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HomeMy WebLinkAboutMiscellaneous - 21 WEYLAND CIRCLE 4/30/2018N O N O m gm wZ T v 00 So r r o m 0--- AMERICAN CLAIMS SERVICE MULTI -LINE ADJUSTERS BUILDING INSPECTOR/COMMISSIONER, BOARD OF HEALTH AND/OR BOARD OF SELECTMAN Building Inspector Town of North Andover 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 Insured: Rozenblit Address: 21 Weyland Circle North Andover Policy: PHO 0100 82 91 79 Loss Date: May 10, 2015 Loss Type: Leak ACS File: 32054 Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Craig Gillespie Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. Date 5/11/15 7 KIMBALL LANE, BUILDING C, LYNNFIELD, MASSACHUSETTS 01940 TELEPHONE (781) 245-9516 / FAX (781) 245-1077 E-MAIL — daims.acs@verizon.net AMERICAN CLAIMS SERVICE MULTI -LINE ADJUSTERS BUILDING INSPECTOR/COMMISSIONER, BOARD OF HEALTH AND/OR BOARD OF SELECTMAN Building Inspector Town of North Andover 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 INSURED: Rozenblit and Kadoshi ADDRESS: 21 Weyland Circle North Andover POLICY: PHOO100829179 LOSS DATE: 03/24/2015 LOSS TYPE; Water Damage ACS FILE: 31451 PD Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Craig Gillespie Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. Date 03/27/2015 7 KIMBALL LANE, BUILDING C, LYNNFIELD, MASSACHUSETTS 01940 TELEPHONE (781) 245-9516 / FAX (781) 245-1077 E-MAIL — daims.acs@verizon.net AMERICAN CLAIMS SERVICE pjr% MULTI-LINE ADJUSTERS BUILDING COMMISSIONER OR BOARD OF HEALTH OR INSPECTOR OF BUILDINGS BOARD OF SELECTMAN 1600 Osgood Street North Andover, MA 01845 RE: INSURED: Yosef and Yael Rozenblit PROPERTY ADDRESS: 21.Wayland Circle, North Andover. POLICY NUMBER: PHOO100829179 LOSS OF: 04/11/14; Water Damage FILE/CLAIM NUMBER 30814 PD Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Craig Gillespie Claims Representative On this date, I. caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. Date 04/14/14 7 KIMBALL LANE, BUILDING C,.LYNNFIELD, MASSACHUSETTS 01940 TELEPHONE (781) 245-9516 9 FAX: (781) 245-1077 This certifies that . � : an c`^ rQ. P (Al � �- W Z has permission for gas installation .%�N 4 O.A .......... in the buildings of ...P.4—.P -S r�' .......................... at . �. �Q �) .l ;(!� N , ...... North Andover; Mass. Fee'3D .... Lic. No.—�*. } ... ��!" ........................ GASINSPECTOR Check s ' r ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �'k CITYNorth Andover MA DATE 10/29/2012 PERMIT # 5 6 �� To, JOBSITEADDRESS 21 Weyland Circle OWNER'S NAME Danielle Rozenblit GOWNER ADDRESS 21 Weyland Circle TEL 978-204-0443FAX _ PSE OR TYPE OCCUPANCY TYPE COMMERCIAL M EDUCATIONAL RESIDENTIAL CLEARLY NEW: Ej RENOVATION: REPLACEMENT: El PLANS SUBMITTED: YES[] N0[D APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER- CONVERSION BURNER_y'_- COOK STOVE DIRECT VENT HEATER- DRYER-- _— FIREPLACE 1 _.�.,. '.� a', - !� FRYOLATOR" -�'- - - �- - — FURNACE I tLL __� --- GENERATOR - - -® -- - GRILLE INFRARED HEATER �'`'� LABORATORY COCKS_ - - I- ' 7-71 MAKEUPAIR UNIT ,''- OVEN g _ POOL HEATER ._ R` OM /SPACE HEATER-- ,- ROOFTOP UNIT7-71 TEST-_ -- - - -- UNIT HEATER i = I -- a'- UNVENTED ROOM HEATER WATER HEATER } OTHER - u --- INSURANCE COVERAGE- 1 have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES ONO E] I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement CHECK ONE ONLY: OWNER 0 AGENT i SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this 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 complia wit eminent provision the Massachusetts State Plumbing Code and Chapter 142 of the General Laws, PLUMBER-GASFITTER NAME I Richard Martinez LICENSE #52096 SIG URE MP El MGF ® JP ] JGF E] LPGI Q CORPORATION r-1# PARTNERSHIP Q# LLC COMPANY NAME: RM Plumbing & Drains ADDRESS198 Mishawum Road CITY I Woburn STATE ZIP 101801 TEL 781760-0610 i FAX781_933-6439 CELLI------. EMAIL richiem1229@yahoo.com /.�_„ t w F o z z 0 F U W a w I z w �El F o W F a qk z U w' F QW a y a W O Q W w CO) a o a a rA U_ x M H a w r w F 0 z z 0 F U w to \ z x 0 a u RM Plumbing & Drains 198 Mishawum Road Woburn, MA 01801 (781) 760-6601 Fax # (781) 933-6439 Date: November 19, 2012 'To: Maura — Town of North Andover Inspectional Services From: Julie — RM Plumbing & Drains Hello: I am enclosing a check in the amount of $30.00. This is the additional fee for the Gas & Plumbing permit. If there are any questions, please contact me at (781) 760-6610. Sorry for the confusion. Thank you for all of you help. Julie RM Plumbing & Drains N° 9682 Date .I444v=.. . �'<��•° :'� TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that .? `. .. . has permission to perform ..v J' �." 0.t ............... plumbing in the buildings /o}f . �4� Z Q s-��-�,� � ................ at .... ZA... W.q -1 1A—.. ! ..1* -f- -.... , North Andover, Mass. l Fee .�..a{).2.... Lic. No.�.--�..°�f °... .......................... PLUMBING INSPECTOR Check # 22 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1.112 4° CA - l., wk IP- V% MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY ,North Andover MA DATE I 10/29/2012 PERMIT# JOBSITE ADDRESS 121 Weyland Circle OWNER'S NAMEJ Danielle Rozenblit POWNER ADDRESS 21 Weyland Circle _ — i TEL 978-244-0443 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL [] EDUCATIONAL Q RESIDENTIALE] PRINT CLEARLY NEW: [ RENOVATION: REPLACEMENT: 0 PLANS SUBMITTED: YES NO[ FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB—_ -- CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM J_ _ DEDICATED GREASE SYSTEM _ _ DEDICATED GRAY WATER SYSTEM ; , DEDICATED WATER RECYCLE SYSTEM _. _ T.,'.' T_- _. DISHWASHER— DRINKING FOUNTAIN FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK ------- _ _._—tea ____ _—__-7 ____ _ _ _LAVATORY LAVATORY ROOF DRAIN SHOWER STALL _--' 1 ._ a —__i . _ _-_._J SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING OTHER INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[] NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND Q OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [] AGENT [] SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this 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 co lian Pertinent pro ' on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ol PLUMBER'S NAME •Richard Martinez LICENSE # 32096_ IGNATURE MPI-71 JP 0 CORPORATION M-- LLC# COMPANY NAME RM Plumbing & Drains ADDRESS 198 Mishawum Road CITY Woburn ESTATE L I ZIP01801— —j TEL 781-760-6610 _ FAX 781-933-6439 CELL EMAIL richiem1229@yahoo.com 1.112 4° CA - l., wk IP- V% W O z z 0 F u w a I w o� z El Z o w on 7 wF W a u = W 4 a a W o W a 0al w a a a � a y LU = W LL rA w F O z Ov z o i � F u w a z z as P-4 x w*� The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Richard Martinez Address: 198 i1llishawum Road .AI_L.._- AIA AA OnA • Y_Y r 1, rYr/7 v r vv r ,7Q4 man_aain rnone ff: - -- Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. [] I am a general contractor and I employees (full and/or part-time).'* have hired the sub -contractors 2.0 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.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGI. insurance required.] t c. 152, §1(4), and we have no employees. [No workers' Insurance Type of project (required): 6. 0 New construction 7. Remodeling 8. '© Demolition 9. Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.'C] Roof repairs 13.0 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: Job Site Address: City/State/Zip: 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 certify under the,, its andpena/tiess fperjury that the information Provided above is true and correct Phone #: Official use only. Do not write in this area, to be colleted by cky or town ojj'uial City or Town: PermitaAcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #• AMERICAN CLAIMS SERVICE MULTI -LINE ADJUSTERS BUILDING COMMISSIONER OR BOARD OF HEALTH OR INSPECTOR OF BUILDINGS BOARD OF SELECTMAN 1600 Osgood Street North Andover, MA 01845 RE: INSURED: Yosef Rozenblit PROPERTY ADDRESS: 21:.Wey-la,nd.,C±rcle, North Andover, MA POLICY NUMBER: PHOO100829179 LOSS OF: 10/11/12;Water damage stain FILE/CLAIM NUMBER 30104 PD Claim has been made involving loss,damage.or destruction of the above -captioned property, which may -either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6., to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number,. -date of loss and claim file number. Craig Gillespie Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. October 12, 2012 Date 7 KIMBALL LANE, BUILDING C, LYNNFIELD, MASSACHUSETTS 01940 TELEPHONE (781) 245-9516 • FAX: (781) 245-1077 (00,,"0711; tiro ,'�MO Date .......� TOWN OF NORTH ANDOVER PERMIT FOR WIRING F� CS �/� of This certifies that ..... .... owe. �. �,+��.- CU r` has permission to perform ........ N:f ...&A)..........Wv.nV)l ........................ x R U wv ging in the building of Ci 7 ..:. (. .. ,North Andover, Mass. Fee 27f. ic. No .......:...... ........ N ELECTRICAL INSPECTOR CU L WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 014e TalullivilweatO of fflundivatto lkpartutcttt of I-Jublic £bttfct0 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. �s Occupancy ,& Fee Checked 3/90 (leave blank) j-7 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 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) _l a2��I 11A J1JA Owner or Tenant lrzzx 1trn r-4-/�2,y, l� V—bJ Owner's Address lar-&) Is this permit in conjunction with Et building permit: Yes No El (Check Appro/p�riategBox) Purpose of Building (� , <<( Utility Authorization No. h d / 3 6 Existing Service Amps _/ Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service _2-60 Amps <Zy / ZI Volts Overhead Undgrnd Ix No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- ❑ ❑ grnd. 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 No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total e Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local Municipal ElConnection El Other .d No. of Dryers Heating Devices KW �.� No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP > OTHER INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Copl ted Operations Coverage or its substantial equivalent. YES NO ❑ 1 have submitted valid proof of same to the Office. YES -7 NO ❑ If you have checked YES, please indicate the ty f coverage by checking the appr priate box. INSURAN&I-kBOND ❑ OTHER ❑ (Please Specify) 'Ir . (Expiration Date) Estimated Value of Electrical Work $ Work to Start) Za /l -!26 Inspection Date Requested: Rough 4 J 4�z Cr,(( Final Signed under the Penalties of perjury: FIRM NAME LDtinineArC-Q- !LQ CZ)' /C Lf 11� , Licensee Signature Address LIC. NO. //� 2 214 NO. Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) x-6565 Location Zl No. Date t' 0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ JBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL 11 $_" 0*4 Building Inspector .� 1/95 13:38 1,239.00 PAID F =� 943-1- Div. Public Works L& icy Location cwu a2 No:Date (i --7 ..... TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ oc-,�"_ Other Permit Fee $ S C ewer onnectlon Fee $ # Water Connection Fee $ TOTAL $ 60 ,k.,. Building Inspector 9341 �150.00 PAID 7 l u 4 Div. Public Works Location.-, o {D Dates. NORTH TOWN OF NORTH ANDOVER 7 �0��.ao p Certificate of Occupancy $ s ; Building/Frame Permit Fee $ Foundation Permit Fee $ SACNUSE Other Permit Fee $ Q , ,✓ j. Sewer Connection Fee $ Water Connection Fee $ Q 7 7 5567 TOTAL $�7 J� k:fi - - - �} �, Odin �A7 i1L091 .13c55 17000.00 PAID / //��� Div. Publl'fNorks g' 1 PERMIT NO. S q APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP KVO. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK '.PAGE ZONE SUB DIV. LOT NO. i LOCATION PURPOSE OF BUILDING _ Y J r, Q,� ,, / OWNER'S NAMEO / VC 1. X 1A)OWNER'S NO. OF STORIES SIZE ADDRES '� BASEMENT OR SLAB e -T— LO 2&Ae- k" ARCHITECT'S NAME /Ll Z O �l �Q a //-� SIZE OF FLOOR TIMBERS 1ST /,x/ D2ND BUILDER'S NAME /FO/ e a l TSL CbY � SPAN ')oeelia DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS ? •l DISTANCE FROM LOT LINES — SIDES .2V Jl REAR �� GIRDERS /L / AREA OF LOT /iii /ice FRONTAGE z vl/V.LO� HEIGHT OF FOUNDATION ri t THICKNESS d IS BUILDING NEW i SIZE OF FOOTING �� X V IS BUILDING ADDITION / ) i'% MATERIAL OF CHIMNEY IS BUILDING ALTERATION N IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER { y-eS BOARD OF APPEALS ACTION. IF ANY )) N IS BUILDING CONNECTED TO TOWN SEWER -y-es IS BUILDING CONNECTED TO NATURAL GAS LINE Y,tf' INSTRUCTIONS PERMIT FOR FOUNDATION ONLY SEE BOTH SIDES REGULATED BY PARA. 114.8-S. B.C. PAGE 1 FILL OUT SECTIONS 1 - 3 .�.. PAGE 2 FILL OUT SECTIONS 1 - 12 DATE tl FEE PAID _ ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS t f PLANS,MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OF OW R 0 AUTHORI E G T PERMIT FOR FRAME/BUILDING F E E b PERMIT GRANTED DATE: t2 —FEE PAID'17 . Q I9 V� 3 PROPERTY INFORMATION LAND COST 11r 00 , !O �m 1 EST. BLDG. COST {[/J� ���J EST. BLDG. COST PER SQ. FT.. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. # CONTR. TEL. # /- //a CONTR. LIC. # �G 4 0 H.I.C. # 8q$Z&0»:a�� G'? d1 9 4-3,n 5 ROOF II 10 PLUMBING t 1 HIP BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S DRIES FLAT THIS SECTION MUSTSHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _.OFFICES _ LOT LINES AND EXACT, DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS WOOD SHINGES 7 NO. OF ROOMS KITCHEN SINK RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 8 M -T 2nd I><t 13rd I CONSTRUCTION TAR 8 GRAVEL 2 FOUNDATION STALL SHOWER ROLL ROOFING INTERIOR FINISH MODERN FIXTURES CONCRETE -8 3 1 2 13 TILE DADO CONCRETE BL -K. PINE i l HEATING BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY VJALL_— UNFIN. - 3 BASEMENT AREA FULL FIN. B M'T AREA _ - - •• '14 1/1 V. FIN. ATTIC AREA _ NO BMT FIRE PLACES 1 HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS ' B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDINGi' `- HARD"✓'D ASBESTOS SIDING VERT. SIDING _ COMIdCN_ ASPH. TILE , STUCCO ON MASONRY STUCCO ON FRAME-` BRICK ON MASONRY ATTIC STRS. 8 FLOOR BRICK ON FRAME ' e CONC. OR CINDEi BLK. STONE ON MASONRY WIRING STONE. ON FRAME _ �- .�_ .YT - - _ I CIIPFRIf1R I 1 PMR I 5 ROOF II 10 PLUMBING GABLE HIP FORCED HOT BATH (3 FIX.) GAMBREL STEAM MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY ' WOOD SHINGES 7 NO. OF ROOMS KITCHEN SINK SLATE 8 M -T 2nd I><t 13rd I NO PLUMBING TAR 8 GRAVEL STALL SHOWER ROLL ROOFING I MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING II i l HEATING WOOD JOIST A P•IPELESS FURi FORCED HOT TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OI WOOD RAFTERS ' AIR CONDIT14 RADIANT H'T UNIT HEATER 7 NO. OF ROOMS GAS oIL 8 M -T 2nd I><t 13rd I ELECTRIC NO HEATING Vp ;rt k 131 AS Z MW V I C-3 a w A f� jG 10 o c° Cl) .y a cn a v� 2 z a cz ci c U c ii v W Z z a a -� a G w w z W .a W .� °�° a°' v cn w O u W a o °�° cG° w w d owW v L W . cin o cn uj CLI 0 Q' CO o Z m r: O Z 00 0 y O r1•y V O CO ¢ ~ Z Cao IeL oom (�/ O RLL � W Q J LW � v O G .moo= C r �2 CO N � 'a ZC N CO O C 0 N O V= 1 N m O� �•LL 07 � OQ mc O V! OCD C Z C O C Q ;zi y CD C O = m m C3! N r N m m W c 4; :5 c � N Q� m C Z W E v v u O C.3 co VO CO C h O. m :; O 5 = v , o ti o 1— = crm i O L O Z co O CO) � C CO CO) CO M Co �E m m co CL �� scm 03 c G i M O O=. a- . cm< C4 C O C CCc v J� co) Z V V y C CL CO2 is a FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: t -DX W 0C)N P a, �Y (.'� 1r7? Phone 10 7 / _41 0 Fr LOCATION: Assessor's Map Number Parcel Subdivision-Toxwo©Ol Lot(s) %O Street lam V /a v. J CI r I�- St. Number G Use Only************************ RECOMMENDA6TI� S TO AGENTS: / q� -r4 LDate Approved Conservation Administrator Date Rejected Comments vxp�l Town Planner Comments Food Inspector -Health /I Septic Inspector -Health Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections - driveway permit jJ Fire epartment d�al, -4,l7 � 2-c� � ived by Buildin Inspector Date �P'r`sr 4. �A A sa �' {�� r ` Y"`�" �'� �f.af?�'"°,¢t't pf `�^ �k .� w n��'--'�� •..,.,.-' amu.,=+.-�..,;.,.�.+.. w.. 'e'�s'�i .a ;' w,.. _.... ... �.adrYd s.,. ^a'�}N a:.w�Y�yf1.1•S"c t-��,.>. 3s•+ y ., °fC moi. . d �V r - t ' . �.f�•t+suav "^ketr '�ssc nxs� y"9a..,fi3r xrx.R-ae<a-�_.�'•,. ��. s*ru ue:, 4 q, swr.�. sx�'.•�°' � sa r �"t� �,iV Y.stc,{x.-#;� �,a,r"Yi,„a•..„"`.'S .r,,;u�' j4 •-s-,.....r---'-..._. '4"`Y. �`;"J� ��5� �C4,�,.�r+...� y. i>�.�.-�w,rJ.>�wv.���r �S..; �.a �X`?`-�"'�` ^i•,�.' �r`��:•+. axR"waY''.5' ,r t, a ,y�t.C, �.� Sa$a �¢�,;�km+`s'=�w+.ya .t �;m�,k .. .. w � a. * � t ,,� t d"�-,�ti , '',. a'� 2 '�X F'4 F'`� g, a f•� r r. u.. u^�S ems? - r +. � �" .� �+r 4�J' �z*, � 4 •hw. a ...$ :�.3'i ��nima' -:�+� an�'�=�*.rh., P� .� .v a,e� S -. - � s X:�,.� x,�n.-:, r x... Ri £+ s �'' �'.y5,.5 ,a�"'� C' : •-. �" 3 .,... fir&.. N. «.r>•�rt-rc r• ,��.a ..sx .. >� :. ..r {rar �.i -s .,* ; - � .*,.. F,^4 a, t�•w..-xrd-o G"i. ire, yC �' °^*�+ev'��' ic•x 6..}. S t a v- � •y 15c'" r.� o ?o-�e� i5+ fs �-� � ��; �s.. a # 6 E s-n ^�.L . ...^: y.,.. vcY. .Y„ .�_.�._. ...rYr .v t. ✓.4•}n, s,S �L .".1!-� �.i�, k a' 'P k CiS yS '4 3�4 ♦ - 1, �� - ,.. . .. t • �. _.. XF a S F.14 T� � 9 �-% 3Z4,r0 ZZ �� p x- E d • • s ,r •vc 1 A E cm / 1 •i } R T ,� '. '� y .�� M t� � _ r 4'#-: r 'a> `!i k a R /�5 eze � a :�i �/ :,4 .} '� ^w... � k v. i �. t -�07 i " f �;... •. 2. '0 t �- �Y q c S�xP t� 6�^'. ^9.i `� ' ,. r '° a S -, 'f„ .. ��� 9 cZN 1Y/%V YW&- mw.v A- A" 04/4Vv� eeWOVO .!'WWAt'/Il'AUt cerwstrs i.✓ Mot AdtArrk .+rr~ A$fr-#,eO 44V—A. �AIVN I/V AY�'M�i Cd�aiAI�/iV/Ty /�.INC.Z � 2SOa9g 4V07 C oArra 41ZA3 f 1L or R4 �Qit/ /N 40,e,4.4e l fO.P /'dXU/DOp ,�EAc.Ty C�.E',o /7 I(d, 0144e J7A-gW r o,fAOVOMCeo T Sj OPF-7 0�4 uj 3 011, ,v ,Tk4 O pf -F t, 0 VJ cc ON ,® o Zco c:0 CD CO? T O O Z CR c .�+ O cr 0 CJ C3 Z o .� -j mC�CO (� �: •.� i U. C] Ec m ~ ~ 0 oaWLa o m O O ..-- ra O! mi o c E mm � CS N C 3 C fs O m y'CO p M h 0 c cmc h �cOQ acZ m O Z `o C i 0 Q JC2 d c Q O i Ce CDCD N COD M CL=p C O Lu p "r o y O CJ =CM V2 .O' 4D. - Go � � cc / 10 i ICD Om O O Co �E O O m m CD ow CD �3 CD O ® O L Cc ZE CD CMQ coCD C ev V C CD V co cc c cc CL h z I E U) Locatio , No.Date 4 ,.oR,►, TOWN OF NORTH ANDOVER oL ° Certificate of Occupancy $ ��ss+CMusE<�' Building/Frame Permit Fee $ 1A, Foundation Permit Fee $ Other Permit Fee $ // TOTAL $ !�5 0 ` Check # s 15599 t �� Building Insp c r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: I DATE ISSUED: SIGNATURE: Building Commissionerffns=tbKof Buildings Date I SECTION 1- SITE INFORMATION I 1.1 Property Address: 1.2 Assessors Map and Parcel Map Number Number: a 3 S``— Parcel Number �LAL 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 Recpired Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private 0 Zone 1.5. Flood Zone Information: Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record r Name (Print) Address for Service: 971P- 6 6, Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 pLicensed Construction Supervisor: Not Applicable ❑ l�0gLI S. �SJCCL Licensed Construction Supervisor: -216 License Number Y3 woo; D�iJ � L ssc-X �� al9a`l Address C j I/, 0, I . CQ / ��P 3 ^ 7 6 \( Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ ` Company Name I �" J 4 Registration Number Address C1 li L/ /o Expiration Date Signature Telephone �0 4 O z M 90 O r r z ^ G SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506) 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) ❑ Alterations(s) ❑ `17 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify C' c-l<_ Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit a22licant�. OF FI -LML lList 00,y .... -- ...,. .._ 1. Building Ci ? j / (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction � J 3 Plumbing Building Permit fee (e) x (b) .-- 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , 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, 4 DL c,rpo c c ' 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 6 IJ C:r is f - 2 P-1 C C_ r Print Name Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS is 2ND 3R SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlvINEY IS BUILDING ON SOLID OR FH LED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM ,,_r 1k voo U --e a Rv� (A r Q eqt Sf (&9 16 `FaO Q P e M ctic­ INSTRUCTIONS:NS: 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. i _-_" APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE W` �'q — Uo? C,*�.i� LOCATION: Assessor's Map Number [� ,5 PARCEL `213(^ SUBDIVISION LOT (S) STREET_ C l f, C . ST. NUMBER ****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIOI�IS OF TOWN AGENTS: CO ERVATION ADM i TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS TOR / 676 / DATE APPR0V9D DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 im TE 4 HAVERHILL, MA 4 Phone 978.469.748'a # Fax 978-4M 704a • MORTGAGOR 13W gig i MK L� A���LLSy DEED REF- _ �/7le�i PG. /v_1 AODRESS OF PRINCIPLE Bun,OiNG PLAN REF. ALM!& 4,x111 tri__-- �. ---a DATE OF INSPECTION � SCALE t- _ '/0 r e /at 06 %,A JW' ., i( VA�d W T. I nUUCL CFRTIffCAT'ION TO: No. �6!)t]D 3eTELLS FARGO HOME M -Q GAGE The location of the Principle structureJg This Mortgage plot plan was prepared specifically for `rJs CelStt�� mortgage purposes only and it is not intended or represented +q S . to be a preperty line or land NAI iAKq with the local zoning bylaws in ellect when constructed Survey. This plan is not to be used and/ or is exempt from violation enforeemnent responsibility e establish anye the property lines for any purpose. No action under Mass B.L. Title VII, Chap. 40A, Sec. T. This Certification ti ica is extended o the land location pr occupant ■ SUb)jeet building is not in a Flood Hazard Area. This a sitiGation rs laasod On the IOOAtien of Survey maYtctY Cl Subject building is in a Flood Hezard Area. of others, Flood Hazard determined from the FIRM map# Dated ** TOTAL PAGE.01 ** DECKED OUT DESIGN fjA 978.468.3002 www.deckedoutdesign.com TO ,M t I�-e -�-- T-e<r--� Kp, �I ADDRESS 'Z � WR vl `;f, 0 C 1 V( I -Q Na R N vz�'D \�-e, M � TEL(H) �1�—(�c�._ p'22% rT�r<� V (���� GeZ2�'2.y�$ (W) ��� .3 9Z- — IN O 3 1+ 20 O''L I-) _ Ll -k- I 21 9 8 fpoY G t1- 3S"Z- 2 9 9(1 DIMENSIONS FLOOR HEIGHT MATERIAL SG� ���ti �� 11�w N ��'� STEPS RAILS 5u,� ,1 rebTtV) QST T c (H'A43 '6N YPAATTICE JOIST (off SEPTIC DECKING SET BACKS POST C�,XIE SIDING FOOTING �o.N� �� � � PERMIT WA, -j- -P, \DQ(v el Co N<<e<-c p 1j4QW \q(V,C q) A T (bn (Q S-oNo T vD<<-\� 3C, j 7-- �T- -- - --' JftE619t�I77.G4tlfX.'CI.L[I2 0���4�O.L#7i14P.G T BOARD OF BUILDING REGULATIONS r� License: CONSTRUCTION SUPERVISOR { r Number: CS 068716 B}rtFidet .. 11/21/1965 t 11/2112002 Tr. no: 3719 Restricted To:}00,. ROBERT J REPUCCI 30 CAMPMEETING RD'_«�i TOPSFIELD',eMA 01983 , Administrator 4 � �rmo+,zzt�niz Board of Building Rtgulatsons and Standards s HOME IMP,ROVEMENT'CONTRACTOR Registration: 127156 ExPirationc 09/1412062 I Type: 1NDIV{DUAL f_ ROBERT J: REPUCCI 1.4 ROBERT REPUCCI _ 30 CAMPMEEfING RD TOPSFIELD., MA 01983 Name: - Location: l C.J &rJ Ceti, A a L! YLC_ L e- City N A Phone 9 3� am a homeowner performing all work myself. 01 am a sole proprietor and have no ons working in any capacity I am an employer providing workers' compensation for my employees working on this job. GomQanY_ name: O&O J c c C cl o S T#4 f Address 'C4 ?=,c_.Jy 01:5 1 U d- citi .: S X Phone* .3'Y x-)a��? Ccsm»arty-name: - . Address C_ Ity: Phone* Failure hone#- Failure to secure coverage as required under Section 25A or MOL 152 can lutea to theitrfposrlion d aiminal penal -of a fine up to $1.500.00 and/or one years' imprisonment as well as evil penalties in: the form of a STOP WORK OR and a fine of ($10000) a day against rite. t understand that a copy of this statement may be forwarded to the Office of investigations of. ihs DW for coverage verification. I do herby certify under the pains and penatties of perjury that the i wbana im pr&A*d above is bue ant! correct Print Phone # 9?0'' ' "Y C;.2 Official use only do not write in this area to be completed by city or town official' OCheek if immediate response is required Building Dept Contact person Phone RM WORKMAN'S COMPENSATION. 0 Building DBpt- - 0 Licensing Board 0 Selectman's office D Health Department ❑ Ofher North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) S. fzwpocc-a Signature of Permit Applicant %a 1 X) Q Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 11 A u. ci OO a "z0-0 w� w w v U G x w u; w EO a w a a chi c w" H GO u: w A w v m z o v ) \T 0 .1 0 0 0 C/) LU Cn w W IrW ui CO �. t i� •vv c ac V �v ca m c " o o A ts �J Or c E H • O M O : � N "! Z : osrs G � � m N ♦ C m \ O O O p N V E m N m ; cm IQ1 � � y � v 'h o °� � • z o cm •C = m m �: N m C m C o rL... fV m W C N C. r t s •tto 1C �- oC LU •E CL=11 C=3 gym,, •NCM Z o a mECOD � g = A N •O C = oo- 064- \T 0 .1 0 0 0 C/) LU Cn w W IrW ui CO �. t P(AM 3 I(lr7 47 0 -4 O� µORTH TOWN OF NORTH ANDOVER Sao ` °*6 °0 OFFICE OF ° : " p BUILDING DEPARTMENT 400 Osgood St xrro ;� North Andover, Massachusetts 01845 D. Robert Nicetta, Building Commissioner TO: FAX ,p, w, tee.L 'rj r?y(—q DATE: �j - 1 FROM: TEL: V v 4 (_ [Lc- V,,4 C 978-688-9545 FAX 978-688-9542 Telephone (978) 688-95454 Fax (978)688-9542 --C-�A (S -i 5 A ( ( C) BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688- 9535 i k * a d � t r •o`��eo 'oy b J qC� # �9\ :Z .v�eY ctrer�rr its rte' rnrs• ivrcae�u.wv 1b f:Nf' dE�NK nwr 17�Y awYLMY /! LOcbg7hV OA/ Ti1lflll.I.!!A/�M1Y.I.VOTJWT/TO'0/J etiWiRatM ,W" f.Wm N 4- N. Au00H' l ~AW IIfN/K.�77pILf c I C4.1.V ~ w Daae ~14AoV wr 4WI4 4WSVN ON iKMd "0 e-17-0 &9.6 0007 C ' Owrpp 6/y,/S'3 pWMW,4 PL OT PLAN n)/N P.e.4AeA ' OVA' �XL!/DOO �EAtTy LO,Cp p40 NO✓. 17 /997- .ME.t,��nwGt' fw�rYE•Mrfi .tE.�riac'Ed .�,voor�,c .�ici1'.t+tvrtdrrs oisio n � t • Nr. 4 �. r . n ; � S �n Y Y IR qS :Z .v�eY ctrer�rr its rte' rnrs• ivrcae�u.wv 1b f:Nf' dE�NK nwr 17�Y awYLMY /! LOcbg7hV OA/ Ti1lflll.I.!!A/�M1Y.I.VOTJWT/TO'0/J etiWiRatM ,W" f.Wm N 4- N. Au00H' l ~AW IIfN/K.�77pILf c I C4.1.V ~ w Daae ~14AoV wr 4WI4 4WSVN ON iKMd "0 e-17-0 &9.6 0007 C ' Owrpp 6/y,/S'3 pWMW,4 PL OT PLAN n)/N P.e.4AeA ' OVA' �XL!/DOO �EAtTy LO,Cp p40 NO✓. 17 /997- .ME.t,��nwGt' fw�rYE•Mrfi .tE.�riac'Ed .�,voor�,c .�ici1'.t+tvrtdrrs oisio n qS r8 :Z .v�eY ctrer�rr its rte' rnrs• ivrcae�u.wv 1b f:Nf' dE�NK nwr 17�Y awYLMY /! LOcbg7hV OA/ Ti1lflll.I.!!A/�M1Y.I.VOTJWT/TO'0/J etiWiRatM ,W" f.Wm N 4- N. Au00H' l ~AW IIfN/K.�77pILf c I C4.1.V ~ w Daae ~14AoV wr 4WI4 4WSVN ON iKMd "0 e-17-0 &9.6 0007 C ' Owrpp 6/y,/S'3 pWMW,4 PL OT PLAN n)/N P.e.4AeA ' OVA' �XL!/DOO �EAtTy LO,Cp p40 NO✓. 17 /997- .ME.t,��nwGt' fw�rYE•Mrfi .tE.�riac'Ed .�,voor�,c .�ici1'.t+tvrtdrrs oisio n HP Pax K1220xi Last Transaction Date Time Tyne May 18 9:23am Fax Sent Identification 817819443117 Log for NORTH ANDOVER 9786889542 May 18 2005 9:24am Duration Pages Result 0:32 2 OK Location No. 96 Z' Date MORTM TOWN OR NORTH ANDOVER O't.o ,,ti0 Certificate of Occupancy $ �'�S''^° •'�� Building/Frame Permit Fee $ s�C HUSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Q Check # "18352 Building Ins .� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE. OR DEMOLISH A ONE OR TWO FAMILY DWELLING . r. BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: 1J,19t1f )4�j4L� Building CommissionerA for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Pr erty Address: 60 WC-1L1*Af1) 1.2 Assessors and Map Number Parcel Number: Parcel Number /V o R T N AN 0 0�1 R 1019- 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: LA Area Frontageft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provided RequiredU�,5r4- R red Provided 1.7Water 5 M t C.1.3. Flood Zane Information: _a -Zone Outside Flood Zane ❑' Municipal Public ❑ PrivateSECTION 1.8 Sewetap Disposal System:°��' ❑ On Site Disposal System ❑ 2 - PROERSHIP/AUTHORIZED AGENT i:�i:iif I{; 1 't(lCf; �ing (Jo 2.1 Owner of Record t/ /2cL u�G�c�sH L ✓ ai Name (Print) Address for Service / U wEyL�n/� C�2c_r_r Signature Telephone 2.2 Owner"of Record: Name Print Address for Service: Sianature, Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: 1 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 I. SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2! Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... ❑ SECTION 5 Description of Proposed Work check applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Accessory Bldg. kll" R� ' & lino_ 11 Other ❑ Brief Descripti of Proposed Work: with this application. Failure to provide this affidavit will 0 ❑ 1 Addition ❑ I __11�1'1+.s I ii a Inn ma Q� 1 �fc A�i IV 1)6L�C' �[LYAV_ gin/C^Ps' t�Gv,1JIUPI>�Y� a \vin V%V4 W1"fa'\A(n I�IQ c,'Ycy�'� �YQ6�fQJs�e�c, ID`S f4 1' Ci 1xi%tV cleCl (rIlii "_J _''� 5 �s I V'I)lo I I SECTION 6 - RSTIMATRD Cf1NRTR1T1rT1rnN rncTc I Item Estimated Cost (Dollar) to be Completed by permit applicant OF11''ICIAL USE ONLY. 1. Building o0 (a) Building Permit Fee Multiplier 2 Electrical �_o (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee t,l x (b) DD 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 35 © Check Number ama, x aari1 r a v vvilvmx% rsv a ra Viexe.et x 11nI 1 V nZ 1, V1YlYLE l XL W k1Er 1 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT yAS L u /900 Slay as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to . • rl�uthorized by this building permit application. /a Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATInN 1, ,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 0 I Print Name Signature of Owner/AEent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1' 2' 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING. CONNECTED TO NATURAL GAS LINE c 91 •4 0 z s� 5 s F - h W H IC W L3 COD c o o � c* O N �V •d Oca O C := O O � Ea o O o a N o= o �t D C_ G CL-- ro ' C O �N CO C � O i �m �-0 N W E� CLW 0C.3 ` N • z SO �a N ID Of 'WIZ o o.o ID to to Go SO S NmoF" CL -S E � CL O c :E C wim t $ a0 -m _N Z N N C re a cm • ac CD c _a 0 m `o cm c c N m 0 Z 0 0 zip O E L O Z d O y D C I CD cm � Q� Co -g m m CD 0 3� CD O O Q CL o = W c cc O =� C O V 'D CL O Ca C Z m 0 CL C.i ca O C C c CLCos C o w U w a w a w x 5 s F - h W H IC W L3 COD c o o � c* O N �V •d Oca O C := O O � Ea o O o a N o= o �t D C_ G CL-- ro ' C O �N CO C � O i �m �-0 N W E� CLW 0C.3 ` N • z SO �a N ID Of 'WIZ o o.o ID to to Go SO S NmoF" CL -S E � CL O c :E C wim t $ a0 -m _N Z N N C re a cm • ac CD c _a 0 m `o cm c c N m 0 Z 0 0 zip O E L O Z d O y D C I CD cm � Q� Co -g m m CD 0 3� CD O O Q CL o = W c cc O =� C O V 'D CL O Ca C Z m 0 CL C.i ca O C C c CLCos C 978-688-9545 978-688-9542 Fax Please print DATE -T JOB LOCATION Number t0RTPj Ot „to 0�0 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER MA 01845 HOMEOWNER LICENSE EXEMPTION Street Address HOMEOWNER._ �igEt_ K/jfh�S/f= N y, 20 � ✓3? __T Name Home Phone Work Phone PRESENT MAILING ADDRESS a) W E IL e!gwa GSaC L E n/p 0 -TO IW Oj),JF A o t 2 u s-- 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 HOMEOWNER: 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, one or two family dwelling, attached or detached structures attached or detached structures accessory 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, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. _ HOMEWOWNER'S SIGNA APROVAL OF BUILDING OFFICIAL 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 PHONE LOCATION: Assessor's Map Number e� PARCEL c>-- SUBDIVISION >SUBDIVISION LOT (S) STREET V"'1 0 ( V— ST. NUMBER OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT 'FIRE DEPARTMENT- �DUMPSTER PERMIT RECEIVED BY BUILDING INSPECTOR DATE FORM U - Revised 6.05 JMC .} 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 at: � a VVfYj,,drJ0 65nCL _ is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: Fire Department Sign off. Dumpster Permit (Location of Facility) Signature of Permit Applicant Ao�— Date � ,m m m o ra 'q . _ _ ;n �= � � _ � _. DFPARTAfW0FPUBLICS4FEIY BOARD OFF IREPREVFYI70NREGUL4TIOAS527C,KR IZ:UO Permit No. Occupancy & Fees Checked APPUCATTON FOR PE Aff TO PERFORM ELECMCA.L WORK O(PLEASE ALL WORKTO BE PERFORM D IN ACCORDANCE WITHTHE MASSACHUSSTS ELECTRICAL CODE, S27 CMR 12:00 PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perfbrm the electrical work described below. Location (Street & Number) Owner or Tenant Y,9E L, K Owner's Address 'z s vo<rr 20 To the Inspector of Wires: 6 1 ,n/r v t /Zn/n i -n rL / �W(%vC2 AA C -'- 4,77'�\ r"`-, Is this permit in conjunction with a building permit: Purpose of Building 6, eAyy`et, f YZY Yes � No ►l sra (Check Appropriate Box) Utility Authorization No, Existing Service, Amps auC�Volts Overhead [D Underground No. of Meters New Service Amps �� Volts Overhead r --J Underground Q No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work SEA Co K,.n K . 77y\%.w ogYid 7777/f 10" ,c v],�k� ll c No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures a Swimming Pod Above Below Generators KVA Jground ground No. of Receptacle Outlets / b No. of oil Burners No, of Emergency Lighting Battery Units No. of Switch Outlets 3 j No.'ofGas 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. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER htsutwwCamagr. Rmiarttit rmfimiMoDAmmdum&Cz=d aws eYJ a Iha%eIT aa=tLd dyhmm=Pn6C,yni&lgCa Mitt Cma2Wcrirssis�li�agrivalat YES NO Iha%es1ttani0adM&pW f0fWMblheOffM YES rJ NO M If}ouhaiedwdWYES,plea rdmtthetAtafa crWbydtedatgthe bcpL a BOND all &R a (PfeaseSparii� E*rafimD EM*dV"dE b*W Wdk $ WakiDSwt IilspacnanDtlreRalue ad Rao Find utldar$ieP�>I�es Signed afPaJtry: I FIRMNAME Lix=Na IiMIM Sigroft Limwl- o Busit=TdNa AkTe1Na UWNER'SVZURANMWANE[t;Iama =fttheLioensedwat lbeiluuaroem►er a siatalteleglire�tas184aedbYl GaeralLaws a4a�arrrrysig>ehaeon8�parn'tapp�w�stf>irequaerlaY (Please check one) Owner Agent a Telephone No. 7-1- 7-1--W-5-3 PERMIT FEE $ S ,�� ,- Xw' V r � s� i ION NORTh Date..6— -30 ... ............................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING '11�11U—� OLUA.-O;�N This certifies that .... *- tv A0 Fr ................................................................... has permission to perform .......... ................................... wiring in the building of ......... ........ at .......... ) ...... U.1-4. ... V 1—IfA-'P (2 .< ............ . North Andover, Mass. Fee .n'5-0 1-16NE .................. Lic. No... ........ ELECTRICAL INSPECTOR Check # 5b78 DEPARMENTOFPUBLICS MY BOARD OFF7REPREVEVITONREGUL4TIOAS527CVfR 12:00 Permit No. 7�? Occupancy & Fees Checked APPUCATION FOR PERW TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ill L Cs Qr L C Owner or Tenant Y19C L K 19ODS/fr .� Y 0 S t' F R19 Owner's Address a I WCY L- IWO C1( Cc C- AU 2T h` '�9NGbJE2 /IJ/L -- Is this permit in conjunction with a building permit: Yes LL -IJ No (Check Appropriate Box) Purpose of Building Existing Service o ,v AmpsU - Volts New Service Amps Volts Utility Authorization No. Overhead Underground Overhead Underground Q No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ba cn inn(I YJv� V��vJ Wl'ri %� c��t? �S i �v►,� c �Y�v;°f I,Yca+ No. of Lighting Outlets No. of Hot Tubs No. of Transformers Tom KVA No. of Lighting Fixtures Swimming Pool AboveBelow Generators KVA and ound No. of Receptacle Outlets / �j 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 btitiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Connections a Other No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis Na Hydro Massage Tubs No. of Motors Total HP InStsatoeCmerage PtttsuattothelH�IIHT1H1St)QV)a�1SA��tQlt7atI.4W5 j�� ItmeaamagLiabt7dylt ==Pb[ ym&ingCaTgi* C0AWCrilS2k5W fff1iValart YESL�L.J NO Itmesthnitedvalidpla£ofsanebtte0lfim YES n NO WjauhaeedwdccdYES,pkmmdc*thet peofwmWbydedatgthe aBOND E:] OTM M ftm- FstQr *d Vahed kcftW Wade $ WakioSlat hlspadmD*Regt mWd Ro* Fatal Signedtatda'i&%laldesafpgW Liw=No. FIRMNAME I�oasee Signale I�oalseNo Btts nwTd.Na ddm AItTd Ish OWNER'SrVS[JRA WAIVER;IatnawatethattheISoewdoesnot ttteicsummwvmWa'itsskmrAalewndatasm*medby C$edLzm aodthatinysigftmonttispwdgVlicMmvm" esftm*Manat. (Please check one Owner rlt/" Agent a �f � � /- Telephone No. 711 - 7-1--W-S-37-1--W-S-3 PERMIT FEE $