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BOARD OF FIRE PREVENTION REGUUTIONS 527 CMR 12:00 3190 Pom blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, S27 CMRA2:Op
(PLEASE PRINT IN, INK OR TYPE ALL INFORMATION) Date
M* or Town of NORTH ANDOVER To the In'spector of Wlresf
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 02�6 Irl-IL111-0,C)'. Alz(�
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yes'N?c No El (Check Appropriate Box)
Purpose of Building 10al"oz-z Utility Authorization No.
Existing Servige ;?A 0 Amps
Volts Overhead Undgrnd No. of Motors
aew Service
Amps -Voits Overhead Unogrno No. of Motors
Numuer of Feeders ano Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets No. of Hct '%-cs No. of Transformers Total
I I KVA
No. of Lighting Fixtures
No. of Receptacle Outlets
No. of Switch outlets
No. of Ranges
I
No. of Disposals
No. Of Dishwashers
No. of Dryers
Swimming Pcoi Abcve—
In-
grna. —
grna.
No. of Oil Surners
'No. of Gas Bumers
No. Ct Air C--r.c. 'Otal
!Cns
No.of Heat Toai
Purncs
--oiai
7ons
KW
SoaceiArea 4eatma
KVJ
Heating Covices
K`W
.4 No. of 140. 31
No. at Water Heaters KW Signs aad'as:s
0 -
No. Hyaro Massage "iubs No. of motcrs --Otal HP
OTHER:
Generators KVA
No. of Emergency Lighting,
Battery Units
FIRE ALARMS No. at Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Saill Contained
DelectionlSounaing Devices
Local Municipal 7 Other
connection �—
Low Voltage
Wiring
INSURANCE FCVERAG-� Pursuant a the recuirements ;f %Iassacnisers ;eneral Laws
Af
I have a current Liaoility Insurance Policy incluaing C i -X� atec Ccerations Coverage of its substantial equivaient. YES = NO
have_.Au,o.M, I t h "
Loac vau proo a same to 1 9 0 'Ice. YES ;KZ 140 It -ou have ChOCK643 YES. please indicate the typ
covem cy
(VRMg-th a moriate box. go
,U 11
N�S ZINICOF. BOND = OTHER = (Please Scec:!-4) sx/ A P
(Expiration Ostel
Estimated value of E!sctncal Work S
Work to Stan Insoocnon Date Aacueszec: Rougn Final
Signeo un*aer Me naities at egury: r
FIRM NAME 4 LIC. NO.
Licensee S;gna:ure -T�7�- --UC. 140.
Address us. Tol. No. ,2 -E7= -Z
Alt. Tel. No,
OWNER4 INSURANCE WAIVER: I am aware if n a, to/ ins insurance coverage or its substantial equivalent as rio-
Quireo by Massacnuse ' its General Laws. ano that my signature an :nis :�ermit aopsication waives this requirement. Own* Agent
iPlease chocK onel- 7
7oteonone No. PERMIT FES It
(Signature of Own*r or Agenti X4545
Date. .
"ORTh
A
TOWN OF NORTH ANDOVER
0
41
PERMIT FOR GAS INSTALLATION
SACH 5
This certifies that
'has permission for gas installation ...........
in the buildin-g§ of .................
North Andover, Mass.
Feex:--Y-��. Lic
N' . ..........................
GASINSPECTOR
_:)�Jheck#
won,
U
T.... W-' '-**---' '- -"" - -' ' - '-#" 'G;r%'vlll 1 %.1 UV
(print or yp I
A/64 kvbvev- Mass.., Date Permit
w
y /ne
f:a� _
Building Location
Owne s Name Buj(�O_MarA
Type of Occupam
Newo Renovation 0 R epl acernenW �
Plans Submitted: Yeso Noo
Installing-CoM an, Check one: Certificate
Business Telephone 97L 1412- aQJAQ
0 Corporation
0 Partnership
Name ofLicensed Plumber orGaS Fitter fflu Aw-
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its subs tantlal equivalent which meets the requirements of MOL Ch. 142.
Yes No 0
If )�ou have Checked yes, please Indicate the type of coverage by checking the appropriate box.
A liability Insurance policy Other type oF Indemnity 0 Bond 0
OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter
142 of the Mass. General Laws, and that my signature on this permit aFp-llcation vialves; this requirement
Signature of Owner or Owners Agent
Check one -
Owner 0 Agent 0
I hereby certify that all of the details and Information I have submitted (or enterecil In above application are true and accurate to the best oF
my knovAedge and that all plumbing work and Ins tallations performed under the permitIssuedfor this application vAll be In compliance vAth
all pertinent provisions of the Massachusetts State Gas Code andChapter 142 of theCene7�7
L '��e
Type of License:
By yPlumber Signa—turerol[L �CmedPlumberorGas r
Title c) Gasfitter
City/Town 0 Master Lkens e Number--
kPPROVED (OFFICE USE ONLY) ourneyman
�:;'A
Mmmeo
Installing-CoM an, Check one: Certificate
Business Telephone 97L 1412- aQJAQ
0 Corporation
0 Partnership
Name ofLicensed Plumber orGaS Fitter fflu Aw-
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its subs tantlal equivalent which meets the requirements of MOL Ch. 142.
Yes No 0
If )�ou have Checked yes, please Indicate the type of coverage by checking the appropriate box.
A liability Insurance policy Other type oF Indemnity 0 Bond 0
OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter
142 of the Mass. General Laws, and that my signature on this permit aFp-llcation vialves; this requirement
Signature of Owner or Owners Agent
Check one -
Owner 0 Agent 0
I hereby certify that all of the details and Information I have submitted (or enterecil In above application are true and accurate to the best oF
my knovAedge and that all plumbing work and Ins tallations performed under the permitIssuedfor this application vAll be In compliance vAth
all pertinent provisions of the Massachusetts State Gas Code andChapter 142 of theCene7�7
L '��e
Type of License:
By yPlumber Signa—turerol[L �CmedPlumberorGas r
Title c) Gasfitter
City/Town 0 Master Lkens e Number--
kPPROVED (OFFICE USE ONLY) ourneyman
�:;'A
Date ........ .. .... .
P' 1155
4,
TOWN OF NORTIK ANDOVER,
0
iFO
PERMIT. R -,WIRING
SACHUS
This certifies that ....... .......
....................
has permission to perform .... .......
wiring in the building of ... .......... T'U . C1( -.S...
7 7
C Ik dI/ led
a ........ i .............. North Andove't, M.
t ...........
R
WHITE: Applicant, CANARY: Building Dept. PINK: Trels'ur�er
oca ion
t
Date
TOWN OF -NORTH ANDOVER
Certificate of Occupancy $
Buildi,ng/Frame Permit Fee $
Y: ---Foundation Permit Fee $
CHU
'Othef Perim4itee $ C) Q
Sewer Connection Fee
Water Connection Fee
MJAY
�aAL $ �,c
Building Inspector
_'�7 2 4r Div. Public Works
.4ocation
NO. Date
TOWN OF NORTH ANUOVEK
Certificate of Occupancy $ 4�=L !�V
Building/Frame Permit Fee $ 1h ;r 7.
Foundation Permit Fee
Oth6r Permit Fee $
VVVVI V""CL, V" V
Water Connection Fee $
TOTAL $
-Bulfrding Inspector
194
09:42 1,037.50 PAID
Div. PublicWorks
As
Locatlon,�;2
ONO. —/9
Date
'hoRT",
TOWN.,OF NORTH ANDOVER
0
Certificate of Occupancy $
.............
Building/Frame Permit Fee
Foundation Permit Fee $ Ad
Other Permit Fee $ . ....
Sewer Connection Fee,
Water Connection Fee $
TOTAL
1.2
-Y0000v
—1 Sper
Building A Ctor
7120
Div. Public Works
6924
Other Permit Fee
Sewer Connection Fee $
Water Connection Fee $ /&0
TOTAL
s
Bugii;)di g Inspecto
"o
bi 0/lubfic Works
Location
No.
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Fratne P-eirmit Fee $
Foundation Permit Fee $
6924
Other Permit Fee
Sewer Connection Fee $
Water Connection Fee $ /&0
TOTAL
s
Bugii;)di g Inspecto
"o
bi 0/lubfic Works
PEWMIT NO._
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
%
� &, PAGr
MAP 4-40.
(o-2—
LOT NO.
2 RECORD OF OWNERSHIP 16ATE
I
BOOK
;PAGE
ZONE
SUB DIV. LOT NO.
p
Ta m IATq A De v - Cxtv - olpilqq
LOCATIO
�2,6 6 66,,, 111 U
PURPOSE-bF BUILDING I 'Sj�/e
_ FaQ A
OWNER'S NAME I a r&'Tet"q'k -L)-Dk,-,InwA c
4� -
NO. OF STORIES 'c/
f till'
OWNER'S ADDRESS
BASEMENT OR SLAB &5P-,Ke4
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND
3RD t. -
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
Z--� 6 P.T.
DISTANCE FROM STREET
POSTS
-3 S C Lc, lly
DISTANCE FROM LOT LINES - SIDES Z(q/ + REAR
GIRDERS( V
q) 10.
AREA OF LOT gqel FRONTAGE j-33,-
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW 2 �� -5
SIZE OF FOOTING Zi-l'l x
IS BUILDING ADDITION po
MATER:AL OF CHIMNEY '6R I ce
IS BUILDING ALTERATION i,'Jo
IS BUILDING ON SOLID OR FILLED LAND s
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
/ "es
IS BUILDING CONNECTED TO TOWN WATER 1XIF -s
BOARD OF APPEALS ACTION. IF ANY �jo
IS BUILDING CONNECTED TO TOWN SEWER �111-5
IS BUIL DI NG CONNECTED TO NATURAL GAS LINE ?6's
INSTRUCTIONS
SEE BOTH 61DES fa a2z
Bm. MMIT
PAGE I FILL OUT SECTIONS I - 3 titS FM FEF -
PAGE 2 FILL OUT SECTIONS I - 12 DUE FRAME PERMIT $14-1 �,-
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
OF OWOOR OR AUTHORIZED
F E E 1417/3 21 s- 0
4vft/w'r'0 1 ej C)
.PERMIT GRANTED
19
T �7
OVMER TEL 91- x
CONTR. TEL.,
CONTR. LIC. #44;��
3 PROPERTY INFORMATION
LAND COST oa-)-.4a' 0
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.'
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
�e�
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
51111110-
q
RUALDING RECORD
12
I OCCUPANCY'
�.INGLE FAMILY S FROM
THIS SECTION MUST SHOW EXACT�DIMENSIQN ' OF LOT A ' ND,DISTA
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS_OF BUlLDINd!S; WIT14-1*61RCHES. GA -
APARTMENTS .RAGES. ETC. SUPERIMPOSED. THIS RE . PLACESPLoT.�PLAN,.-.�
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE 3 1 .2 13
CONCRETE BL K. INE f
BRICK OR STONE HARDW D
PIERS PLASTER'
DRY WALL
UNFIN. oe
3 BASEMENT
AREA FULL FIN. B M*T AREA
J/, FIN. ATTIC AREA
t!C) 8 M T FIRE PLACES
HEAD ROOM MODERN KITCHEN
4 WALLS FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE
WOOD SHINGLES EARTH
ASPHALT SIDING HARDI'J D
ASBESTOS SIDING COMIAGN
VERT. SIDING ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME, '131 T:ll
BRICK ON, MASONRY ATTIC STRS. & FLOOR
BRICK ON FRAME
CONC. OR CINDER -BLK. AS Z?,3J
STONE ON -MA�ONRY WIRING
STONE 6NL FR4ME TV 1134 3MAR! 3110
SUPERIOR P2�2�R
P _ —
NONE
IDEQUATE 11 H
5 ROOF 10 PLUMBING
GA �EXZ H I P BATH (3 FIX.)
GAMBREL] MANSARD TOILET RM. (2 FIX.)
FLAT SHED WATER CLOSET
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING
TAR & GRAVEL STALL SHOWER
ROLL ROOFING MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
e,
0 -
11 HEATING
WOOD JOIST
Noor
PIPELESS FURNACE
FORCED HOT All FURN.
TIMBER—%ZV-�& COLS.
STEAM
STEEL EMS. 14�
HOT W T'R OR VAPOR
WOOD RA TERS-
AIR CONDITIONING�
7 NO. OF ROOMS
RADIANT H'T'G
UNIT HEATERS
AS
OIL
��CTRIC
B -M T 2�d
�111� I -L3 'd
I NO HEATING
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*****************
APP LICANT: .7
-a Lo mek -1:11�6rct(L - Phone
LOCATION: Assessor's Map Number Parcel
Subdivision t Lot(s)
Street �11' I St. Number 7-66
61
************************Official Use Only************************
RECOMMEND TIONS OF TOW" AGENTS:
ti i tor Date Approved
Conserva on Admin stra Date Rejected
Comments
tE Date Approved .
Town Planner Date Rejectea
Comments
Date Approved
Health Agent Date Rejected
Comments
Public Works - sewer/water connections---...--'
- driveway permit
Fire Department
U
Received by Building'Inspector
Date
FROpOSED SITE PLAM
Uo-r 2-1 �tCKORY HILL NPAD
40
H 14 Ll
06W-27 182-06
Lor 2R
21,844 S.
S O9fO2L31"E -t407/7
a
60. '*� �-
Wc-0 -A41 L L-
:4.954'
ES
V4
Q
I OT 28
CERTIFIED FOUNDA TION PLAN
L OCA TED IN - NO, A NDO VER p MA.
SCALE-: /"".= 40' DATE: 4128194
Scott L. GlIes R. L. 5
50 Deer Meadow Road
North Andover, Mass.
12500 1
HICKORY
HILL
ROAD
LOT 30
MAY 2 W4
CERTIFY THAT OFFSE TS SHO WN A RE FOR THE USE
THE OFFSETS OF THE SUIL DING INSPEC TOR ONL Y
SHOWN COMPLY AND SUCH LISE IS FOR THE
WITH THE ZONING DETERMINATION OFZONING 13M
SY LAWS OF CONF-ORA41TY OR NON -CONFORMITY tm
NO. A NDO L�M WHEN CONSTRUCTED. uu_
WHEN SUIL T 4128194
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CHIMNEY A1111LICAHON ANO VERAll f
WS I �-
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OMER I S� NAME:
If LVER'S NAME: 4.0 lZA0
:kSON'S NAME:
kSON'SAVDRESS:
�SOWS TELEPHONE:
:1ERIAL OF CHIMNEY: Z5n6� t 8/"
irERIOR CHIMNEV:- EXIERIOR CIIIA114EV:
ll�iBER AND SIZE OF FLUES:
(ICKNESS OF HEARTH:
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-GRATURE OF blASON
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_RMIT GRANTED:
IBERT NICETTA
fILDING INSPECTOR
SPECTEV:
11ARKS:
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PERMIT NO. !!fs !f --
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. I /
PAGE I
MAP 44O.jq,&
LOT NO. pj 71 5
2 RECORD OF OWNERSHIP DATE
-
BOOK '.PAGE
ZON E
SUB DIV. LOT NO.
I F
LOCATION
PURPOSE OF BUILDING M
OWNEW'S'NAME
NO. OF STORIES SIZE
OWNER'S ADDRE!;S Z '/66
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME Vezripj
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
POSTS
DISTANCE FROM STREET
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
IS BUILDING ADDITION yo
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION rikp-
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF�CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS I - 3
PAGE 2 FILL OUT SECTIONS I - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED 9 - -Z, -7 -!j -7
SIGNATURE -OF.OWNER OR
F E E oec 4 --
PERMIT GRANTED.,,/
3 19
I/
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST T,14n, 7z,
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BUILDING INSPUCTOR
OWNER TEL. # IAS -E)S-09z.
CONTR. TEL. # G5 i —s ZZ)
CONTR. LIC. # 45 65? ?, gg-
H.I.C. #
BUILDING RECORD
OCCUPANCY 12
71
SINGLE FAMILY I—ISIORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROt4
MULTI. FAMILY 1_10FFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA -
APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REP I LAC ES I�LOT.JPLAN.
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
3 1 2 13
PINE k
CONCRETE
CONCRETE BL'K
BRICK OR STONE
_HA`RD_W _D
PIERS
PLASTER
DRY WALL
UNFIN.
3 BASEMENT
AREA FULL
FIN. B M'T' AREA
1/1 V2
FIN.'ATTIC AREA'
t!C, 8 M T
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS
9 FLOORS
CLAPBOARDS
DROP SIDING
WOOD SHINGLES
B
1
2 3
CONCRETE
EARTH
HARDW D
COMMGN
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_MPH -TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
ATTIC STRS. 8
BRICK ON FRAME
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIO POOR
TE NONE
ADEQUA! ' I
5 ROOF
10 PLUMBING
GABLE
BATH (3 FIX.)
GAMBRELl
I
-dip
MANSARD
TOILET RM. (2 FIX.)
FL -ATI
SHED
'WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD $HINGES
KITCHEWSINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COILS.
STEAM
STEEL SMS. &-COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
AS
L
[ElLiCTRIC
B'M'T 2nd
I st I 3rd 11
NO HEATING
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