HomeMy WebLinkAboutMiscellaneous - 28 MOUNT VERNON STREET 4/30/201800
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Location L),ec'Juo �,�
No. — t� Date 36 - 0�
0.1 j0*Tpj TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
C
Foundation Permit Fee $
Other Permit Fee $
C�)
TOTAL $ 0
Check#
15489
AA AA
J ' ' building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BMDING PEPMT NUMBER: DATE ISSUED: 342 00
SIGNATURE:
Building Commissioner/I!k=—tor of Buildings Date
SECTION I- SITE INFORMATION
1. 1 Property Address:
X\?&jo /-IT, tletlulvA) sT.
� \i /
Al- ,9A)D 0 Ulft,
1.2 Assessors Map and Parcel Number:
0
10 Q — V
Map Number Parcel Number
1.3 Zoning Information:
Zoning DisV idt Proposed Use
1.4 Property Dimensions:
LA Area (sf) Frontage (ft)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
—+
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public 0 Private 0 Zone — Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHMIAUTHORIZED AGENT
2.1 Owner of I�e�d
A XA1 V
/V L)"
A46',(Pria) Address for Service:
Telephone 7
Signa�Z�
2.2,dwner of Re' -cord:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Codstruction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable 0
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
T
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X
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0
0
M,.�
0
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90
0
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I 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 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 (chemck
applicable)
New Construction 0
Existing Building 0
Repair(s) 0
terations(s) 0
Addition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
Ne k..) 60-t_m elt �5
SECTION 6 - ESTIM[ATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
0 FFICIAL USE ONLY,.�
1. Building
P)
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction 1
-3 Plumbing
Building Permit fee (a) x (b)
-4 Mechanical (ITVAC)
-5 Fire Protection
-6 Total (1+2+3+4+52
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWN AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
-1, e�e�r/thorized Agent of subject property
Hereby author to act on
My behalf. in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNEIPJAUTHORIZED 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 knowl�dge
and belief
Print Name
Sivature of Owner/Aient Date
NO -
NO. OF STORIES SIZE
-BASEN4ENT OR SLAB
SIZE OF FLOOR TTMBERS 2ND 3m
SPAN
-DIMENSIONS OF SILLS
-DWENSIONS OF POSTS
-DIMENSIONS OF GIRDERS
-HEIGHT OF FOUNDATION THICKNESS
-SIZE OF FOO'flNG x
MATERIAL OF CHIMNEY
[IS BUILDING ON SOLID OR FELLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fro . m
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
******************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT PHONE 779
LOCATION: Assessor's Map Number PARCEL_
SUBDIVISION LOT (S)
STREET AlaOWT ��IUOAi 5'7� ST. NUMBER
USE
,,RECO E DA
TIO
CONS RVATIONi
COMMENTS
TOWN PLANNER
COMMENTS
OF TOWN AGENTS:
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMME
TOR DATE APP—R—OV5D
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
Revised 9\97 jm
ATE_
The Commonwealth of Mas sachusetts
Depaftmen t of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Print
,,V jl,, <�I,;qep U,("
,9 /)-17-, A'2-�WN01V S7-,. Alt IVAlboilelL - ^11�,s-s-
City N , IqAl Do Ll-&-�- 14,14�S - Phone
am a homeowner performing all work myself.
I am a sole proprietor and have no on6 working in any capacity
am an employer providing workers'compensati on for my employees working on this job.
Comp—any name:
Address
city: Phone
acimpgay name:
Address
0 Lty: Phone*
F:61iure to Secure coverage as re4uired under Section 25A or MOL 152 can lead to the Imposition of crinjinal penardes.of a fine up to $1.&)0.00
andtor one years' imprisonment as'well as civil penalties in 016 form Of a STOP WORK ORDER and a fine of ($100. 00) a day against me. I
understand that a copy of this statement may be fOrw2rded to the Office of Investigations of the DLA for coverage verification.
I do herby certify under th_e pains and pena#jes of pei7uy lhat the infonnation provfi*d alme is &ue and coffect
ME
Print name.
py/ Phone# SV 3 7
Official use only do not write in this area to be completed by City or town official-
OCheck if immediate response is recluk-ed Building Dept
Contact person: Phone A-
RM WORKMAN'S COMPENSA TIOM
E]
Building Dept
Licensing Board
El
&-lectman's OfFic e-
0
Health Department
0
Ofher
N2 3 4,-;- 3
Date// ...........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .... �% ...........................
...........................................................
has permission to perform ........... ��: ...............................................
Z'
wiring in the building of ......................................
........ ....... ........ .............. . North Andover, Mass.
Fe a :�ev � '-'/z i-, " IK .
-,P ............ Lic. No: ............. .............. /*
ELECTRICAL INSPECTOR
611
Check #c1b
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
11W LAJ1V1WJUJyWre�1" Ur JyML%"LnV&3r1J 13 util" ubc uIlly
DEPARTAMWOFPUBLICS4MY Peratit No. 2,�
BOARD OFMEPREVEMONMGM4770AN527CM 12-M
Occupancy & Fees Checked
UVA
APPUCATIONFORPERWTOPEUORMELE C wo
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL COIDME,27 L 1 :00
(PLEASE PRINT IN INK OR TYPE ALL INFORMAnON) D at /o/
Town of North Andover TO the Inspector of Wires:
,A i '
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address
Wyh-7-
e .1
.a r & / ell 424/'-7
e oL oL .6 c �/ E,
Is this permit in conjunction with a building permit:
Purpose of Building
Yes [jZf No (Check Appropriate Box)
Utility Authorization No.
Existing Service Amps 1201 011OVolts Overhead Ef Underground M No. of Meters
New Service Amps Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work ay/ff,t/---6 n
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
3
Swimming Pool Above
Below
Generators
KVA
ground
0
ground M
No. of Receptacle Outlets
lo
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones -----------
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Other'
No. of Dryers
Heating Devices KW
0 Connections
M
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER -
�Gaynglmvs
di�sChma�peritsWxbntiala*diat YES E:]r NO F-1
NO IfyuhawdwdWYESpkmmdc*lhet�WofmuaWbydmkzrgthe
�'4 ' �C
?,emeSpm&y)_rJ (,V
WctkbSw // - 2, 0 �, hpecfi D*Ro*xsWd
Expir= D*
11A10 Pir1�Vah&cfEkcfticalWork
Rao — Fmal
SigrWundeMlknaltimof t
FIRMNAME Mer- t (r le>- e l4ec —U=wNkx
Li.
BusirMT(iNh 50E -V-51- Y/,?
Adless— avc Ai Tel. No.
OWNER'S DqRJRANCEWAIVERl arnammdrithelLimmi3m not themmoxcamWorilssibontol e*hdlatasreqwWbyN1xmdms&Caxd Lam
and dvtmysigm�cnifis pem-dWpkationvAW'vtsth�s re4mimulk
(Please check one) Owner ED Agent 0
Telephone No. PERMIT FEE $,5Z
2-1
D. Robert Nicetta,
Building Commissioner
TOWN OF NORTH ANDO VFR
Office of the.Building Department
Community -Developmentand Selvices
27 Charles Street
Nortb Andover, Massachusetts 01845
DEBFJS DISPOSAL FORM
Telephone (978) 688-9545
FAX (9718) 688-9542
In accordance with the provisions of MGL c 40 s 54, and as a condition of
building permit # the debris resulting from the work shall be
disposed. of in a properly licensed solid waste disposal facility as defined by'MGL c
11, s 150a.
The debris will be disposed of at/in: bu^Ko
(Site location)
Signature of permeappli
MichaelMcGuire, Local Buil&ng Inspector James Decola, Electrical Inspector James Diozzf, GaslPlumbing Inspector
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Location. -PR wk)
No. / Date al
TOWN OF NORTH ANDOVER
'1k 0 .0"
- .. - "t 0
' AiIIIIII1911ilk
Certificate of Occupancy $
Building/Frame Permit Fee $
CHU
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#, /V90
/P N L,
i 5 0 18 Building Inspector
I
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILD
JE ISSUED:
SIGN
Building Conunissioner/12yect6r of Bui Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
3�0
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning Di strict Proposed Use
LA Area (sf) Ffontage (ft)
1.6 BUILDING SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Provided
-RNWred
1.7 Water Supply M.G.LCZ 5 54)
1.5. Flood Zone Information:
1.8. Sewerage Disposal System:
Public 0 Private 0
Zone, Outside Flood Zone D
municipal 0 On Site Disposal System D
SECTION 2 - PROPERTY OWNERSEEIP/AUTHORIZED AGENT
2.1 Owner of Record
Nam'e tPrint)'
Address for Service
Signature
Telephone
2.2 Owner of Record:
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable 0
"e -
Licensed Cf siruction Slupervisor:
7-
6�j
License Number
A ss
;ae
e7 7YC
Expiration Date
�—v
Telephone
3.2 R ister Home Improvement Co
ctor
Not Applicable
Co any me
Registration Number
a. '711-71a 1—
es
;.R4n
Expiration Date
at
Telephone
I
SECTION 4 - WORKERS COMPENSATION (ALG.L C 152 § 25c(6) 1 01, � .
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) _71�tions(s) 0 Addition 0
_ 7q I
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work.-
0 -
I SRCTTON 6 - FSTIMATF.11 C.0N.V.TR1TrT1nN MQTQ I
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
M40,4",
(a) Building Permit Fee
Multiplier
5 k?l
Q W '--05
1. Building
5—oo C).
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
'r
4 _ Mechanical (HVAQ
5 Fire Protection
6 Total (1+2+3+4+5)
Check Number / /) TZ7
IMI
I _11VA /a VW14JVjK AU 1HVKJLLA11UN IV BE COMFLETED WHEN
OWNERS AGENT OR CONTRACTOR "PLIES FOR BUILDING PERMT
1, , 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
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
Date
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
of Owner/.
8031EM
Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TUvIBERS 1 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DWENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
N
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
cily Al� Phone
Ejam a homeowner performing all work myself.
Yaram Aa�le proprietor and have no one working in any capacity
I am an em%oyeLproviding workers' coxnsation for my employees working on this job.
1-% A
Insurance Co. Policy #
Compgny name:
Address
City: Phone
Insurance Co. Policy #
Failure to secure coverage as required underSection 25A orMGL 152 can leadtothe imposition of criminal penalties of afine up to$1,500.00
and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DLA for coverage verification.
I do herby certikdn-der th� pains arid petisAY&Z_of pe ormation provided above is true and correct.
dW that the Of
S
Print name Phone 17 Z T- '2-'�V?,
X, P*,Om-a� !�&rclke- c7
I , -
Official use only do not write in this area to be completed by city or town official' n Building Dept
nCheck if immediate response is required Building Dept n Licensing Board
0 Selectman's Office
Contact person: Phone n Health Department
n Other
FORM WORKMAN'S COMPENSATION
e - . a
Building Department
27 Charles Street
North Andover, Massachusetts 0 1845
(978) 688-9545 Fax. (978) 698-..9542
DEBRIS DISPOSALpoR_A4
0
0
td
(34 A
A
In accordance with the Provisions. OfMGL c 40 s 54, a'nd-a condition of
Building permit.# the debris resulting frorn the work shall. be -disposed
of in a Properly licensed s oilid waste disposal facility as defined by AIGL c 1.1,
s150a.
The debris -will be disposed of in /at:
Facility
NOTE.- A demolition permit from the Town ofNorth Andover must be obtained for- t
project through the Office of the Building Inspector. his
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Location—
N o. —/ Date
01 40RTh A TOWN OF NORTH ANDOVER
Certificate of Occupancy $
90,
Building/Frame Permit Fee $
C
Foundation Permit Fee $
Other Permit Fee $
TOTAL 67 96?,
/ 0 �,:g
Check # 0
14,738 , "f ((a, —
Building Inspector
1. 1 Property Address:
17117vgT j!�ZIYON
1.2 Assessors
Map Number
Map and Parcel Number:
Parcel Number
1.3 Zoning Information:
1W, q —
Zoning DisVict Proposed Use
VName (Print)
1.4 Property Dimensions:
/ 0 'Wo /00
Lot Area '(sfL) Frontage (11)
1.6 BUILDING SETBACKS (ft)
2.2 Owner of Record:
Front Yard Side Yard
Rear Yard
-- Required Provide ReqWred
Provided
RegWred
Provided
'30 3eq
->
—30
;7 30
1.7 Water Supply M.G-L.C.40. 54) 1.5. Flood Zone Information:
Public 0 Private 0 Zone Outside Hood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System 0
�3m%- JL 1"I'v z - rlmvrv,]K 1 T RJWfNhKbt11Y/AUT110K1ZED AGENT
2.1 Owner of Record
VName (Print)
Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print
Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Constructio� Supervisor:
Not Applicable 0
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signatu -e Telephone
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
5
9
I X1
I SECTION 4 - WORKERS COMPENSATION (MG.I. C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will restit
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 [I
Existing Building 0
Repair(s)
0
Alterations(s) _, 0
Addition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
Xemtl
/00 V
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit licant
1. Building 000
(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 PER?fflT
F
/ ��- "'4 , �9� , as Owner/Authorized Agent of subject property
&eby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT 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 knDwledge
and belief i
Print Name
Si a Lire of Owner/Agent
a MW —1. 1
NO. OF STORIES
Date
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS I ST
2 ND 3M
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING
X
MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
[_IS BUILDING CONNECTED TO NATURAL GAS LINE
FORM U - LOT RELEASE FORM 1 Cy
1,NkRUCTIONS: This form is used to verify that all necessary approvals/perm . its from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
I*****************************APPLICANT FILLS OUT THIS SECTION******************
APPLICANT 1116'AINCT14 J-1 660QUJ�41_14- PHONE
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION LOT
STREEf_/Jf0vn7 kl�FIZ_NoN S7-7 k /ST. NUMBER
OFFICIAL USE
LRECOMMENDATIONS OF TOWN AGENTS: I
CONSERVATION ADMINISTRATOR
COMMENTS
TOWN PLANNER
COMME
FOOD INSPECTOR -HEALTH
�1:40 [41 z &*J;[6] C61.1a 0 1*1111 d 0
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWERAIVATER CONNECTIONS
I I][:] VA WIT"AU 4 1.1 IT, I k i
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9\97 jm
TE
D. Robert Nicetta
Buildin,g'Commissioner
(978) 688-9545
....;(978) 688-9542 Fax
Please print
DATE
,AJOB LOCATION
Number
OMEOWNER
PRESENT MAILING
1 uwj # uj viut u -i Anciaver
Building Department
�7 Charles Street ..
North Andover, MA. 01845
HOMEOWNER UCENSE EXEMPTION -
Name
/�/VOOL/I/L —
City Town
btreet Address
70 �/_3 7
Home Phone
L) N) 4,��Itvv C) -,j 57—.
State
ro
TV 1A
AC
17 / go
Map / lot
I c- .414 r e
Work
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of two units or less and to allow such h6Meown , ers to engage an individual fbr hire who does
not possess a license,. provided that the owner acts as supervisor. (State Building Code Section 108.3.5. 1 Y
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 it 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 horneowner.
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other
Applicable codes, by4aws, rules and regulabons,
The undersigned "homeowner" certifies that he/she understands the Town of No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedures and requirements.
HOMEOWNER'S SIGNATU
APPROVAL OF BUILDING OFFIC
I
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 0 1845
(978) 688-9545 Fax. (978) 688-9542
DEBRIS DISPOSAL FORM
0
0
In accordance with the provisions. of MGL c 40 s 54, and a condition of
Building permit.# — the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by A4GL c 1 *1, s I 56a.
The debris will be disposed of in /at:
------------
Facility location
S iit;7
Ap icant
qr /eq
Date
.1
NOTE.- A 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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Date .....
16
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
..................................
has permission to perform ........ '1�e I
. ................
wiring in the building of
........ . North Andover, Mass.
Fee.�� Lic. Ni�l&i ....... ..
#. AQ...
ELEcTRICAL NSPECTOR xt-
Check #
5759
aSA us
/�
This certifies that
......
Date .....
16
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
..................................
has permission to perform ........ '1�e I
. ................
wiring in the building of
........ . North Andover, Mass.
Fee.�� Lic. Ni�l&i ....... ..
#. AQ...
ELEcTRICAL NSPECTOR xt-
Check #
5759
I rm Lulyliviuly ryrVi"17 ur
DEPARnHW0FPUBUCS4FB7Y Permit No.
DOMDOFFMPREVENHON CM120
0 CX
LAU
X
W
Occupancy & Fees Checked
APPLICA77ON FOR PERNff TOP RM ELECMCAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE *rH THE M HUssTs ELEcrRicAL CODE, 527 CMR 12:00
4 AC 2
(PLEASE PRINT IN INK OR TYPE ALL INFORMATIOn Date
Town of North Andover To the Inspector of Wires:
Ile undersigned applies for a permit to perform the electric I rk described below,
Location (Street & Number) -D
OwnerorTenant ZefPk)(-fJ4 1.4 b 0) AWTly-- --1' 4 A.�Lgqv
Owner's Address
Is this permit in conjunction with a building permit: Yes[:] No,[a (Check Appropriate Box)
-2 r, -A f, ) �, Utility Authorization No. �JL _q)
Purpose of Building . fWA,
Existing Service �) bb AmpsL)Yt/ P nits Overhead Underground 1:3 No. of Meters
Amps? I b �'JVOlts Overhead Underground No. of Met ers
New Service
Number of Feeders and Ampacity
"y
Location and Nature of Proposed Electrical Work 41,1L4-TPZ LJ
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimn-dng Pool Above
El
Below
Generators
KVA
ground
itround
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Connections
Other
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER-
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INSURANCE BOND
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(Please check one) Owner Agent E] T�lephone No. PERMIT FEE
signature of Owner Of Ag-e-nr
irm Lviviinuiv ryrdt"n ur ivLq&mmtnuLx�A.1L3
DEPARMWOF]'UNKSOMY
Permit No.
0
BOAMOFFMPREVEMON 0
CMIZIM
Occupancy & Fees Checked
P I'
APPLICA77ON FOR PEI;Mff TO ELE=CAL WOPS
FVACHUS2 ;ELECTR!
rq
ALL WORK TO BE PERFORMED IN ACCORDANCE � [TH THEE M HUSSTS ELECTRICAL CODE, 527 CMR 12:00
M7
PRINT IN IN K OR TYPE ALL INFORMATION, Dat
(PLEASE
Town of North Andover
To the Inspector of Wires:
The undersigned applies for a permit to perform the electric I w rk described below,
Location (Street & Number)
owner or Tenant A-�
Owner's Address
rM "IMV
Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box)
Purpose of Building AA 419 A- il\ �V�L 4 , rn, J
Utility Authorization No.
Existing Service Amps )Yd )dNolts Overhead Underground No. of Meters
1:3
Amps? d\JVolts
New Service Overhead
Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work 77,17777,77 Li5,7�0
67775747-7 J 06767 1 777 71�1—
No. of Lighting Outlets
No. of Hot Tubs
No. of Transfbrmem Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generato KVA
ground
ground
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Bantry Units
of Switch Outlets
No. of Gas Burners
To—.of Ranges
FIREALARMS No. of Zones
No. of Air Cond. Total
Tons
No. of Hw Total Total
of Disposals
No. of Detection and
Pumps Tons KW
Initiating Devices
Space Area Heating KW
of Dishwashers
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local municipal Other
Connections
of Dryers
Heating Devices KW
of Water Heaters KW
No. of No. of
Signs Bailasis
Hydra Massage Tubs
No. of Motors Total HP
ER-
i
COMW
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Telephone No. ...PERMIT FEE$
Signa -15-17-3-7 Owner Of Agent