVER, MA 01845 COMPANY INFORMATION: WILLIAM BARRETT HOMES 1049 TURNPIKE ST. NORTH ANDOVER, MA 01845 COMPLIANCE: PASSES Required UA = 754 Your Home = 748 ' Permit # ' Checked by/Date , Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS 2465 38.0 0.0 74 WALLS: Wood Frame, 16" O.C. 3012 15.0 3.0 201 WALLS: Wood Frame, 16" O.C. 584 19.0 3.0 32 GLAZING: Windows or Doors 786 0.480 377 FLOORS: Over Unconditioned Space 1424 30.0 46 BSMT: 8.0' ht/7.0' bg/0.0' insul. 58 0.0 13 BSMT: 8.0' ht/4.0' bg/4.0' insul. 33 19.0 5 HVAC EFFICIENCY: Furnace, 86.0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR Builder/Designer Date -7 `-/ 0� t BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 052241 Birthdate: 10/10/1952 Expires: 10/10/2001 Tr -no; 7876 Restricted To: 00 WILLIAM K BARRETT. 1049 TURNPIKE ST N ANDOVER, MA 01845 Administrator - .. -4— -*--,-, 4---'---' Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01 845 (978)688-9545 Fax(978)688-9542 DEBRIS DISPOSAL FORIti1 NORTH O _ OL o ��SSgcHus���y In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from he work shale dis of in a properly licensed solid waste disposal facility as definedtby MGL11, sl OapOSed The debris will be disposed of in /at: ��/�� Lam. •'✓!;✓G�✓ � j �� � J, t �• c Facility location k::. s� Signature of Applicant 71l 710 ci Date NOTE: A 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 Please Print Name: Location: City Phone F-1 am a homeowner performing all work myself. F7I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. Co_mpany name: Cnlo>-;,x.1 V't11 qDeo, orn o6A - Ahbo�- neocorn. Address 161ti 4 City: A -)n Phone # (r; SS 3L - ;� n Insurance Co. GCea t (� m &,- pC-n ,.) Policy #QAC ($ i a 5 a a Comaany name: Address City: Phone #• Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. i do herby certify under the pains and pens of peAutPUitthe-inkrTation provided above is true and correct. Print name Phone # 0-v Official use only do not write in this area to be completed by city or town official• ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #• ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Growth Management Bylaw Exemption Statement Town of North Andover Building Department This fort shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. WN ©f Applicant on Buil ing Permit below) Address of Property for Perm, it (below) Map and Parcel :39&1 06rpose of Applica heck below) Phone Number of plicant Ingle Fai y Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit ig issued. Eased on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with ane or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement. restoration, or reconstruction of a dwelling in existence as of the effective date of this by-iaw, provided that no additional residential unit is created. XThe lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing_ one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Oevelopment Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above.item which does not comply, whether done to my knowfedcle or not, is grounds for refusal b ng Department to issue a Building Permit. t e Z5r Ow6er or Autffanzed Agent wno signed the Attacned Budding Permit 0 e his form must be attached to the Building Permit upon application for such permit X tol I@ -mri 1 ,' �' \� � � �y►� ►ice -Jr _ ., lop { ���n�jTl f11 p. -4? {�Ul�{O^ FIN �? j C�Ca_ � �OZZOrD:a X tol I@ -mri 1 ,' �' \� � � �y►� ►ice -Jr _ J.WILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT Telephone (978) 685-0950 Fax (978) 688-9573 DATE�� _ LOCATION Z, r t bo g BUILDER phone OWNER phone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. 982 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. Application by the undersigned is hereby, made to connect with the town water main in subject to the rules and regulations of the Division of Public Works. The premises are known as No. 14 4 or subdivision' lot no. Owner Address / Contractor PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to�°� ! �C`Cc �C� dY e to make a connection with the water main at. C?r d jai U(G�L subject -to the rules and regulations of the Division of Public Works. Inspected by Date Street Board of Public Works BY / See back for rules and regulations 1527 APPLICATION FOR SEWER SERVICE CONNECTION All- hal. North Andover, Mass, �2- t 19^" — 4, Application by the undersigned is hereby made to connect with the town sewer main in re -r t t` �(e i _ � f S4eet- subject to the rules and regulations of the Division of Public Works. , 4 The premises are known as No or subdivision lot no. % 14, c VK �q rrc=�l Owner Contractor 0 Address Addr ss Applicant's Signature PERMIT TO CONNECT W�I`TH� SEWER MAIN The Division of Public Works hereby grants permission to _ !� i �t /� �e Gd'Z l �` ✓ E�' Street to make a connection with the sewer main at r l,r I Ute �^ GL U)Qq Street subject to the rules and regulations of the Division of Public Works.. 111f Inspected by Date Dpi>vis�'on ofublic Works By %LZL'9Z' G See back for rules and regulations NIS. 3a5� Date.... TOVVN ®F NpRTH ANDOVER RE�,-Pl II - e O -a . ........... :This> 'C certTAeSthat . �� .). has paid . �. for ....5 \ L ...... yy Depatme"t .................. piNK: treasurer ent CANARY: Departm Wlil'fE: Applicant 10tg �PlCi�P '121TS, 4�7,4E OF — w Er"LA j p Y 11JV WAY � �1 170 17Z 17Y 176 T Iff r. V1 rz i I I Tj p :T FN�_Yk. u ZF kL, .1 T mn-i 13, rF !J A M T --w I I Z. T Y't Y!, I f A T., a -n c: rf fa T, FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT f�/f/</i9lis`/��� PHONE ASSESSORS MAP NUMBER LOT NUMBER `� '7 SUBDIVISION b a l//��/di' LOT NUMBER 0 STREET vVC� / 10) AJk Ile, A4 STREET NUMBER OFF CIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED _ bb 0 CONSE VATION ADMINISTRATOR DATE REJECTED t`l t Vii CUv-� . • tin- g J --,g pul tti1 DATE APPROVED( TOWN R DATE REJECTED COMMENTS FOOD INSPECTOR - HEALTH SEI SPE OR - TH COMMEENTS Cif n=, J r' DATE APPROVED DATE REJECTED DATE APPROVED 00 DATE REJECTED PUBLIC WORKS - SEWER / WATERNNECTIONS �'� - � 7-17-6b DRTVEWA C�/ a� Q �rer 5-j� J DATE APPROVED J--/ l C U FIRE DEPAATMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE p r pp C: N o cn � rn T T ?J � r m m m M �Q Ln::r in m aio na n m m o a Iv C CLO m O M M cr3 CL D 5. O Un n m u� m O_ C Ln ...q.l C n E. O cr m x m Lo aj aj a E m a� 0 C '•r 0 Ael y rn a � cD ( N n rrm oc 3 V) 0 0-0 0, 0 = ,» cD D cr x > fD(C n ~ �� O _? ,! 0 fD •Q lD c c` CL OC C ' 0 A, r o Q ID lD 0 d �0 0 (DD fCDD r•► ,ma o Z • o v CD a v F Z J � . :cn D FD CL0 �• z a to C �s CA Cl) m m U) 0 CA CD 0Z CD O d Q =. n� CL ov CD Q ,c d =� CD O .. I rw-- 5:o O to CD CO2 10 CD O Lei FWJN 1r d C) CD r� CD CD a. y CD CA O bo co 0 CD I C13 -0,10 10 O -• y O Q N dO m y Om A CD Cl) m N 0 G. 0 m Z ' CD ?Zt N• � ...r= .O.* m N T CD nod O y CD O O N p N ?m m 2 0 3E> >� O n to o Z�.n 1 O N O aCOto ) <S O CA � !D . � C-)= co C nm .Ow: m m p N Di N N d Q O .� �• , a CL w�C �m CO) 00W � � CD c, 0 .�• 0 CD O `� a Af m :Q ED CD R� O � !9 � O o m G (n C/) Z GW`i1 ^+ OTJ r o� aGa CL n (rte'-" Cn b . CA 'r1 Q rD d 0 C I� II I I I I I I I II I I I I I I II I I II I I II I I I I I I II II II II � II II II Z II II I I I.I I I I I I t I I I I I I I I I I I I I II I I I I I I I I Lr---- rt -------- I I I I I I I I I I I I I I I1 IL-------- 1- 4 I IL-------- I I 1 I I I I I I I I I I I WILLIAM I3Afi2I?� 1''1' o.�ct,m �: ZI KR WINK �"" j� VAS: ter: PULPM, OF FINS HOW5 r"' ` 5M RZVA110N5 3'-0111 91-B11 5,.811 16-8" 13'-01 1 - - ---------------- 9' X1, O 16' X 9' ------------------------ ------------------- r OVi An POOrZ OVWAP POOR 1 = II I I I -a. V► � I �--6T T,611 -/'-Oil. 1 5'-0" 1 14'-0" 1 5'-011 , -011 C' N b 4 WILLIAM L3Ap�� -rf r'RO. cr : 21 MUCK nor - 8 -I . -0' PAS: : 13UILn�R OF FIN� NOMAS : FOL�N19AIONMAN �`��: I r - --I I ; I I I --J L L J , I - I --� I �N ��V► I j I � -'�W I I I _ I r--� r--� r--� 1 I ' L -1-J L --J L --J L --J I I I I I I a i T- I�11 �� �� 511, X11 _Ib 1� s -fib 1 1311 6 I I I I I --------I r --- --------- ------- I r , --------� I I 1 i-------- -� I L -J Fir L -J------- J --------------� L ----- J I __Jr6 I I___ -/'-Oil. 1 5'-0" 1 14'-0" 1 5'-011 , -011 C' N b 4 WILLIAM L3Ap�� -rf r'RO. cr : 21 MUCK nor - 8 -I . -0' PAS: : 13UILn�R OF FIN� NOMAS : FOL�N19AIONMAN �`��: 20'-6" i 9'-6" 7Z QQ 7�i PRO,ECT ?I?I.i: 5CAL,- PATI:MAW 51 1: WILLIAM 13A�p� �'1' Zi t cx Lor - 8 I / 8" -1' -0" I3UI�n�� O� � INS NOMAS �n�' �� Igo -0.. 20'-01I N I 1-6' 9'-0" 2' 12';6" �► p I LJ I - s. I O I `� = I I I O d b � 2,�6 m�� d W b d 7,a„ b — 13'-0.. �► 91-01 I I = >u -\ �. Z bQ3 WILL IAM i3A?M?F,-.,F,t o.�crtrn�: 21 MR Wcx fpr^8 '�Bn,l �ii PAZ: H AI s�coNn PLooR FILM s - kk I� Q WILLIAM . r : 21 MRWCK got - 8 1'/811-11-0 • � PAZ: , PULPM OF BIW HOW5 : RX MOOR PWiN6MAN MMOY: 00 WILLIAM mojXr w: 21 rMWICK nor - 8 5M, PAZ PULPM OF FIM NOME 5 ffvme. %CONn FLOM FRAMING mm mm YI 7 V S Y 1 i Y i � yF S a 4 r � fI Me � N X CLO -R 1 O a � Cl -z i Me rRoecr,me:nnn;r WILLIAM i3App� -i"1' 21 MWCK nor - 8 I/:1,11,01 0-0 I3UILn�p OF FINS NOMAS r UN6 Fri% FLM � N X CLO -R 1 O a � Cl -z r - rRoecr,me:nnn;r WILLIAM i3App� -i"1' 21 MWCK nor - 8 I/:1,11,01 0-0 I3UILn�p OF FINS NOMAS r UN6 Fri% FLM i ,u cn 0% WILLIAM 13Af�1�� 1'1' o.�`r : ai KRWcx Lor, B :/ 8� .1 �� PAS: r PIA QPM Or r M How5 `'' : Boor FRAniNC4 PLAN PRAWN OY: ti Ipll Cis O O� Q Q X NI � o x r � N I L X0 � WILL IAM t3A?-,F,-r-r rw.ftffu:21 PICKWICK J1.of d T8110 --I0 IIA sir. PUILPM Or FINS NOMAS .%uff=` PULPING %CION f ► 1 f L cation of��a� -Pr�wtN flI-e- I'm i Date 8 TOWN OF NORTH ANDOVER n e Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # /3.1 V 14136 Building Inspector 7L Ct •%-na,,, Ike � . 1 I HRUDY CMIV7 r0 M JJ gg:r4 ar2j::: K.>o•,.1V- rJur rar Fmj-rATw Is LocAnm ON ,'w LOT AS slmrx An raAr Ir Dors Cox"" xlrlf rxa T*wu OF Nv• a navee- Somo mouu 70NS MaMMNc SRMCXS FROM SrRBarS & Lor Lmss.' I FURnM CrRrIFY r rMS F prP. Is Nor LOCAMB I1VnMF FLOOD NAZUM AREA AS SHOWN ON Fr IrY PANSL f z gp p9 ooaG� - rJAT , � 9q 3 ` G�kl SraP ... S• DITR MOT pa BOUxDARY BommuY numq inam rAA'Rx FROM yes_ PLOT PLAN IN DRAWN FOR A WTT' per, evp-p, 10" TU tz" PI 1lRR MCK RNCrMRRRINC SERVERS 86 PARK STRUT ANDOMR, YASSACRUSMS 01810 A) //- 4,j N2 2632 Date .................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ... ; ......................................................................................... has permission to perform ....... ........................ ..... ............. .... ....... .................. wiring in the building of .... < I--, 6/ at.... .L ............... ................................................... .. North Andover, Mass. Fee"-�' .............. Lic. NeQbV740 . ......... I ...................................................... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 0 I COpiAfORiYia[Lh o� l �ud�ac/tu�a�! (Rev. 11/99) For Office Use Only cc��r� cc77 �7 � .1JaPartna<an1 c`}ira .JYrwiW Permit Number: -- BOARD OF FIRE PREVENTION -REGULATIONS Occupancy & Fee 2,S1" APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (AL1 WORT: 70 BE PERFORMED WITH nM MASSACHUSEM ELECTRICAL CODE 527 CMR 12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: City or Town of: ANDOVER By this application the undersigned gives notice of his or her intention to perform the electrical work described below. To the Inspector of Wires: Location: (Street & Number) .'2 f I�F2! �✓1iv ,�G �.a y Owner or Tenant:_/�/Z Owner's Address: Is this permit in conjunction with a Building Permit? Yes No oCheck Appropriate ppropriate Box) Purpose. of BuildingUtility Authorization t Existing Service: Amps / Volts Overhead p Underground. ❑ # of Meters New Service: Amps / Volts Overhead ❑ Under round.❑ 9 # of Meters; Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work:163141re3l /U. _ --bb WtSIVUE] Dy ins owner, no permit including 'completed operation" coverage or its substantial`equ�fv ent The undersigned the performance ocert fe electrical coverage ork may issue is in force, nless theland has exhibicensee eed proofrooi of same to the insurance issuing office. CHECK ONE: INSURANCE (I� BOND l7 p ���t �^1 OTHER o Please specify: Estimated Value of Electrical Work $ �IO o (When required by municipal policy) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penaltie/s/of/perjury, that the Information on this application Is true and complete. Firm Name: �(�/h vza;7 J4at T _ " /,L /Ap'e Address:OF OWNER'S INSURANCE WAIVER: I am awai waive this requirement. 1 am the (check one) v //, applicable, enter 10 that the Licensee does not have the Owner D OR Agent o LIC. # in the license number line) LIC. #_�.� 7 742 Bus. Tel. # /Alt. Tel. # nwurance coverage normally required by law. By my signature below, I hereby Signature of OwnerlAgent: Telephone # PERMIT FEE: 2456 Date.... ...................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... / ........ :......................... has permission to performll.—�!!:4 �-s' ' .......................... wiring in the -building of ... - r -� ............ v-� �'................ at ..... ... , N?rt�h Andover, Mass. .....:....... Lic.No. .a,� t i (/ ELECTRICAL INSPECTOR Check # // G? WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MECOM IONWEALMOFWMMUSE'M Office Use only DDNRT1' 16W0FPUB1K&4FE7Y Permit No. Ci 400.0 BOAROOFF7REPREVEMONREGUTA77ONS5270MR1Z- Occupancy & Fees Checked APPLICATTONFORPERIVIIT TOPERFORMELE=(R 'AL 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 The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address % 6 �% Is this permit in conjunction with a buildi Purpose of Building 5� ✓ G G z (aj,'/ U WAY ku permit: rmi L Existing Service Amps / Volts New Service Amps 0 Volts Yes ® No F] c in *6 Overhead Overhead ED To the Inspector of Wires: P L-,lt6 (Check Appropriate Box) Utility Authorization No. t Underground M No. of Meters Underground r-,7 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /10eiyy t/1 6 f No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground El 2round 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. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. `�Iater Heaters KW No. of No. of Signs Bailasis .No. lMassage Tubs No. of Motors Total HP OTHER- -T VAT777, .. q:l :fl I�"iJ •-'•1. � I•�I �• • i..a-•f:.11•,. •': _-• II. `'q: Y.i :1: :•i :I 199 so. 1 V ' • i'• I• . • I•' (a fill •,• • �.� 1 af:•L•. •:n• ':. :orf - "9j 10 1• I ♦ r Li mm 1�hm rti v llt,Zt2 EstanstedVa1wdFkdricd Wdk $ Ro# Final C OWNERSINSURANCEWATVER;IamawdtetlrattheLmisedoesmttowthemz meeaxWcritssulsbritialegrAc iasreca andthatmysigtmtnc dwpmrmtapplicatmwai%tsthisrega¢mui (Please check one) Owner M Agent Signature ot Uwner or Agent ai Telephone No. PERMIT FEE $ :J 3 5 Date. .; ..:.G..... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .................. has permission for gas installation in the buildings of .*//-.-/%,f�, e .'.:' ........................ . at : ................. . North Andover, Mass. Fee.:: :.... Lic. No. . .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer i -Type or print) NORTH ANDOVER, MASSACHUSETTS MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS Building Locations Owner's Name Date , (' —l0 J200 a New 1LY Renovation ❑ Replacement ❑ - Plans Submitted ❑ Permit # ,33J J -- Amount Amount S e2Q (Print or type Name r Address P—, U, 6 oie 6 -?r->/ Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate Install' g Company aCorp. 4 fo-6 ❑ Partner. ❑ I Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ lfyou have checked yes,please indicate the type coverage by checking the appropriate box. Liabiiin insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ElOwner❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State 4s Code and Chap 142..@f the General Laws. By: Title CityrTown A-PPROVED (UFFIC}: USE ONLY) gnature of Licensed Plumber Or Gas Fitter Plumber ilc ❑ Gas Fitter Liceilse i umoer i'vlaster r7 Journeyman Date. No 4592 "��� :��a TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING This certifies that !�fx. Z� •••••••••••••• has permission to perform ....At • • • • • • • • • • • • plumbing in the buildings of ... ... • ... • • at. .� ..%��� !� .i.� �.j "'......... • • • • �, North Andover, Mass. Fed ?�l. 7. . Lic. No./OP(Y. .......... PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer I 2 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 21 pe, r r w Owners Name rITI Date `. © Permit c y Amount New 12 Renovation ri Replacement Plans Submitted Yes No WS K . • G • .. • ®sec�nn�� nnnnnnnn�n�nnnnnn ..• nnnnn��nnnnnnnnnnnnnnn�■nn� (Print or type)Check one: Certificate Installing Company Name (9 C+ IJA ` P` C - 0 rp• Address 'P -C-) (�8�C I �'� / 0 Partner. J e5 J,(.-inA O It 3 Business Telephone 11 Firm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy F1 Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature 7 Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu ,Stated$lumbo-Pldyd Chapter 142 of the General Laws. D (OFFICE USE ONLY /TyRe�ofPlumbing License License0Y7 Number MasterEr Journeyman ❑ Location 2� ' Uig � f� Wl"� No. 6 3 S Date 6- t�. a,% NORTh TOWN OF NORTH ANDOVER w Certificate of Occupancy $ �'� s'•^° t<�' Building/Frame Permit Fee $ t. �cMus s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # QS- / 16472 ,fit (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: DATE ISSUED: SIGNATURE: C—""t, Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address:(' _ ^ 1.22AssQessors Map and Parcel Number: %—)J Z «� Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes „.,,N 0 2.1 Owner of Record Nae ( nt) Address for Service: Q • g 2i`�. Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Addr jm r Signaque Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone M O Z M 90 Mn r v M r r Z Q 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 .......❑ No ....... ❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction 0 Existing Building ❑ Repair(s) P" Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant , ' ; _(}FFICIAL USE QN.Y 1. Building ' �O r (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 -�r -i %�J 14J.: s l Check Number SECTION OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER AG NT OR ONTRACTOR APPLIES FOR BUILDING PERMIT •�Q�-- as Owner/Authorized Agent of subject property orize to act on HerebQaf, My ben all m rs rel tive to rk 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 Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVIBERS 1 2 ND 3 PD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 1)EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE C/) x C m m 0 m CO2 CD 0 O n' O CO) COD 0 CD CD H CD CO) -• CAO cr h aOSm � Ns = m n m C) C y n C.n T CD ^. c Z O, -C y O 03 0) m H T =r m a?O y CD X 0 0 H O O m CD -4 n = H m 'fl O cli n O N• COJ O CD H � 16 '6 r ea oos: Aw rr^^ m m N cn O Ci= c CD w.. d m3 ® O N � O7 co): CA C4 G d C _:� c C 0 0o a f� o:� N 03 (^� WN o tW CDd 3 m daCD: CD CD H cn y z o b: o =CD fth CD CD cn cn W C2su. r• � o W _ o. 0 o c CD=a: y o = cn o rt c w w y w cn n 7d w Z M w CD z � 11 o M O d o r L` omi 0 0 c CD ol -..,,,,V --Z' b Date ....� — 3 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ .................... ...... .......... has permission to perform ...... ..................................... wiring in the building of ....... ..................................................... � IF � W'-dfl( U at.........-r).........i....................................... Fee ..I... -e ............. Lic.No.r.,b.2..3 Check # 11/-5! 377 M } 4 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. kq Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527,CMY, 12.00 (PLEASE PRINT IN INK OR TYPE ALIS INFO TION) Date:— <=r) City or Town of:)I To the Inspector of Wires: By this application the undersigned gives no,4e of his or her inteyntion to„perfo;m the electrical work described below. Location (Street & N Owner or Tenant Owner's Add Telephone No. 9 0 " ress Is this permit in conjunction with'a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd I g ❑ No. of Meters Number of Feeders and Ampacity -Location and Nature of Proposed Electrical Work: Installation of Security system Cmmnletinn nfthe inllnwino tnhln +nn„ ho u,ni, d h,, +t.� t + -r pv.,... No. of Recessed Fixtures -u No. of Ceil.-Susp. (Paddle) Fans w. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- E] rnd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alertine Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water Heaters KW No. No. of No. o Signs Ballasts Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: ` No. o. Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 ❑ BOND ❑ OTHER ❑ (Specify: (Expiration Date) Estimated Value of Electrical Work: ' (When required by municipal policy.) Work to Start: (p 03 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:Sacwrity Services HC)JLIC. NO.: 15 1,� Licensee: John S. Bassett Signature LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line.) Bus. Tel. No..• 603 594 $ Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Liclosee 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 Telephone Si phone No. PERMIT FEE: $