HomeMy WebLinkAboutMiscellaneous - 27 BUCKLIN ROAD 4/30/2018C:
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Date.....................
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that:A.�/L C. 6PP"-JC.Q--
...........
has permission for gas installati ..... !71:�
in the buildings of ........... .. . ..........................
............. I North Andover, Mass.
at .4>)
Fee-.--�:qP. Lic. NoA-�'� Ub .......................
GASINSPECTOR
Check #OeV
8189
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY L&gT -L Z— MA DATE PERMIT #
JOBSITE ADDRESS ]OWNER'S NAMEF WOOD
GOWNER
ADDRESS -1 TELI' FAXI
TYPE OR
PRINT
OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
El
CLEARLY
NEW:Fl- RENOVATION: D -J REPLACEMENT: 211� PLANS SUBMIT -TED: YES D NO
APPLIANCES -1 FLOORS- BSM 1 2 3 4— 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOKSTOVE LJ
DIRECT VENT HEATER
DRYER
FIREPLACE F—I I
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST I I J
UNIT HEATER . . . . . - - - - -
UNVENTED ROOM HEATER
WATER HEATER
—ER
—dT
H F LLj
I---- F -
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES JUINo Ell
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY B/— OTHER TYPE INDEMNITY E] B 0 N D
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER Of AGENT 0
SIGNATURE OF OWNER OR AGENT
—Fh—ereby
certify that all of the details and information I have submitted or entered regarding this application are true and a
jQcurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in comp��/ t-pre�vi f th
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBE Ile
7-GASFITTER NAME LICENSE SIGNATURE
IMP M F 0 JP JGF LPGIE: j! #
J] CORPORATIONF PARTNERSHIP El#= LLC [J--#
COMPANY NAME: DRESS
1AD j_.j.Q y,
CITY ZIP TEL
STATE _j
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The Commonwealth ofMassachusetts
Department of IndustrlqlAccidi�ts
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeLyibly
Name (Business/Organizatiordlndividual):_ 6- CC- PLwt- Pl-(,
6 X� lnr�
Address: 0,1
City/State/Zip: ��U,9L�LICP� Phone 70ac�
Are you an employer? Check the appropriate box:
LEI I am a employer with
4. El I am a general contractor and I
employees (fall and/or part-time).*
have hired the sub -contractors
2. F1 I am a sole proprietor or partner-
listed on the attached sheet. I
ship and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. *insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3. 0 1 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.]
Type of project (required):
6. El New con.struction
7. FJ Remodeling
8. E] Demolition
9. n Building addition
10.E1 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roof repairs
13.[5jOther fjA
*Any applicant that checks box#1 must also fill outthe section below showingtheir workers' compensation policy information.
Al Homeowners who submit this affidavit indicating they Aire 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.
lam an employer that isproviding workers'compensafion insurancefor my employees. Below is thepolicy andjob site
information. I
Insurance Company Name;
Policy # or Self -ins. Lie. 9: SY4 0a \_ Expiration Date:
Job Site Address:— 9:7 6v(_Y_t_,,j C tate/Zip: f0a AJmvQl 94-�_
r ity/S
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 well as 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.
I do hereby certify under thepains andpenalfles ofperjury that the information provided above is true and correct.
Signature: Date:
Phone#:
Qfjlcial use only. Do not write in this area, to he completed by city or town offlclaL
City or Town:
Permit/License 9.
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
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 ofhire,.
express or implied, oral or written."
An employer1s defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint 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 lo'cal licensing agency shall withhold the issuance or
renewal of a license or permit 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 requ - ired."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into 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-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ 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 does have
employees, a policy is * required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance 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 Eno.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided 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 submit multiple 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. A new affidavit must be fille * d out each
year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture
(i.e. a dog license or p* ermit 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:
The Commonwalth of Massachusetts
DePartment of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
.Tel, # 617-727-4900 oxt 406 or 1-877�,MASSAFE
Revised 5-26-05 Fax # 617-727-7749
_.WWW.MQss,goV1dJa,
Date. . i�hA� .........
04 TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
010
This certifies that .................
has permission for gas installatior, .. .6pk . 7�
in the buildings of .... lelm� ..............................
at .... No:rlh An ver.,�ass.
Fee..�7,�P Lic. No..D!V6�.
GASINSPECTOR
Check #
MAU
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY MA DATE _QYU / PERMIT#
JOBSITE ADDRESS OWNER'S NAME tL, oad
GOWNER
ADDRESS I TEIf-7____
TYPE OR
PRINT
OCCUPANCY TYPE COMMERCIAL 01 EDUCATIONAL E] RESIDENTIAL
CLEARLY
NEW: El RENOVATION: El REPLACEMENT: F—R' PLANS SUBMITTED: YES Ej No E]
APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER L
---j
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER . . . . . . . . . .
DRYER
FIREPLACE
FRYOLATOR
FURNACE . . . . . . . . . . .
GENERATOR
GRILLE L=
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
LINVENTED ROOM HEATER
WATER HEATER
H —ER
if F
INSURANCE COVERAGE
I have a current liabili!y insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES 1PNO El
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE Box BELOW
LIABILITY INSURANCE POLICY � OTHER TYPE INDEMNITY [] BOND
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER Ej AGENT E—J—j
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true —and accu-rate to the be t f knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in comp '!�&cith all ?prtinenWrovlsTiy f the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUM BER-GASFITTE R NAME D LICENSE # VSIGNATURE
N4P El MGF Eli JP JGF LPG1 E] CORPORATION [a# PARTNERSHIP D# LLC [,3#
COMPANY NAMEIKi�,� ADDRESS
CITY STATE ZIP 0
F-114 [&/Ej
--j�—TEL
FAX CELQ� IL
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The Commonwealth of Massachusetts
Department of IndustrialAccidints
Office of Investigations
600 Washington Street
Boston, MA 02111
Ut www.mass.govIdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
City/State/Zip;
Phone 4:
Are you an employer? Check the appropriate box:
El I am a employer with
4. 1 am a general contractor and I
employees (fall and/or part-time),*
have hired the sub -contractors
2. El 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.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3. El 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.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. El New construction. '
7. E] Remodeling
8. 0 Demolition
9. El Building addition
10. F1 Electrical repairs or additions
1 LEI Plumbing repairs or additions
12.F] Roof repairs
13. Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy info ation.
im
T Homeowners who submit this affidavit indicating they Aire doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that cheekthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
Iam an employer that 1sproviding workers'conpensation insuranceformy employees. Below is thepolicy andjob site
information.
Insurance Company Name;
Policy # or Self -ins. Lie.
Expiration Date;
Job Site Address: City/State/ZiD:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requireclunder 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 well as 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cero under thepains andpenalfies ofperjury that the information provided above is true and correct.
Signature: Date:
OfJI-clal use only. Do not write in this area, to he completed by city or town officiaL
City or Town:
Permit/License 9.
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
Information and Instructions -
Massachusetts Oeneral 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 oihire,.
express or implied, oral or written."
An employerIs defiried as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint 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 permit 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 commonwealthiror any of its political subdivisions shall
enter into 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-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ 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 does have
employees, a policy is. required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance 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 Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided 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 submit multiple 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. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or*permit not related to any business or commercial venture
(i.e. a dog license or permit 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 Commonwoalth. of Mossac-husetts
Department ofladustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
TQL # 617-727-4900 cxt 406 or 1-877rMASSAFF,
Revised 5-26-05 Fax # 617-727-7749
wwwmass.gov/dia
40RTH
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D a t e—: Ofl� �
TOWN OF NORTH ANDOVER
This certifies thatx—,.-vw'�I
has permission to perform
plumbin the buildings of
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Fee Lic. No.
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6358
PERMIT FOR PLUMBING
SS.
MASSACHU El I UNIF0RM APPLICA
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AMA .. 7;r, /n
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FOR PE.R1MIT TO DO PLUMBING
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
.*11 ID
OU
This certifies that Z-1
I
..... ..... I ........ I .
has permission for gas installation
in the buildings of . VZ -rt. ........... .........
I Z Mass.
at r,�7,&�- ZtY-, L - -/. . North Andover,
Fee4��� Lic. No. 1,3114�4 11Z . .
T�OR?zklvl,
1� Check #.. L A/w
"5,1 0 5 7
-as zubstanW�equhwefCwhlch-,meeu, the ',Ck.
requlrem&t&.O(-UGL- -142-,
U F
ff Yoveae clhee:::�;�O ='Or
Owlypeimvmge.
by, Oxx*kV 'Appmpirldezbox
aw
A lIaWky.knuranOe,)OQr
y OUWIYP e-OL-IrKlemnityll. Bond [I
OWNER'S INSURAtCE
MAIM:I U* the ficermeg. MM2Lh
thage�r j42*'d(-the.A4asL- A _avp - Vw Irtafrancecoverage required -by.
Gem �-LAiM-&Wlhd�MYSIgn8kwe-ontgtpennitappocationwabmst�isrequr&
menL
Check one:
OwnerO Agert,O
Ahs(ebycw*-
bww'O aW=WOn ank bw and accuraw
Q6 and Mat All PlumbbV wa(k and kutapabo(w (Or Onto" in above i -to,dw best of my.
pertkWA wavwam of Pubmed under the Pernlitft'sued tor ftaW46M will
tM MauighUSW3 SUft Gas Code and ChaPter 142'Of the Gwow-,L&*,L be in cm0anog wwt at
T a of tk*nsc .......... w
rMe plurnber natum of
---------- Gasfifter
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MY,/,T(Pwn Lkense Nmtw
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MCI
10
Location C?
No
Date 9 ZZ
j0RTjj
TOWN OF NORTH ANDOVER
0 4 "10
0 Certificate of Occupancy $
Building/Frame Permit Fee $
e $
Foundation Permit Fe
C
Other Permit Fee
jewer Connection Fee
Vt.
bection Fee J'Y
Water Con $
TOTAL
buildirig inspecfor'
7036
Div. Public Works
L--ocation 22 4Z.,
NO. Date
V44ORTN
Of
TOWN OF NORTH ANDOVER
,go, +
Certificate of Occupancy
s
Building/Frame Permit Fee
$
v .2 CHUS
Foundation Permit Fee
Other Permit Fee
Sewer Connection Fee
Water Connection Fee
TOTAL
02/02/% 09:%
Building Inspector
150. 00 PAID
Div. Public Works
Location Z7
No. Q d Date /—Z
TOWN OF NORTH ANDOVER
Cerfil7cate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
.4p
6:3.3 Sewer Connection Fee $ /02P
3Z(o Water Connection Fee $ = et
$ el
Buitaling In ector
1,000.00 —P;A—�
Qjv'. PX11c Works
- --TOTAL
"002-00 -PA102/02/94 09:56
6918
PER 11---Z N: APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE I
MAP +40.
LOT NO.
12 RECORD OF OWNERSHIP IDATE
PAGE I FILL OUT SECTIONS I - 3
BOOK ;PAGE
ZONE
SUB DIV. LOT NO
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
F—
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
LOCATIONAho,.l '1'1.ja1V
DATE FILED
PURPOSE F BUILDING
0
OWNER'S NAME h
11
NO. OF STORIES SIZE
OWNER'S ADDRESS r� 3 3 Tu v-
37
BASEMENT OR SLAB e
ARCHITECT*S NAME
rd' 'p, 7'-ec-riA r --e
els, 'y
SIZE OF FLOOR TIMBERS IST 2ND
3RD 10'
-A
BUILDER'S NAME =le!b ji4 dIR
SPAN
DISTANCE TO NEAREST BUILDING zo
DIMENSIONS OF SILLS yx
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES
REAR Ir 7
GIRDERS
AREA OF LOT 5:2"
FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
15 BUILDING NEW
SIZE OF FOOTING x
'p V��
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
11es
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
'tve 5, -
IS BUILDING CONNECTED TO NATURAL GAS LINE
I/ -e.5
INSTRUCTIONS
SEE BOTH SIDES
= Fmff ware
PAGE I FILL OUT SECTIONS I - 3
PAGE 2 FILL OUT SECTIONS I - 12
ME FWE POMIT $
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
F E E
PERMIT GRANW/W L5 49
mo
[13tMOOM DOMMENT
OWNER TEL.
CONTR. TEL.
CONTR. LIC.
m
3 PROPERTY INFORMATION
LAND COST
EST. 81 DG. COST
EST. BLDG. COST PER SQ. `FT.Zg4
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
Y�
BOARD OF HEALTH
X PLANNING BOARD
BOARD OF SELECTMEN
NUILDFRG -1N8PECTOR
SINGLE FAMILY
S;ORIES
MULTI. FAMIL'
L&FICES
APARTMENTS
CONSTR,UCTION
2 FOUNDATION
;rl
8 INTERIOR
FINISH
CONCRETE
PINE
HARDW D
a.
11
-XV
2 13
CONCRETE BL K
BRICK OR STONE
PIERS
TASTER
D__
lY WALL
NFN
3 BASEMENT -
AREA FULL B M T AREA
14 1/2 1/1
_�FIN.
IN. ATTIC AREA
�LO B M T
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 W�ALLS
9 FLOORS
CLAPBOARDS 111"Vt
CONCRETE
EARTH
HARDW D
COMtACN
ASPH. TILE
1
2
3
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
STUCCO ON MASONRY
STUCCO ON FRAME
11
BRICK ON MASONRY
ATTIC STIRS. & FLOOR
BRICK ON FRAME , ..
I—
CONC. OR CINDER EILK.
WIRING
STONE, ON MASONR.Y,
STONE ON FRAME
SUPERIOR 1 .1 P0OR__J_
DEQUATE IX I NONE 1
10 PLUMBING
BATH Q FIX]
5 ROOF
GABL: I HIP
MBREL MANSARD
�_LATI� SHED
TOILET RM. (2 FIX.)
WATER CLOSET
ASPHALT_ SHINGLES
LAVATORY
WOOD SHINGE§
ox
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
WOOD JOIST
11 HEATING
PIPELESS FURNACE
FORCED HOT AIR FURN.
_E0
TIMBER BMS. & LS.
STEAM
STEEL EMS. & COLS.
HOT W T R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H*T G
UNIT HEATERS
7 NO. OF ROOMS
I AS
'L
B M T 2�d
3,d
EECTRIC
I NO HEATING
'THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. Wli-A'-PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN �7-
............
C
fain
TLIRMAIng ONT(I.M,
L . — J02
FORM U - LOT RELEASE F0R)(
INSTRUCTIONS: This form is used to verify that all necessaxy
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*****************
APPLICANT: ai /k, Aw A ZL
42 Phone
LOCATION: Assessorls Map Number
Subdiv . ision Aeo 4 -&JO -6w
Street
Parcel
Lot (a)
St. Number
************************Official use only************************
REComMNDATI,01g; OF TOWN AGENTS:
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Conservation Administrator
Comments
-WR wjy� 9
Town Planner
Comments
JV 4
Health Agent
Comments
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Date Approved
Date Rejected
Date Approved I
Date Rejected
Date Approved
Date Rejected
Public Works - sewer/water connections
- driveway pemiit
; Z, <
Fire Department
Received by Building Inspector
Date
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number 022 Date APRTT, 2s, 1 qq4
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 27 BUCKLIN ROAD - Lot #8 (lype D)
MAY BE OCCUPIED AS SINGIF FAMTLY DwETj.iNc, W/j cAg GARAGEIN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
fO'�
CERTIFICATE ISSUED TO Hillside Realty Trust
733 Turnpike St.
ADDRESS -North Andnyt-r, MA
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