HomeMy WebLinkAboutMiscellaneous - 21 SKYVIEW TERRACE 4/30/2018Date .../ o7:.&
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............. J)
..............................
has permission to perform ..... se�rev ..A.A QP,.....
wiring in the building of ...........460 ................................................
.at ....... � .... ............................... Vqrth Andover, M14ss.
Fee ...........^:'_'. Lic. No. ....... .
crRICAL INSPECTOR
Check # 57-73
10539
lrommonweaR of Maijac4weth
2epartment ol3ire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked
[Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I)". _ t G - t 1
City or Town of. �k J\00oy E:K To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) V (' Q L0
Owner or Tenant
Owner's Address
Telephone No.
Is this permit in conjunction with a building perrmit? Yes ❑ No V (Check Appropriate Box)
Purpose of Building \jt�Xlf O VVVN� 7tcrVf Ce a!AWI tility Authorization No.
Existing Service'100 Amps ('7C:/ Z,ti[� Volts Overhead ❑ Undgrd
New Service 2—AL0 Amps IW / 2WOVolts Overhead ❑ Undgrd Eg
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 'Ly,_{.0y, t 011 RlG Uig, �� L
No. of Meters
No. of Meters
o(—
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ElITOT—OT
rnd. rnd.
Emergency ig ig
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
No. 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/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal El Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of WaterK`4,
Heaters
No. of No. of
Si ns Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or E uivalent
OTHER:
Attach additional detail if desired, oras required by the Inspector of Wires.
Estimated Value of Electrical Work: �U� (When required by municipal policy.)
Work to Start: A,C) A, j Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent; 'The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains andpenalties of perjury, that the information on this application is true and complete
FIRM NAME: 1, LIC. NO.: e3 S 't C,
� l
Licensee: Q—%Jx 1wi'�j �S C� Signature LIC. NO.:
(If applicable, enter "exempt" in the license number line.) �, � Bus. Tel. No.•�'�1 _ F s� Z(f
Address: L W 7 s l,r[ �: f1'`�—ffx & "v " 011Q4 Alt. Tel. No.: JJ
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent PERMIT FEE: S
SignatureturaTelephone No.
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www. mass.gov/dia
ation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ease Print L
Name (Business/Organization/Individual):
Address: 3 U S vJ M
City/State/Zip: VVI G -t -K U 6- tJ t'K I� Q kVVPhone #: P '� 0 3
Are you an employer? Check the appropriate box:
1. Mam a employer with
4. ❑ I am a general contractor and I
_0
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.t-
required.]
5. ❑ We are a corporation and its
3. ❑ I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
insurance required.] t
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.�lectrical repairs or additions
I L ❑ Plumbing repairs or additions
12.❑ Roof repairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date: L 1 Z
Job Site Address: a1 5k City/State/Zip: Not h& 41JINVM
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cert i under the pains and penalties of perjury that the information provided above is true and correct.
Signature: C-�:->ti Date: i
! S03, -5t,
use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
/
'
r", , ^Yk( /2- /�_// pl---�
`
^ .
` --
�.
°
El
+
�
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the.legal representatives of a deceased employer, or.the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111.
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 11-22-06
www.mass.gov/dia
Location a)/
f
No.
Date
TOWN OF NORTH
ANDOVER
. „
�
Certificate of Occupancy
$;
it 4. s
Building/Frame Permit Fee
$
H�s ��
Foundation Permit Fee
$
bee
'Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
t` 0�,r,..
037 8
Building In pector
Div. Public Works
n
r
r
O
r
m>
u
D
D
>
s
ht
O
z
n
m
a
r
m
r
r
i
�►
i
t1
C
p'
' f
C
;a
0
;
0
,
0
-•1
,
A
IIn
I
>
A
,.
- O
Y
z
n
m
<
i I
•
�
O
2
0
_C
r
_m
r 0
0
A
z
s
� I
O
z
O
r I
O
n
A
n
A
n
A
a
A'
n
•
-+
Yi
O :
w
d
z
> t
r
x
0
z i
i
>
D
z
>
C1X1`'
p
> t
p
S
S
�
m
A
C
_
a2
N
0
A 3
A
0
O
D
p
>
>
z
0
A
m i
O
z
�
w
>
n
r
i
r n
A
f
;;
A;>
D �
s
2
m
Z
p n
x
Z =
m n
�
s
S C
0
m
A
n �
C'
n
O i
o
r
,m
i
a e
Z
ul
M
c
n
.4
0
z
A
r
w
w
w>
m>
u
D
D
m>
0
O
n
m
a
r
m
r
O
n
A
�►
�
prp
O
C
p'
' f
f
;a
0
i
Z
o
0
,
0
-•1
,
0
m
D
;�
C
z
n
m
<
7g
8
•
�
O
2
0
_C
r
_m
r 0
z
s
m
O
-r
O
O
O
n
A
n
A
n
A
a
A'
n
•
-+
Yi
0.
w
z
z¢
r
0
r
i
0
z
•.V
m
f
a
m
m>
o
D
D
m>
0
O
r
A
�►
o
m
C
p'
' f
f
0
Z D
A
r
>
;�
C
z
n
n
O
_C
r
_C
r
_m
r 0
s
m
O
-r
O
O
O
n
A
n
A
n
A
a
A'
n
•
-+
Yi
0.
w
z
z¢
r
r
i
0
>
O
p
O
p
S
S
m
> 2
a2
0
z
D
p
>
>
z
0
0
s
O
w
>
n
r
i
O
O
A
f
;;
A;>
A;
s
m
Z
i
x
s
2
0
m
C'
n
O i
r
,m
i
i
m
O
z
Z
i
m
I
a
Z
N
i'
0
71
9
\
JJJ
N
Z
m
D
ci
z
(D.I
_0
0
S
A
rl
OI-+
o
z
r
a
•�
Z
a
N
>
a
A
M13
_C
C
r'
Z
Z
Z
Z
0
z
0
I n
0
0 0
z
n
z
x
z
c
cl.Z
zA
z
0
>
>
0
_
Z
p
m
p
i
O
0
A
r a
n
p
O
z
r
m
a
0
0
0
m
Z
i
0
i
0
r
r
r
>
O
Z
>
>
r
r
w
>
z
\1
>
a
A
a
A
a
N
A
w
O
r
2
>
z
x
z
O
-1
A
to
n
x
2
m
o
�
m
�
0
0
O
x
'
I
L1
m
A
00
aN
w
u2
Z
< Ct
D �CL
a
p
O 0
v
W <3Z
0 I
�
a?0
Z oda
NJ
DN
.� Z W
�mu
N w
m WDa
lmw
Z
DOtn
=
<zxw
�-
Wn
3w
o Ln
o 0,
u a
m<i
�- X
L'ww
� a
X00
Z Z N
0<
U
~ww
wZ
t -
JW
0w -w
- 7L0<
HJR
�I IIT— 7711TH W
o n ?1Z z
FT
3 _
h...
V .n N Z I O�a�< i �' '� Z .�__ �.S ISI= Z I I.`.� QI.2 `
V I 3�>i mZ; °R �M
�
< o � m it<I<I� Z i Z� O 0) OIIO I I I �Io O
CL
.n0 'd xd07 ,.f uV < n<
u I I Z ' ' TTTI
0
0
2
o
s
°
u
z
o
z
0
0
..
y Y <
°0�
g
c
=
' f
<
n
i m� z°W
0� oof
Z
z0
o
W
0
Nzpozz
or
00 oO
ZV
O a�!
Li V Y
oy
"'
i
o �r
lu5,ox3::q:q>_
u
Z
85o°O �<o:0
.a
S
u UV3 Zn a
Z
a2,n2<a�UO
Illll�
2
o
s
o
z
0
0
..
s
°0�
W
W
T
Illll�
i
o
z
s
°0�
W
m 8
_„8
c
d
-- --'
d
C7
CD
O
CD
CD
a
y.
CD
Cn
0
O
CDa
O
44
CD
O
0
O
•
"i l
77
rm
<
'�7
C
OQ
y
r
?7
w
'JJ
C
n
�
p
G
m
:7"'
p
C
0
Cx
r
d
..
(n
b
91
p
CL
r
C
t V
O
O
r�
�VJ
O
Oq
cn
n:
1
O
n
0
Z
O_
CD
N
0
O
c
to
CD
to
c
0
H
O
CD
O
c o m 2
_. y O CS CA
G O CDcn
��CD0 c
0m
CA =1 CA
co co .r O "►CD H T_
CD a=,M o CA
m
-.40 W CA O
O = CD CD
CD - -W n
� 1 •3
Z 03.
•C2 :
O H o
CCO
n Ham` O
rL
<CD Ilk
c(A -
CL
CD
CA
�1 CO)
CL a
C O.
N O R tt7
C H
O
CaCD
O_
1
CD :�� H
O O
CQ .O.►
O C7 •
O
CCD 0;
� 3
'o o
CD
-
—CD
CD:
CD:
=CA
CD
0 CD
m m
r
CL
ow:
CO3 O
.n.► O
O �
O �
O
O
7r
0
0
O
•
"i l
77
HT1'
w
<
'�7
C
OQ
y
r
?7
w
'JJ
C
It
"? J
N
p
G
m
:7"'
p
C
0
Cx
r
d
..
(n
b
91
p
CL
r
C
oy
O
O
rA
v
y
0
0
c
O
•
•
A
J
rA
v
y
0
0
c
i./v c{, i 1 S- 8 -s
T9910 YX 'C)HOOLsal
I&MG X"d X311 0001
'DMI 'SHHHlOZI8 'I'IOZ
vu amim"
dx ' Moa" HIRO14
5-N �AH HZAOQ r H.LHOK
(Y 17/ 101
rasa=
Kricl .LIS / mumo
-el-1
f404-996 (909) xyi 06Tf-996 (904)
61030 YX ITTHOKMZEI IMMY (EHOd HYH 491
aans v omzm!)Nz
!)NINNVrld UNTI
7V, J T? 7J 773,,-IY0,7
')4013Y iLN0O MIS
3HL AS 43UIH3A 41313 38 Ol 3NY SNOLLd003 u.nLLn my :310N
b 110-7
M in
E j
00.
0;>.
ZI
1
SIN l
Ib'c.bE
}., _ S
/I/
11
1.SOd 4o � I
N°
Z�� 6
Date..........'3:..�...........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .........
has permission to perform .......................................:............................
wiring in the building of .........'1......---......................................................
1
at.�2/ .................... ........... , North Andover, Mass.
nf.-c�.......... ,c
11
Fee :�.ti"�L:...... Lic. No / ?Ie— ............. �.(j a.......................
f " ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
i
Office Use Only
014e &Mmonwfalt of MUSSU[411setts Permit No. ifo
11eyartinent of Public $afettl Occupancy A Fee Chscke645
BOARD OF FiRE PREVENTION REGULATIONS 527 CMR 12:00 X90 heave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) pate 11/10/99
City or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 21 SFYVIEW'
Owner or Tenant KOHEE SHIN
(978) 685-4177
Owner's Address
Is this permit in conjunction with at building permit: Yes ❑ No ® (Check Appropriate Boz)
Purpose of Building
Existing Service . Amps _J Volts
New Service Amps _! Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
- Utifity Authorization No.
Overhead ❑ Undgrnd ❑ No. of Meters
Overhead ❑ Undgrnd ❑ No. of Meters
No. of t ighting Outlets
No. of Hol Tubs
No. of Ttansformers Total
KVA
No. of Lighting Fixtures
No.
Above
Swimming Pool grnd. ❑
In -
grnd. ❑
Generators • KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
Total
No. of Detection and
No. of Ranges
No. of Air Cond. tons
Initiating Devices
No. of Dis Po sal&
No.of Most Total
Pumps Tons
Total
KW
No. of Sounding Devices
#No.
of Self Contained
of Dishwashers
Space/Area Heating
KVi
Detection/Sounding Devices
No. of Dryers
Heating Devices
KW
Municipal C] Other
Local ❑ Connection
No. of No. of
Low Voltage
No. of Water Healers KW
Signs Ballasts
Wiring BURGLAR ALARM
No. Hydro Massage 'Tube
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
1 have a current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent. YES G NO O 1
have submitted valid proof of same to the Office. YES O NO O If you have checked YES, please indicate the type of coverage by
checking the appropriate box.
INSURANCE O BOND. O OTHER O (Please Specify)
(Expiration Oats)
Estimated Value of Electrical Work i 344.00 11/5/99
Work to Start 11/2/99 - Inspection Date Requested: Rough Final
Signed undor the Penalties of perjury: 121111 , 1
FIRM NAME LIC. NO.
Licensee T)nnal d A_ BrnnkA Signature LIC. NO.. 1231C_.___
Bus. Tel. No. (203) 'i41�40013 ---
Address 111 Morse Strget, Norwood, MA _ Au. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have " Inswunce coverage or Its substantial equivalent a& to.
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please chock one)
... Telephone No. PERMIT FEE s . 35.0--
ISlonature of-Ownor or AQonq .ncn4
Location \((ek;)
No. Date ZZ 4
~Of NORTN
TOWN OF NORTH ANDOVER
S
Certificate of Occupancy
$
*
Building/Frame Permit Fee
$ S�
JAS t
sCMUCHU E
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
A
$
Water Connection Fee
$
TOTAL
$
(I u 5 25
Building Inspector
3Z
" Ta8280
Div. Public Works
Lotation 2 SKHg tew
No. Date 1-22 Iq
A
Q
NORTH TOWN OF NORTH ANDOVER!
3?O��t``D •,hOOt
A Certificate of Occupancy $�
.IWIPMWr.
Q'j�+k lz�-UJR 33&2)
Building Inspector
-) 8279
Div. Public Works
Building/Frame Permit Fee
$
AcNust`
Foundation Permit Fee
$
�O
Other Permit Fee
$
Sewer Connection Fee
$
•
Water Connection Fee
$
Fd
TOTAL
$
� &
Q'j�+k lz�-UJR 33&2)
Building Inspector
-) 8279
Div. Public Works
Location
No. Zt O
Date
i
�..
PS
NORTF
TOWN OF NORTH ANDOVEREi
3? 0-
p
Certificate of Occupancy $
• >
Building/Frame Permit Fee $
�ssACMuSEt
Foundation Permit Fee $
.A
Other Permit Fee $
A tY z•
Sewer Connection Fee $
/Ono fid
�3
Water Connection Fee $
11,4-3.1,0
SS
TOTAL $
• uildi
Ins ct r
lswl
TO
0357
Div. u
c Works
PEA.IiIT NO. Z10
b
4
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. v yr �r w���,•PAGE 1
MAP +40.I
LOT NO.
2 RECORD OF OWNERSHIP DATE
BOOK ;PAGE
ZONE
.R
SUB DIV. LOT NO. C/
41 7 O
ATTACHED GARAGES MUST CONFORM TO STATZREGU IONS
PLANS MUST BE FILED AND PPR VED BY BUR
LOCATIONa( Sky
PURPOSE OF BUILDING
DATE FILED ✓ , l / q, 5
�+(�
OWNER'S NAME
OF STORIES 22
SIZE
'-`
l�
g- ` q-
NER'S ADDRESS �J
►T
EM EN LAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS
IST 2ND ��9Q
3RD
BUILDER'S NAME NAME
SPANK 1
DISTANCE TO NEAREST BUILDING >�'�
DIMENSIONS OF SILLS
DISTANCE FROM STREET
1
"' POSTS
Q
DISTANCE FROM LOT LINES e► - SIDES ZREAR La
GIRDERS
ui
r
AoREA OF LOT -z I - FRONTAGE �O
/ 1
HEIGHT OF FOUNDATION
THICKNESS
Oy
IS BUILDING NEW `/�L
SIZE OF FOOTING
71Y-7
X I^1 t
la.�
IS BUILDING ADDITION Iyb
MATERIAL OF CHI Y
z�
IS BUILDING ALTERATION ��
IS BUILDING ON LID
R FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 1,/�L
v' 7
IS BUILDING CONNECTED TO TOWN WATER
p
l/e�
BOARD OF APPEALS ACTION. IF ANY ��/�
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
SEE BOTH SIDES
INSTRUCTIONS
PERMIT FOR FOUNDATION ONLY
REGULATED BY PARA. 114.8-S. B.C.
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12 ��
DATE
� PAID lav
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
�Z
ATTACHED GARAGES MUST CONFORM TO STATZREGU IONS
PLANS MUST BE FILED AND PPR VED BY BUR
DATE FILED ✓ , l / q, 5
SIGNATURE OF OWNER OR AUTHORIZED AGENT
i
FEE
PERMIT GRANTED PERMIT FOR FRAME/BUILDING
19 � 'GJ
DATE: FEE PAID:..�,.._,
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BUILDING
OWNER TEL. Jt
CONTR. TEL. A
CONTR. LIC.# C5 Of 7_!1
H.I.C. #
r 0 e m
i=
D n i.k ts P -zoo 9 0,1 " 2-
1 OCCUPANCY
SINGLE FAMILY STORIES
MULTI. FAMILY OFFICES _
APARTMENTS
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE a 1 2 13
CONCRETE BL'K. PINE
BRICK OR STONE
PIERS PLASTER
_ DRY WALL
UNFIN.
3 BASEMENT •I
AREA FULL FIN. B'M'TAREA _
1/1 1/2 1/1 FIN. ATTIC AREA _
NO BMT FIRE PLACES
HEAD ROOM MODERN KITCHEN
4 WALLS I 9. FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDIVJ'D _
ASBESTOS SIDING _ COMMCN
VERT. SIDING ASPH. TILE
STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ r
BRICK ON FRAME
BUILDING RECORD
12 "
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. R
0
•
CONC. OR CINDER BILK.
STONE ON MASONRY
WIRING
ST E ON F AME
/
�4 t
SUPERIOR IPOOR
1
ADEQUATE ONE
5 ROOF
10 PLUMBING
GABLE
1
HIP
BATH I3
GAMBRELII
MANSARD
M. (
TOILET RM. 12 FIX.)
FLAT
SHED
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
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. d COLS.
STEAM
_
STEEL BMS. & COLS.
_
HOT W'T'R OR VAPOR
W O RA;TRS
AIR CONDITIONING
�!
p
RADIANT H'T'G
_
UNIT HEATERS
_
GAS
7 NO. OF ROOMS
OIL
_
B'M'T 2nd _
ELECTRIC
_
1st I.3rdI
NO HEATING
BUILDING RECORD
12 "
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. R
0
•
11
z
(n
n
O
z
i
C
O
0
0
CD
0
0
cc
0
cm
n
0
m
CD
m
c
O
H
C
0
CL.
y
N
m
0 d x
Q N
dOm y
=2m 0 m C7
Hma= 3
='- N
CD y -�
CD a�M m
hoCDy S ti
rrnnCDx
� D N.
CD
O V-
O N n
m
aye:
C a . S
o ?�
OCD H
a
CD
H
Of y
CL
'C o
N
3 =
m ,
m
Tj f
� rr
� n
O O
CS
m
RA
rn
r gym:
m -=+a
Q -M N
W ,2
C)= CD
CO d
oar
4�b o= =. �
bo C=*
(n C/)
o�
7c- � �,
�-401.100
.
a- „• as �
Z
Z
.
�_
o PTI�►�rz
c
r,
o• C
� r
CA
a
C
�
e z
�-
CA
>
0 Z
y
O
Q O
�.
r
Q
y
5
nU
70 O
CD
C
CL.
Q
l< a
CD
n
CD O
CD
21-1
m
w
C. CD
a
V!
CL v
y
C)
CD
I
z
—
CA
y
v
O
CD
Z
ICZ
O
�
•
CD
T
z
O
c
11
z
(n
n
O
z
i
C
O
0
0
CD
0
0
cc
0
cm
n
0
m
CD
m
c
O
H
C
0
CL.
y
N
m
0 d x
Q N
dOm y
=2m 0 m C7
Hma= 3
='- N
CD y -�
CD a�M m
hoCDy S ti
rrnnCDx
� D N.
CD
O V-
O N n
m
aye:
C a . S
o ?�
OCD H
a
CD
H
Of y
CL
'C o
N
3 =
m ,
m
Tj f
� rr
� n
O O
CS
m
RA
rn
r gym:
m -=+a
Q -M N
W ,2
C)= CD
CO d
oar
4�b o= =. �
bo C=*
(n C/)
o�
7c- � �,
�-401.100
.
a- „• as �
ac �
^'' 3• oGa �
�_
o PTI�►�rz
r,
o• C
� r
y ?C O
a
e z
�-
y
p
O
D
W)
M
y
0
0
c
w
FORM U - IAT 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: kelte%i7.�c ° ��� Phone f �3
LOCATION: Assessor's Map Number Parcel
Subdivision __ M,_ 14W"4� Z7 Tom— Lot(s)
Street 51<4 Vje4 & St. Number
r
************************Off'cial
RECOMNMENDA O S O OWN GENTS:
Conservation Administrator
Comments
Town Planner c
Comments
Food Inspector -Health
L7
__,F,
tor-Health
Commehts 6)^ St o') -e r
Use Only************************
Date Approved
Date Rejected
Date Approved t
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Public Works - sewer/water connections
- driveway, permit 7� 45
2 �,
Fire Department d �
Received by Building Inspector Date
7 0 21995
MAI -146710 Val
i �-s �a7..�1 ••
2571, 7p
T--
\ \ •s
{ 0
rip `I k
/
t
t-0 7'14
A
1%
UP
I%
1 RG7'grt4'F16x
WA "I
N
s- /v -. 6•
NOTE, ALL UTILITY LOCATIONS ARE TO bE FIELD VERinED BY THE
SITE CONTRACI'OR.
CORA-letL f uE 841 -
LAND PLANNING
�rr�nt->�turrc � atrl�v�
lel HARTFORD ANrMr 4 MWNGHA L WA 02019
(506) 006-4130 JPAJL (508) 066-5054
9
GRADING / SITE PLAID
wcn0 AT
IAT I3 -G
NORTH ANDOVER Mtki H'.'S
NORTH ANDOM KA
FWAM P"
TOLL BROTHERS, INC.
leoo incl PAM DPJ"
N*MRO, MLA 015Q1
s- B - 9X" 1 i''- 40 N.1 14 ��'
FROM : LAND PLANNING BELLINGHAM PHONE N0. : 508 966 5054
f TERRA CE
SKYVIEW
(gU' WIDE APPROVED WAY)
0
101.90'
C' V
t.44
LOT 15 LOT 14
ry 34,782 S.F.
SETBACKS: F-20' S-0' R-20' (20' betw. aldgs.)
I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED
ON THE LOT AS SHOWN ON TI1IS PLAN AND THE
LOCATION DOES CONFORM WITH THE FRONT, SIDE.
AND REAR SETBACK REQUIREMENTS SET FORTH IN
THE TOWN'S ZONING BYLAWS AT THE TIME OF
CONSTRUCTION. I FURTHER CERTIFY THAT THE
STRUCTURE IS NOT LOCATED IN THE SPECIAL
IDD YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT
TO BE USED FOR THE ESTABLISHMENT OF PROPERTY
LINES. ERECTION OF FENCES, OR CONSTRUCTION OF
ADDITIONAL STRUCTURES ON THE LOT.
MAP NO. 0006C COM NO. 250098 DATE: 6/2/93
00
4
R 175.00'
L = 13.10'
LOT 13
613��
FOUNDATION AS—BUILT
1AOm W
LOT 14156
NORTH ANDOVER GHTS
NORTH ANDOVER, MA
wsam Im
TOLL BROTHERS, INC.
1800 WMT PARK DR[VE
WWTBORO. MA OIWI
LAND PLANNING
awnum m is 3VRM
!dT i141ClfbAD A1OM SUMMAK 1V 0mg
(m) 888-4180 PAN (W 90-W4
6-30-95 1"=40' INAE 56 14)
to
P01
SKYVIEW TERRACE
(50' WIDE APPROVED WAY)
FoUNoa nQy
55.
r
101.90'
R = 175.00'
L = 13.10'
LOT 15 LOT 14
N 34,782 S.F.
SETBACKS: F-20' S-0' R-20' (20' betw. bldgs.)
I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED
ON THE LOT AS SHOWN ON THIS PLAN AND THE
LOCATION DOES CONFORM WITH THE FRONT, SIDE,
AND REAR SETBACK REQUIREMENTS SET FORTH IN
THE TOWN'S ZONING BYLAWS AT THE TIME OF
CONSTRUCTION. I FURTHER CERTIFY THAT THE
STRUCTURE IS NOT LOCATED IN THE SPECIAL
100 YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT
TO BE USED FOR THE ESTABLISHMENT OF PROPERTY
LINES, ERECTION OF FENCES, OR CONSTRUCTION OF
ADDITIONAL STRUCTURES ON THE LOT.
MAP NO. 0006C COM NO. 250098 DATE: 6/2/93
co
31.8.
48.9
pOt/NOAnoN
LOT 13
OENMRD
E.
MU RSO SR.
No. 344342,
FOUNDATION AS -BUILT
LOCATED AT
LOT 14 �s,6
NORTH ANDOVER HEIGHTS
NORTH ANDOVER, MA
PREPAM FDR
TOLL BROTHERS, INC.
1800 WEST PARK DRIVE
WESTBORO, MA 01581
HEMMEHEmmw
LAND PLANNING
ENGINEERING do SURVEY
197 HARTFORD AVENU$ BRUINCHAK MA 02018
(505) 999-4130 FAX (608) 996-6054
6-30-95 1 1"=40' NAE 56 (14
CO)
CD
-v
Cl)
Z
CD O
CL r
d �
O �
CL
-v
CDv
CL
cr
O
O O
M m
C, CD
D <
=0
m—�
z o
�C O
CD
\`
`\% CA
m
'�
CSD
O
z
n
0
On
CA
O
O
CA
c
O
C
C05
EM
C7
CD
O
�F
CD
CO)CD
a.
CD
y
O
O
CD
0
dc
CD
Fis-
C>
at
0
O
CD
m
0
a
5
A
O
c
s.
W
C=
S.
0
N
C
0
CL
N
N
m
c ? � O to S
Q y dc m y y.
m 0 m cli
o .c i
_EF -0E-4
CD
n: N T
m
a?d m
o m N „� C/2
CD
f o m a
WX
O N CD
CD �
aye •�
CL
s
O =�
Q m N
a
m
N
N y ro
CL.d ; Q
W
Um�m
c m ' y
5
m�
m
Go
CD
tC .O�r.��
O O
..► O
W O
Crncm
c
TO = m .
�Cmm� •
Oaf
�• mac., m
C. ota C
CO Z.y.« �
O�
co -<F
V
�q
Cn Crt aJ
O
z . 4,z
c? -
w
w C
t14
tz
`s 1
- zC c
w
a
0
C/)71
b
F O
\`
V
'V oc\ z
�
O
z
n
0
On
om
b
c^^
n
O
z
Fis-
C>
at
0
O
CD
m
0
a
5
A
O
c
s.
W
C=
S.
0
N
C
0
CL
N
N
m
c ? � O to S
Q y dc m y y.
m 0 m cli
o .c i
_EF -0E-4
CD
n: N T
m
a?d m
o m N „� C/2
CD
f o m a
WX
O N CD
CD �
aye •�
CL
s
O =�
Q m N
a
m
N
N y ro
CL.d ; Q
W
Um�m
c m ' y
5
m�
m
Go
CD
tC .O�r.��
O O
..► O
W O
Crncm
c
TO = m .
�Cmm� •
Oaf
�• mac., m
C. ota C
CO Z.y.« �
O�
co -<F
V
�q
Cn Crt aJ
O
z . 4,z
"r7 •z
le
w
w C
t14
tz
`s 1
- zC c
w
a
0
C/)71
b
F O
\`
V
'V oc\ z
�
s
z
_ _. � .. _ �.. .• _ ., rte, .. � .... _ _ . .
to 30 eo
y
0
9
0
c
_ALL - - -- --;- -•� -�� - - .._
a _