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TOWN OF NORTH ANDOVER BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING MT X
OTHER THAN A ONE OR TWO FAMILY DWELLING
Section for Official use Oral .- �.� � � .. � ��� � ic
BUILDING PERNUT NUMBER: DATE ISSUED:
SIGNATURE:
Buildin Commissianer/I or of Buildin Date
LI Property Address: 1.2 Assessors Mat d Parcel Number
l t J,� 7
Parcel Number
!�f
o4c.-,� 14U
1.3 Zoning Information: 1.4 ensions:
Zoning District Proposed UseLot Area ! Frontage ft
1.6 BUILDING SETBACKS(ft) M
Front Yard Side Yard Rear Yazd
R red Provide Required Provided 7R red Provided
1.7 Water Supply M.G1..C.4o. 54) 1.5. Flood Zone laf rmation: 1.8 Sewerage Disposal System:
Public 0 Private ❑ zone Outside Flood Zona ❑ Municipal On Site Disposal System ❑ Q
C.p
2.1 Omer of Recor,�j ll `
zC
Name(Print) Address for Service
._���� m
Signature Telephone
2.2 Au orized ent '
t
+ ITame Print Address for Service: z
-Sigilrture Telephone e z
m
3.1 • Constructi Supervi 4 Not Applicable ❑ '
A ss 7 ^`�/�f�`„�w � f —• �✓,f License Number 0
onf
Licensed ConstydeQu AA Su sor: r
Expiration Date 3
ignature Telephone Z ;
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number m
r
Address ° r
Expiration Date ^Z
Signature G)
8n Telephone
mum
ZOOM
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 Yea.......❑ No.......❑
SEC"I'1 O 5 PROEM , -�' ; S T
;G`ON5'Jt'SfiiiC"�"IOI�t Cff,AlflL�"T���' 3 �1>L6� � lf+lC� ►3� IG�.!b�'�Ti�'IEED S1!'A
5.1 Registered Architect.-
Name:
rchitect:Name:
Address
Signature Telephone
Area of Responsibility
Name:
Registration Number
Address:
Expiration Date
Signature Total
Not applicable ❑
Name:
Registration Number
Address
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
1
Not Applicable ❑
�ipan Name:
Spon bible in Charge of Construction
t
feet -i
New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other 0 Specify
Brief Description of oposed Work:
_-_91 — I/
/Y 10,
USE GROUP Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 0 IA ❑
A-4 ❑ A-5 ❑ 113 ❑
B Business ❑ 2A ❑
C Educational ❑ 2B ❑
F Factory ❑ F-1 0 F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
IInstitutional 0 I-1 ❑ I-2 ❑ I-3 ❑ 3B 0
M Mercantile 0 4 ❑
R residential 0 R-1 ❑ R-2 0 R-3 ❑ 5A ❑
S Storage 0 S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use 0 Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
BUILDING AREA EXISTING if applicable) PROPOSED
Number of Floors or Stories Include
Basement levels
Floor Area per Floor s
Total Area s
Total Height ft
a�
Independent Structural Engineering Structural Peer Review Required Yes ❑ No
SECTION 10a Owner Authorization- TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
r
I, as Owner of the subject property
Hereby authorize ,j rlh� to act on
My behalf;in all mat0ris relative two work aidthdrized by this building permit application
Signature Owner Date
t ,
A
I> WN
A � as Owner/Authorized
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my
knowledge and belief.
der the pains and penalties of perjury
G%J
ignature of Owner/Agent Dahe—/
Item Estimated Cost(Dollars)to bet � bft }
Completed b t applicant
F Y Pyr PP
1. Building (a) Building Permit Fee
Multi lier
2 Electrical (b) Estimated Total Cost of
Construction from(6)
3 Plumbing Building Permit fee (a)x(h)
.11714o
4 Mechanical(HVAC)
5 Fire Protection
6 Total (1+2+3+4+5) Check Number
�':.;F r,,.„ 7.,�,k;�, H'.?y,t..q��f,, t 2a"5 .'s=.�� .5�,��r�/x�>� 'h'',+12�„rn ,u���� ,;hi rwi)'(�'!y. r�'24;�'. ✓�.,• i'�ir:t :.§ tT` ,. �\�.��S��V(Jr^: � �sr� .
��,k����v77++ f:.,Yj "ati�,�fl }(F.�.�,F..!'i'r g-. k'>� #t�,1.t;M V.;. .S.yj`v�'id l7 y,}...rkY `�! !1 li Yin"�y,,.k TS+f$•:;����v✓J.. ry�� �\ ..)'iL ;3`-':7..th&” '`r_.,x. .�u.,, 24 r..�2 .Y ��1f ry;
k, 'S.iS�•,e,c . .�, ,si. '�5.3 C3,k r. �'.a,. , ! ,.Fr�'a i„r�t ksr.-.$ ���a�1+:�v X7,4);F�t 'Y�5 �i�t b-i s �,,.s' r,,� d:;� ���i t� i i S � ti'
,4t r.,.N. �.rc;'S.,"•.t v. sa;a g"^ a @,. P•.rf:� .,i}"ri �-�s.�,''�,y��'
NO.OF STORIES SIZE
BASEMENT O LAB
SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD
SPAN
DEMENSIONS OF SILLS
DEMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING x
MATERIAL OF CHRANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
n t a � N+3 ;nC! f�� ,� r a��. � ���:�--�'��� ;� ''�J •�� e nt .sd .�Nu «qr � .rfi- ;- s
X
Location
No. __1_ — Date
NORTH TOWN OF NORTH ANDOVER
9
` Certificate of Occupancy $
�'�S'•••°'Eta'• Building/Frame Permit Fee $
s�CHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ a 3 6 r
Check #
oap0107
s 3 3 7 4� i144t
Building Inspector
.:" OFFICE OF BUILDING INSPECTOR
TOWN OF NORTH ANDOVER
CONSTRUCTION CONTROL
PROJECT NUMBER:
PROJECT TITLE: Oakridge Village and Maplewood Reserve
PROJECT LOCATION: Turnpike Street
NAME OF BUILDING: Buildings Nos. 1-4, 6-28
NATURE OF PROJECT: New Building
IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,
I, William D. Lovallo REGISTRATION N0. 36883
BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I
HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS,
COMPUTATIONS AND SPECIFICATIONS CONCERNING:
ENTIRE PROJECT ARCHITECTU L STRUCTURAL M CHANICAL
FIRE PROTECTION • ELECTRICAL • OTHER(SPECIFY)
FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH P
COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS
STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.
AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B
EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT
THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING
PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0
1. Review,for conformance to the design concept,shop drawings,samples and other submittals
which are submitted by the contractor in accordance with the requirements of the construction
documents.
2. Review and approval of the quality control procedures for all code-required controlled materials.
3. Be present at intervals appropriate to the stage of construction to become,generally familiar
with6the progress and quality of the work and to determine,in general, if the work is being
performed in a manner consistent with the construction documents.
PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT
TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR.
UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE
SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY.
SIGNATURE
SUBSCRIBED AND SWORM TO BEFORE ME THIS—!Aft—DAY OF March 20 05
�97.
NOTARY PUBLIC MY COMMISSION EXPIRES 22 Dec. 2011
OFFICE OF BUILDING INSPECTOR
�.
TOW11 OF NORTH ANDOVER
:, CONSTRUCTION CONTROL
PROJECT NUMBER: ,
PROJECT TITLE:�/4��••..• � I�I LLE � M�P�EwO�oT� ��� �"
PROJECT LOCATION: TU��I PSI cT _ S
NAME OF BUILDING:W1L-P/ 5 tjos' l�
• ,r. , �����Irt� ��yr-ZoPr1�l7-
NATURE OF PROJECT: 1 l ry �� '
IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHREUGIETTR TION NO.-S STATE NG CODE,
om_
1, UIE--016
16
BEING A REGISTERED PROFESSIONAL USED THE PREPIARAT ON OF ALL DESIGN F►LANTECH HEREBY CERTIFY T S,
HAVE PREPARED OR DIRECTLY
COMPUTATIONS AND SPECIFICATIONS CONCERNING:
ENTIRE PROJECT ARCHITECTURAL Id STRUCTURAL D MECHANICAL 0
D
FIRE PROTECTION 0 ELECTRICAL OTHER(SPECIFY)
nR TH^ABOWE N.4AriEa^�FRv.iECT nir'3 THAT.TO TI'.E FEST OF Vff lk `I �XLEGc,.iv�.r.r1./11VJ' �r
E .u',S„fiCnuSc� .
COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF i7-I �•
STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.
AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE.AND OCCUPANCY.
I FURTHER CERTIFY THAT 1 SHALL ON SITEORM THE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT
THEY PROFESSIONAL SERVICES AND B
EPRWOR IS THE CONSTRUCTION IN ACCORDANCE CTI THE DOCUMENTS
THE WORK IS PROCEEERD�PONSIBLE OR THE FOLLOWING NAS SPECIFIEDAPPROVED SECTION 1 6 OBUILDING
PERMIT AND SHALL BE
1. Review, for conformance to the design concept,shop draWngs,maples and other subrnittals
which are submitted by the contractor in accordance with the requiren tents of the construction
documents.
2. Review and approval of the quality control procedures for all code-required controlled materials.
nate to the stage of construction to become,generair.0 My-
1
•
3, Be present at intervals appropriate y ting
with6the progress and quality of the work and to determine,in general. E®
performed in a manner consistent with the constnx1ion documents-
PURSUANT
oc - �
TION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REP
PURSUANT TO SEC '.
TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING I cI
5
UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE
SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANC
IG RE
IB)- 3 S 0 _
THIS 4DAY OF c�� 20
S BSCR __..
� MISSION EXPI ��a''..:�
• :' ,C MY COM
TARY PUBLIC
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:
(Loc ion of Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
�) FORM U - LOT RELEASEFORM
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 42ZZ ��L/-�.3 9Z
LOCATION: Assessoes Map Number PARCEL
SUBDIVISION C"0 LOT(S)�, _,�33 ,
STREET ST. NUMBER
OFFICIAL USE ONLY
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS-SEWERIWATER CONNECTIONS r y W. /Av6-2z:05
DRIVEWAY PERMIT F/�;
FIRE DEPARTMENT
AQ��/J//��—,-,-- A!50
DUMPSTER PERMIT
RECEIVED BY BUILDING INSPECTOR DATE
FORM U-Revised 6.05 JMC
NORTH
Town of 4 over
_ _
No. a _
3ird " * = - i
�. z A E o dover, Mass., `
COCHICKEWICK V
�ADRATE D
BOARD OF HEALTH
PERMIT T Food/Kitchen
Septic System
THIS CERTIFIES THAT V A ��� r4'0 !� v� BUILDING INSPECTOR
..................... ...... ................ ...... ....................�.
.................................................. .. .... Foundation
has permission to erect............./....................... buildings on A.3 r7.....T'a..�Aofif...... '�:.......,5,'................. Rough
6 L Chimney
to be occupied as............. ........ A... . ...............................*4..............................................................................................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. ^ i08 A f Co #9 /7 -31 a31 03 9r PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
• PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
. .t............................ ough
........ Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
NORTFj
own of 4 over 5
No.
�0 ._ LAE y dover, Mass.,
A_ COCHICKE WICK V
452- f 6 7�A01?ATEG O`Pa,`�5
`s BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
THIS CERTIFIES THAT V a#; 000H x Dv* v' A k C BUILDING INSPECTOR
. .....................I'll,...Y..................................................................................... Foundation
7 T p #!�! SIL..has permission to erect............ ....................... buildings on. .. .5...............v ...... ............................. Rough
t0 be occupied 88 A G.. .......*A 6 L Chimney
p ..................................... . .............. ........... .............
. . . . . . .... ... . .....
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. ^ /Oa A f C p n 1031.38 3 9r PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
. .t.................................... RService
oughBUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
z3" xD,-A/ S 1=SEE REVERSE SIDE Smoke Det.
NOR Tfy
Town of over
O
No.
h
dover, Mass., A W S
/ COC MIC MB WICK y
RATED PQa��S
7 BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT........0041ISFYA' 11
.............�... ...... .................................................. Foundation
has permission to erect............./....................... buildings on-44T9....To t!wP!.A......S....f'........ Rough
to be occupied as........S.....
p ... ..... ............... .............. ... . . ............ . ..................... .......... . .. . Chimney
.... . .... . .. . .
provided that the person accepting this permft shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. p, jj a in f C #9 nor a*O a 3 t PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
Rough
.0..................................... .. Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
�i - Street No.
it,
/ TIF—SEE REVERSE SIDE j Smoke Det.
NORTH
own of . s itAndover �.
No. y
3dover, Mass., 7"
oS
I� COCMICMEMCK V
A0 ATED C2
`S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
THIS CERTIFIES THAT....... .../A441........40.0.r.....1010* .......... .. ... ........................... BUILDING INSPECTOR
Foundation
has permission to erect............. ....................... buildings on .0.3.57.....T V f%ho p..��......a to.. Rough
to be occupied as.............al—....48A.Y........Is 0 44��................................................................................ Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. **40 it 4 }& 0 PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION START Rough
......0�. .............................. .. Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal
No Lathing or Dry Wall To BeDone FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
/M-Al Street No.
/0
IFSEE REVERSE SIDE Smoke Det.