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HomeMy WebLinkAboutMiscellaneous - 21 WEST BRADSTREET ROAD 4/30/2018 (3)f /�x Location�� No. `/ Date l , TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # %6t -GJ 1 567b- Building Inspector C/ TOWN OF NORTH ANDOVER • BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ^ c ,z Y% SSi'x"tw"i* „y , �3 F°Y° 7�y�• , 3N _ ,, z b,e„ ... ..., - ,...� BUILDING PERMIT NUMBER: / DATE ISSUED: SIGNATURE: ��-`- - Building Commissioner/12EIrctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 00 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.40.3d), 1". Flood Zone Information: Public ❑ Private 0 — = pone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record :bok-.re.s T\K Name (Print) Address for Service : i1(' 1099'`?60-/ Signature ' Telephone 2.2 Owner of Record: Name Print Address for Service: Signature!, Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Lice!. Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone V M X ic z O M V I q� 1— z M 90 O Wn M r z^^ Q SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 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 ❑ .' Existing,Building ❑ Repair(s) ❑Alteratioris(s), ❑� Addition ❑ Accessory Bldg. Demolition ❑ Other ❑ ~Specify ` Brief Description of Proposed Work: q ` SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item 1. Building Estimated Cost (Dollar) to be Completed by permit applicantME 15-b , oo QFFICIA'IUSE (3NLY 4, „ (a) Building Permit Fee Multiplier 2 Electrical er (b) Estimated Total Cost of Construction 3 Plumbing _er Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5 3_075 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ( I, Dd � oy?� , Yl. as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf. in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 'tc� ('Dy-e's CV4 x2 -J* A Own /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 ,�,�✓/,,,, 10 D 0 a irPf �/( �i-oY27 r' Print Nam Signature of Owner/Aent Date 2101M. 1. LAI NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS Dl"Iv1ENSIONS OF GIRDERS IIFF'IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 4-0a(0 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 or requirements. *****************************APPLICANT FILLS OUT. THIS SECTION*********************** APPLICANT D -b (0�f uvl_ 6Ye� LOCATION: Assessor's Map Number, SUBDIVISION STREET 9-1 Q PHONEVI -699-960/ PARCEL LOT (S) ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: SERVATION ADMIN COMM TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH TOR DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm DATE D. Robert Nicetta Building Commissioner (978) 688-9545 -..;(978) 688-9542 Fax Town of North.Andover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Please print )) % DATE 6 O� V JOB LOCATION Number Street Address "HOMEOWNER t>b 16jfj (vL' V0 7 Name H me Phone PRESENT MAILING ADDRESS City Town (00�- �6 09 Map / lot Work Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual -for hire who does. not possess a license, provided that the owner acts as supervisor. (State Budding Code Section 108.3.5.1) .DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures_ A person who constructs more than one home in a two-year period shalt not be eonsidered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures a HOMEOWNER'S SIGNATURE 41 APPROVAL OF BUILDING OFFICIAL MORTGAGE iNspwcnoN n AN NORTHERN ASSOCIATES, INC. , 401 SOUTR SROAowAr, LAwsENCE MA. W643-3322TEV976) 83>-3333 FAX(978) 837-3336 MORTGAGORi DOL.ORES K4•GOYET'1'E DEEP Ref? .1022 1382 1ACA'9'1ON_ 21 WEST 5RAD STRMT RDAD FLAN R --. 43155 GITYSTA'TE: NOM ANOOVER MA SCALE 1'-30' DAM OCT,3O,2001 JOB P. 201/09541 t LOTS 1 417 LOT 5 ! 1.570 sf:L- N LOT 4 LOT 6 N 1.5 STORY O WOOD 421 03 4iti^ 63 o R-726.15' ti L=05.Od W BRAQSTRjffffT ROAD CCRnFtW TO: MA555ANK +' F&p" hasard sone has bans diftM nad by Scutt and 9a "#I twomartty accuratr.Unt-t drfi Mim 1mnv am imnod by BUD awd/ir a vm4a d Santrat slaws it perfirme4pred" alae Amm amrabd ba dtbrmnad JhMUd(rr W GdWftd 6. mg�m d !M K j�tYMrYs Nei! am ew dyr ytrk 1 a IS of 4 Yf L i �► �R 4wev1..1 M.-1 _ b U, a The =.M.6. d M 0 h ilre lhwd �+r+ � uots >� fr -groa 9g CGCA,- — r T 0 z ri O C** I t xwj Au � C u O w � �% v cC/)w Cd O w a ° -a O mOQ O a: c C U C w a Eo U w a + mcz p 04 C_ x a ° w a w DCO p c4 Gj y Cf) cz C w" p z o7p p c4 cd C w w A w a c� ° z C/)cn o ui om r r. 0 O M•��r Q O E Z O v w co .E 0 Q C O co Q CL y O R) .CL CO) C O C.1) Q 3� co 0 Q O a CL cm4 C J O .O O O Z a CL CO) C 0 U) LLJC W W crW CM F- a+ m '•voimc •c L W 4 CO3 p y m� `ate m 2 a vi u v� O ac v-, •E at •N �a o LU ti h-0 d cm O� 2 0"0cc ON- 0 O M•��r Q O E Z O v w co .E 0 Q C O co Q CL y O R) .CL CO) C O C.1) Q 3� co 0 Q O a CL cm4 C J O .O O O Z a CL CO) C 0 U) LLJC W W crW AI No 3470 NORTH -te 6 0 Date....!....: "./ ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that. . . ........................................ ............................... .. has permission to perform ..... ..... ........... I .......................... ................. wiring in the building of at ........ / ..... North Andover, Mass. Fee.�z) .............. Lic. No: �C�' .. Vq —ELECTRICAL INSPECTOR. ................. Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ae&e�tsuent oa �u81[e Sasetry BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use Only \� Permit No. J 7 (7 av Occupancy & Fee Checked (3 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) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit lto/perform the electrical work described below. Location (Street & Number W �'S� ' led � ��✓�� � ��a Owner or Tenant D14 U BGG(" �C' U t rCr A � y� Owner's Address �sc?m -e—. Is this permit in conjunction with a building permit ` Yes ❑ No (Check Appropriate Box) / Purpose of Building- '�U� C� r�/7yFFdf Utility Authorization No. 0 397 Existing Service /o10lao wits Overhead` Undgmd ❑ No. of Meters _ Z New Service o? -O U Amps 120,90,�iVoits Overhead �� Undgmd ❑ No. of Meters .— Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work OTHER: i , INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws h i have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent 4G1= NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES.please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of E)etri al Work$ /0C) Work to Start Inspection Date Resquested O4 ough Final Signed underthe enatties of perjury: FIRM NAME �I LIC. NO. p Licensee Ayl ll ( l �� Y" Signature 7 LIC. NO. Bus. Tel No. % 60 Address AltTel. No. 791 %l06 e `1 o OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have a the insurance coverag or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Healing KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: i , INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws h i have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent 4G1= NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES.please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of E)etri al Work$ /0C) Work to Start Inspection Date Resquested O4 ough Final Signed underthe enatties of perjury: FIRM NAME �I LIC. NO. p Licensee Ayl ll ( l �� Y" Signature 7 LIC. NO. Bus. Tel No. % 60 Address AltTel. No. 791 %l06 e `1 o OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have a the insurance coverag or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ (Signature of Owner or Agent) Date ... . . < c N2 4681 ".° R' :��o TOWN OF NORTH A DOVER 0 1-0 pe.p PERMIT FOR PLUMBING ,phis certifies that ...l. r. .'.�?f �'• • • • • •�• has permission to perform ... 1!1�.L"t... ..•..••••••••••••••••• plumbing in the buildings of ...SC / ....................... at... !.1... ��....f.J/.�.�� f ........ ,CNorth Andover, Mass. Fee ._Lic. No.2.3 .. ..... / --') ..... . s' PLUMBING INSPECTOR Check # % C, 1 / � WHITE: Applicant CANARY: Building Dept_ PINK: Treasurer �F MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO UMBING (Print or Type) h o✓� Mass. Date rmit # a Building Location i VV Ps -f 4,02d—," wner's Name 4Q1 Z ;"(�' %i y, rLVCe r1Q ) Type of Occupancy Residential New ❑ Renovation ❑ Replacement K Plans Submitted: Yes 14, No ❑ FIXTURES Installing Company Name Heritage Htg . &P1g . Co. Inc. ` Check one: Address 35 Pleasant Street Stoneham, Ma 02180 Business Telephone 781-A3-a—=— Name A38— 7 7 7 f_Name of Licensed Plumber Gordon Switzer LX Corporation ❑ Partnership n Firm/Co. Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy I3 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stale Plumbing ode and Chapter 142 of the General Laws. By _ _ Signature o Iceumnse Pler Title Type of Liconse: Master [� Journeyman ❑ City/Town $ 3 2 2 APPROVED TO�FICE�S�ONLY) License Number.__ Z (n a ri ri I_ tn m o W z r �: O b to JW > V •i ~ �) D 0 N S n o z u) `�' 4 a z v' ¢ I- x V N? w Y a n O _ 2 a— a 3 tlt I ttR1j� V N z m a m v~i n w r 't � n I (n _ o a N Q a (fid N a W W 0 z r Uj d 3 tn. o p s� Q uj J N a �_ •< x 3 z x a Oj o~ a C 3 F- Q Y J Q m = N N o N O Q J Q O C x h (n LL.. Q C it cc O (C Z 3 (. C) SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR ATH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Heritage Htg . &P1g . Co. Inc. ` Check one: Address 35 Pleasant Street Stoneham, Ma 02180 Business Telephone 781-A3-a—=— Name A38— 7 7 7 f_Name of Licensed Plumber Gordon Switzer LX Corporation ❑ Partnership n Firm/Co. Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy I3 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stale Plumbing ode and Chapter 142 of the General Laws. By _ _ Signature o Iceumnse Pler Title Type of Liconse: Master [� Journeyman ❑ City/Town $ 3 2 2 APPROVED TO�FICE�S�ONLY) License Number.__ N 0 Q N z U 'W m O J z w J a U a O ccIL O w N W U W Y h 0 z m J z J O a O w cn o LLS ►' U LL LL O O w z a w m ,. O 3 LL O z J w O m h- a U J W d LL Q N W U W Y h Date. k.. ..U. L TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .D 4 ryl .� ......L�i 1� .l. S, �............ . has permission to perform ....) !A .S ... ............. plumbing in the buildings of .. ,/.. 7 / ........................ at..1.. ?.� C( .�... , North Andover, Mass. Fee. . J . Lic. No..//)Z% .. .......' �, c_. .-1........... PLUMBING INSPECTOR Check # / 5124 5600 re- fiSP ar, e- - MASSACHUSETTS UNIFORM APPLICATION FOR PERMIToTO DO PLUMBING (Type or print) ^/ NORTH ANDOVER, MASSACHUSETTS/ L � _ D Z— Date Building Location 2% W e5 74 &4 L7 S t Owners Name DO La Re.s (TOYS T re Permit # Amount --;33, --- Type of Occupant New ❑ Renovation [Ei Replacement [:] Plans Submitted Yes [] No E] FIXTURES (Print or type) Q Check one: Installing Company Name Ro BERT P R /,s j n Corp. Address TPartner. , 7A/MP STEAD. A11Y. 6,39PI Business Telephone / 3 L,t L S10 Firm/Co. Name of Licensed Plumber: Rn b E R j A�, P is / Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy n Other type of indemnity ❑ Bond ❑ Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above thr c g. 1� q Mp,( Signature Owner Agent I hereby certify that all of the details and information I have sub4 sub'ed (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations perfo under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa�ttySta*luphbit Code and Chapter 142 of the General Laws. y:W=UL4 442 ad,,d Signafure of Mcenseaum er City/Town Type of Plumbing License Title // $// icense um r Master !� Journeyman E]PPROROVED (OFFICE USE ONLY u op (Print or type) Q Check one: Installing Company Name Ro BERT P R /,s j n Corp. Address TPartner. , 7A/MP STEAD. A11Y. 6,39PI Business Telephone / 3 L,t L S10 Firm/Co. Name of Licensed Plumber: Rn b E R j A�, P is / Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy n Other type of indemnity ❑ Bond ❑ Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above thr c g. 1� q Mp,( Signature Owner Agent I hereby certify that all of the details and information I have sub4 sub'ed (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations perfo under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa�ttySta*luphbit Code and Chapter 142 of the General Laws. y:W=UL4 442 ad,,d Signafure of Mcenseaum er City/Town Type of Plumbing License Title // $// icense um r Master !� Journeyman E]PPROROVED (OFFICE USE ONLY u 4 Location! No.Date '4 MORTIy TOWN OF NORTH ANDOVER 3? •• O AL _ + s Certificate Occupancy $ of CH Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ f _ TOTAL $ — a Check # 15259 /'/ Building Inspect 1.1 Property Address: wn� Ped 61-ak 0, 2.1 Owner of Record Name (Print) 7 l77 qc� 1.2 Assessors Map and Parcel Number: 3 � Map Number Parcel'Nufiiber Signature Telephone 2.2 Owner of Record: Name Print 1.3 Zoning Information: Zoning District Proposed Use Signature Telephone 1.4 Property Dimensions: Lot Area (sf) Frontage (ft 1.6 BUILDING SETBACKS ft Front Yard . Side Yard Rear Yard Required Provide RegWred Provided Re red Provided Not Applicable ❑ Company Name Registration Number 1.7 Water S ly M.G.1-C.40. 54) Public Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sew Disposal System: Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) 7 l77 qc� /�;; �Aiddress for Service: 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: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (NLG.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 .......0 No ....... ❑ SECTION 5 Description of Proposed Work (check alt anulicable ) New Construction ❑ 1 Existing Building ❑ I Repair(s) ❑ 1 Aherations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ Demolition ❑ 1 Other ❑ Specify N .i, �oA aA" Brief Description of Proposed Work: 1a 1 I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Estimated Cost (Dollar) to beCompletedQ Com leted b rmit a licantt CAL COAL . ° �`�� USENL ` USENL ��. 1. Building (a) Building Permit Fee Multiplier 2 Electrical �� (b) Estimated Total Cost of Construction 3 Plumbing / '5-00 Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire.Protection — 6 Total 1+2+3+4+5 / O Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED`A�GENT DECLARATION I, 70 O hQ S /l/� - �i-rrD�. 't"I-(' _ _ _,as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief -V-')-0 t o Print Name 1 Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T 4BERS 1 ST 2No 3 RD SPAN DIMENSIONS OF SILLS DINIENSIONS OF POSTS DWENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE JAN.09'2002 14:26 9787947546 ELDER SERVICES #0503 P.004/005 L Elder Services of the Merrimac Valley Senior Aide Program Senior Aide: i Rudolf Rutolo Date of Assignment: s, =January 200z__ _ Assignment Title: General Assistant to Bldg Dept Staff, Training Objective: Host Agency: North Andover Building Dept. Telephone: `1 978-688-9545 _ Supervisor Name &Title: Robert Nicetta, Building Commissioner Assignment Location: Town of North Andover. Hours &Days of Work: Mon -Fri 9:00 AM —1:00 PM Rate of Pay: Duties & Responsibilities: Answers phones, take messages, assisting Building Dept staff with filling, copying, date entry and various office tasks. _ D. Robert Nicetta Building Commissioner (978) 688-9545 °(978) 688-9542 Fax Please print DATE 10 12oo-r—? JOB LOCATION 2 - Number "HOMEOWNER Town of North Andover Building Department 27 Charles Street . North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Street Address Home Phone Map / lot , - q)s--a Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for "homeowners was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does . not possess a license, provided that the. owner acts as supervisor. (State Building Code Section 108.3.5.1) .DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, bylaws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC 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 Js 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: W (Location of Facility) Signature of P rmit Applicant �2002- Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector s. O b MM4 til d z ti T-. ,..� b ° u.o v cn o U G o w m o w .� U ca r w o H w a m a iz a 0 w c2cY) w a o c:G ir. z � v CQ z cn Q o co H W C.3 N H c a o C o o O N O C3C3 C.3 m C o :ate : N � Ea `~ o mts �m o C. N : E C o m :oma 1 co cm CD y. S C 3 ' N � {p CR 63 � � m 12 Co N mo C. V i C OQ N t m S wCD C3 N Z ca O SCD O. O y O C = m m+ p C. O � C#* C. m +- IAA CL= A _C C r.. IUD N C3 cm O. O� o C m W O` y C t. v C."m mi N N 32 cmN c 0 A cm m C: CO C m O Cif C C N m t 0 CD i � c CM o •— y m -E m CDCDCL_ CD cc oa o- c�aC C Cl cc C3 .5'.0 CL cl CD co ts C CD CL V y Cc C C C c CL _y 0 cn cn CC W W 0 s I M o x E-� A w cn O z w° oG U w � U a O W U Z bo w q W H c c 0 o � c N O C O C3 C3 CL c �v cc LIS O O L m H Ea D o o� :.r a N ES y- .c o -- cm t4rA c CL mac+ U;W N m 0 0 a.w N m a :tom o Co - RE 43 N Z � o C o CL O N O C = O mS O 0 a O Co CD t - W c o IL N dt to c 42 go V m p.O:C C O. m.' 010 - N OLCL:s CS N•5 C. N t N 32 O N C arc CO S m O cm C C N m t O Z O O �9� 0 O CD h m � -E m cc aCD � 3.0 iS cc O m _ � =Q ca O +r Cc to •C Z CD m CD CL C.3 (A c C C c — y 0 U) V/ Ir W crW CD °L Zoning Bylaw Denial Town Of North Andover Building Department " °0 % 5 �`�, 27 Charles St. North Andover, MA. 01845 Phone 978=688 ar5? 978 6$.8-9542 treet: Ma '/Lot: A licant: .Re nest: g''Yt3'.oPleN:�cf<'.:. s�oRw�e Date: - % FrNi� WIN Dot, Born o t- -g �o?OOa Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning B.ylaw„,reasons: Zoning Item 4: Pre-iexisti xceeds ng e e mplies Com A Lot Area r: F Item Frontage Complies 1 Lot area Insufficient c s 1 Frontage s ove, (°Frontage 2 Lot -Area Preexisting y"'4;S 2 .. Fronta e ng CBA 3 Lot Area Complies 3 Preezisti Maximum <4 Insufficient -Information , ' ..-: 4 Insufficie it Information B Use Y_ 5 No acces Complies 1 Allowed y c 3 G Contiou allowed 2 Not Allowed f` 1 11nsufficie king Required 3 Use Preexisting 2 Complies ng Parkin 4 SpeciahPermlt Required.; c 5 3 Pfeexisti 5 Insufficient Information 4 Insufficie C Setback M,.... H Building 1 All setbacks com , I 1 Height -E 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisti 4 Right Side Insufficient 4 Insufficie 5 Rear Insufficient. Building 6. Preexisting set! y e .S 1 Coverag 7 Insufficient lnformatlon 2 Coverag D Watershed. - 3 Coverage 1 Not in Watershed `> e s 4 Insufficie _.2 In Watershed -4- j Sign ,3 Lot prior to 10/24/94 _..._ - 1 Sign not 4 Zone to be Determined 2 Si n Co .,5 Insufficient fnforrmation - 3 Insufficie E Historic District ^„ r, Parking I-- In District review required 1 More Par -2 Not in distriet y c;S: 2 Parking 3 Insufficient lnforrnatlon 3; Insufficie 4: Pre-iexisti xceeds ng e e mplies Com Notes Insufficient Complies ng frontage c s nt-Information s ove, (°Frontage ous Building Area N it Area ng CBA nt Information Height Maximum Height c s it Information Coverage exceeds maximum Complies Preexisting c� e s nt Information allowed nt Information king Required Iles nt information ng Parkin y s I e adove review and attached explanation of such is based on -the plans and information submitted. No definitive review and or.advice shalt be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive.answers to:the above reasons for DENIAL." Any inaccuracies. -misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds -for this review to be voided;_at the dfscreUon of the Building Department.. The attached document titled "Plan Review. Narrative" shall be attached herein aradncoarporatedih'erem by reference.. The building department will -retain all plans and documentationfo"r the above rile. You musDfle a new^6utldin,g permit application form and in the, ermittin a _w _ P g process ` rl;.' _. uilding Departmt;Official Signature) a i Application:Received Application Denied .. Denial Sent: If Faxed Phone Number/Date: Plan Review Nar'ratiye The followinn nnrr-nf,%,a q ta t Referred To:. Fire j Conservation EEEEEE 4onirBoar lannin lal'rent of pi)IIc Wo OtherCommission '' BUILDING DEPT f FORM U - LOT RELEASE FORM(C. �- �� INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Bbards 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_ 00k F fs 0 .P- (' 1 d 6m o 6 o(� LOCATION'' Assessor's Map Number 3 Q_ PARCEL SUBDIVISI,OhhN�� LOT (S) STREET ST. NUMBER USE RREC9_�IIMENDATIONS ¢F TOWN AGENTS: CONSERVATION ADM COMMENTS kO W TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH CO TOR DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm DATE IA -:TON_M_ ,i0F NORTH--AND4VER APPLICATION TOCONSTRII RF8 R@TOVA ::OWDEMOLISH AONBQRTWOF YDVAUJ"G BUILDING'PERNIIT NUMBER: DATE ISSUED: _ : ic SIGNATM: BU dln COIDn11SS1 i df BUIL i _ I)w - SECTioN 1- SITE INFomATIoN 0 1.1 PropatyAddress .. Cz. A Map and parNumber. 33, 131 Zuaingluforneatia¢ + 1.4 .P+oPdh' Doag: ; loniugDk id Froposed Use Lot Area - FOutage $ 1.6 BIJUD1NG SETBACKS (ft). Front Ygrd : Side.Yard ..........: _ Rest-Yard._ ._' ....Regaired _.:. ..... _ Provide Required - : Provided _ liWdw s%VtyALGL .40.M) is-.. rmouz t t a . saor I dsy iubenr o rtivfa o Zone oa�,ae�a2ooq ❑.. o......_.: .. oosaen�a s��o . a SEMON 2 - PROPERTY OWNERSHIP/AUTHORUZD AGENT " m 2.1 Owner of Racoid I)o Iores M,.. Name (Print) Address for Service : S4oid-um 2.2 Owner of Record .. _. Name Print Address for Service: .. : m Sigmiture T hone:.... SECTION 3 CONSMUCTION SERVICES - 3.1 Licensed Construction Supervisor:' _ Not Applicable o LT wi Licens Cgnstruction S u� J 4 0 s: I:iixa9e Number . � n /j 'ij VExpiration Dale signature Telephone.. 3.2 R ' egistcredFIomeImpruvemegl;_Contractor. _ _ _.;.gt. ...:.... ..NotApplicable 17..:...-.:_.....•.;-:..._-:. ._ • � w Company Name Reg�sttenogNumber-• .�`� Lsi z Date Y/ Teleaho� IA 06/26/02 _. 11 :06 FAX., . MORWAGE INsWenON MAN NORTHERN ASSOCIATES, INC. 401 SOUTH BROA MAY. LAWRENCE M& 01&d-3372 fEL:(976) 837-3335 FAx:(978) 857-3536 MOUGAGOR: DOLOR M-GOl'EM OCED MPP .1022 1382 IACAYIPN: 21 WE5T HIr.AO 5TRM ROAD PLAN FxF-. d3 t 55 CrffSTAIL: NORM ANDOVER MA SCALA: 1•-I0' DAM: OGT.30,200I JOB 0: 20IM9541 L075 11 i t 2 a- 90joo �y LOT 5 E 1,570 sf:t -�--� 1.0T' 6 N �'• F- 1.5 STORY O_ WOOD m 0191 O" %'fig-10� 4" is R�726.15' W BRAD5TREFi F OAA Flood Aamrd amw Ma ban da"Moted by swe Und *7 eat UPWM arUV aMVUla.VNM doh sftft are twwA by NOD awdAr a wKiad awalog sta+i v LOT 4 Aa}.lfM as M%MMM" AU L•.'�'. er a MR. f 4 dowwAv. A.a Ab..& � a� •r.ru�a ps rtes �asAar A.y Aftv sr. G Z002 5 `#{a In P op IV x i � t 4, f .•, F J I IN Of c If WIN -A tz e� '`'ki '� ,•1 �p� � � �9� k 4 L� .1yy ��•' i i �k �` �'�y-"ne..,t.. �s��y. .� M., a *.'1 .{ �`� �a � .� ilk' {� i �'. '4i � A ' .��• �' � �A �-aw *qe � � � � ``4 ry� , 41 'i �, .�' r •rad r k �1._aM6.�'+#670...._ {• 4 n.+6i'4.zi<�����' �6•. a - _ �f. °� di, r�.y 2 00 N o o .4 p N 0 a (� z a Page 1 of 1 DATE: 07/02/02 TIME: 10:22 AM TO: Michael Mr—i— R 1-Q7R-6RR-QSd9 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYY) 07/02/2002 PRODUCER (781) 273-1630 FAX (781) 270-4047 MacDonald $ Vaccaro Ins Agency, Inc. 9 Bedford Street P.O. Box 799 Burl inaton, MA 01803-5799 THIS CERTIFICATE IS ISSUED AS A !RATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Acme Construction & Remodeling 296 Edgemere Road Lynnfield, MA 01940 INSURER A: Zurich Insurance Group INSURER B: Royal Insurance Group INSURER C: II R D:RER P E bVYCRMVCQ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ RTYPE LTR OF INSURANCE POLICY NUMBER O C CTI DATE MMIOD P EXPIRATION DATE MM/DD LIMIr1l GENERAL LIABILITY P36770981 08/28/2001 08/28/2002 E 1,000,000 EACHt&ADVI X COMMERCIAL GENEP-L LIABILITY CLAMS MADE ® OCC! IR FIRE one fire) 300, 00 MED 10 0© person',A PERSNJURY QQQ, QQ GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-- _ COMP/OP AGC, $ 2,000,00( RECR0. 17 POLICY F JT F I LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHEP. THAN EA ACC $ AUTO ONLY: A.GG $ EXCESS LIABILITY OCCUR ❑ CLAIMS MAD[ EACH OCCURRENCE $ AGGPCGA.TC $ $ DEDUCTIBLE $ RFTFNTION $ - $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY R10UB-667X773-8-01 09/02/2001 09/02/2002 X I TORVLIMITS ER E.L. EACH ACCIDENT $ 100,000 B E.L. DISEASE -EA EMPLOYEE $ 100,00 E.L. DISEASE- POLICY LIMIT $ 500,00 OTHER DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLHSIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Location: 21 W. Bradstreet Road t - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. North Andover Billing Dept. AUTHORIZED REPRESENTATIVE Leticia Re o/TISH 1 'K?xj &Lf ACORD 25-S (7/97) FAX: (978)688-9542 OACORD CORPORATION 1988 NORTH Zoning Bylaw Denial Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 9Ssq`""Ss Phone, 978-688-9545 Fax'978-688-9542 Street: 02 / W e5 -f& �.6 f Ma /Lot: .3ay Applicant: J>0/oars Request:�- Date: 7-2 Please be advised that after review of your Application and Plans that your Application is DENIED for the following; Zoning Bylaw reasons: Zonina -R q Remedy for the above is checked below Item # I Special Permits Planninq Board Site Plan Review Special Permit Access other than Frontage Special Permit Fronta a Exception Lot Special Permit Common Drive 3Y Special Permit Congregate Housing Special Permit Continuing Care Retirement Special Permit- Independent ermitInde endent Elderly Housing Special Permit Lar e Estate Condo S ecial Permit Planned Development District Special Permit Planned Residential Special Permit R-6 Density Special Permit Watershed Special Permit Item # Variance C- Setback Variance Parking Variance Lot Area Variance Height Variance Variance for Si n Special Permits Zoning Board Special. Permit Non -Conforming Use ZBA Earth Removal Special Permit ZBA Special Permit Use not Listed but Similar Special Permit for Si n �- Special Permit preexistina nonconforminn The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion,of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and in Building herein by reference. The building department will retain all plans and documentation for the at3ove rile. You must file a new building permit application form and begin the permitting process. uilding Departm t Official Signature Application Received Application Denied Denial Sent: x If Faxed Phone Number/Date: Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient --I--Frontage Insufficient 2 Lot Area Preexisting y S 2 Frontage Complies 3 Lot Area Complies 3 Preexisting frontage c s 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed y ( Contiguous Building Area N 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required 5 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height -5 .4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed --3 --Coverage Preexisting y e -S 1 Not in Watershed y c 5 4 Insufficient Information 2 In Watershed j Sign 3 Lot to prior 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 In Information E Historic District K — -EHE1 Parking 1 In District review required 1 More Parking Required 2 Not in district 2 Parking Complies 3 Insufficient Information 3 Insufficient Information 4 Pre-existin Parking y e S Remedy for the above is checked below Item # I Special Permits Planninq Board Site Plan Review Special Permit Access other than Frontage Special Permit Fronta a Exception Lot Special Permit Common Drive 3Y Special Permit Congregate Housing Special Permit Continuing Care Retirement Special Permit- Independent ermitInde endent Elderly Housing Special Permit Lar e Estate Condo S ecial Permit Planned Development District Special Permit Planned Residential Special Permit R-6 Density Special Permit Watershed Special Permit Item # Variance C- Setback Variance Parking Variance Lot Area Variance Height Variance Variance for Si n Special Permits Zoning Board Special. Permit Non -Conforming Use ZBA Earth Removal Special Permit ZBA Special Permit Use not Listed but Similar Special Permit for Si n �- Special Permit preexistina nonconforminn The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion,of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and in Building herein by reference. The building department will retain all plans and documentation for the at3ove rile. You must file a new building permit application form and begin the permitting process. uilding Departm t Official Signature Application Received Application Denied Denial Sent: x If Faxed Phone Number/Date: Plan Review Narrative The following narrative is provided to further explain the reasons for denial for the application/ permit for the property indicated on the reverse side: Referred To: Fire Police Conservation Planning Other Health Zoning Board Department of Public Works Historical Commission BUILDING DEPT