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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATIOI
This certifies that...!. ./"'.. ?
...........
has permission for, gas installation . . . ......
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n the building o
at .5.1
.......... North Andover, Mass.
Feb :5�. . Lic. No. .UAd .. ..... A. -,d4,1. AM
GAS INSPECTOR
Check #
7249
MASSACIH SETTS UNIFORMVI APPLICATIO4i�7
PERMIT TO DO GASFITTING
Mass. Date 20 10 Pen -nit 4
Building Location ner's Name
Type of Occupancy
Ne\v ❑ Renovation
❑ Re .laces ent ❑ Plains Subnutted: Yes ❑ No ❑
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ac�x�'wHQo
SUl- 3A TMENT
BASIN ENT
FWST (1ST) FLOOD
Sl- C(')NI> (2 ) FLOOR
THIRD (;;RD) FLOOR
FOURTH (4TH) FL(K)
F'IFTF[ (5T1 FLFLOOR
six - H (GFH) FI.00.R
SFVI-NFH (7TH) -FL(:)(--)R
Elu-1`LH (8TH) FLOOR
hitalling Cotnpa,uv Name
Address31,U
T
\Check one: Certificate
�- e p"'Corporation -)LL, 1 �
B) list ness Telephi>ne �: .� .��- �:
Name of Licensed Plurnber or Gasfitter❑ Partnership
❑ Finn/Co-
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGt,
Ch. 142 Yes .. No ❑
If you leave checked yq& please urdicate the type of coverage by checking the appropriate box.
A liabilit-) rrtisurutce policv tom'".— Other type of indenuuty ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have ( the' coverage required
b)'Chapter 142 of the MGL, and that my signature on this permit application waives this requirement.
t nahue of or ()Nvuer's
(hvner
1 hereby certily that all of the details and information I have submitted (or entered) m above application are true
and accurate to the lest of my knowledge and that all plumbing work and installations performed under the
pe,mit issued for this application will be in compliance with all pertinent provisions of t Massachuscits State
Gas Code and Cha ter 142 of theGeneral Laws.
i
Title
Type of License d ,
`Title
[Num
City/'I,oNvrt ber aster Si la of Licensed lumbar/Gaslittcr
APPROVE17 OFFICE USE ONLY)
0 Gasfitter 0 Jounteyman License Number
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--tbcaton 24 �Gtllz( J�
No. Date f
TOWN OF NORTH ANDOVER
pa
Certificate of Occupancy $ So
Building/Frame Permit Fee $
N-.�4 I Fou Permit Fee $
OtIrerVerm' Fee $
j ZG 6j Sewkr connection Fee $
7� er Cognection Fee $
/oo
TAL 9�G6i $ 223 , oa
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N° 10183 `vim Div. P i orks
PLOT PLAN
LOT CI BA LDW I N STREET
NO. ANDOVER , MASS.
SCALE: I"= 30' OCT. . 9 , 1997
TROY , MEDE G ASSOCIATES
R£GiSTERED LAND SURVEYOR
936 EAST STREET- TEWKSBURY, MASS.
IRON PIPE
BALDW IN STREET
I HEREBY CERTIFY TO THE BUILDING INSPECTOR THAT
THE DWELLING IS LOCATED ON THE LOT AS SHOWN AND THAT IT DOES
CONFORM WITH THE TOWN OF NO -ANDOVER ZONING REGULATIONS
REGARDING SETBACKS FROM STREETS AND LOT LINES. 41 "OF
I FURTHER CERTIFY THAT THIS DWELLING ISNOT LOCATED IN THE RICHARD
FEDERAL FLOOD HAZARD AREA AS SHOWN ON MAP DATED -JUN -1!5 1983 J.
MEDS JR.
t #36864
REGISTERED LAND SURVEYOR;.,
THIS PLAN IS NOT FOR BOUNDARY DETERMINATION IAN S�
BOUNDARY INFORMATION TAKEN FROM: EXISTING RECORDS,
to cm
U
Locations
-.�--'
No.
Date vo
NORTq
TOWN OF NORTH AN -DOVER
? • . •L9
jaillimigibi
Certificate Occupancy
of $
s�cHusE
Building/Frame Permit Fee $
.
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
i Check #�
15550
(/Building Inspe d
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TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER:
DATE ISSUED: 4
SIGNATURE:
z/!w
Building Commissioner/Ina.Wor 6f Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number-L�
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
l56;-4)17 lo(�
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Required
Provided
Required Provided
1.7 Water Supply M.G.L.CeAO. 54) 1.3. 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
Na` e fi/P An t)
Address for Service
Sig ature
Telephone
2.2 Owner of Record:
Name Prin
C574 /lam �Oy`(h✓
Address forService:
Sigriature
Telephone
SECTION 3 - CONSTRUCTIONS
VICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature
Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable
Company Name
Registration Number
Address
Expiration Date
Signature
Telephone
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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 bViflAing permit.
Signed affidavit Attached Yes ...... X, 11 No ....... ❑
SECTION 5 Description of Pro osed Work(check ail applicable)
New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) Addition 0
Accessory Bldg. 0 Demolition" 0 Other 0 Specify
Brief Description of Proposed Work:
1-2 IJ
SECTION 6 - FSTIMATF.D CONSTRUCTION COSTS '
Item
Estimated Cost (Dollar) to be
Com leted by permit applicant
1. Building1016)00—
/ 0 (, 0 0 —
(a) Building Permit Fee
Multi lier
2 Electrical
�D D D
(b) Estimated Total Cost of
Construction
3 Plumbing
N
Building Permit fee (e) X (b)
�-
4 Mechanical HVAC
�U
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 BUH.DING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
i
a4�uthorized 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
PtN
-71
/ r ature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIlvMERS iST 2 ND 3
PJD
SPAN
DEVIENSIONS OF SILLS
DIMENSIONS 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 k2—g
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02191
Workers' Compensation Insurance Affidavit
Please Print
Name:
Location:
Clty Av. 2y� "�i'! / M 4 Phone
am a homeowner performing all work myself.
01 am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
City: Phone #
Insurance Co. _ Policy #
Companv name:
Address
City: Phone #•
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties.of a fine up to $1,5o0.00
and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.06) a day against me. I
understand that a coO of thisstatement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herby certify un er ,pains and penalties perjury that the information provided above is true and correct.
Signature .% %�Y �Z-- __ Date
v
Print name Phone # `vim (olo�
Official use only do not write in this area to be completed by city or town official' I] Building Dept
[]Check if immediate response is required Building Dept E] Licensing Board
E] Selectman's Office
Contact person: Phone #: n Health Department
❑ Other
FORM WORKMAN'S COMPENSATION
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 dosed of in:
(Location of Facility)
v Signature it of Per Applicant
off/ -7//0�_
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
Tel: 978-688-9545
Town of North Andover
Building Department
27 Charles Street
North Andover MA 01845
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE cz;12� % Lo
JOB LOCATION C,1_9`7
Number St eE
Address
Town
"HOMEOWNER � � �(YGt)/✓% Sr � /���� � �� � 7 7F o�3 �OD/?
Number Home Phone Work Phonef
PRESENT MAILING ADDRESS O2y � ld�kj
City Town
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of six 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 109.1.1)
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 to six family dwelling, attached or detached structures ac-
cessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned "homeowner" certifie that
Building Department minimum inspec on pr,
comply with said procedures and req ire ei
HOMEOWNER'S SIGNATU
APPROVAL OF BUILDING OFFIC
understands the Town of No. Andover
s and requirements and that he/she will
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
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BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 LM #saw bw*)
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 //- /!l -17
7& or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Locatio
Owner
Owner':
Is this i
Purpose
Existing
New Sol
Number
Location
No. of SM
N
NO. of Oil
No....
No.
Nom_
No.���.
OTHER:
INSURAN
I have a
have suoi
checking
INSURAN
Esttmatec
Work to S
Signed ut
FIRM NAI
licensee
Aooress .
OWNER':
quireo by
(Plea"
Date /J— ........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that .......................................... ...... .....................
has permission to perform ....
....... .......
wiring in the building of . .... . .....
at... ........................ .. ......................... , North Andover, Mass.
Fee-.� ................
Lic. NoAd.yc, ..............................................................
CA. 7t-- 6 ELECTRICAL INSPECTOR
11/20/97 14:38 35,00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
ON
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CERTIFICATE OF USE & OCCUPANCY'S'
Town of North Andover
Building Pefmit Number 460 Date March 24, 1998
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 24 Baldwin Street
MAYBE OCCUPIED AS singli, -Fqmilv nWA111hug IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
.4"4
SUCH OTHER REGULATIONS AS MAY APPLY.
11
9
CERTIFICATE ISSUED TO 'Rurz1aff
24 Baldwin St
ADDRESS No. Andover MA Oli45
Building Inspector
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NO 768
APPLICATION FOR WATER SERVICE CONNECTION
North Andover, Mass. 5 1937
Application by the undersigned is hereby made to connect with the town water main in JL!'! Street,
subject to the rules and regulations of the Division of Public Works.
The premises are known as No.
or subdivision lot no.
0 �'� /1?VrzA44�
Owner
Contractor
! Kc //, le
Address
Address
f
AppiSignature
,'tf'��Je r &-- + Oa oc?
PERMIT TO CONNECT WITH WATER MAIN
The Board of Public Works hereby grants permission to Z 9 `I ,,-1 �tl—' RU/- Z /-r
to make a connection with the water main at !c
subject to the rules and regulations of the Division of Public Works.
Inspected by
Street
Street
(,/--Roard of Pub i Works
By
Date
See back for rules and regulations
60
/-- n'(,� CI -7
TTGi%
RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES
1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town
of North Andover without a valid permit from the Division of Public Works.
2. All water services shall be installed a minimum of five feet below the finish grade.
3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964.
4. Service connections shall be 1" type k copper tubing.
5. All fittings shall be brass flange type Mueller or equal
H 15202 Corporations
H 15212 Curb stops
H 15402 Three part unions
H 8185 stop and waste valves
6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 41/2 foot rod and brass plug
type cover.
GEORGE PERNA
D I PEEcT 0:
i ..A NUN I ND VE'i, %4AC j T,
Sd-J OSGC)0' D, S F BEET. v': 84 i
a ; Via^ y _'_-9`r_ � I a
& —�
9,gSgC'NU JET
DRIVEWAY PERMIT
Telephone (508) 685-0950
Fax (508) 688-9573
[BUILDER:
ate: c a
OCATION: 2 �����'�
phone:
WNER: Z
���t �e `' >J,�zXgg phone: moa /,'z` 7_560f>
The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the
grade and set -back from street established in any driveway entry onto any street or way maintained by
the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval
of such entry.
FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT.
I Remarks:
Approval:
N° 1268
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass.
r `
Application by the undersigned is hereby made to connect with the town sewer main inI L'1 Street,
subject to the rules and regulations of the Division of Public Works._
The premises are known as No,
or subdivision lot no C —/
f1
� c) /R./
Owner
Contractor
PERMIT TO CONNECT
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at
subject to the rules and regulations of the Division of Public Works..
Inspected by
Date
Address
Address
V . -- ::�d�
Applicants Signature
TH SEWER MAIN
Street
Street
ivision of P is Works
By L�
See back for rules and regulations
lgCo� WCt��
RULES AND REGULATIONS FOR GOVERNING THE INSTALLATION OF SEWER SERVICES
1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer
or appurtenance thereof without first obtaining,a written permit from the Division of Public Works.
2. All costs and expense incident to the installation and connections of the building sewer shall be borne by the owner. The
owner shall indemnify the (town) from any loss or damage that may directly or indirectly be occasioned by the installation
of the building sewer.
3. A separate and independent building sewer shall be provided for every building; except where one building stands at the
rear of another on an interior lot and no private sewer is available or can be constructed to the rear building through an
adjoining alley, court, yard, or driveway, the building sewer from the front building may be extended to the rear building
and the whole considered as one building sewer.
4. Old building sewers may be used in connection with new buildings only when they are found, on examination and test by
the (Superintendent); to meet all requirements of this ordinance.
5. The size, slope, alignment, materials of construction of a building sewer, and the methods to be used in excavating,
placing of the pipe, jointing, testing, and backfilling the trench, shall all conform to the following requirements. The sewer
shall be 6"diameter SDR 35, PVC pipe. Minimum slope shall be 1/8" per foot. The minimum depth of sewer shall be four
feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a
minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown
of the pipe. Care shall be taken to carefully grade and compact the stone, and prevent pipe displacement. The remainder of
the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift.
6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. In all
buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such
building drain shall be lifted by an approved means and discharged to the building sewer.
7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or
ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer.
8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for
inspection and connection to the public sewer. The connection shall be made under the supervision of the (Superintendent)
or his representative.
9. All excavations for building sewer installation shall be adequately guarded with barricades and lights so as to protect the
public from hazard. Streets, sidewalks, parkways, and other public property disturbed in the course of the work shall be
restored in a manner satisfactory to the (town).
1`
ft
MASSACHUSETTS UNIFORM APPLICATION -FOR PERMIT-TO:Dp'PLUI�RI '
(Type or Print)
NORTH ANDOVER ,Mass. Date,*`
Building Location.t% f� wart S Permit 1
—+�•t.
Owners Name
New Renovation Replacement j] Plans Sybmitted II a10
FIXTURESw
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(Print or Type) Check one: Certificate
Installing Company Name 1"-,a,-Iy /�%v�bi.�g (� Corp.
Address 70 Aleo,- tlt?Ts& I-eil Partner.
Firm/Co.
Business Telephone 5'0'j;;A6z9�/"/S�
Name of Licensed Plumber: e�
Insurance Coverage: Indicate the type of insurance coverage by checking the
n ro riate box
PP P
Liability insurance policy Other type of indemnity [—] Bond
Insurance Waiver: I, the undersigned, have been made aware - that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of ownerlagent of property Owner Agene%
I tlerebp ccrtifr 16a1 all of 11ie details and infornialion I lu•e wLuoittcd (or entered) in aMr.e application ire Trot arrdrrale to Use btat of Mt
knowkdgc aad that all plumbing work and installations lrcrfnrnicd under rcrutit 1%sued for this application will be M toalpij)IrICa 1111111 all pcs/irlctlt I601d1
•Wam of Ow Xamchumils State Numbing Code and Quptce 142 of the G"Cial Laws, L
-4, i7
By
Title.
City/Town:
.ADDRr1VF=n 7AFFIC17 USE oNLYr
ME
Signature of'Licensed
Type of Plumbing
iI5yv
License Number
Plumber
License
im Master Q Journeymri
Y_
i, 3538
Date../� l�
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
8
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This certifies that .... .... .. . ' ' .. ......... "'
has permission to perfor .... ..........:.
plumbing in the buildings of ....... M
CU
�.. ............ , North Andover, Mass.
.FeUW/a.Lic. No..�.u.
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a'
PLUMBING INSPECTOR ^"
1.4£-1,R5 -7
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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AL
T
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having
have been obtained. This does not relieve the applcaajurisdiction
landowner from compliance with any applicable local or state law
regulations or requirements. ,
****************Applicant fills out this segtion*****************
APPLICANT: �'�/ ,��'���
Phone
LOCATION: Assessor's Map Number
Parcel
Subdivision
Lot(s) /
Street
St. Number
************************p icial Use Only************************
RECOHN
WATIP 0 TO ENTS:
Conservation Ad inistrator Date Approved ALOZ?
Date Refected
Comments " LQ S6l 14J 1 �P-v T",,V IAA"r-,
` Food Inspector -Health Date Approved
Date Rejected
r
Date Approved
,,,Septic`Inspector-Healt
h Date Rejected
Comments /.��_`- ✓�
Public Works -sewer/water connections
- driveway permit `TT`—�
F�irJ De tmept
Received by Bui
�-��y��e� N1i�✓`C
ling Inspector
Date
C/
�1t.0 lO0 rl7ln(1)ta�QQ/��0�.��(,�/JJ�c/t t�JeIIJ
I DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Nueber: Expires: Birthdate:
CS 061249 0512012000 05/20/1963
Restricted To: 00
RICHARD A FIORENZA
82 WOBURN ST PO B% 28
ANDOVER, MA 01810
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF INDUSTRIAL ACCIDENTS
OFFICE OF INVESTIGATION
600 Washington Street
' Boston, Mass 02111
Workers' Compensation Insurance Affidavit
city 4.741, ove-/I ✓/MS'S1 0/9-/0
_I am a homeowner performing all work myself
loam a sole proprietor and have no one workina in anv capacity
_I am an employer providing workers compensation for my employees working on this job.
company name
address
city phone #
insurance co, oolicv #
company name
address
city phone #
insurance co. policy #
_I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed
below who have the following workers' compensation police:
company name
address
city phone #
insurance co.
company name
address
city phone #
insurance co
Failure to secure coverage as required under Section 25A of MGL xxxxxxxxxxto the imposition of criminal penalties of a fine up to $1,500.00
and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me.
I understand that a copy of this statement may be forwarded to the Office of Investigations of the DA for coverage ver►ficadon.
1 do hereby cerdly under the paps anSj penpldees gt9edury that the information provided above is true and i
Print Name ______144'e.4,cr4 /r} 7-1ljre n 7e, Phone (S0,5-0 Y-7/9 —0
Growth Management Bylaw Exemption Statement
Town of North Andover Building Department
This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as requested below.
Name of Applicant on Building Permit (below) Address of Property for Permit (below)
Map and Parcel : 7 � Purpose of Application (check below)
Pho.�nrumber of Applicant: Single Family Two Family
I the undersigned applicant for the above property attest that the attached building permit for which this
form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth
Management Bylaw. I also understand providing this form does not absolve me or any party to this permit
from the requirements of obtaining other permits required prior to the issuance of the Building Permit.
Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building
Department and is only officially accepted when the Building Permit iq issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the
above lot, in the building permit application and associated attachments, complies with one or more of the
following sections as indicated by a check mark.
This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in
existence as of the effective date of this by-law, provided that no additional residential unit is created.
JZThe lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
Bylaw.
This application is for dwelling units for low and/or moderate income families or individuals, where all of the
conditions of 8.7.6.c�are met and/or represents Dwelling units for senior residents, where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
purposes of this Section "senior' shall mean persons over the age of 55.
This application is a part of a development project which voluntarily agreed to a minimum 40% permanent
reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the
environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently
designated as open space and/or farmland. The land to be preserved shall be protected from development by an
Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism
approved by the Planning Board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an
adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth
Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the
parcel.
This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and
commissions have been received and the project is in compliance with those permits), and the Development Schedule
does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per
Development until such time as the Development Schedule accommodates issuing building permits. Applicant must
supply approved form U with this EXEMPTION.
Please provide any and all information that would assist the Building Department in making a determination'
that your application is allowed one or more of the above EXEMPTIONS.
By signing below I attest to the accuracy of the information provided and that the attached building permit is
allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or
inaccurate information, or the checking off of an above item which does not comply, whether done to my
knowledge or not, is group s for refusal by the Building Department to issue a Building Permit.
Signature ot Owner or Authorized Agent w igned the Attached Building Permit DaX
This form must be attached to the BujWing Permit upon application for such permit