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Miscellaneous - 211 SOUTH BRADFORD STREET 4/30/2018 (2)
N N 0 -- Cl) N A 0 W�7 n D 00 A T 0 o v oCl)0 p p m m Lib�qy Mutual. INSURANCE May 12, 2015 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Re: Property Address: 211 South Bradford St, North Andover, Ma 01845 Policy Number: H3221814665411 Underwriting Company: Liberty Mutual Fire Insurance Company Claim Number: 031857044-0001 Date of Loss: 4/10/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, 5 313, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect a lien pursuant to Mass. General Laws, Ch. 139, § 3A & B, or Mass. General Laws, Ch. 143, § 9, or Mass. General Laws, Ch. 111, § 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 Date ...... //.. T TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ kr�n ..... . .............................. has permission to perform ......... St X. A. ............ wiring in the building of ..... 7- ....... ................................. at ......... 0 v� ... !�� il An( ................... Jmorth lover,,Mass. Fee... . . ........... Lic. No., rH- M ............. ........ . ...... . .. ..... A .................. Check # / �/, v 'E ECr I�A�l S�ECTOR 4(/437 UmUlc(1 Ube 1 Permit No 41�� fG�12nuZti�rg.�' 6� i?zS.s(r2s��s Dia 4 pop" S*ef Occupancy & Fee Che( BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK i' All work to be performed in accordance with the Massachusetts Electrical Code 527C R 7 :00 (Please Print in ink or type all information) Date 4 To the Ins ctor of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described/below. Location (Street & Number .1/ / 57--&-A 8141 til rz-- Owner o IS�C'^,= Is this permit in conjunction with a building permit Purpose of Building Existing Service Amps_ New Service Amps Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Yes 0 No 0 (Check Appropriate Box) Utility Authorization Voits Overhead 0 Undgmd 0 Voits Overhead 0 Undgmd 0 No. of Met( No. of Met( INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = 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)/ f Estimated Value of Work to Start Signed under the p5patl FIRM NAME ✓ r? �4 Inspection Date C4— 3 LIC. NO -15Z D _IC. NO. IBus. Tel No. , e �0?® 3� Address 01 ow',Tel. No. OWNER' INSURANC�VER: I am aware that a Licenses does n a e he insurance coverage or its substantial equivalent as required by Mas� General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) Telephone No. PERMIT ✓✓✓ Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA ' Above 0 In 0 No. of Lighting FixturesSwimming Pool gmd 0 gmd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units �G7 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 Diposal No. Plumps Tons KW No. of Sounding Devices _ NoJ of Self Contained No. of Dishwashers Space/Area Heading KW Detection/Sounding Devices _ 0 Municipal 0 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 INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = 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)/ f Estimated Value of Work to Start Signed under the p5patl FIRM NAME ✓ r? �4 Inspection Date C4— 3 LIC. NO -15Z D _IC. NO. IBus. Tel No. , e �0?® 3� Address 01 ow',Tel. No. OWNER' INSURANC�VER: I am aware that a Licenses does n a e he insurance coverage or its substantial equivalent as required by Mas� General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) Telephone No. PERMIT ✓✓✓ NOTE - THIS PLAN IS NOT TO BE CONSIDERED AN AL TA/ACSM LAND TITLE SURVEY, NOR IS IT TO BE USED FOR RETRACEMENT OF PROPERTY LINES. HELEN R. & H. MICHAEL SMOLAK CONC I. PIPE fcb-_ �(FD) Sp�T ti ¢O' ASSESSORS.• MAP A� 104c, LOT 43 ZON�/1LiZe' R-1 RESIDENTIAL 1 DISTRICT WA TERSHED DISTRICT NO SEE NORTH ANDOVER ZONING BOARD OF APPEALS DECISION 2002-018. fq WFA 1 I ,L 150.24 PARCEL 1 WFA2 1.05± AC AVC WFA3 WFA 4 ' WFA5 REFERENCES: DEED BOOK 4494, PA GE 7 PLAN #7489 RECORD OWNER: MICHAEL ✓. & TARA M. HURLEY 211 S. BRADFORD STREET N. ANDOVER, MA 01845 MERIDIAN fROM ?LAN 17489 WFA5A WFA 6 WFA 7 WFA DECK is WOOD FRAME 05B�FER 211 470, EXIS77NG COR FOUNDA 77ON BD 100' BUFFER ►.�"v rn 191?4D _ 'c -°moo 96.60' (PUBLIC N VARIABLE WIDTH) CAMERON & MARGUS DEER Y (PLAN 17489) 660' TO WINTER STREET STREET PLOT PLAN I CERTIFY TO THE NORTH ANDOVER BUILDING OF LAND IN INSPECTOR THAT THE EXISTING BUILDING AND NORTH ANDD VER F04INDA 77ON SHOWN HEREON ARE LOCA TED ON , MA THE GROUND AS SHOWN. PREPARED FOR TA RA HURLEY le O ^, SCALE. I" = 40' SEPTEMBER 8, 2003 C. «= O 20 40 80 160 ''A0. -36iia`sjj' SURVEY ASSOC/ATES/NC. lGoo�,a .�,a��rHSAHANCOCK 235 NEWBURY STREET, DANVERS, MASSACHUSETTS 01923 VO/CE 978-777-3050 FAX 978-774-7816 PROFES /ONAL LAND SURt,EYOR www.honeockossoclotes.cam CHECKED BY.• CWG 9212 Town of North Andover NORTff Office of the Zoning Board of Appeals Community Development and Services Division 27 Charles Street "� _ " 41 North Andover, Massachusetts 01845 "Ss""° ^CHUS� D. Robert Nicetta. Telephone (978) 688-9541 Building Commissioner Fax (978) 688-9542 Any appeal shall be filed Notice of Decision within (20) days after the Year 2002 date of filing of this notice in the office of the Town Clerk. Property at: 211 South Bradford Street NAME: Michael & Tara Hurley DATE: 4/22/02 ADDRESS: 211 South Bradford Street PETITION: 2002-018 North Andover, MA 01845 BEARING: 4/9/02 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, April 9, 2002 at 7:30 PM upon the application of Michael & Tara Hurley, 211 South Bradford Street, North Andover, MA, requesting a dimensional variance from Section 7, Paragraph 7.3 and Table 2 for relief of the left side setback in order to construct a proposed attached breezeway and garage with a storage room over the garage within the R-1 zoning district. The following members were present: Robert P. Ford, Walter F. Soule, Ellen P. McIntyre, George M. Earley and Joseph D. LaGrasse. Upon a motion made by Walter F. Soule and 2°a by George M. Earley, the Board voted to GRANT a .dimensional Variance for relief of the left side setback of 16.5' to allow the addition of a proposed attached breezeway and garage with a storage room over the garage as per the Plot Plan of Land prepared for Tara Hurley by Wayne C. Jalbert, PLS # 36118, Hancock Survey Associates, Inc., 235 Newbury Street, Danvers, Massachusetts 01923 dated February 28, 2002; and the plans drawn by Chip Sheehan, Chip Sheehan Contractors, 35 Onway Lake Rd., Raymond, NH 03077. Voting in favor: Robert P. Ford, Walter F. Soule, Ellen P. McIntyre, George M. Earley and Joseph D. LaGrasse. The Board finds that the applicant has satisfied the provisions of Section 10, Paragraph 10.4 of the zoning bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, and may be re-established only after notice, and a new hearing. ti Town of North Andover o Appeals =�` `''• r. Uj y. :G7 7 Roe Ford, Acting Chairman` t! co Decision2002-018 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PL NNMG 688-9535 A" Date......... ....................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING W, s certifies that .............................................................................................. h&i permission to perform .... :� ......................................................................... wiring in the building of .......... K ... ............................................................ at....... .................................................................... . North Andover, Mass. Fee�� ........... Lic. No . ............. ... .................................... .................. ELEcrRICAL INSPI&R Check # 10357 THE.CO MON SALMOFMAS'S4CHUSE+TIS Office Use only DEPARTNIENlOFPUXJCSAFM Permit No. BOARDOFFIREPREVF. MONREGUTAT70NSR7GM? 12.E Occupancy &Fees Checked APPLICATIONFOR PERMIT TO PERFORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 2 ;PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: Che undersigned applies for a permit to perform the electrical work described below. _ocation (Street & Number)17 IR/ZA� -oJ21 f — )wner or Tenant Av e )wner's Address -L/ / Sd v-1% Rkl;DreAt-) this permit in conjunction with a building permit: Yes No r-1 (Check Appropriate Box) urpose of Building Utility Authorization No. xisting Service Amps / Volts Overhead Underground M No. of Meters ew Service Amps / Volts Overhead Underground No. of Meters umber of Feeders and Ampacity )cation and Nature of Proposed Electrical Work Jo. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA 1o. of Lighting Fixtures Swimming Pool Above M Below Generators KVA ground ground to. of Receptacle Outlets D No. of Oil Burners No. of Emergency Lighting Battery Units lo. of Switch Outlets G No. of Gas Burners o. of Ranges No. of Air Cond. Total FIRE ALARMS No. of Zones0. Tons o. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices a. of Dishwashers Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices �. of Dryers Heating Devices KW Local Municipal Other Connections �. of Water Heaters KW No. of No. of Signs Bailasis I. Hydro Massage Tubs No. of Motors Total HP -IER_ : • ' -. , —Ir C53i M R.• 1, 1: :ti • cati • n : • i o r '• i r; m ._ • • : •:.•� ••.• • • iti nor .i . :• �r ms• . r• • •• r y� - r• i • i�•- ® �1 � e • r :r a• A • rc• i •.r:.!• i - •- • u - • Estirn&dVakrofEbcfticalWcdc $ bspeclionDak-,Regiested Rough 4' �'`` Final e�`-e; ;' «✓/ _% � . g Licer&�No. • 3 G `7 D �e )=nr1{ /l!" AiI/Sf< All Siglahue Lx)mseNo � / y-� �% BusurssTel Nozo 3 G 3 777 3 --r- 's 'c 0` g�t>' H i /�1.. �/��/t l`�J� �d( ./1� � D �-d 3 AIL TeL1% HC S SCE WAIVER; I am aware that the Licrosc does not have die ma uartce coverage or its substaDtW egmvalag as tapted by Massaclxisens C>eneral Laws itmysigtaaueonthispemitapplicationwanes thislewh" l se check one) Owner � Agent �rJ Telephone No. PERMIT FEEL C;73 � Signature ot Uwner or Agent Name Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for rry employees working on this job. Company name: City: Phone # Insurance. Co. Policv# Company name: Address City: Phone#: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of airrinal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as_well.-as-civil.penaitiesinlheinm-da-ST_OP VAM ORDJ_Rand a.fine_cf.($1110.D0)-allay against.m- I understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification. 11 l do hereby certYy under the pains and penalties of perjury that the information provided above is true and correct. Signature Print name Pbone.# Official use only do not write in this area to be completed by city or town cffic iar City or Town Permit/licensing D Building Dept EJCheck if immediate response is required E] Licensing Board p Selectman's Office Contact person: Phone # n Health Department F, Other Town of forth Andover Office of the Zoning Board of Appeals Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Richard J. Albano, M. A- 235 Newbury Street Route 1 North Danvers, Massachusetts 01923 RE: Michael and Tara Hurley— Petition 2002-018 211 South Bradford Street North Andover, Massachusetts 01845 Dear Mr. Albano: Regarding your request for a six (6) month extension of your Variance: Telephone (978) 688-9541 Fax (978) 688-9542 March 17, 2003 Town of North Andover Zoning Board of Appeals 27 Charles Street North Andover, MA 01845 a a„ rm T( N -CVC) CDrnCD ZE Please be advised that the Zoning Board of Appeals approved a 6 -month extension relative to property at 211 South Bradford Street, North Andover, MA, reference attached decision #2001-018. At the regular meeting on, March 11, 2003, upon a motion by John M. Pallone and 2°d by Joseph D. LaGrasse, the Zoning Board of Appeals voted to grant a 6 -month extension from April 23, 2003 to October 23, 2003 (Mass. Gen. L., ch. 40A, § 10 allows the Variance permit granting authority to "extend the time for exercise of such rights for a period not to exceed six months".). Voting in favor: Robert P. Ford, John M. Pallone, Scott A. Karpinski, Ellen P. McIntyre, and Joseph D. LaGrasse. &Ij Robert P. Ford, Acting Chairman Zoning Board of Appeals Enc.Decision2002-018. CC: Town Clerk Michael and Tara Hurley ZBA file Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 L Town of North Andover Office of the Zoning Board of Appeals Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 D. Robert Nicetta Telephone (978) 688-9541 Building Commissioner Fax (978) 688-9542 Any appeal shall be filed Notice of Decision within (20) days after the Year 2002 date of filing of this notice in the office of the Town Clerk. Property at: 211 South Bradford Street NAME: Michael & Tara Hurley DATE: 4/22/02 ADDRESS: 211 South Bradford Street PETMON: 2002-018 North Andover, MA 01845 1 DARING: 4/9/02 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, April 9, 2002 at 7:30 PM upon the application of Michael & Tara Hurley, 211 South Bradford Street, North Andover, MA, requesting a dimensional variance from Section 7, Paragraph 7.3 and Table 2 for relief of the left side setback in order to construct a proposed attached breezeway and garage with a storage room over the garage within the R-1 zoning district. The following members were present: Robert P. Ford, Walter F. Soule, Ellen P. McIntyre, George M. Earley and Joseph D. LaGrasse. Upon a motion made by Walter F. Soule and 2nd by George M. Earley, the Board voted to GRANT a dimensional Variance for relief of the left side setback of 16.5' to allow the addition of a proposed attached breezeway and garage with a storage room over the garage as per the Plot Plan of Land prepared for Tara Hurley by Wayne C. Jalbert, PLS # 36118, Hancock Survey Associates, Inc., 235 Newbury Street, Danvers, Massachusetts 01923 dated February 28, 2002, and the plans drawn by Chip Sheehan, Chip Sheehan Contractors, 35 Onway Lake Rd., Raymond, NH 03077. Voting in favor: Robert P. Ford, Walter F. Soule, Ellen P. McIntyre, George M. Earley and Joseph D. LaGrasse. The Board finds that the applicant has satisfied the provisions of Section 10, Paragraph 10.4 of the zoning bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, and may be re-established onlyafter notice, and a new hearing. 0 �v ti C- CD Town of North Andover _`+ o �; Appeal . 'W TI R Ford, Acting Chairman r - Co Decision2002-018 BOARD OF APPEALS 688-9541 BLTILDING 688-9515 CONSERVATION 688-9530 HEALTH 688-9540 PLANT TNU IG 688-9535 Location tg (I Q-0 j- � � No. Date TOWN OF NORTH ANDOVER AL to 4, 4 Certificate of Occupancy $ Building/Frame Permit Fee $ 115170 CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /YC/D Check# 5-c>-) 1575 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH AA`}ONE OR TWO FAMILY DWELLING 41 -.7777 77- BUILDING PERMIT NUMBER: 37 DATE ISSUED: ^� _ c - SIGNATURE: zl /1/1 Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 I Property Address: J� C 1.2 Assessors Map and Parcel Number: VT c, q3 Map Number Parcel Number 1.3 Zoning Information: 7-on-ing District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING ETBACKS (f : t 17 o6 and Side Yard Rear Yard R 'red-. ,•, �F'r8vide = Required Provided R red Provided 1.7 Water Supply M.G.4C.110. 154)- 1.5. Flood Zone Information: Public ❑ Private ❑ < ' ,, = Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record G NaIa (Print) Address for Service -2'St nature Telephone 2.2 Owner of Record: C e I s a(,a HU44 2it & - & S�'-. Nam nt Address for Service: � , NU 44ztl�r (419-)6t5-2bojS- Sigtm,Kv-Tele one SECTION 3 - CONSTRUCTION RVICES 3.1 Licensed Construction Supervisor: ahrn �d&o Licensed Cbmstruction Supervisor: Address t ?U V 6 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/ ou M X Z O v n 3 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 .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction �❑ - Exiling B ng ❑ _.. — Repair(s) ❑ Alteraoie�s(sP ❑ J. Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: •' J / MV VA -7-d all 5 am %�.kffyrmm.s :1 am SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pennit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier /�c�• " = /Sly, oeo d 2 Electrical (b) Estimated Total Cost of Constructions q, �`~!! D pD • 3 Plumbing Building Permit fee (e) X (b) ` f/ 9D• —' 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, r as Owner/Authorized Agent of subject property Hereb authorize to act on My h f, in all rs rel ve to work authorized by this building permit applica ' i. r,, , _ hire of wrier Da SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 Print Name t Signature of Owner /A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMERS 1 ST2 ND 3 SPAN DINIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE W K -oz FORM U - LOT RELEASE FORM aN�(�o� IAe,Qc�l c7� 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*********************** APPLICANTMdY&b' 1 PHONE LOCATION: Assessor's Map Number PARCEL (qA,)���zd SUBDIVISION LOT (S),_Y5 STREET ,21 / sa) ACt( dn-v ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMMENTS COM DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMME PUBLIC WORKS - SEWER/WATER CONNECTIONS FIRE DEPARTMENTV,4� RECEIVED BY BUILDING INSP Revised 9\97 jm TE Cl) m U) Cl) m 0 _ y .p 10 0 CD C � n Z CO) CLO r _ O d =• y nCO -v CD O p C. O Cr rc CD Er CD 0 CD _� Co 00 C O N)� CD CL O CO) cc CD p CO) O 10 CD O vC�D 0 CD 0 b Q 0 I a c \ / O z cn r 0 r-� V J O -• a, c cr CO) _no :5.m 10 N! cmc � C7 o Ona m Z =r•cp ca °:m c � Erm � =r O y O C2 5 m O CD > C >'o �� m O �. O 0 oZ _S. X Co :Lc m c =r . : � � dnCe om CR ... to c =r` CD m N t0 C7� o pc_ta m •�•, `N O O O N N d N Cr c C � _ c CAC-CD m `7 C � co C. CD FWcf w to -b 000. NIM 0a. CD O F •C O Av r m- -lit �' :CO c crt� co d m c = 0 1 z 0 C� H 0 0 c ti o C � ° O O OPoo77. C*O 00 x O p CL ro x 0 0 0 1 z 0 C� H 0 0 c North Andover Building Department a 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 IVIG" c11,S150A. The debris will be disposed of in: (Location of Facility) A NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector am a homeowner The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Wor' ers' Compensation Insurance Affidavit 1J ► n `� o__ Phone all work myself. �1 am a sole proprietor and have no one working in any capacity f am an employer providing workers' compensation for my employees working on this job. Coma name: Address Phone # r '14-'•t ~_ Adriress - �itv._: Fatulre tt><seCUM coverage as n�ir� andel n 26A or MGL 152 can lWd tattle of criminal and/or one years' lmprisortment as'watt as dvd . of flee t tot:500.00 understand that a o penalties in the farm of a 51 oP WOF3Kand a fine of i3i00 E)o) a day against me. I opy of this staie►t tt may be forwrarded to tate bfrrce of k� of the M& for coverage y on: / do herby certify under the pains and penaNes of pwftry UW ft informaAm provided above is bue and -correct Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' - QEheck if immediate response is requked Building Dept 0 0 Contact person: Phone # ❑ D 0 , 0R,1(MA,Y,S COMPENSATIOM Building Dept- ' Licensing Board Selr ctMan's Office Health Department Ofher NOTE. REFERE_Vcrs• THIS PLAN /S NOT TO BE CONS/DERED MAP 104c, LOT 43 AN AL TA/ACSM LAND TITLE SURVEY, jw".. DEED 4494, PAGE 7 NOR /S /T TO BE USED FOR R-1 RESIDENT/AL 1 DISTRICT PLAN #774848 9 RETRACEMENT OF PROPERTY LINES. WATERSHED DISTRICT RECORD OWE• MICHAEL J.&TARA M. HURLEY 2115 BRADFORD STREET N. ANDOVER, MA 01845 MERIDIAN FROM PLAN #7489 HELEN R. & H. MICHAEL SMOLAK N 150.24 WFA 1 PARCEL 1 WFA2 1.05.& AC WFA3 WFA5A Rai WFA6 WFA7 WFA8 WOOD FRAM 50 BUFFE-,Q 47.0' /. PIPE BD 1 pp • BUF,cER i CAMERON & MARGUS DEER Y (PLAN .f7489) 96.60' -! 660' TO --- WINTER STREET (PUBLIC - VAR/ABLE W/DTH) S TREE I CERTIFY TO THE N. ANDOVER BUILD/NG PLOT PLAN INSPECTOR THA T THE EXISTING BUILDING SHOWN OF LAND IN HEREON IS L OCA TED ON THE GROUND AS N. AND V£R, MA SHOWN PREPARED FOR TARA HURLEY SCALE. 1" = 40' JANUARY 9, 2002 �O 0 20 40 80 160 y�A HANCOCK SURVEY ASSOCIATES, /NC. aZ 235 NEWBURY STREET, DANVERS, MASSACHUSETTS 01923 PROFESS/R EYOR O c£ 978-777-3050 FAX 978-774-7816 <<�,D ou CHECKED BY www.hancockassociot&s.com 9212 s I D x r 7 11� • i I "' V f III t � r �i" ` � ` ` i | � ` ` \ � ` \ ` Town of North Andover (i' { e of the Zoning Board of Appeals �, v >iity Development and Services Division � .14 ER 27 Charles Street '� ° '' �' °RR7lD !'f ��.�J Z00,Z 0 C T 2q p 2: �b� Andover, Massachusetts 01845 9SS�aus�t D. Robert Nicetta Telephone (978) 688-9541 Building Commissioner Fax (978) 688-9542 Any appeal shall be filed Notice of Decision within (20) days after the Year 2002 date of filing of this notice in the office of the Town Clerk. Pro at: 211 South Bradford Street NAME: Michael & Tara Hurley HEARING(S): October 22, 2002 ADDRESS: 211 South Bradford Street PETITION: 2002-047 North Andover, MA 01845 TYPING DATE: 10/24/02 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, October 8, 2002 at 7:30 PM upon the application of Michael & Tara Hurley, 211 South Bradford Street, North Andover, for a Special Permit from Section 9, Paragraphs 9.1 Non -Conforming Uses and 9.2 Alteration or Extension of a pre-existing building on a non -conforming lot to allow for the addition of a breezeway and attached garage; and a second floor addition to an existing dwelling on the existing footprint, within the R- I 1 zoning district. The following members were present: William J. Sullivan, Walter F. Soule, John M. Pallone, Scott A. Karpinski, and George M. Earley. Upon a motion by John M. Pallone and 2°d by Scott A. Karpinski, the Board voted to GRANT the petition for a Special Permit from Section 9, Paragraphs 9.1 and 9.2 for to allow the construction of a breezeway and attached garage; and a second floor addition to an existing dwelling on the existing footprint, on an non -conforming lot per Plot Plan of Land prepared for Tara Hurley by Wayne C. Jalbert, P.L.S #36118, Hancock Survey Associates, lnc., 235 Newbury Street, Danvers, Massachusetts 01923, dated February 28, 2002; and the plans drawn by Chip Sheehan,, Chip Sheehan Contractors, 35 Onway Lake Rd., Raymond, NH 03077: Voting in favor: William J. Sullivan, Walter F. Soule, John M. Pallone, Scott A. Karpinski, and George M. Earley. The Board finds that the applicant has satisfied the provisions of Section 9, Paragraphs 9.1 & 9.2 of the zoning bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Town of North Andover Board of Appeals, van, Decision 2002-047. Board of Appeals 688-9541 Building 688-9545 Conservation 688-9530 Health 688-9540 Planning 688-9535 NORTH Zoning Bylaw Denial 4 Town Of North Andover Building Department qs°'n" K.� 27 Charles St. North Andover, MA. 01845 sACNU. Phone, 079488-9545 Pax 978=64-9542 Street:. Ill..,.._S o ..k Q.Ji�: . Special Permit Required Ma /Lot: Applicant: N Insufficient Information Request: io'Yra' 43 e.1way .w a y'Va6 Ca/i'aG� Date:d — i3 -�©m 1 Height Exceeds Maximum Please be advised that after review of your Application and Plans that your Application is DENIED for the following;;Zoning Bylaw-Ireasons: S Zoning 5Aecl D/,Sfp-rCf ) 77FTt—em Notes Item Notes A Lot Area -� F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Coverage Complies 5 2 Lot Area Preexisting Lie 5 2 Frontage Complies 6 Preexisting setback(s) 3 Lot Area Complies 3 Preexisting frontage `t Q g Insufficient Information 4 insufficient Information 4 Insufficient Information 3 Insufficient Information 2 B Use 5 _No access over Frontage 3 Lot prior to 10/24/94 1 Allowed e S G Contiguous Building Area Zone to be Determined 2 Not Allowed 1 Insufficient Area 1 3 Use Preexisting 2 4 Special Permit Required 3 Preexisting CBA ,ko+ 5 Insufficient Information C Setback 1 Height Exceeds Maximum 1 All setbacks comply S 2 Front Insufficient 4 Insufficient Information 3 Left Side Insufficient 4 Right Side Insufficient 2 Coverage Complies 5 Rear Insufficient 6 Preexisting setback(s) j Sign 7 Insufficient Information D 1 Watershed Not in Watershed 3 Insufficient Information 2 In Watershed eS 3 Lot prior to 10/24/94 2 Parking Com lies 4 Zone to be Determined 5 E Insufficient Information Historic District 1 In District review required 2 Not in district 9 e5 3 Insufficient Information 2 Com lies 3 Preexisting CBA ,ko+ eS 4 Insufficient Information H Building Height 1 Height Exceeds Maximum 2 Complies S 3 Preexisting Height 4 Insufficient Information I Building Coverage 1 Coverage exceeds maximum 2 Coverage Complies 3 Coverage Preexisting 4 Insufficient Information j Sign N A 1 Sign not allowed 2 Sign Complies 3 Insufficient Information K Parking 1 More Parking Required 2 Parking Com lies 3 1 Insufficient Information 4 1 Pre-existing Parkina Remedy for the above is checked below. Item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit C-3 Setback Variance Access other than Fronta iie S ecial Permit ' Parkin Variance Fronta a Exce tion Lot S ecial Permit Lot Area Variance Common Drivewav Soecial Parmi+ c;on re ate Housing Special Permit Variance for Si n Continuing Care Retirement Special Permit Special Permits Zoning Board Independent Elderly Hou sin S ecial Permit S ecial Permit Non-Conformin Use-ZBA Large Estate Condo S ecial Permit Earth Removal special Permit ZBA Planned Development District Special Permit Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Sign R-6 Density Special Permitrm Special Permit � Watershed Special Permit Preexisting"""`'"""""'i"` 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 incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. .,building Department Official Si nature Application Received d Application Denied Denial Sent: If Faxed Phone Number/Date: s� 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 Plannin Other uepartment of Public Works Historical Commission 4eC167- �5�Pf'/yJ/• C}A'i 9 t � 41r rve /G..v lr� 1-1h r v -�` 1 �e �ti d e,2S�i >a c� �S7` r� c s eeU �1/M.ti,ti T3a�h� LIA /i 7r 71- d dav-e- Referred To: Fire Police Conservation Plannin Other uepartment of Public Works Historical Commission cStot M z 0 0 112, - —4 0 z 0 In z 0 z a 0 m m CD --i 0 * w o > 0 C) o :0 3 :3 CD Mm CD :03 --P 0 0 0 0 3 — 0 — 0 C-0 -% CD 0 :3 :3 3 0 -p -p = -n CD N c -0 CD CD 3 CD CD CD — Sb CD =) p CD 0 CD fA fA 69 69 'Ga w VI —4 0 z 0 In z 0 z a 0 m m CD m 1� N Q > m i. i G 0 > m z m o 0 j_ z a �► Mjl c i z N 3 c 7 4 m m r m v a> z v I > 9 A o m v v m m N -• F r c c m rmn i -4 0 0 z z N N N W Z N 1 A c 0 z N r� C O A 1 q •-Ni Z W �/' Z n m m m O rVA r' m m > A .i01 X401 n r r •0 ; A n n 0 �c as m =1 p0p 0 0 z i i m M m m v' x A C- W g o t NZ Q 0 z Z 9 M * H w u> v v v m> o.i 0 0 3 A r C C C > >I D > r I z z ii Z ° m r o z z z m + A A m 0 C 0 0 0 m m m A n N N Q T r 2 Z Z r i0> Z � > L1 0 0 A z 0 z w O > Z z3 > 0 3 T r O o m 3 m 3> m m M O p 0 1 A m m N, z > 1 r N -/ A Z z z ? o H o c 0 z "� �A W z> a o 0 0 0 c m < N A rl m ^r 0 m .S $� b 0. 0 n A 0 0 0 m Z > 0 A 1 m N N N N 3 N I O 9 N m Z I N m m m m D m m ; > IN'I N O A C C C c m = 2 2 0 3 0 0 O 0 O O > 0 0 _N m Z N m m r m 0 0 m i i 0 0 0 0 0 0 0 m y 0 0 0 0 0 1 0 O A A n n n o 0 n z c A N m c v 0 0 0 z Z Z Z N= 0 z 0 vl Ni> r OI n n n r z i o" r m m z mm m 0< 0 m N N A C 0 0 0 0 z yAj N < Z 0 0 0 Z i i r A z z r c v rN * > m > z N 0 A z r z r- D Z x i ° m m x z N W 0 O * � Im a n h M * H w u> v v v m> o.i 0 0 3 A r C C C > >I D > r I z z ii Z ° m r o z z z m + A A m 0 C 0 0 0 m m m A n N N Q T r 2 Z Z r i0> Z � > L1 0 0 A z 0 z w O > Z z3 > 0 3 T r O o m 3 m 3> m m M O p 0 1 A m m N, z > 1 r N -/ A Z z z ? o H o c 0 z "� �A W z> a o 0 0 0 c m < N A rl m ^r 0 m .S $� b 0. 0 n A 0 0 0 m Z > 0 A 1 m N N N N 3 N I O 9 N m Z I N m m m m D m m ; > IN'I N O A C C C c m = 2 2 0 3 0 0 O 0 O O > 0 0 _N m Z N m m r m 0 0 m i i 0 0 0 0 0 0 0 m y 0 0 0 0 0 1 0 O A A n n n o 0 n z c A N m c v 0 0 0 z Z Z Z N= 0 z 0 vl Ni> r OI n n n r z i o" r m m z mm m 0< 0 m N N A C 0 0 0 0 z yAj N < Z 0 0 0 Z i i r A z z r c v rN * > m > z N 0 A z r z r- D Z x i ° m m x z N W 0 O * � Im a n h a n h 1� 00 m IL WW UI Z Na �I of . 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C2 te a' 3 rn z mss o CL 06 3 m O -40 o 30E�m m U2 g o o �' 0CD � c = 7 r n sm rn m CL, =r?'6 . Cn m m Cn m 7:� c am n CD ~ H Oo 01y z �° t cr a� C c —� Cn � � � • a m �dr- cc ? o � o m o a' CmD 3 'j O\ mom . .)r .. m L7' 0 0 Sr a m o CO2 O ' z mo. tv CD m C/)v .T N Y so CL 0 .y► 0 C o �r 0 � m MA Cn (n Cp M a m z M a 5. m �" w 0 tv Z �' ?r m C O 7d d ° '3 O T y 'C n O rO z y ' n CD O -o. E CL r n CL y � 7d c v CDCL cD O Q CD CD C') 2-- CCD O CCD < m C LD CO)m -W < cv y m z o CC CD < z v O � CD z m �. CD T O r CD a tov i O C C 44, Q a d m V2 CL m i! C2 te a' 3 rn z mss o CL 06 3 m O -40 o 30E�m m U2 g o o �' 0CD � c = 7 r n sm rn m CL, =r?'6 . Cn m m Cn m 7:� c am n CD ~ H Oo 01y z �° t cr a� C c —� Cn � � � • a m �dr- cc ? o � o m o a' CmD 3 'j O\ mom . .)r .. m L7' 0 0 Sr a m o CO2 O ' z mo. tv CD m C/)v .T N Y so CL 0 .y► 0 C o �r 0 � m MA Cn (n Cp M a X17 Du a 5. m �" w 0 tv Z �' ?r G C7 z z O 7d d ° '3 O0 � 7d 0 c OFFICES OF: APPE.-\LS BUILDING CONSERVATION HEALTH I'I-•\NNING d ,.owrN Town of NORTH ANDOVER DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR f', 120 Main Street North Andover. Massachusetts O 1845 In accordance with the provisions of INIGL c y0. S 5.1, a condition of Building Permit Number ?d(_ is that the debris resulting from this work shall be disnosed of in a properly licensed solid waste disnosal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (Location of Facility) �JL4C--J k Signature of Pe it Applicant Date NOTE: Demolition permit from the Toun of :forth Andover must be obtained for this project through the Office of the Building Inspector. in Date .......... I ....................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 'rbis certifies that ..... / ............. .... ...... / ............... ;.:�: ........... has permission to perform-....! ....................................................................... wiring in the building of ........ I .......... .................... ................................. at .............. / ......... / .............................. ... North Andover, Mass. Fee... Lic. No . ...... I/ ... Z .......................................................... Ft.r.r-rwrAl TV -,PP( -MR Check # 4 5' 1r_ 0 A Cir Offici else Permit No. Dy�a�suart Du6Ue Sam Occupancy & tithe( BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 C R 12: (Please Print in ink or type all information) Date Q _f:1 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number Owner or Owner's E Is this permit in conjunction with a building permit Yes U No U (Check Appropriate Box) Purpose of Building Utility Authorization f Existing ServiceAmpsD Voits Overhead V.,� Undgrnd 0 No. of Mets New Service z,z,:Amps__01:y�Voits Overhead al/ Undgmd U No. of Met( Number of Feeders and Ampacity, Location and Nature of Proposed Electrical Work OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO have submitted valid proof of same to the Office YES = NO - If you have checked YES please t nate)6e type of coverage by checking the appropriate box. INSURANCE�BOND a OTHER . (Please Specify) V (Expiration Date) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC. NO. G y0 NO. r Bus. Tel No. �0 L/' o D w 3j Address Alt An Tel. No. -42 OWNER'S INSURANCE VER: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Mass General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or bent) Telephone No. PERMI EE $� Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures Swimming Pool gmd D gmd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices _ Heat Total Total No. of Dipos2I No. Pumps Tons KW No. of Sounding Devices _ Nol of Self Contained No. of Dishwashers SpaceiArea Heating KW Detection/Sounding Devices _ 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO have submitted valid proof of same to the Office YES = NO - If you have checked YES please t nate)6e type of coverage by checking the appropriate box. INSURANCE�BOND a OTHER . (Please Specify) V (Expiration Date) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC. NO. G y0 NO. r Bus. Tel No. �0 L/' o D w 3j Address Alt An Tel. No. -42 OWNER'S INSURANCE VER: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Mass General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or bent) Telephone No. PERMI EE $� Name Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation.insurance Affl-davit Please Print City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one v orking in any capacity I am an employer providing workers' compensation for my employees worlang on this jot Company name: Address Faikwo to secure coverage as repaired under Seebon 25A or h4M 152 cm*d tvthe iri pwidw 4 crW ee. penalties br arfrn and/or one years' imprisonrrxffias_wvgossaA penakiiesyu3heSam����7 :fi[�e�if j� y understand that a copy of this statement may be fonnarded to the Office of InVesbgatioos d the DIA ror co%erage verification. / do hereby certiy wx/ar the pains and pensl6es o/pegwy bW the infwmabw provided above a bue and correct Signature Date Print name Pboth--# s Official use only do not write in this area to be comps by city or town of Liar city or Towr► QC heck if frnmecNate response is required Liu Q Sets Contact person_ Phone A Q HeE Q Oth 14 I Location-QU Sea '57f -- No. 0" Date 7-Z 40RTN 0 Check # / 73 T- 65./1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ JZD . 8-6ilding inspector . TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING °=F-4,rro,:��„nk'�� 7 '4Y .—.7777777, .yk BUILDING PERMIT NUMBER: DATE ISSUED: I c>2 A71 I V/V C SIGNATURE: Building Commissioner/I for of buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: I. -a Alw 1.2 Assessors Map and Parcel Number: . C q �)O AA4Gye ( (i ' � �' �^ J rV� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R 'red Provided d 1.7 Water Srpply M.G.L.C.40. 54) 1.5. ood Zone Information: Public X private ❑ Zone Outside Flood Zone J`3�/ 1.8 ewerage Disposal System: Municipal on Site Disposal Sys ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes _N0.4 - O2.1 2.1Owner of Record ( Uu-Ak�- Nam ( rint) Address for Service ,� Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 4 Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: (J V rov�nd { License Number Address � Expiration Date Signatures hoho 60 ( 3.2 Registered Home Improvement Contractor Not Applicable ❑ S Company Name Registration Number Address Expiration Date Signature Telephone i SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work(check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I SECTION 6 - F.STIMATEn CnNCTRTTf TION rnCTC Item Estimated Cost (Dollar) to be Completed by permit applicant ©FFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 1.6 Total 1+2+3+4+5 Check Number JLC l; I IVA is UW1NEx Au INUKILA TUN TU BE CUMPLE"TED WHEN OWNERS AGENT ORCONTRACTORAPPLIES FOR BUILDING PERMIT I, I as Owner/Authorized Agent of subject property Hereby a thorize U to act on My f, ' all matters ela ve to o k authorized by this building permit application. Si e of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject Property i Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief a ( Print Name of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS iST 2 ND 3 RD SPAN DIlvIENSIONS OF SILLS DIN ENSIONS OF POSTS DM ENSIONS 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 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. ----" ""—AF'F'LICANT FILLS OUT THIS SECTION*********************** APPLICANT t /(�� LOCATION: Assessor's Map Number 0 C E STREET, R CO SERVATION ADM COMMENTS _PGkSS2 USE ONLY OF -TOWN AGENTS: TOR DATE APPROVED DATE REJECTED PHONE� l�?5 -20() PARCEL= LOT (S) ST. NUMBER_ r 1 ;1 e — Con/y S &U - o — DP P El e4r- .1 q; -1188 s TOER DATE APPROVED DATE REJECTED COM NTS �A/ P ,n� AV f 11A) fi An D/ FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE -REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm ' 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 c 11, S.150 A.. The debris will be disposed of in: of Facility) Si nature of Kermitlicant d Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector Town of North Andover ?°.�*�•• ,.,� , o Building Department ` p 27 Charles Street _ North Andover, MA. 01845 =.'��--5•' D. Robert Nicetta Building Commissioner (978) 688-9545 -978 688-9542 Fax ire •�����rr��w�� HOMEOWNER LICENSE EXEMPTION Please prfi `nt� �� DATE �J Lk 1( 2m Z JOB LOCATION .21 / �--�(J Number �� Street Address Map /lot "HOMEOWNER PRESENT MAILING ADDRESS City Town State 1 EZ 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 BtWding Code Section 108.3.5.1) DEFINITION OF HOMEWCNVNER: 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 struchwes. 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 cf No. Andover Building Department minimum inspection procedures and requirements and that helshe will comply with said procedures and requijements. HOMEOWNER'S SIGNA APPROVAL OF BYILDING OFFI f e 0 , f NaRTJi Town of North Andover �°,1�4is 1+ o Building Department M 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 •°(978) 688-9542 Fax • rr�r nr rr��wr�.��� HOMEOWNER LICENSE EXEMPTION Please print DATE J bUle 2� lo 2L�y 22 JOB LOCATION '2-1 Number Street Address 'HOMEOWNER I 7 Name 'RESENT MAILING ADDRESS City Town L% Map / lot J Home Phos Work Phone 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. 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