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North Andover Board of Assessors
�4roperty Record Card
Parcel ID :210/045.B-001 1-0000.0 FY:2013 Community: North Andover
SKETCH PHOTO
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116
27 ADALMS AVENUE
iic/T)Pr)'PA'DT) /A; o.ln- A A -- 1 /1 n/)1)1'1
acation: 27 ADAMS AVENUE
wrier Name: LY, HUNG SAU
DIJONG KIM LEE
wrier Address: 27 ADAMS AVENUE
City: NORTH ANDOVER State: MA
Zip: 01845_
eighborhood: 5 - 5 Land Area:
0.11 acres
se Code: 101-SNGL-FAM-RES Total Finished Area:
2088 sq!L_
ASSESSMENTS CURRENTYEAR PREVIOUS YEAR
Dtal Value: 288,500
269,500
uilding Value: 143,300
122,200
and Value: 145,200
147,300
larket Land Value: 145,200
hapter Land Value:
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7565 Date. //�� 11� ..........
TOWN OF NORTH ANDOVER
10
X PERMIT FOR GAS INSTALLATION
This certifies that ..... ............
has permission for gas installation ..... // /) ..................
in the buildings of .... ....................................
at North -Andover, Mass,
Fee -07 Lic. No... ...... .....
GAS INSPECTOR
Check#— 1�tY2 )
1�
MASSACHUSErIS UNIFORM APPUCATON FOR PERNHr TO DO GAS FfrnNG
(Type or print) Date 1_2 —A 611
NORTH ANDOVER., MASSACHUSYTTS I
Building Locations 7 Ad #4 J AW Permit #
I Amount
Lv —Owner's Name
New Renovation Replacement Plans Submitted F1
(Print or type) Qhecl/rone: CertificALe Installing Company
Name #V -A //4 tccA-wo Corp. /7JW
Address CAJ-es� P41 er Partner.
6—\" Firm/Co.
Business Telephone Cf-) YU El
Name of Licensed Plumber or Gas Fitter 6u, //,/"
[INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked yes, pleasiYindicate the type coverage by checking the appropriate box.
L Ll
. ity j ur
iability insurance policy Other type of indemnity Bond
,I P 1 0 C
Owner's Insurance 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 pennit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent
I hereby certify that all of the details and inlormation j nave suomitica kor enEerea) in aouve appivation aut; Lruc anu accurate LO Ene
best of my knowledge and that all plumbing work and installations perfo un er Permit Issued for this application will be in
u
compliance with all pertinent provisions of the Massacht ;7oNdean C�a/er 142 of the General Laws.
.wtts State
- I I j
JBY: .1
City/Town
[APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
4e
Plumber a f
161 r
Gas Fitter Liceifse Number
Master
Jourricyrnan
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SUR -BASEMENT
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PORBASEMENT
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(Print or type) Qhecl/rone: CertificALe Installing Company
Name #V -A //4 tccA-wo Corp. /7JW
Address CAJ-es� P41 er Partner.
6—\" Firm/Co.
Business Telephone Cf-) YU El
Name of Licensed Plumber or Gas Fitter 6u, //,/"
[INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked yes, pleasiYindicate the type coverage by checking the appropriate box.
L Ll
. ity j ur
iability insurance policy Other type of indemnity Bond
,I P 1 0 C
Owner's Insurance 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 pennit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent
I hereby certify that all of the details and inlormation j nave suomitica kor enEerea) in aouve appivation aut; Lruc anu accurate LO Ene
best of my knowledge and that all plumbing work and installations perfo un er Permit Issued for this application will be in
u
compliance with all pertinent provisions of the Massacht ;7oNdean C�a/er 142 of the General Laws.
.wtts State
- I I j
JBY: .1
City/Town
[APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
4e
Plumber a f
161 r
Gas Fitter Liceifse Number
Master
Jourricyrnan
.1"
14ORYPI
$A HUS
Date. . 41 - t�—. 2 'ge-,
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
I
This certifies that .......... .- .........
has permission to perform .... A"
plumbing in the buildings of ............
a,. .......................... North Andover, Mass.
V
Fee.c�'� . . 4. �'. � PJ0
... Lic. No .... .......
P L"'
UMBINGJIN-�-'-PtECT R
Check# 71-3 45
------51 UG.7----- -
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS Date
Building Location, Permit#
Owner Amount
New FM Renovation Replacement Plans Submitted Yes No
�Q� 1:1 1:1 El
FIXTURES
(Print or type) Check one: Certificate
Installing Company Nam t1,24VY Corp. 30-()6LA3(0(10
&D S� ', 4re� 'Sj --L Partner.
�Q),)��Y-6:W 10�-, InA)5-31
Business'lelephone I (r. P-) ?Oq - 'Q50 0 Firm/Co.
Name of Licensed Plumber: ---Tb5P-c1 W T oL3
Insurance Coverage: Indicate the type 6f insurance coverage by checking the appropriate box:
Liability insurance policy 0 Other type of indemnity El Bond
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By:
Signature or Licensea rulmoer
Type of Plumbing License
Title
City/Town Mcense iNumFer Master Journeyman
APPROVED (OFFICE USE ONLY
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
RENOVAT&
APPLICATION TO CONSTRUCT !FAI OR DEMOLISH A ONE OR TWO FAMILY DWELLING
ow
BUILDING PERMrr NUMBER: DATE ISSUED:
SIGNATURE
Building Colnmissioner/IR�Lwor of Buildings Date
SECTION I- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
IS,41FNurtiber Prrc
V, o'
1.3 Zoning InformaLion:
Zoning District Proposed Use
1.4 Property Dimensions:
(9f) Frontage (1)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard Rear Yard
Required Provide ReqWred Provided Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infannation: 1.9 Sewerap Disposal System
Public 0 private 0 zone Outside F" Zone 0 Municipal 0 On Site Disposal System 0
- ' /,?
SEICTION2-PROPFRTYOWNF,RSEIIP/AUTHORMDAC-ENT NI 3 —No
2.1 Owner of Record
ffA"6)& -S�,46t 7 A P, 5 g
Name (Print) rvice:
- -�' �- '2-- ^\ 4 -3
,
SILgiiaiure
Telephone
2 Owner of Record:
Name Print Address for Service:
Si re Telephone
ISECTION 3 - CONSTRUCTION SERVICES A
#3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not ApplicabT
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable D
company Name
Registration Number
Address
Expiration Date
Signature Telephone
00
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I SECTION 4 - WORKERS COMPENSATION (XG.L C 152 6 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application- Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....... 0 No ....... 0
SECTIONS DescriEtion Proposed Work (ch"eck aqWk-abk)
New Constrpction 0
k�Exijting Building 0
Repair(s) 0
Alterations(s) 0
Addition 0
AccessoryBIdg.-
0 Specify
f
Brief De I ption o Proposed Work:
inq
SECTION 6 - ESTMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by penrut applicant
OMCLAL USE ONLY
I . Building
(a) Building Pennit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1 +2+3+4+5) '�Y
Check Number
SECTION 7a OWNER AUTHORIrLATION TO BE COWLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERNHT
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,
I S=, \,I / --- s dAo Idi-
� —1guature of Ow_ne-r'�, I Date
SECTION7b OWNER/AUTHORIZEDAGFNTDECE—MATION
1, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Si ature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS iST 3ku
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION TIUCKNESS
SIZE OF FOOTING x
MATERIAL OF CHM-4EV
IS BUILDING ON SOLID OR FETED— LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Check # 014ps-
18364
Building Inspector
I Location
No. 00
Date
At
ony k
TOWN OF NORTH
ANDOVER
Certificate Occupancy
of
$
CH
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check # 014ps-
18364
Building Inspector
,40RTN
0
-Is c,"45
D. Robert Nicetta,
Building Commissioner
Please print
DATE: �Z30
I I
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 0 1845
HOMEOWNER LICENSE EXEMPTION
Telephone (978) 688-95454
Fax (978) 688-9542
JOB LOCATION: c� 7 /1 DIYIIS 4�16— 14AI� Y4h(PeV4--k
Number Street Address Map/LA
HOMEOWNER- Nu�i6 5AM (Y L?7!9) �'rbl--3-S,?2
Name Home Phone Work Phone
PRESENT MAILING ADDRESS c�j 49fiHS
I
�( � r4 xj "14 0 ( L� Vj
City Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to 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 HOMEOWNER
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 structures. A person who constructs more that one home in a two-year period shall not
be considered a homeowner .
The undersigned "homeowner" assumes responsibility for compliances 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 North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Ro.,kRI)OFAITEALS 698-9541 CONSE.RVATION 688-9530 111',A1,111 699-9540 111,ANNING o89-9535
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 IVIGL
c 11, S 150 A.
The debris will be disposed of in:
(Location of Facility)
Signatur of Permit A�plicant
bate
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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