HomeMy WebLinkAboutMiscellaneous - 28 MORRIS STREET 4/30/201800
cn
M
m
4
-7 - ?- 8P-6 A
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... T.c.). ... A.I. ............. lif-4�1f.7 ............
has permission to perform .......... P,9,0.z ......................................................
........ ....
wiring in the building of ....... �7 ............................
........ S..7 .............................. . North Andover, Mass.
Lic. No ........... ..................
Fee ....... q ... 5 ........... 0 .....
LECMICAL INS]
Check # 677
6830
I ThFC0A0J0AWE4LTH0Fg4MCHUSEM
DEP4RnXVToFpuBLICS4Fay Off-ce W, only
BOARD 0FFREPRDZM0NR5GU4170AS527ai fR 12-00 Pemlit No. 1?3 0
MI,
Occupancy & Fees Checked
(PLEASE
Town of
The undersigned applies for a permit to perform the electrical work described below. To the Insp r of Wire�
Location (Street & Number) I -
Owner or Tenant 1:7-- -ze A0 ra4k S- Ok-Tt� ATJ6 u er
) bscj2h- 9) 0 /'J 0 +�-/ 7
Owner's Address
Is this permit in conjunction with a building permit:
Purpose of Building I . Yes M NO (Check Appropriate Box)
17 - -�� )d I �/V
Existing Service 00 Utility Authori2ation No.
- Amps 12-0 7-0voits Overhead Underground No. of Meters
hLew —Servce -- Amps -61
Overhead Underground
Number of Feeders and Ampacity No. of Meters
Location and Nature of Proposed Electrical Work
- - 12v),J&
No. Lightin Outlets No. o- -UL I u0s
No. of Lighting Fixtures No. of _01unners
'wltmning t'001 Above Below Generators
No. 0 Receptacle outlets und G3 grourid KVA
No. lill Bourmners;
No, Switch utl ul cmcrgcncy Lighting Battery i s
No. or manges No. OfGas Burners ---------
No. ofAir Cond. Total FIRE ALARMS
No. of Heat Total Tons Total No. ofzones
— PUIMIDS Tons KW NO. Of Detection and
Space Area Utitiating Devices
KW NO. OfSounding Devices
'No. or uryers No. ofSelfContained
He DetectiOn/Sotinding Devices
No. KW Local Municipal Other'
No. of Connections
J'40- flYaro Massage Tubs Sits Bailasis
Total HP
0
k0mmCmerd9a R=antIDIhem#wzMdNhMdUetIsG—maW Lam
fhmeaamftLiahTdYfiwrd= Pckymdxk%CaTFiftOPwaborisCumagcrdsaksWWa;nWat
I have stinjilbd Vdid F1010fofsamelotheOThe YE N YES NO
WCPri*bcPL 0 ED ff�w havedxdzd YES, Pkm nkzlethv�,cfay,�byldl,,
BOND [D [7� WS,�,
Y)
E*afimD*
Wakfosba L Etm*dValuedTk&,CWWCtk S
SigWd undwTe L L-- kqieC"D*R0W—W R .. 0
44b . . -TI — FEW
GIVE
FIRMNAW 0 (ecf r I C OL
LbLmm *�4t4o- a6 /V
LiwwNo E
tLrm�l �d Bu�r= Td Nh 44-7
OWNER'S NSIJRANCEWAIVER, lam mmedlattheLimze LIL:� AkTdNh
kPlease check one) Owner 0 Agent ID
Telephone No. ----------_�PERMTT FEE,$
AL
Location
No. Date
01 14ORTN I TOWN OF NORTH ANDOVER
00 Certificate of occupancy $
Too Building/Frame Permit Fee $
MU
Foundation Permit Fee $
Other Permit Fee $
-44
TOTAL $
Check #,-21-1<3 --
1 6�;48 Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
W Ell
0
BUELDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissionerflnjg=tor of Buildings Date
SECTION 1- SITE INFORMATION
1. 1 Property Address:
1.2 Assessors Map and Parcel Number:
L/
Map Number Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage (il)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Reqwred Provided
154)
1.7W&ter Supply M.G.L.C.40 1.5. now Zone Mformation:
Public 0 Private 0 Zone Outside Flood Zone 0
1.8 SeweMe Disposal System:
municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSIUP/AUTHORIZED AGENT
2.1 Owner f R rd , cuo, IS
Address for Service:
C, 7g 0
"a e Telephone
2.2 C*ner of Record:
Natilt Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Lice ed Construction Supervi
0<
Licensed Construction Supervisor:
Addrm
Signature N7elephone
Not Applicable 0
License Number
Expiration Date
§.2 Regish!�OoN imp6vement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
Ma
M
X
z
0
M
�j
0
z
M
90
0
M
z
0
1-
I SECTION 4 - WORKERS COMPRNISATInN (M V- ir. r 141 a 7c,tc,, 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
SECTION 5 Description o Proposed Work (check
applicable)
New Construction 0
Existing Building 0
Repair(s)
Alterations(s)
Accessory Bldg. 0
Demolition 0
_O
Other El Specify
BriefDescn' tion of Proposed Wor
'w -4 jee,4
A -4
Ll
V
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
O-Mic
1. Building
Z.
(a) Buildin Permit Fee
9
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)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
OQ
A�r <�D/Authorized Agent of subject property
Hereby a orize - to act on
a a
My behAalt,' allimatters; relative t ork a orrized by this building pennit application.
I- S7 Is III(
Signatu of r Date
S 10 UT IZ T
ECTION"" ER/AUTHORIZ ENT DECLARATION
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
Signature of Owner/A ent Date
NOW= ENN
NO. OF -STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR THVIBERS OT 2ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIME--NSIONS OF GIRDERS
1- IEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING' X
MATERIAL OF CHIMNEY
IS BUIJDING ON SOLE) OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
'0
I (A
m
m
Ov
c
noun
C40
"0
tz
um.
CO)
CO)
CD c
CD
CL r—
-0
OM a
0
ca
cn
CD
noun
C40
"0
CM)
CD
CO)
CD c
CD
CL r—
-0
OM a
0
ca
cn
�
cn
cn
cx =
um
n
*
.tb=
a
CD c
0
z
0
CD
CD
cn
CD
C*
C4
CD
C
CD c
CD
0
CD
C*
C4
cc CD
I
cz
co
cd
C/i
COO
S mmg-R a --r -.4
0 C cr
0 —"C a
Am CCIL a sc co
-OCD —f
CD
CD CD
CD -4
z R C 0
s Am, C .
0 Go o. -O
CD -
a: 4-4
CL
CL
0
CS
CD
n -C
cc.0
u
= =C0
CL cr
ca
Cl **4Sb,&.CD
CD
,Mu
w CO C
ec
aa.*
.V4,
o
CD:
ce
CD
=A
CD:
Mo.
Ce Of
CD:
z
0
CA
t H
FORM U
LO ,�?Q-K,
INS-rFjUCI'!0NS: 'This form RELEAS 'FORM I . -ao,o 3
Boards and Dep,,,, Is used to
the app ents havingiu verifY that all necessarY app
rOvals/PerMits fror
lic ant and/or landowner fro nsdiction have been obtained. This does not relie.,
In compliance with any - n
***;***)%PPL1CANT FIL I applicable or requirern
APPLICANT \/.d� 00, LS 0U -r THIS SE
I */ 4414) C7'IoIV******,,* ents.
L0cA7-jON: A8sessors MaP Number PHONE 11-7f-�IS
SUBDIVISION
STREE-r 4104elS PARCEL
LOT (S)
ST. IVUA413ER
OFFIC
Re IAL USE 0
ENDATI
AG
Co TION
"TION AD
TOR
DATE APPROV�rr%
COMMENTS DATE
TOWN P NN'ER
N
DA
COMWENTs DA 'M APPpIC)yro
-rE REJECTe�
FOODINSPE
Spe p?
-HEAL-ril �JEC*D-
APPFIG
COMMENTS R
PUBL'C WORKS
SEWERIWATER CONNECTIONS
DR'VEWAY PERMIT
FIF?e DEPAFITMENT
RECE, LDING INSpECTOF?
VEDBy BUI
�TF?
Revised 9197 jrn
DATS
k
M
CA
`7� QQ
-- nr\ -
z
License: Col
J30ARD OF BUILD14 EGULAT16NS
NS
TRUCTION
Number: cs 065127 SUPERVISOR
Sirthdate: 11/05/1964
Expires: 11/05/2005 Tr. no: 8156.0
Restricted: 00
JOSEPHA DONOFRIO 1
28 MORRIS ST
N ANDOVER, "A 01845
Admj�
2 Board f Building Regulations and Standa
0
rds
r
HOMEIMPROVEMENT
4 CONTRACTOR
Registration:
12009s
Expiration: 10/17/2005
Type: Individual
JOSEPH DONOFRIO
JOSEPH DONOFRIO
28 MORRIS ST
N. ANDOVER, MA 01845
Administrator
-AA-
$1
North Andover Building Department
voyv� V Tel: -976-388-9845
IVA
DEBRIS D.NISPOSAL FO"'
IR IV,
n accordance with t.he provision of MGL c 40 S 54, ra condit . ion of Building Permit
Number debris resulting frbm this work shall be
disposed of in a properl licensed solid waste di,-s,'posal facilit,/ as defined by MGL
-Y
c 11, S. 15") A..
XA -
The dabris will be disposed of in:
WAZA-,-
(Location of Fat7W
Sigri�iuu—r'30�f
Elate
Applicant
NOTIE: Demolition p'ennit from the Town of North Andover must be obtained for,
ti olis project through. the Office of the Buii'ding !nspectpr
IL
c
z
CZ o
M
13
4
z
U)
M
c
M
z
>
m -r
-< m
>
z
M
r -
m FL< z
U) G)
--i
U) C/)
r
0 C)
z
T
m
C/)
c 0
z C)
>
--i
m
>
Cf)
T
0 >
z
-Ti
Z
0.
S41 *08'00"E
rQ
I -j
:lj
cn
0
0
0
m
C)
N
0 z N41*
-P� 08'00"W
C� 90.00'
ul
0
0 m
rri
U)
(A :*z
Ell\ OD
0
z ;u
N41*08'00"W
90.00'
U)
M
>
;u
co
>
C)
M
C)
Z
C:
N
0
z
N
0
m
K
z
Z
o
CD
M
;u
Z
Z
z
:70
m
co >
M
M
m C/)
cn
z
m
m
z
0
z
-i
V)
(f)
M
-Ti
;d
0
x
0
90.00'
M
>
--q
;:a
Z
-TI
z
< 0
M U)
0
<
z
G-)
0
-1
cn
m
-U
m
m
0 CD
-TI
0
Cf)
-P� M
0
�j
o
Z
>
m
-Tj
M m
-TI,
M
M
--- I
�u
N)
M
41.
> m
m C)
>
M M
M
CO
>
4�1
m
0 0
(A
C)
7\-
0
N41*08'00"W
90.00'
Un
0
N41*08'00"W 0
90.00'
Ln
0
0
N)
N)
U)
-P,
co
01)
Z U)
m
0 -u
C)
N
0
z
N
0
0
0
m
z
Z
Z
z
:70
m
co >
M
m C/)
cn
>
z 0
0
z
-i
C
—
r-
U)
0
m
0
o
z
0
z
--q
;:a
Z
-TI
< 0
M U)
0
Un
0
N41*08'00"W 0
90.00'
Ln
0
0
N)
N)
C-
0
co
Z U)
m
0 -u
C)
N
0
z
N
0
0
0
m
z
Z
Z
z
m
co >
M
m C/)
0
>
z 0
> 0
M
z
-i
C
—
r-
U)
0
m
0
o
z
0
z
--q
;:a
Z
-TI
< 0
M U)
0
C4
G-)
0
m
-U
m
0 CD
-TI
0
Cf)
>
m
-Tj
M m
-TI,
M
M
--- I
�u
>
M
C-)
> m
m C)
>
M M
M
CO
>
4�1
m
0 0
0
C)
7\-
0
OD z
0
Z
z
CTI
-th,
0
4
_J
,-) C
Location.-_J_!5L_
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL s
Check# 7
18937 --Building lnsP66r
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
AMICATION TO CON9rRUCr RENOVAT4 OR DEMOLISH A ONE OR TWO FAMILY DWELLING
TF7 %I
BI J11 DING PERMIT NUMBOL DATE ISSUED:
SIGNATURE: �7,
Bui1dinE-Commissi6ner/IRS=Wr of Buildings Date
SECTION 1- SITE INFORMATION
1. 1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area (sf) Frontage (fl)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
RegWred Provide ReqWred Provided
ReqWred Provided
1.7 Water Supply NLGJ-C.40. 54) 1.5. Flood Zone Information:
Public 0 Prhraw 0 Zone Outside Flood Zone 0
1.8 Sewerap Disposal System:
municipal 0 OnSiteDisposd System 0
SEC'TION 2 - PROPERTY OWNERSEM/AUTHORIZED AGENT
Historic District: Yes No
2.1 Ownerof Record
J*�—� ()A/,i 4-1-D 0-2.R 44 6!�-915 57,
-
(Print) Address for Service
978- �q 9,3,675- 3 0
Sipg(!!!re\ Telephone
12 0,�vner oAecord:
Na Print Address for Service:
Signatare Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed tonstruction Supervisor:
Not Applicable 0
License Number
Addre
Sign:! Telephone
Expiration Date
3.2 Regi m:e y1proverneil Contractor
1)
Not Applicable 0
0
Company Name
Registratim Number
Addre
-Signat6% Telephone
1> 7
Exl;,iratiom 10letie
T
M
z
0
0
z
M
90
0
mn
rM
M
z
G)
I SECTION 4 - WORKERS COMPENSATION (rYLG.L C 152 § 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
SECTION 5 Descifliption o Proposed Work (check
applicable)
NewConstruction 0`00
Existinj,Buildifig 0
Repair(s) 0
Alteratiot2
Addition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
;rNSP111 �xAWS 6r6
SECTION 6 - ESTMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
0 TICIAL. SEV L
—0
Al
I Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAQ
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 BURDING PERMIT
1, 0 \�D-Sb"
_L L as Owner/Authorized Agent of subject property
e
Hereby au e to act on
My behalf, '111 �ma�tters relative to �6"W�Ja�rized by this building permit application.
�7-
Ignature of Date
SECTION 7b OftER/AUTHOR'zEAAGENT DECLARATION
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
Signature of OwnerIA ent Date
..... . . . . . .
NO. OF STORIES SIZE
L
BASENIENT 07R SLAB
SIZE OF FLOOR TRv1BERS IST 2 ND 3 RD
SPAN
DRAENSIONS OF SILLS
DINENSIONS OF POSTS
DMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING x
MATERIAL OF CHRVINEY
IS BUILDING ON SOLD) OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
k.
Gerald A. Brown
Inspector of Buildings
Please Drint
DATE:- /- /9-L)p
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 0 1845
HOMEOWNER LICENSE EXEWTION
Telephone (978) 688-9545
Fax (978) 688-9542
JOB LOCATION:- ;- e 1117-Dez'Is S-1-11,
Number Street Address Map/Lot
HOMEOWNER J05zPY bbk/d-fe/o 7 0- -7 W- �S�3 Y
0
Name Home Phone Work Phone
PRESENT MAILING ADDRESS cP8 1-4(j,0e1,5 ST–
/V AV16 6 Ve� 11_� 0 1, PV5'
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 "homeow-ner" 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 understa-fids —the Tov��O�orth Andover Building Department
minimum inspection procedures and requirements in� that he/she will compl with said procedures and
requirements. h I
HOMEOWNERS SIGN
APPROVAL OF BUILDING OFFICIAL
Raised 10.2005
Form Homeowners Exemption
, a
6
q'Ilk
i�
%wor
LILM
COD
uj
CLLU
co
P4
0
t
P-4
.
CL
2
co
CL:5
CD
R.
-r,
0 C.)
GO
CL=
CL
S
Go
.0 :2
m
or -
z
0
0 b. C=m
4- CL ON
x.
co
CO)
o
%wor
LILM
COD
uj
CLLU
co
Cc
cc
CL
CD
co
CL:5
CD
Cc CD
.0
-r,
0 C.)
GO
CL=
CL
S
Go
.0 :2
m
m
.=
0
0 b. C=m
4- CL ON
co
CO)
CL
. .
. cm
ts
C L
V) m
(D
CA
cm
:4D
.=co
Mo
go
EL-,=
CD 0
CLU L:
n
%wor
LILM
COD
uj
CLLU
co
.fti
E
.05
ca
Q
cm
cm
0
Q
5
M
cf)
®rp-4
U)
71
0
u
c/)
-e
ts
co
E
co
ts
CD
CL
CD cm
0.—
ca
CD
M
E
CD ow
I- �— =
cc 0
CL cm<
'co
cc
o CD
co Z ts
G3
0 CL
U CO)
cc
cc
ME
CA
E
uj
LLI
0
19
uj
w
19
ul
uj
U)
CL
cc
CL
CD
co
CL:5
CD
Cc CD
.0
-r,
. LD —M CCU
GO
CL=
C2 CD CD
S
Go
.0 :2
m
m
.=
0
0 b. C=m
4- CL ON
.fti
E
.05
ca
Q
cm
cm
0
Q
5
M
cf)
®rp-4
U)
71
0
u
c/)
-e
ts
co
E
co
ts
CD
CL
CD cm
0.—
ca
CD
M
E
CD ow
I- �— =
cc 0
CL cm<
'co
cc
o CD
co Z ts
G3
0 CL
U CO)
cc
cc
ME
CA
E
uj
LLI
0
19
uj
w
19
ul
uj
U)
HearthStone
ngProducts
Quality Home Heati
Tri*bute
Non -Catalytic Wood Stove(8040)
OWNER'S MANUAL
INSTALLATION AND OPERATING INSTRUCTIONS
We recommend that our
products be installed and
serViced by professionals who
S are certifie d in the. U.S. by NFI
SrIT (National Fireptace Institute),
www.nficertified.ortv
PLEASE READ TMS ENTIRE OWNER'S MANUAL BEFORE YOU INSTALL AND USE
YOUR NEW Tribute WOOD. STOVE. To reduce the risk of fire, follow the installation
instructions. Failure to follow these instructions may result in property damage, bodily injury, or
even death.
SAVE TRESE INSTRUCTIONS FOR FUTURE REFERENCE!
CONTAC T LOCAL AUTUORnUS HAVING JURISDICTION (BUILDING DEPARTMENT or FIRE
OFFICIALS) ABOUT PERMITS REQUIRED, RESTRICTIONS AND INSTALLATION INSPECTION
IN V0119. ARFA.
Tribute Model# 8040
6400-40447
05-25-04
HearthStone
-Tr1*bUte
k- Qttali�l,,HonieHectti.ng-Prod.ucts
Non -Catalytic Wood Stove(8040)
OWNER'S MANUAL
INSTALLATION AND OPERATING INSTRUCTIONS
We recommend that our
products be installed and
0
serviced by professionals who
are certified in tha U.S, by NFI
T (National Fireplace Institute),
www.nficertified.org
PLEASE READ TIUS ENTIRE OWNER'S MANUAL BEFORE YOU INSTALL AND USE
YOUR NEW. Tribute WOOD STOVE. To reduce the risk of fire, follow the installation
instructions. Failure to foflow these instructions may result in property damage, bodily injury, or
even death.
SAVE THESE INSTRUCTIONS FOR FUTURE REFERENCE!
CONTACT LOCAL AUTHORITIES HAVING JURISDICTION (BUILDING DEPARTMENT or FIRE
OMCL4,LS) ABOUT PERMITS REQUIRED, RESTRICTIONS AND INSTALLATION INSPECTION
INN01119.ARRA.
= A
Tribute Model# 8040
6400-40447
05-25-64
9 -
IN
Ubcationz—�? e�
0 - 66
.No Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
18523
----Bui
Iding Inspeeter'
I
TO OF N
....... ....... ........
OR7HA NDOVIER
BUILDING DE
z �PrAA R �TMM� E N T
BUILD–I–N–CTP–E����
�IGNATURE:
kA
)f2miSSi0nerfi1n-7qrw-,-t--�- '-,
I SECTION 1 --SITE INF tor of
N
ftY- dd,
Propel A ORMATION
'e,7 I ess.
/7
r-, e �15
7—
Er—On–t Vard
1. 7 Wat,, Sawym-G.
PUblic 0
te 0
SECTION 2 - PROPR
2.1 owner of Record
2.2
Name P—,jnt
DAM �ISSUjj�..
Date
I - 2 A -s -s e -,-s
Ors MaP an-d-Pa-r-ce-13-tim—ber.
0J(9
�7
MV—Num� —_
CKS ft it,krea
Frotita
PrOvide Reqw-red Side ard
4, Zone 1.5. Flood Zme .0n: PtOvidW R -rw
RS OUts'de Flood Zone 0 Mmic Seweng,
UTHORIZED AGENT
Address f—o, S�ej,
_e
—Telepho.t��—�35 �0—
'3z'--u1()N3 - a
h
3.1 LicVjJSW Constru —v;,'-----eJeP one
A ction U Sor: SERVICES
lo
Tcensed Construction Supervisor..
kddres
af-
Telephone
3.2
Address for —Seri,,.
Not Ap—pjiZWb�leo
xPiration
Dat
Rear Va—rd--
Z---
Ptovided
Sile, Di�poW SY.W. 0
. is
R Reg,
egistratio.
gmtion �Numb�er��.
E xp L
iration Date
M
z
0
0
z
m
m
90
0
MEN
z
a
V-L-V.-r1rn1V A - wniD"Rv. rnm-PY.NRATInN (M-G.I. 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 p!rmit.
Signed affidavit Attached Yes ....... 0 No ....... 0
SECTION 5 Description o Proposed Work (check
applicable)
New Construction 0
Existing Building 0
Repair(s) 0
. ,
Alterations(s) E�—
I I
Addition 0
. —
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work: J
44�m (4 n4-eA
ey-11 4 C, "
SECTION 6 - ESTIMATED CONSTRUCTION
COSTS
Item
Estimated Cost (Dollar) to be
Completed by pennit applicant
OFFICIALVA `ONLY
1. Building
�RD
(a) Building Permit 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)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
cS,0—,0 as Owner/Authorized Agent of subject property
Hcreby\��O�e to act on
My beha , in all matters arclati t6- uthorized by this building permit application.
u �e
re ot er Date
—Signa
SECTI WNER/AUTH�i�ED AGENT DECLARATION
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
Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASENENT OR SLAB
SIZE OF FI.00R TIMBERS I ST 2 ND 3RD
SPAN
DIMENSIONS OF SILLS
DINENSIONS OF POSTS
DMIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CIMvINEY
IS BUIIDING ON SOLD) OR FI1,LED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
0
0
fm�
t
;mq
A
0
W)
W
4
co
Q
CCXIL'CO
ca cc
i0
f I u SO
u
u
0 RX
0
cc
C,3 40 -
cm
CIL A
—M
'm de
ca
COS) IS
(a
0 4=6
Imam
E og*
MC.3 CD
Q Cm
C2
gab
c
cjj2
cm
a CL
C2
c
r
Ot
cc
C
CL
4D
.0 cm
LU rA
Go
as
C.3 1.0-0 a a cm
42 0
CL CO CL
.0 CL:s COO
cc
co
CL
co
cm
Z C -S
CO a -0
CD mm
03
cc
0 CD
cc
cf)
CD
z Q CX
2 CL
0 m
*now 10
Cla
CL CD
C.)
COD
cc
c
moms
.N.M
cc
CL
CA
is
E
co
Q
CCXIL'CO
ca cc
i0
f I u SO
u
u
0 RX
0
cc
C,3 40 -
cm
CIL A
—M
'm de
ca
COS) IS
(a
0 4=6
Imam
E og*
MC.3 CD
Q Cm
C2
gab
c
cjj2
cm
a CL
C2
c
r
Ot
cc
C
CL
4D
.0 cm
LU rA
Go
as
C.3 1.0-0 a a cm
42 0
CL CO CL
.0 CL:s COO
cc
co
CL
co
cm
Z C -S
CO a -0
CD mm
03
cc
0 CD
cc
cf)
CD
z Q CX
2 CL
0 m
*now 10
Cla
CL CD
C.)
COD
cc
c
moms
.N.M
cc
CL
CA
is
0
lu
0
FED
LATION4
-BOAR6/-��F �BUILDIIN�"REGU
ucenie. CONSTRUCTION SUPERVISOR
CS., 065127
BIftdAt6. /051�i 964
1165/2665, Tr. no' 8156.0:
pires,:!
,t Adi 00-
Restfic Q.,''
EPH A DON60,1�10
IORRIS ST
'.ihi.r tor
4DOVER, MA Admi
NORTH ANDOVER 13UILDING DEPARTMMNT
DEBRIS DISpOSAL FORM Tel. 978-688.9,45
in accordance with the prov- -
at: 1slon of A4GL c 40 S 54, a condition OfBufldng Pefu�t
........ .. is that the debris reWting from this
C I L Sl 150 A. 11 Properly licensed solid waste disposaj work shaU be
Also, note Pennits fac* as del, I MGL
10k .. are reqWred under Fire Prevention 'aws Chapter 148 Section
71* debris wiff be disposed of in:
ation
Fad
Fire Department Sign of Ignature of Applicant
f
Dumpster Pe,�t
K
A
Check # C;LL60
183u5
---Bdilding InspEosr
Location��O
A,
No. Date W/-
1 IA40RT#hl
TOWN OF NORTH
ANDOVER
0
0
0
Certificate of Occupancy
$
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
41
Check # C;LL60
183u5
---Bdilding InspEosr
8
I A
t
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT !F.A_% !EMV_Aj�2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUELDING PERMrr NUMBER rDATE ISSUE D-
P. A . 17b -Cl,. Z , 1'7- al
SIGNATURE: , -, - -, - I - - Loor-
Building Commissioner/InEemlor of Buildings Date
SECTION I- SITR INFORMATION I
1.1 Property Address:
oa/s
LJII�tr!Ct: ",IeS NO
1.2 Assessors Map and Parcel
Map Number
Number-
Parcel Number
Telephone
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
LA Am (d)
Frontage (il)
1.6 BUILDING SETBACKS (ft)
SEC17ON 3 - CONSTRUC770M SERVICES
Front Yard
Side Yard
Not Applicable 0
Rear Yard
Required Provide
Required Provided
Required
Prwided
11-15-- 657"
Expiration Date
Signature Telephone
1.7 Water Supply MG.L.C.400-.1 54)
Public 0 Plivate a
1.5. Flood Zone hdimmation:
zow Outside Flood Zone 0
1.8
mmkipal
Serwersp Disposal System:
0 OnSiteDisposal System 0
SECTION 2 - PROPERTY OWNERSEUMUTHORIZED AGENT
LJII�tr!Ct: ",IeS NO
2.1 Owner of Record
j 0!�e P9__--,&0xj &-X/ D 1YI0445
N e (Print Address for Service
(.0
Telephone
T2 Ownerof kecord:
Name Print Address for Service:
SiRnature Telephone
SEC17ON 3 - CONSTRUC770M SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable 0
,-44,
r r — - 9�
- —
Licensed Construction S rvis r*.
&5 /9
License Num
Address
.921) 693-2210
0 --- -
11-15-- 657"
Expiration Date
Signature Telephone
3.2 Registered Home Improvement )Contractor
Jos-,eey Aw-441a
Not Applicable 0
/;001s,
Company Name
Registration Number
/0
Address
E*ration Date
Sioature Telephone
--------------
iL,
SECTION 4 - WORKERS COMPENSATION (MG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidg
in the denial of the issuance of the building pe!Mit.
Signed affidavit Attached Yes ....... 0 No ....... o
a CTION 5 Descrigtion o Proposed Work (cchweek appBeable)
New Construction 0 Existing Building 0 , RepWs) B'*- Alterations(s) �5dition 0
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
�ZWSIFAII -4)'
&"Jac -r_:� —
J,
result
I A*CAJ 171A S —±::4 &V4 //C w-4�4 — I
I q]F.CTTON 6 - RSTIMATED tONSTRUCTION CbSTS I
Item
Estimated Cost (Dollar) to be
Compl by permit applicant
OVICIAL USE 014LY
I .
Building
(a) Building Permit Fee
Multiplier
2
Electrical
(b) Estimated Total Cost of
Construction
3
Plumbing
Building Permit fee (a) x (b)
130-
4 Mechanical (HVAQ
1 5 Fire Protection
16
Total (1+2+3+4+5)
it.— LA17-6-
Check Number
SECT1UN7aUWAEKAtJ1'nUKLLA1-1Ufq lu BE ComrLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERAGT
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 OWNERIAUTHORIZED AGENT DECLARATION
L— 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
1. 1�3
'-I Print Name
Signature orOwn&(Agent -- VIS, Date
NO. OF STORIES — SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 167 2 -ND 31w
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DINIENSIONS OF GII?DERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHRANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATT A[ GAS LINE
A
rA
i.
(A
m
m
x
m
m
x
Cn
m
m
Cos
a. 0)
CO) Co)
0
CD
MZ CO3
CD
C26
C2
C
0
=r
CL -3-
0 Ca
C.)
CD
CD
CL
Cr =r
C*a
CD
cc
w
a
CD
CA
CD
F
Cos
CD z
CD
CD
Cn
Cn
n
0
z
Cn
0
!rg�i0ow
4
o"
of,j
n
m
X
z
0
0
4 fias
0
0
M
CL
0
0 -OM -0
C Z-1 0
=r
"Go
Sr
— Go Ca Cr
-C
W
17
S
CL
"o
CO2
0
r-
a
5
Cp
Ca
m
to n 06
tv
m
z
coo
" C
EF -8
a
Is
—i
=r
CL
a mr
08
Fri
CO)
Ca
C',
Z
0
C2
NJ
go C2:
2
0 C-3
CD .0
=r 7%:
C-0 —
CR
=r
Co
cro
0 0:
CL
CD
Coj
CK gr
CA
CD
Ca
Ce
C�
CA
Co q
0
0
Co):
Z-0
CL's -
C.)
0
!rg�i0ow
4
o"
of,j
n
m
X
z
0
0
4 fias
0
0
M
CL
0
Sr
W
17
v
W
z
n
:"*
SO
S -
0
r-
a
5
Cp
Ca
811
tv
0
!rg�i0ow
4
o"
of,j
n
m
X
z
0
0
4 fias
0
0
M
CL
0
1W.
00
OD
cc
$A
on aw
S
U M
Ir (n
Z
C4
E
z
20
U.
1130
to
LO
0 z
OR OR
01
1W.
00
OD
cc
$A
on aw
S
U M
Ir (n
Z
C4
E
z
a
U.
1130
to
LO
0 z
01
J.
0 0
E
v
a.
= , LL
0
z
0
a U)
>
a. wo
uj 00
(n 2
0 co Ic
Z
0
z
Cl)
M
c
M
r
>
m -r
-< m
> 0
Z:�E
M
F-
m r -
x z
C/) C)
U)
r
0 C)
Z ::E
z
m
C/)
o
c 0
z C)
>
--- I
m
> C)
C/)
0 >
:�E z
z
-9.-
Z
S41 *08'00"E
0
z
N41*08'00"W
N
90.00,
>
Cc"
M
—
z
>
0)
0
rri
z
m
m
M
G-)
> 0
M
Z
o
CO
M
U)
3:
M
z
(-n
0
C,4
x z
m
z
0
00
V)
V)
m
0
x
-q
M
M
m m
rrl Lf)
--i
>
Z
m m
r ---i
o
<
z
0
�j
z m
cn
0
m
M
C) -<
0.
m
0
0 m
m
0
m
9
m
> m
C) Z
M c)
m
U
cn
0
m
0
2�
N41*08'00"W
90.00'
C-
0
Z U)
0 m
00 > m
>
71 K
0 0
0 ;;a
< �u o -TI
m (n C)
m
> m >
m ::j
0---1() 0
00 z
0
0
r<
N3
N41*08'00"W
90.00,
Pl
K�
N)
co
LA II�j
0
01
Ln
Ln
0
N
N
>
0
Z
M
—
z
>
m
C)
z
m
o
M
G-)
> 0
M
Z
o
CO
M
U)
3:
M
z
m
C,4
m
z
0
0 cn
V)
V)
m
0
x
-q
M
M
m m
90.00,
--i
>
Z
m m
m
<
z
0
�j
0
Ti
cn
0
m
M
(o
0
C)
cn
0
Z
0
z
N)
M
C4
r<
N3
N41*08'00"W
90.00,
Pl
K�
N)
co
LA II�j
0
01
Ln
Ln
0
N
N
0
Z
—
z
Z
—
C)
Z
m
o
G-)
> 0
M
z
--j
Z
-TI
C,4
G-)
0
0 cn
0
C/)
-TI -q
-q
M
m m
m
--i
>
m m
m
co
-P'
>
C)
0
z
:�;
LLI
6i
v
0
�C'41
0
0
Lf) T
z
C5
M,,00,20.L-VN
M
LLI
Lj
LLJ
0)
P-
LLJ
Ld
bi
LLJ
LL
LL-
LL
ry
V)
0
Lo
0
0
C)
0
ED
ui
LL-
0)
0
z
0
Z
C)
LLJ
z
0
<
_j
UJ
M
0
�0-
LLJ
z
C
.
cr
LL
V)
(n
all
Z,
Z
Z
Lu
z
0
Z
0
N
0
N
m
D
w
0
0
cj
Lr)
I
0 '\
0
ci
U*)
- I
,00*06
M,,00,90J-VN
0
(Y-
L, Lo
0 t
z 00
0 0
F- LL,
L.LJ <
LJJ U)
— ry
0 :2 V) LL)
LL- 0 >
z 0� 0
of C)
ID Z
0� :2 ":c
LLJ 00
C'� T
z F--
3: ly-
01 Ld 0
(f) Z
0
3
,00-06
M,,00,90.L'vN
LLI
0
0
�C'41
0
6
C14
1,00-06 A
Lf) T
z
C5
M,,00,20.L-VN
0)
0
Q,
0
Lo
z
0
ED
ui
0)
0
0
(Y-
L, Lo
0 t
z 00
0 0
F- LL,
L.LJ <
LJJ U)
— ry
0 :2 V) LL)
LL- 0 >
z 0� 0
of C)
ID Z
0� :2 ":c
LLJ 00
C'� T
z F--
3: ly-
01 Ld 0
(f) Z
0
3
,00-06
M,,00,90.L'vN
>-
U) ui
00
N
7— W- zttt
F -
Ln
<
y
Ji
-L
o
(.0
-Li
-11 0
ni 0
m
cy)
k,
Ld
0
7< CD
Lj
LLI
0
�C'41
6
C14
1,00-06 A
Lf) T
z
M,,00,20.L-VN
0)
0
0
Lo
z
0
ED
ui
0)
0
0
LL -
0
0
z
U)
\V
00*06
_j
UJ
of
0
x
UJ
W
LL-
V)
(n
z
ui
Lu
z
0
w
(n
Z
m
D
w
z
Lu
C)
LL -
>-
U) ui
00
N
7— W- zttt
F -
Ln
<
y
Ji
-L
o
(.0
-Li
-11 0
ni 0
m
cy)
k,
Ld
0
7< CD
Lj
LLI
0
�C'41
6
C14
1,00-06 A
Lf) T
z
M,,00,20.L-VN
PIP
3,,00,20. LVS
z
LL -
z
z 3:
< (D
m
cn
<
Ld
F— C)
< z
0 D
0
_j 0
cf)
z F-
3: z
(n V)
F—
CD U)
z T<
Li
LLJ C)
<
L -ti >-
LLJ
D
<
z
LLJ
LL :2
5
Lj- r"
LLJ �-
V)
z
LU
ca CC
0
CC z