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HomeMy WebLinkAboutMiscellaneous - 25 CRANBERRY LANE 4/30/2018 (2)N) Date . l.�..l+ !.- %................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... -4-0....X-P.%L, C A4n,..... �1 �t •; i ............................................................. has permission to perform ......{,/„�,, , ................................................................ •� wiring in the building of......... �-'L- ,,r�� .�............. ......................................... at ..2 .. 1!!, .. ..;�. ........... orth Andover, Mass. Fee.... Tj._'............ Lic. NoQ3". .j.:.............. .PECTOR ....... CAL ................. .......... Check # 1 s . E LECTRIINS Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. I b ( Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: �� / �/ _ J 3 City or Town of: NORTH ANDOVER To the Inspector of *Vires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Q S e-rc(Ki N to N L 6 N -e Owner or Tenant fl/ A cJ S/ A Telephone No. q 2 V- 2 5 �`_W/od Owner's Address SI' "t''1- . Is this permit in conjunction with a building permit? Yes ❑ No 9-- (Check Appropriate Box) C Purpose of BuildingS % N� wi t tst P til eb W J Utility Authorization No. - Existing Service 'ZD 6 Amps ) ZJ 12VO Volts Overhead ❑ Undgrd B No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: j NSU // da h I -J A4- Ad a -k e3fNe KA io Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA 2d C ,,J No. of Luminaires Swimming Pool Above ❑ In- ❑ No. of Emergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and InitiatinLy Devices No. of Ranges No. of Air Cond. TotalTons No. of Alerting Devices No. of Waste Disposers HeatPump Number I Tons ­J*'" I KW """"" No. of Self -Contained Totals: i J---"' Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �, �0 ` d (When required by municipal policy.) Work to Start:// — / #- / 3 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The dh Cio L$ �S un ersigned certifies that suc coverage is in force, and has exhibited proof of same to the permit issumg office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) �y (� h1 A 0,0.0 5 G 33 JAlltl I certify, tinder the pains and penalties ofTejury, t 10 the information on this application is true -and complete. FIRM NAME: _ HD_Oy/ Z JC �� LIC. NO.: 9&4 L" Licensee: �Kt'L1c �.s%Zy9 t'r't Signature LIC. NO.Qt/ tray C (If applica ter "exem t" ' the license number line. Bus. Tel. No.-- S7 9 G,i.3 S kd l Address: 3 c! 4 �i ti� Icy aow 1, /,J V r� ��t 6� yVl Alt. Tel. No.: �Yq 37C dy Sri *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ L� Signature Telephone No. CJS ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed + on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass F?1 Failed M Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass M V Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Com Inspectors Signature: Date: V DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 `W www.mass.gov/dia ,Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers • . Y •1 1 A fty/State/Zip: ame (Business/Organization/ladividual): ddress: 'i'�td, iIn -e RC1 u -e vJ m � Phone #: �P Are y u an employer? Check the appropriate box: 1.I am a employer with !�_— 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing. repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. i'Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. � f Insurance Company Name: L ' `j �5� •J 4f J s ©� �/ Expiration Date: M A& Policy # or Self -ins. Lic. #: � P . Job Site Address: 7 2 ' �` ,1 ''t ILjj/t,�/ L "� City/State/Zip: )JJ i1�`� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as wellas civil penalties in the form of a STOP. WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido Hereby certifya r the pains and penaltig4fperjury that the information provided above is true and correct. /_iy_✓3 Phone # Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone COMMONWEALTH OF MASSACHUSETTS K GENERATOR APPLICATION DATE: I/- ? -- )J/3 LOCATION: �13'S C% )J � / L A OWNERS NAME: PP J 1 A*)-) GENERATOR kw d k`,j NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: 9 Sk v� f F t l PHONE NUMBER: 17 F .325 — dVcly ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: el q4T 1 -Jr -,1a s,'tv t9Fpo� /s FT fps W� *ZONING DISTRICT. K� *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL � G� North Andover MIMAP November 8, 2013 \ \ \ `1,.'--,i;-----059.0-0Q45 , 1" - `.�'.:-::-: 059.0-0048 \ \ \ \\ 50 COBBLESTONE -11, 059.0-0067 059.0;0096 \ 059 09. 695 .._._. \ 0\ �0 ETTS' \� 'l'•••-` • '=' ' == 'MASSAGHUSETTSRVE 41- :=:'-::•' 58wCOBBLESTONECIR` ...,if• 059'00080,?I!r ,,p. _ of - _ :'::yam _ \,. `. � - �� ''�•`.:. -;�.• .........h ..._ _ ._.. 059:0-0092::_. -••.:_:_: aU�i .. _. '�L\��, '••" G� . � '..:::.•_• r`�'dt�. • :•_.�_.;•'_.. � : �.:.•_•�aVfE<::::.::...::.� slur - - ���.\s"-�. _ . ... •._..•::•_:"�I; .._:_: •:��•�31tr' 80 O.SGOOD•ST � R �• \nen n nnn� \\ \�\� \\���� \\ 059.0-0081 \ \\\\ 57 COBBLESTONE CIR _ 059.0-0069 \ 25 CRANBERRY LN, 059.0-0070 47 CRANBERRY LN 35 CRANBERRY LN 162' 059.0-0071 1167" Clranbe;LaPe; 059.0-0073 ave _- 059.0-0057 059.0.0058 O.LD VIL'LAGE'LN 059.0-0022 O -- Rail Line ='„, Wetlands Zoning Interstates 11 Exempt Lands Busine s 1 District — Interstate — Major Roads C7 Busine C3 Busine a 2 District s 3 District Horizontal Datum: MA Slateplane Coordinate System, Datum NAD83, ■ Busine s 4 District Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission Roads Gene■ Business trict HCRTIy 4 O of �.O (MVPC) using data provided by the Town of NNorth Andover. Additional data by Ci Easements Plann C7 Planne Commercial Dev ial Dev �+ta � • ! ? provided the Executive Office of Environmental Affairs/MassGIS. The information depicted this is ❑ MVPC Boundary ' Corrido Development Dist �� O G on map for planning purposes only. It may not be adequate for legal boundary C3 Municipal Boundary Zoning Overiay G' Corrido O Corrido IrulZri Development Dist Development Dist 11 District I' -_ 00 to A definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE G3 Adult Entertainment • Industn 12 District f = e ; ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY Q Downtown Overlay District 1 O Industri 13 District * c * OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT E` Historic District O Indusld S District 1 .o<.'.<' :. . + pO��tao ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ® Water Protection Reside Reside ce 1 District ce 2 District 7f.�,�°J S THIS INFORMATION ❑ Parcels Hydrographic Features Streams 1" = 85 ft 91 Recide de . de YYT de m e ce 3 District ce 4 District ce5 District ce 6 District esidenlial District �•� SACHUS Date ....I. ................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ... This certifies that . ........................ ...... :;� ......... .. ............................................. has permission for gas installation ..... 121P-4 in the buildings of ........... ... A-..... ..14,k ..... .............................................. . ...... . .... ... ......................... at ...... * ............ , North Andover, Mass. Fee id,, Lic. No. . ... . ........................................................... Check# GAS INSPECTOR U0 �IAtf, �,c,— 4o 61c, evv\&-A-P- J- -� Ism G TYPE OR PRINT CLEARLY APPLIANCES 1 BOILER BOOSTER MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT70 PERFORM GAS FITTING WORK CITY e VMA DATE PERMIT # l JOBSITE ADDRESS �0TNR'SIAME OWNER ADDRESS OCCUPANCY TYPE COMMERCIAL Fj EDUCATIONAL NEW: [� . RENOVATION: D REPLACEMENT: FLOORS- I BSM CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE TELL" FAX RESIDENTI PLANS SUBMITTED: YES E] NO []J� 10 1 11 1 12 1 13 1 14 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES [] NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF C VERAGE BY CHECKING THE APPROPRIATE BOX BELOW I BILITY INSURANCE POLICY OTHER TYPE INDEMNITY I BOND �] OWN4RW'SU R: I am aware that the ce see does not have the insurance coverage required by Chapter 142 of the Mas al Ws, and that my signature o is permit application waives this requirement. CHECK ONE ONLY: OWNER �I AGENT _�J( 61ATURE OF NER OR AGENT hereby certif that II of ails and information I have submitted or entered regarding this application are and that all plumbi work and installations performed under the permit issued for this application will be in c9 Massachusetts State Plumbing Code an Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME C ;r w LICENSE #� SIGNA sst of my Knowb provision of the MP I MGF JP JGF LPGI D CORPORATION [I# PARTNERSHIP ( LLC E]#= COMPANY NAME: _ ADDRESS - -J] CITY STATE ZIP TEL FAX_ CELL - -- _ EMAIL C AA r O z 0 H • U W con a ,y W o El z O �rl W >- O w O H a U z 3 LU w � � 7� Q w W f0 CO w a �+ w W N W o a a a Un U J F., a LL Q � � w xw F- u. W H O z 0 H U W P6.( C�7 Ch - t The Commonwealth ofliMassachusetts Department ofIndustriglAccid nts Office of Investigations 600 Washington Street .Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl NarnO (Business/OrganizationlIodividual):—S �� , L Te 4. Address: 4% City/State/ZipPhone #: q��-3 g° Type of project (required): 6. [] New construction 7. [] Remodeling 8, ❑ Demolition 9. [] Building addition 10.[] Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs 1Other -uv y app scant t at checks box#1 must also f111 out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they 2're doing all work and then hire outside contractors must submit a new affidavit indicating such. ?Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and joh site information. r Insurance Company N Policy # or Self -ins. Lic. 0: Expiration Date: Job Site Address: City/State/Zip: Attach a. copy of the workers' compensatio policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required_under Section 25A o£MGL c. 152 can lead to the imposition of criminal penalties of a Rue up to $1,500.00 and/or one-year imprisonment, as wellas civil penalties in the form of a STOP -WORK ORDER and a fine ofup to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA forJnsurance coverage verification. I do hereby cer ' n s ancdpenalties ofperjury tliat the information provided ove l true and correct. Si ature: Date: / A Phone #: 7 -27 11 Official use only. Do not write in this area, to he completed by city or town official. City or Town: PermitMeense Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CitylTown Clerk d. EIectrical Inspector 5. Plumbing Inspector 6.Other - - _ Are you an employer? Check the appropriate box: 1, ❑ I am a employer with 4. ❑ 1 am a general contractor and I loyees (full and/or part-time).* have hired the sub -contractors I am a sole proprietor or partner- listed on the attached sheet, x hip and'have no employees 'These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3111 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp, c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp, insurance required.] *An 1' h Type of project (required): 6. [] New construction 7. [] Remodeling 8, ❑ Demolition 9. [] Building addition 10.[] Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs 1Other -uv y app scant t at checks box#1 must also f111 out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they 2're doing all work and then hire outside contractors must submit a new affidavit indicating such. ?Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and joh site information. r Insurance Company N Policy # or Self -ins. Lic. 0: Expiration Date: Job Site Address: City/State/Zip: Attach a. copy of the workers' compensatio policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required_under Section 25A o£MGL c. 152 can lead to the imposition of criminal penalties of a Rue up to $1,500.00 and/or one-year imprisonment, as wellas civil penalties in the form of a STOP -WORK ORDER and a fine ofup to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA forJnsurance coverage verification. I do hereby cer ' n s ancdpenalties ofperjury tliat the information provided ove l true and correct. Si ature: Date: / A Phone #: 7 -27 11 Official use only. Do not write in this area, to he completed by city or town official. City or Town: PermitMeense Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CitylTown Clerk d. EIectrical Inspector 5. Plumbing Inspector 6.Other - - _ I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhi m,• express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or p ermit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states `Neither the commonwealthnor any of its political subdivisions shall enter iutq any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP floes have employees, apolicy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents fox confiration ofinsurance coverage, Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' . compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. ' City or Town Oftcials -Please be sure that -the affidavit-is-complete-andprinted legibly: The Depaitmerithas provid3 a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submitmultiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license orpermit to bum leaves etc) said person is NOT required to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: Tho Dop.artmout o f dusWal Awidents Office o1; J[ notigatiom 6W Waft&a fteot Boston? MA 02111 Tel, # 61.7-727-4.900 at 406 or 1-877�UMS. F, Revised 5 -7.C, -p5 Bax# 617-727-7749 =COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: JEFF S AGNEW 4m i 55 CHASE ST I METHUEN MA 01844-3709 12060 05/01/14 183456 { r • n Location 9S No. :?ve ' bl� Datez-- 0.1 NORTIj TOWN OF NORTH ANDOVER L Certificate of Occupancy $ s„ „U5 t� Building/Frame Permit Fee $ �Z- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # J 15271 Building-fector • TOWN OF NORTH ANDOVER BUILDING DEPARTMENT kPPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING gq 3UILDING PERMIT NUMBER: DATE ISSUED. SIGNATURE: P-ilrlino i'nmmiccinnP.r/In.gneCtOr O Bul dlnl?s Date Tl l ♦ TTAWT N 7L`I.lYVl�. a-vaaa•. ay•avaa..a�,�a a�. 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �210Q0-0041- G" t N- Parcel Num _ 1.3 Zoning Information: 4 Property Dimensions: ; °ply ?onin District. Use Lot Areas Frorita' "e it 1.6 BUILDING SETBACKS ft Front .Yard Side.Yard Rear Yard Required Provide R red Provided Reqtured Provided ` ' l.7 Water S t.5 Flood Zone Information: upPtY M.G LC.40. 54). Zone Outside Food Zone ❑ 1.8 Sewerage Disposal Sysiem Municipal ❑ On Site Disposal System. ?ublic ❑ Private ❑ SECTION 2 - PROFERTY :OWNERSIHP/AUTHORIZED AGLNT 2.1 Owner f Record y " r ds �4 , !Jame nt) J� Address for Service: 2> Signature Telephone 22 Owner of Record: Name Print Address for Service: TPlrnhnne Srgnaturg CF.0 'FON 3 - coNSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature 3.2 Regisi Home Improvement Contractor Company Name Address Signature Telephone Not Applicable ❑ License Number Expiration Date Not Applicable ❑ Registration Number Expiration Date aw— 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 -permit. $i ned affidavit Attached Yes .......0 No ....... 0 SECTION 5 Descri tion ofPro sed Work checkafl a licable. New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ —T -Addition 0 Accessory Bldg. ❑ Demolition . ❑ Other ❑ Specify Brief Description ooff Proposed Work: a0e �11 g'4 61X G 9L "-k rll- /(� 4 i at,C Leet42 0 IVlv I40'- -ESTIMATED CONSTRUCTION COSTS Item I Estimated Cost (Dollar) to be SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L 7x4 as Owner/Authorized Agent of subject property Hereby authorize Seto act My beha j n re ti work authorized by this building permit application. Signature wrier Date SECTION 71b OWNER/AUTHORIZED AGENT DECLARATION 1, As Charter/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 Signature of Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TRABERS 1 2 3 SPAN R ONS .OF SILLS NS OF POSTS NS OF GIRDERS F FOUNDATION THICKNESS OOTING x L OF CHRvfNEY G ON SOLID OR FILLED LAND G CONNECTED TO NATURAL GAS LINE Completed,by permit applicant u 1. Building / �� v (a) Building Pertiiit Fee � Multi Tier 2 Electrical (b) Estimated Total Cost of • Construction 3 Plumbing.. ,� .- Building Permit fee (a) x (b) 4 5 Mechanical : HVAC . Fire Protection Q ~� 6 Total 1+2+3+4+5 /� j -v Check W47-9 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L 7x4 as Owner/Authorized Agent of subject property Hereby authorize Seto act My beha j n re ti work authorized by this building permit application. Signature wrier Date SECTION 71b OWNER/AUTHORIZED AGENT DECLARATION 1, As Charter/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 Signature of Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TRABERS 1 2 3 SPAN R ONS .OF SILLS NS OF POSTS NS OF GIRDERS F FOUNDATION THICKNESS OOTING x L OF CHRvfNEY G ON SOLID OR FILLED LAND G CONNECTED TO NATURAL GAS LINE D. Robert Nicetta Building Commissioner (978) 688-9545 °(978) 688-9542 Fax Town of North Andover Building Department 27 Charles Street .. North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Please print. q / DATE JOB LOCATION Z � Number Str t Address ap / lot ..HOMEOWNER ��0101ear J % �q7 _ Y q71 Name Home Phone Work Phone ZZ Z S'- PRESENT MAILING ADDR S 1. "C�� ��� G� CJ li.�l7✓� City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does . not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection pnocedpWand requirements and that he/she will comply with said procedures and requirements HOMEOWNER'S SIGNATURE .e APPROVAL OF BUILDING OFFIC if 1� - ..- `---� -- --. ----- - -- -- Ll t 1 I � 1 � 1 1 I I I 1 i 1 i I 111 111 i _-. . 1_ -__- _ - __4.-__ i 1 - 1 I ; 1 f - P14CIE t XtSrloi - Ne o- ov-jo SAL f -6,w, Co vt54r'r'Awf f Dae v ft iC stU COMSMVCTio1) Fret ? o f' 2 4LL) k. 1� Z�oft } ,4. - - - i - - -- -- - --- -- - - -- - -- 7-0 - --- - S - -- I, I - --- - - --- - I i � i I I 41 I I 4- w i i I r _ I - fiSVii2 10 = ID - , kl �- C N __ - r 5x167 -1Q : Ft4kE% 4LL) k. 1� wi cd Ej x A O, b g a chi o U z � z o w a�' E �"c U c w U a �' cz w W U �u x p w w a z d C4 ro w z w d w w w CO cn o V) Q YM � W CLM z Cl) CD .y O L CL O c O Q v _Q CL COI) 0 .Q y O V 0 co Q 3� CD 0 Q O � �4 c -510 ev O O Z CD CLCO2 c Lli 0 C/) LLI VJ Ir W W LLI cn ' � o g� c �;c o �' oc ` c O C V V •dam ;ac cv ev is �_ CD �4 =o� «• m CC: C ca o" Q .. cm t� mm F` I rAi N � w C 7 J � � = C C : N cc, O 16 �� ? aCD � y LO) m ac m o c cC' 1=c= mo� O m h O Z `c G • o cn o cm c QCD y m C p = m :m�3 ;a o N S V) m O •cc �� C: 2dt E C m •N Z O w V m coamCM o�oc f= COO CL a O CL m > Cl) CD .y O L CL O c O Q v _Q CL COI) 0 .Q y O V 0 co Q 3� CD 0 Q O � �4 c -510 ev O O Z CD CLCO2 c Lli 0 C/) LLI VJ Ir W W LLI cn Location—c � il�L No. ® /CI Date r N°"T" TOWN OF NORTH ANDOVER : p . Certificate of Occupancy $ //"� `/ � Building/Frame Permit Fee $�61 311v In. cNesE� Foundation Permit Fee $ Other Permit Fee $ Connection Fee $ 7-/ Y-43 Water Connection Fee $ N �, TOTAL $ / 75�, 64� w -F 1 �/3 4Z Building Inspector 6370 Div. Public Works Location t 'No. Date TOWWOF .NORTH ANDOVER ° , p Certificate ofi3Occup6ncy $ it • r' * Building/Frame Permlt-*� e r 9 ,SSACMUst� FouncAA ki Permit Fee $ rftJ- n G Othefltil $ - -- J ewer Coniiedtiorj§e $ Wat r Connection Fee $ TOTAL !J• U 1 Building Inspector Div. Public Works } r< Location No. Date _ cj_ 93 ^ f NORrh fb ° O 4 , _ °` wN �F NOR7�'�ryp s s Certificate of ��, OVER Oc g cXzee Y $ , A uildi ;gym "D ::�` ., # n I/Frame J'�tNUSEt Fo $ � Foundation P'rim rms �/ Other ml dee:' 1 ,/Up. ZbG Permit Feei �// Sewer Connection Fee S77 Watei Connection� Fee $ _ TOTAL s� 'fir 0 (3{� �Iding, lns i 7ecor Div. Public Works v r PEJUVIOT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER. MASS- Pi A ji i La /) /PA r_u I MAP 440. 1�1� LOT �NO. TSSUB 2 RECORD OF OWNERSHIP BOOK PAGE ZONE !� _ OT NIF IDATE i� — LOCATION a� Cra.- �u`ry ne I PURPOSE OF BUILDING94 �%�� I1 OWNER'S NAME 1 ^� l� 7 ►,,r OWNER'S ADDRESS d/ O me►�2na -���3 NO. OF STORIES SIZE p '2 - BASEMENT 7�0 ! �,�� �p� �, OR SLAB ! yt5Ci'h�-1 ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 3RD 2ND ax�vo zx s BUILDER'S NAMEL- ` _ ) n1A,,,,,,.n 1. c CVFQao � /L SPAN DISTANCE TO NEARES BUILDING / C/ (O56 U/ DIMENSIONS OF SILLS •�J = a'X 6 - GjJ`' DISTANCE FROM STREET O POSTS 7 Al DISTANCE FROM LOT LINES - SIDES38 /° (t �^y REAR 11 V� GIRDERS . ! y/D �r ' AREA OF LOT /}rcjo r•� /� {J JCS /fC FRONTAGE - HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING �� y �jO �� X 19 BUILDING ADDITION O MATERIAL OF CHIMNEY IS BUILDING ALTERATION ��/A ACP IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE es IS BUILDING CONNECTED TO TOWN WATER CS BOARD OF APPEALS ACTION. IF ANY NG IS BUILDING CONNECTED TO TOWN SEWER �3 IS BUILDING CONNECTED TO NATURAL GAS LINE C5 INSTRUCTIONS 3 PROPERTY INFORMATION SEE BOTH SIDES �IF 1 /S -b, D LAND COST 00o fGfi /F � EST. BLDG. COST lo�o'v !S 1A / X10 / v , PAGE 1 FILL OUT SECTIONS 1 -3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 12 mm • +>fi► Paw 420 EST. BLDG. COST PER ROOM ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS J PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DAA FILED /J OF IZED AGENT FEE 7 C) PERMIT GRANTED 19 i BOARD OF HEALTH OWNER TEL. # ($c CONTR. TEL. #_ CONTR. LIC. 131000 A �6p 4)1141 �7p PLANNING BOARD BOARD OF SELECTMEN 1 OCCUPANCY SINGLE FAMILY STORIES MULTI. FAMILY _ OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE ---III PINE HARDw D B 1 2 13 CONCRETE BL'K. BRICK OR STONE PIERS PLASTER WOOD RAFTERS _ DRY VJALL UNFIN. AIR CONDITIONING RADIANT H'T'G 3 BASEMENT AREA FULL FIN. 8 M'T' AREA '/. 1/2 �/� GAS FIN. ATTIC AREA _ N_O 8 M'T B'M'T 2nd 1st 13rd I FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS 9 FLOORS CLAPBOARDSB DROP SIDING WOOD SHINGLES CONCRETE EARTH � 1 I 2 3 _ _ ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDw'D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MAS N Y BRICK ON FRAME CONC. OR CINDER BLK STONE ON MASONRY 5 ROOF u 10 PLUMBING GABLE I I HIP i 11 BATH 13 FIX.1 SINK SLATE OTE SHINGES KIT -1I NOCHEN PLUMBING I� a BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 6 FRAMING 11 HEATING , WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. a COLS. STEAM STEEL BMS. a COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd 1st 13rd I ELECTRIC NO HEATING . J FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** /- C APPLICANT: cf �e ;�` r'r� �'� Phone LOCATION: Assessor's Map Number c Parcela Subdivision Lot (s) Street St. Number ************************Official Use Only************************ REM NDATIONS OF TOWN AGENTS: Date Approved t3 Conservation Administrator Date Rejected 1 Comments gPelt ig' 514A Wt )WJ IA9011 0.1A-V4rh r.VL19 J� - 2QC�&h A Town Planner Comments Food Inspector -Health .2 J_ Septic Inspector -Health Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved 93' Date Rejected Public Works - sewer/water connections 1INJI Z /-) - driveway permit Fire Department V rk t �. fiReceived by Building Inspector Date I Q,9 OF WCTL-14OU JZA�,P,31E-12 RY PIK owr—c, F�Lpfv OF 4.040 T, CAl c-#, aft,VF JZA�,P,31E-12 RY PIK owr—c, F�Lpfv OF 4.040 T, CAl t 4m ui C�2 0 z q cd : H �: � c � Z � • U O :w c H z: CA OCD to%jej C3.O P-- ; ac ZO� 4 • � :off :ca 'o = l c w o rA o. EE 1E CD A CD O z O CDm O H� N 3� N � 01 L C ca cc CSD w U CD o cm F�l CLL) mCDc cm~ N cn O Q W N 1 cc m V N O i • CS '- Z O OV ,8 CO3 � co* .o SO N LAO CD c o .cLL pN OZ •CNc- oog g vm=" CO o�y a m C A '=w N •O C $ c.51, iL 0 a y coMA .E CD C O CD cc '.7 CO2 O O Q CO2 C 0 R C R CLCO2 �_o O v Q3 Q H C 0 CD co L ►i 0 0 o Q d o�Q C 4-0 C CD O J � O O Z CD CO2 C o o x z W W w p W z W4 a A U z w z U O A L U a v w w o �' bo W X00 u ADO y aC iu cz co C � p a2' w a' cn w cG° w rA cn cn 4m ui C�2 0 z q cd : H �: � c � Z � • U O :w c H z: CA OCD to%jej C3.O P-- ; ac ZO� 4 • � :off :ca 'o = l c w o rA o. EE 1E CD A CD O z O CDm O H� N 3� N � 01 L C ca cc CSD w U CD o cm F�l CLL) mCDc cm~ N cn O Q W N 1 cc m V N O i • CS '- Z O OV ,8 CO3 � co* .o SO N LAO CD c o .cLL pN OZ •CNc- oog g vm=" CO o�y a m C A '=w N •O C $ c.51, iL 0 a y coMA .E CD C O CD cc '.7 CO2 O O Q CO2 C 0 R C R CLCO2 �_o O v Q3 Q H C 0 CD co L ►i 0 0 o Q d o�Q C 4-0 C CD O J � O O Z CD CO2 C ILI Ta AUG 1 91993 CERTIFIED FOUNDA TION PLAN J LOCATED /N ka AmpovER , MA, . -SCALE:/"= DATE Scott L. Gi/es R•L.5 50 Deer Meadow Road North Andover, Mass. r _LOT 5 25pc o e_ -,.F, ., '• � TIU�t� � r J -36' 33.35 ,x-32 r R !$o.� 57,30• . GRAN BEML.A.l�i� c� � �3f"�•, 1 .�3 / CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE Aw THE OFFSETS OF THE BUIL DING /NSPEC TOR ONLY SHOWN COMPLY AND SUCH USE /S FOR THE W/TH THE ZON/NG DETERMINATION OF ZON/NG BYLAWS OF CONFORMITY OR NON -CONFORMITY i o. Ampck tF. MA. WHEN CONSTRUCTED. WHEN BUIL T. 8 116 43 fx CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 297 Date NOVEMBER 23, 1993 THIS CERTIFIES THAT THE BUILDING LOCATED ON 25 CRANBERRY LANE (Lot #5) MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/3 CAR GARAGE IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Lucas W. Smith, Merna L. smith 03� p� 46 Royal Crest - Apt. #3 ADDRESS North Andover, MA ,t "```J' Building rector JF� I IN Lul _ est 0 z j as c cCd ki ci O c N C O �� z CD C A Ego 5 N C-%, a ¢ ,C CD CL EE _fir o m — �*44; `� O � � N =Cc 32 co y c � O LT� J N � � CD as avv CO 0 t o CD *4..- N — •a c t CL W • .. c o c Q �� y m c •c .�•� W �. 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