HomeMy WebLinkAboutMiscellaneous - 284 SALEM STREET 4/30/2018 (2)rn
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Ile
Locationz_o(q_C;)
No. Date
0
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
ow
$
TOTAL
Check # -�,14- 7--
"18 6 7 3
.-Building Ins:wfor
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI!� RENQVATE, OR DEM0,LI$ff A ONE OR TWO FAMILY DWELLING.
IN
01-11 TIES- U, IS 11, - "Iffi.,
a, 0�1 �
BUILDING PERMIT NUMBER: DATE ISSUED:
le - A -111 -
SIGNATURE: � V�- — -,
Building Conunjssioner/IEEI�2ctor of Buildings Date
SECTION I- SITE INFORMATION ... ;. I �. -' i '�, '- '-- ' . L . . .
1. 1 Property Address:
SI
1.2 Assessors Map and Parcel Number:
Map Number Parcel Numbtf
1.3 Zoning hiformation:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area Frontage (fl)
1.6 BUI[LDING SETBACKS (ft)
Front Yard.
Side Yard
Rear Yard
Required Provide
Required Provided
Required
Provided
1.7 Water Supply MG. -L -C-40. 54)
palic 0 . P . rivato 0
1.5. Flood Zone Information:
Zone Outside Flood.Zone 0
Scvvcragc Disposal System:
Municipal 0 On Site Dispbsal Syttem. 0
SECTION 2 - PROPERTY OWNERSEEIP/AUTH.ORIZED AGENT
2.1 Owner of Kecord
L
Name (Print)
Signature
2J Owner . of Record:
Name Print
Sig"Ature
elephone
Address for SerTice
Address for Service:
SECTION 3 - CONSTRUCTION SERVICES
K' Licensed Construction Supervisor: Not Applicable C)
k
J�6 �j W
Li�ensed Construction Supervisor:
License Number
z, I
Address
Expiration Date
Telephone
3.2 Registered Home Improvement Contractor
Company Name
/�ew; T1 9L.1c. 4
Address
A A/
re , Telepbone
Not Applicable 0
Registration Number
Expiration Date
[_jSCTION '' 4 ''
t t iij 13
ENS 4MON MG. L C 15"1 li�25c(6)
)l el !�: Uompensation Insurance affidavi Mus Completed and.siAn' �c�(6)
in the denial of the issuance of the buildin itted.With ibis.*applica
11; — 1 31
Si ne affida 'I k
4Z'VrTYr%AT 1 5 ...... Id— No ....... [D
ralluTee to provide this affidavit will r-e—SUIT-1
J Des cri tion of Propoi I work check AU a
New Construction 0 Ekisting building 0 Repair(s)
A]. terations(s) El Addition 0
Accessory Bldg. 0 Demolit'orl 0
I Other 0 Specify
Brief Description Of PrODOsed wnrk,*
------------ -
SECTION 6 - ESTMATED CONSTRUCTION COSTS
Item E
stimated,Cost (Dollar) to be
COM leted b ermit a licant
Building
00 41$ . (a Building Permit Fee
2 Electirical Multi lier
(b) Estimated Tota]'Cost of
3 Plumbin construction
4 Meclianin.1 Building Permit fee (.)x.. (b)
5 Fire -protection
6 Otal +
1+2+.31 4+55
SECTION 7 CheckNumber
"W"ER AUTHORIZATION To 13E COMPLETED
OWNERS AGENT OR CONTRACTOR 4 PPLIES FOR BUILDING,=ERMIT
Hereby authorize as Ovmer/Authorized Agent of subject property
My bell,
in. all inatters relative to work authorized by this building pennit application. to act. on
SiEllature of Owner
I IUIN 7b OWNTR/A ITTRORIZED AG NT DECLARATION Date
properi,y la9;�Authorized Agent of subject
Hereby declare that the statements and information on the foregoing applica.t,
and belief, ]oil are true and accurate, to the best Of my knowledge
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9OAMOF REGULATIONS
BU ILDIN
OWSUPERVISOR
Litense: MUCTA
N umbor,.4�-r;�,S,", 058245.
v
—031241-la43
r. n o: 2f031
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F
;Ratrida
tEW
XENNETH13� X
2VHE.
WITITAV—
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A 1.
N:ANPPY9; Attin§(RC&O her
Board.of �ialdifig�tejgulatibns iknd StafidaMs-
-HOME lmllp 160VEMENTCONTRA"
R6�js
b n.
nl 108383'
2006
C I qVC
KEEN CONSTRU�c 04-
Kbhh-6tt
v
,21'�HeWit,t-A e
Andover, koli-05
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0
I;; F'a
G
The Commonwealth Of Massachusetts
Department of Industrial Accidents
gffiev of Iflyesliffolloffs
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
name: pi gE
location: Z- I t7 A?o er
cit� �1) - AVJ6 L)Lrt ��ft 72 - 6
I am a homeowner performing all work myself
am a sole proprietor and have no one working, in any capacity
1�
M I am an employer providing workers' compensation for my employees working on this job.
nirect tfie contractors listed below who have
Failure to secure coverage as required under Section 25A of M L 152 can lead to the imposition of critt inal penalties of a fine up to . $1,500.00 and/or
one years' ini prison mcntas well as civil penalties in the forra of a STOP WORK ORDER and a fine Of 5100.00 a day against me. I understand that a
COPY Of this statement May be forwarded to the Office of Investigations of the DIA for coverage verification.
I do h ereby certify u n der th e its andpenalties ofperjury thal the information provided above is true and correct.
Signature --Date no IN.
Print. narne "Feed Phone #
o "'ific
. 7fflclal use only do not write in thisarea to be -completed by city or town official
ci or to"".
city or town: permit/license #
D7
Building] epartment
0,
0 check if immediate response is required oLiceiisingl3oard
's offi
oSelectmen's Office
contact person: phone#; OHcalth Department
Other
(reviscd 3/95 PJA)
n4dress:
nsunince �0�**:
..... .. . ...
nirect tfie contractors listed below who have
Failure to secure coverage as required under Section 25A of M L 152 can lead to the imposition of critt inal penalties of a fine up to . $1,500.00 and/or
one years' ini prison mcntas well as civil penalties in the forra of a STOP WORK ORDER and a fine Of 5100.00 a day against me. I understand that a
COPY Of this statement May be forwarded to the Office of Investigations of the DIA for coverage verification.
I do h ereby certify u n der th e its andpenalties ofperjury thal the information provided above is true and correct.
Signature --Date no IN.
Print. narne "Feed Phone #
o "'ific
. 7fflclal use only do not write in thisarea to be -completed by city or town official
ci or to"".
city or town: permit/license #
D7
Building] epartment
0,
0 check if immediate response is required oLiceiisingl3oard
's offi
oSelectmen's Office
contact person: phone#; OHcalth Department
Other
(reviscd 3/95 PJA)
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
dispose of in a properly licensed solid waste disposal facility as defined by.MGL
cJ1,S150A.
The debris will be disposed of in:
L A 36
(Location of Facility)
oglignature 36T rermii—Applicant
I f) — I S —0 6 --
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
KEEN'CONSTRUCTION CO.
21 HEWITT AVENUE PROPOSAL
NORTH ANDOVER. MA 01845
Tel: (978) 691-5201 All home improvement contractors and subcontractors
Fax: (978) 682-3231 engaged in hon16 improvement contracting, unless
.�pecifically exempt from registration by Provisions of
Chapte 142A of the general laws, must be�registered with
Submitted t �,j.;V I I (� �; .- 11
he Commonwealth of Massachusetts. Inicluliries about
TO:
registration and status should:be made to the Director,
Home Improvement Contract Registration, One Ashburton
....... ........ Place., Room 1301, Boston, MA 02108 (617) 727-8598.
Owners who secure their own constructionielated'
permits or deal with unregistered contractors, wi,11
be excluded from the Guaranty Fund Provision of
MGL c. 142A.
PHONE
REGISTRATION NO.
_/ff 7en 6- MA7.H.I.C. 10838 ?5-8052
> C/S CustornerSupplied S + I = Supply + Install
We hereby -submit specifications and. estimates for work to be performed and, mate rials,to,be used:
I v _4 / ell
[I"' __,( -5 6 ) r� w , T��\' ( (�
C) ... ... .. . L
. .... . .......... ........... . ............ .
.. .............. ............... .... ................. ... . ......
.................. ... ...... . .... . .........
-7 _� .. . .. . . ... . ..
C)
....... . ... ...........
. . ....... ........ ... . .......... . ....
")C)
.............
> Construction related permits:
WORK SCHEDULE ................. ..........
Contractor will not begin th"ork or order the materials before the -third day following the signing of this Agreement,, unless specified here in writing, Contractor -will begin the work on or
about / A - I :Z - i1_),_' -)(date). Earring delay caused by circumstances beyond'Contractor's contro'l,,the work will be completed by . // -/ ',b - e'), �—(date). The Owner hereby
acknowledges and agrees that the scheduling dates.are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement.
WARRANTY
m r.
fr6m.d6f6cts-in7' atenas'ihd k pe to 0
The Cori actor warrants that4he w6rk'fumished hereunder shAll�
`Wf.ir , _wor mins ip r at r fo'llowing:completion and shall
comply with the requirements.of this Agreement. In the event any defect in workmanship or,materials. or damage caused by the Contractor'
his subcontractors, employees or agents, is
discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied,
repaired, or replaced, such damage or such defect in mater ials or workmanship.The foregoing warranties shall survive any inspection r. rformed in connection with the agreed-upon work.
We Propose hereby to furnish material and labor - complete in accordance with above s
F-n— �z T)z o�, a _1�1 J 4- /1/ C�l it-) r,111—A, I 'e� e --
Payment to byrnade as follows:
— % upon signing Contract;
% upon -completion of
%
U QA�G��
% ($—) shall be made forthwith upon
completion of work under this contract
ifications, for the sum f :
W C
dollars
KENNETH B. KEEN
Name of Contractor / Designated Registrant
21 HEWITT AVE. . -
5treet Address
N. ANDOVER, MA 01845
city / State
(978) 691-5201 (978) 682-3231
Phone Fax
Notice: No agreement for home improvement contracting work shall require.a
down payment, (advance deposit) of more than one-third of the total contract. price Name of Salesman
or the total amount of all deposits or payments which the contractor must mal�e, in
/ A/E
advance, to order and/or 'otherwise obtain delivery of special order materials and. t�wl
equipment, whichever amount is greater.
Note: This.proposal may bemithdrawn by us if got accepted within days,
Acceptance of;.Proposal - ihave read both Sides of this document and all attached documents and accept the prices, specifications and conditions stated.
I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as Specified. Payment -will be made as outlined above.
You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of
this transaction. Cancellation must be done in writing.
DO NOTSIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. -
- f J__,f / -
Signature
IMPORTANTINFOR TibNOWBACK 110 -
MAT
Date. /,/ ) -..0 / ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ...
has permission for gas installation
('7 .......
in the buildings of ... .........................
at ... North Andover, Mass.
Fee. . IA. j� . . Lic. No.. ....... ... 4, ...........
GASINSPECTOR
Check #
3 8 3 0"
MASSACHUSETTS UNIFORMAPPLICATON FOR PE RMITTO DO GAS-F=c
e or print)
\. ;r
NORTH ANDOVER, MASSACHUSETTS
/.
Building Locations 1� K�-( I- Permit Im
Amount S
Owner's Name rw- Awkf-t
New Renovation Replacement 7 - Plans Submitted 0
3 k; (9 -
(Print or type) Check one: Certificate Installing Company
Name— 9, T, 6 ,� 1-e m,2 u A- --/ F� Corp.
Address ail �- Fj /t, --( S 7-
0 a L".et -44. --Y D / F- Le S�
usiness le
Name of Licensed Plumber or Gas Fine,
F� Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Y es No
If vou have checked ves, please indicate the type coverage by checking the appropriate box.
Liabilicy insurance policy Other type of indemnity Bond 7
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 permit application waives this requirement.
Check one:
Slanarure of Owner or Owner's A-ent 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
I
best of my knowledge and that all plumbing work and ions e. ormed under Permit Issued Ibr this application will be in
compliance with all pertinent provisions of the Massaofius, St Gas Code Chapt 2 of the e -al Laws.
�: Ell R'.er_ I --C*,—' �
By:
Title
CityiTown,
A2 P RUV'ED (OFFiCE USE f)NI. Y)
Skmature of Lie, --n Ved Plumber Or Gas Fitter
Plumber a 2 �
r7 Gas Fitter 77,n—se Numo&
F
71 Joumeyman
z
W
-r.
z
z
W
z
S 0 6 - 3 :k 5 E NI E N 'T
If A S F M E N '17
I?S'r. F L 0 0 K
2 N D F L 0 0 R
3 R D F L 0 0 R
.4tr I I F L 0 0 It
57 11 F I, o o R
6T [I F 1, 0 0 R
7T If F L 0 0 It
IST I I F 1, 0 0 R
(Print or type) Check one: Certificate Installing Company
Name— 9, T, 6 ,� 1-e m,2 u A- --/ F� Corp.
Address ail �- Fj /t, --( S 7-
0 a L".et -44. --Y D / F- Le S�
usiness le
Name of Licensed Plumber or Gas Fine,
F� Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Y es No
If vou have checked ves, please indicate the type coverage by checking the appropriate box.
Liabilicy insurance policy Other type of indemnity Bond 7
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 permit application waives this requirement.
Check one:
Slanarure of Owner or Owner's A-ent 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
I
best of my knowledge and that all plumbing work and ions e. ormed under Permit Issued Ibr this application will be in
compliance with all pertinent provisions of the Massaofius, St Gas Code Chapt 2 of the e -al Laws.
�: Ell R'.er_ I --C*,—' �
By:
Title
CityiTown,
A2 P RUV'ED (OFFiCE USE f)NI. Y)
Skmature of Lie, --n Ved Plumber Or Gas Fitter
Plumber a 2 �
r7 Gas Fitter 77,n—se Numo&
F
71 Joumeyman
Town of North Andover
Office of the Planning Department
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
Heidi Griffin Telephone (978) 688-9535
Plaiming Director Fax (978) 688-9542
PUBLIC HEARING NOTICE
NORTH ANDOVER PLANNING BOARD
In. accordance with the provisions of M.G.L. Chapter 40-A, Section 11, the North
Andover Planning Board will hold a public hearing as follows:
Purpose of Public Hearing:
Application for Watershed Special Permit under
Section 4.136 of the North Andover Zoning Bylaw to
permit the reconfiguring of an existing driveway and
related work, including reducing the size of the existing
deck and restoring vegetation bordering a wetland
resource.
Applicant/Petitioner:
David W. Palmer
284 Salem Street
North Andover, MA 0 1845
Address of Premises Affected
284 Salem Street
I Assessors Map and Lot:
Map 37D Lot 39
Public Hearing Date & Time
Tuesday, December 4, 20017:30 p.m.
Location of Public Hearing
North Andover Public Works Gareige at 384 Osgood
Street, near the High School entrance
Information Available
A copy of the plan and application is on file in the
Planning Board office at 27 Charles Street, North
Andover, MA, and may be inspected Monday through
Friday 8:30 a.m. to 4:30 p.m.
Any person interested or wishing to be heard on the proposed plan should
appear at the time and place designated above.
John Simons, Chairman
North Andover Planning Board
Publish: Eagle Tribune Friday November 9 & November 16, 2001
BOARD OF APPEALS 698-9541 BUILDING688-9545 CONSERN/�ATION689-9530 HEALTH688-9540 PLANNING 688-9535
284 Salem Street
Special Permit - Watershed Protection District
The Planning Board makes the following findings regarding the application of David W.
Palmer, 284 Salem Street, North Andover, MA, 01845, submitted on November 2, 2001,
requesting a Special Permit under Section 4.136 of the Zoning By -Law to allow the
reconfiguration of the existing driveway, related landscaping, and reduction of the existing
deck within the Non -Disturbance Zone of the Watershed Protection District.
FINDINGS OF FACT:
In accordance with 10.31 the Planning Board makes the finding that the intent of the Bylaw,
asmell as its specific criteria, are met. Specifically the Planning Board finds:
I. The specific site is an appropriate location for such a use, structure or condition; the
changes to the site will not affect the use of the site as a single-family residence.
2. The use as developed will not adversely affect the neighborhood; the reconfiguring
of the driveway will increase the, turning r-adii and make the neighborhood safer for
pedestrians and other vehicles. 750 square feet of vegetation will be used as a buffer
from the resource area. The new fencing will help prevent unintended debris from
entering the abutting resource area.
3. The proposed use, will not result in a nuisance or serious hazard to pedestrians or
vehicles; the� reconfiguration of the driveway will benefit pedestrians and other
vehicles by providing safer access to the site by providing an area to, turn around in.
4. Adequate and appropriate facilities will be provided for the proper operation of the
proposed use; the site will continue to operate as a single-family residence. A slatted
fence will be placed on the site to help reduce the likelihood of degradation of the
groundwater and Lake Cochichewick. The infiltration units and water trench
management system will control storm water runoff.
5. The use is in harmony with the purpose and intent of the Zoning Bylaw; the storm
water management infiltration trench will help preserve the purity of the local water
source, Lake Cochichewick, while conserving the natural environment to maintain
the filtration and purification functions of the land.
In accordance with 4.136 the Planning Board makes the finding that the intent of the Bylaw,
as well as its specific criteria, are met. Specifically the Planning Board finds:
6. That as a result of the proposed construction will not be any significant degradation
of the quality or quantity of water in or entering Lake Cochichewick. The Planning
Board bases its findings on the following facts:
a) The topography of the site will not be altered substantially.
�h
b) The work will not contribute to the overcrowding of land.
c) The proposal encourages the most appropriate use of the land by furthering the
safety of the residents in the area and protecting the abutting resource area.
d) The expansion of the driveway will help reduce hazards by improving ingress
and egress.
e) The proposed fence will help control the use of a small stream behind the site.
f) Approximately 750 square feet of lawn will be converted to restore the buffer
zone to a more natural state this is to mitigate the removal of 250 square feet of
natural vegetation east of the driveway.
g) A deed restriction will be placed limiting the types of fertilizers that can be used
on the site.
Upon reaching the above findings, the Planning Board approves 'this Special Permit based
upon the following conditions:
SPECIAL CONDITIONS:
1) This decision must be filed with the North Essex Registry of Deeds. The following
information is included as part of this decision:
a) Plan titled: Site Plan
284 Salem Street
North Andover, MAO. 1845
Prepared for: David W. Palmer
Prepared by: Design Consultants, Inc
265 Medford Street
Somerville, MA 02143
Scale: I" = 20'
Date: July 20, 2001
Plan Titled: Fax -sent by Design Consultant's Inc dated December 18, 2001
Revision to Silt Fence Detail.
b) The Town Planner shall approve any changes made to these plans. Any changes
deemed substantial by the Town Planner would require a public hearing and
modification by the Planning Board.
2) Prior to Start Construction:
a) A performance guarantee of five hundred ($500) dollars in the form of a check
made out to the Town of North Andover must be posted to insure that construction
will take place in accordance with the plans and the conditions of this decision and
to ensure that the as -built plans will be submitted.
b) All erosion control measures as shown on the plan must be in place and reviewed by
I the Town Planner.
c) The use, or method of application of, any lawn care or garden product as sited in
Section 4.136(c)(iii)(4)(5) (fertilizer, pesticide, 'herbicide) that may contribute to the
degradation of the public water supply are prohibited. The applicant shall
incorporate this condition as a deed restriction; a copy of the deed shall be
submitted to the Town Planner and included in the file.
3) Prior to release of the Performance Bond:
a) The applicant shall submit an as -built plan stamped by a Registered Professional
Engineer in Massachusetts that shows all construction, including storm. water
mitigation trenches and other pertinent site features. This as -built plan shall be
submitted to the Town Planner for approval. The applicant must submit a
certification from the design engineer that the site was constructed as shown on the
approved plan.
b) The Planning Board must by a majority vote make a finding that the site is in
conformance with the approved plan.
4) In no instance shall the applicant's proposed construction be allowed to further impact
the site than as proposed on the plan referenced in Condition # 1.
5) No open burning shall be done except as is pen-nitted during burning season under the
Fire Department regulations.
6) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation.
7) The provisions of this conditional approval shall apply to' and be binding upon the
applicant, it's employees and all successors and assigns in interest or control.
8) This permit shall be deemed to.have lapsed after a two- (2) year period from the date
— on which the Special Permit was granted unless substantial use or
construction has commenced.
cc. Applicant
Engineer
File
N2 3005 Date.ZZ ...... ��F ..............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
'Ibis certifies that ...
..........................................................................................
has permission to perform . ...................... :�:-r ... ............................
wiring in the buildipg,of ...
. ........ .
..... .. ........................................................
. .......... .
—11.e ....................................... ....... North Andover, Mass.
Fee ............... Lic. No/
...................
Check # r --ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
TJEC0M1101Vff1E4L2H0F111,4MM
DEPARTAIENTOMBLIC&MY
BOARD OFF1REPREYEW0NREGUL4T10AN527CAM 12.00
IvP
Offic—e Use—only
No. (30ef0
ncy & Fees Checked
APPUCATION FOR PERW TO PWORM ELE=CAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 cMR 12:00 1 q
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date q
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant Dftv
,4 le -PK S4
A I rVA,0- Y,
To the Inspector of Wires:
Owner'sAddress 2-04 Sq1eWL,S,-1-1
Is this permit in conjunction with a building permit: Yes F-1 No (Check Appropriate Box)
Purpose of Building AV,4%�ck-ell, Utility Authorization No.
Existing Service ?-C>O Amps tzolzXetkolts Overhead 0 Underground No, of Meters
New Service Amps Volts Overhead r—J Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work'
No. ofLighting Outlets
No. of Hot Tubs
No. ofTransformers
0
Total
Wopri*bcx BOND F-1 mu, ftwespe*
muw,.m El
.
q- L9 o ( Esttm*dVahieoflArft%21Wolk
L -t- A - 0 t
WorkiDSm hqvcfimD*RaqtxsW Ra#
-
KVA
No. ofLighting Fixtures
Swimming Pool Above
Below
Generators
KVA
4,0'$ - W4. - 30 3
ground
Ak. TeL NU
ground
and dutmysigreWrectithis p=*WpkafimV"*�,es ft MwMinerlL
(Please check one) Owner Agent
No. ofReceptacle Outlets
No. ofOil Burners
No. of Emergency Lighting Battery Units
No. ofSwitch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. ofAir Cond. Total
Tons
No. of Detection and
No. ofDisposals
No. of Heat Total Total
R -C
Pumps
Tons
KW
Initiating Devices
No. ofSounding Devices
No. of Dishwashers
Space Area Heating KW
% 16-4-
Ze
No. ofSelfContained
Delection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
1:1 Connections
M
No. ofWater Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OIVIER
IrWrd=CO`�� R=a1t1DtheWXM121lSdMffiMd1SftCMaa1 Laws
Iha%eaaratLA*hmmxPobcymdudmgCm#AtOpwd*mCovwdWcritssksortUe*ivakrit
rlM
YES V---, I NO F1
IImeWwmwdNeWpluofaf§wxiDtheOffi= YES
0
NO If�cuhawdrdWYESpkmrdc*tctAxcfmeug:bydxckirgte
Wopri*bcx BOND F-1 mu, ftwespe*
muw,.m El
.
q- L9 o ( Esttm*dVahieoflArft%21Wolk
L -t- A - 0 t
WorkiDSm hqvcfimD*RaqtxsW Ra#
-
Sig1WMAXMPWW*�PfP0*. F se
JCJy-%4, v v I e
FIRMNAA4E t -e
M VL
umm L,*L.Jt-C1-JCs Siomm
&4*,041pisw., F.411S A�
4,0'$ - W4. - 30 3
Ak. TeL NU
OWNER'S RNSURANCE WAIVER, lam mmthtthel-kmsedoes not iheismawmWoritsaht3MC#dfftasmgimdbyNtmhfxMCauWLa%vs
and dutmysigreWrectithis p=*WpkafimV"*�,es ft MwMinerlL
(Please check one) Owner Agent
Telephone No.
PERMIT FEE,2'� . . . . . . . . .
Loc ation
0
N Date
x i
60RT#1
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
CHU
Other Permit Fee $
aec wlimfiftvction Fee $
WaVr- onnection Fee,
NC-
rding inspector
957, Div. Public Works
PER13 1[[T�'No. 6-11
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE I
MAP 4-40.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK PAGE
ZONE
SUB DIV. LOT NO.
F -
LOCATION
PURPOSE OF BUILDING
OWNER'S NAME G.ICCIZ6-6 ,C4,0?c
NO. OF STORIES SIZE
OWNER*S ADDRESS .2 e -
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME ',fe4e
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
MATERIAL 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
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 A 0 APPFPVED BY BUILDING INSPECTOR
DATE FILED 6/
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E
PERMIT GRANTED
19
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
SUILDING IN$PkMft
OWNERTELJ
1�7
CONTR . TEL. #
CONTR. LIC #
H.I.C. At
BUOILD4NG RECORD
OCCUPANCY 12
SINGLE FAMILY
�T
MULTI. FAMILY
—1
OFOFLICE2S
APARTMENTS
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
CONCRETE
PINE
3
1
2 3
CONCRETE BIL K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
(�RY WALL
UNFIN.
3 BASEMENT
AREA FULL
FIN. BM'T' AREA
114 1/7 1/1
FIN. ATTIC AREA
�40 8 M T
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS 9 FLOORS
CLAPBOARDS
B
1
2
3
DROP SIDING
WOOD SHINGLES
—
—
RETE
-�O—NC
—�ARTH
ASPHALT SIDING
ASBESTOS SIDING_
VERT. SIDING
HARDW D
COMIACN
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STIRS. & FLOOR
CONC. OR CINDER EILK.
WIRING
STONE ON MASONRY
STONE ON FRAME_
SUPE RIOR I I IP �2�R
ADEQUATE F-1 ;2 _ H
5 ROOF
10 PLUMBING
GABLE
I
III
BATH (3 FIX.)
GAM111LI
I
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
r2 FRAMING
HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
T11MBER BMS. & COLS.
STEAM
STEEL BMS..& COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T G
UNIT HEATERS
7 NO. OF Rooms
GAS
OIL
ELECTRIC
NO HEATING
I 2nd
uA * T ind
lo 3,d
THIS SECTION MUST SHOW EXACT -DIMENSIONS OF -LOT AND DISTANCE FROM
LOT INES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.'
fi�—1 4
Z, 0
COMMONWEALTH EPAKTMENT OF PU'3UC SAFETY
OF ONE ASHBORTON PLACE
MXSSACHUSEZ
t§_7,F
-130STOKMA02108
EXPIRATION DATE L 1 C E N
-U
w CAUnON
09/30/1995
RESTRICTIONS EFFEC-11VE DATE LIC -NO. FOR PROTECTION AGAINST
NONE T' HEFT, PUT RIGHT THUMB
PRINT IN APPROPRIATE
r; '.I
!N3QAA,N .;Ay BOX ON UCENSE.
70 ST
SZ 4 028-34-9269 IN' AIIDQV�71 4 1 A %ril �45 BLASTING OPERATORS
PHOTO GLASTING ORR ONLY) FF7-YUST CLUJ PHr
FEf - 00.CO NOT %1-0 UNTIL SIGNED By LICENSEE AN
HEIGHT: STAMPED OR SIGNATURE OF T HE CC 0 OFFICIALLY
DOB: MMISSIONER JUL 0 6 1993
09/3n/1945
71-41S DOCUMENT MUST BE s. nn
CARRIED ON THE PERSON OF RML ABW_. Gt!! TU R Cl: L12 a)
OTHERS THE HOLDER WHEN EN. E
RIGHT THUMB PRINT GAGED IN THIS OCC6PATION.
*.!.NER
HjME TMpp OVEMENT CONTRACTOR
Registration 117436
Type - DSA
Expiration 10/03/96
ALL UNDER ONE ROOF -PEST IN PE
NORN�N GAY
JEFFERSON ST*
AOMMSTRATCR NORTH ANDOVER MA 01845
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Date...
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
................
This certifies that ......
has permission forgas installation
...............
in the buildings. ................................
at .41 . ..... .......... North Andover, Mass.
rV
Fee ..... Lic. No . .........
-,,, / -P �,, 7 GAS`1N,6l6rCToR
WHITE: Apoilcant CANARY: Building Dept. PINK: Treasurer
-* Y
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFIT71NG
(Print 'or ype)
MA Date V7 �60 Receipt#—
OwneesName
Building Location
Map: Lot: Zone: Type of Occup
New P\ , Renovation 0 Replacement U
Plans Submitted: Yes U No U
Installing Company Name EASTERN PROPANE & OIL, INC. Checkone: Certi ficate
Address 131 WATER ST DANVERS MA 01923 X Corporation,
Estimate Valueof Work: L3 Partnership
Business'Telephone 800-322-6628 . U Firm/Co.
Name of Licensed Plumber or Gas Fitter C— v" C!�> S
I
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes El No U
If you have checked X@.s please indicate the type coverage by checking the appropriate box.
I A liability insurance policy U Other type of indemnity U
Bond U
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 permit application waives this requirement.
Checkone:
Owner El Agent E3
Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with
all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Type of License:
Plumber Signature of Licensed Plumber or Gas Fitter
Title Gasfitter
Master License Number
City/Town RJourneyman
IAPPROVED (OFFICE USE ONLY)
RWwd 05/17/M
..........
Installing Company Name EASTERN PROPANE & OIL, INC. Checkone: Certi ficate
Address 131 WATER ST DANVERS MA 01923 X Corporation,
Estimate Valueof Work: L3 Partnership
Business'Telephone 800-322-6628 . U Firm/Co.
Name of Licensed Plumber or Gas Fitter C— v" C!�> S
I
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes El No U
If you have checked X@.s please indicate the type coverage by checking the appropriate box.
I A liability insurance policy U Other type of indemnity U
Bond U
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 permit application waives this requirement.
Checkone:
Owner El Agent E3
Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with
all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Type of License:
Plumber Signature of Licensed Plumber or Gas Fitter
Title Gasfitter
Master License Number
City/Town RJourneyman
IAPPROVED (OFFICE USE ONLY)
RWwd 05/17/M
V
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Date.
N2 4804
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ....... ....................
has permission to perform .... k).,,. .,.y
. .... .. ... .....
plumbing in the buildings of . .. . ....... ..
at. 't ............................. North Andover, Mass.
Fee 7'�� Lic. No.. ........... I
PLUMBING INSPECT0,14
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
N2 4 81]' 4
1 09
Date
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ...... .............
has permission to perform ........ k - . I � I.
............................
plumbing in the buildings of .......................... I... I ./. �-. .
at ..... .................. ............... I North Andover, Mass.
Fee.'; . . .... Lic. No.. ?.Y. �. (, ... r
, ... .................... .....
PLUMBING INSPECTO.R
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUM13ING
(Type or print)
NORTH ANDOVER, MASSACHUSETFS
Date L/
Building Location 1��- �Ie*l '150'�wners Name
Amount
TvDe Of OCCUDancv
New Renovation Replacement Eir Plans Submitted Yes No
FKT11
RES
N1
(Print or type) Check one: Certificate
Installing Company Name L� '-T, kP"'k'( Corp.
Address 13 bX F J 'e, L -r- Partner.
u, -) lvo [3—Firm/Co.
Business Telephone (0 r& — 6) -K- 2--L
Name of Lic�nsed Plumber:
Insurance Cove ge: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity 11 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 installafio un er erriji
ps performed d P it Issued for this application will be in
compliance with all pertinent provisions of t . he Masse lum ng Code'nt�apte42 �ofthe G�eneral �Laws.
Title
City/Town
APPROVED (OFFICE USE ONLY
Type of Plumbing License
n) � C-
7icense Numoer Master a," Journeyman
� �I�A 71
N2 2957 Date ...... ........... .. ...
0
-A'
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ................................................
/� -r 'eq " "?,
has permission to perform .... . ................. / .........................................
wiring in the building of ...... /.02. xw..!� e�� ...........................
at ......... ....... (- 5.�' IC. mkZ ............... . North Andover, Mass.
Fee ... Lic.
AL INSPiMR
Check# 28—
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Uttice Use-6111—
ThFWAMONWEALIHUPA y
DLPARTAffiW0FPUBL1CS4FM Pen -nit No.
BOAW OF ME PRLYEVH0NRY.GM TIOAN 527 CM 12:00
Occupancy & Fees Checked
kVI'AAMICATION FOR Pf RW TO PEUORM ELEOWCAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 cmR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described b6low.
Location (Street & Number) v--k-A
Owner or Tenant 2 -s -Y 4-- d—/0 - rt,4o-k�
Owner's Address
Is this permit in conjunction with a building permit: Yes M No r7 (Check Appropriate Box)
Purpose of Building
Utility Authorization No.
Existing Service / 90 Amps Id -O 12-'10 Volts Overhead M Underground No. of Meters
New Service Amps Volts Overhead En Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work'
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. ofLighting Fixtures
Swimming.Pool Above
Below
Generators
KVA
0
ground
0
gr ound
No. ofReceptacle Outlets
No. ofOil Burners
No. of Emergency Lighting Battery Units
No. if Switch Outlets
No. of Gas B umers
FIRE ALARMS No. ofZones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. ofDisposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. ofSounding Devices
No. of Dishwashers
Space Area Heating KW
No. ofSelfContained
Detection/Sounding Devices
Local Municipal
Othrr
No. of Dryers
Heating Devices KW
I
ElCorinections M
No. of Water Heaters K W
No. of No. of
—I
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER
hm=Cdvw� R=art1o1he=pmienlsdMwmdxseftG=W Laws
1ha%,eaomftLdm*hn==Poliqy ' Opao6onsCoAWcritssiEtride*ivalat YES NO
1haNesthngledvalidpcofofsamicitheOffm YES M NO Ifyuha,,tdWWYESpkmmdc&tcWcfwvua�pbydrck,,gthe
qvopimebox
INSURANUE [::]- BOND 01111R ftmSpc*)
EViatim D,*
Esftm&dValueofl3echnlWcik
WorkiDSm fiqxc6mDWeReWesWd Roo Fmal
Signed underTr Rnillics ofpe7, V -
FIRMNANIE _ - //,.e- & , a- LkeizeNki S3 -r--3 k�,
Signan 1-kawl.-Jo
BUWMTCLNV Fs- - C-,
Altlel.N4
OWNEP,'SMURANC7EWAfVER,Iana�NmhttheLjcmwdm_W 1hejwrd=amWorftSt*WrtW0W,110tas mgLiiWbyMMdmsMG=rJ Lam
andffttmysign�onfis
(Please
one) OF
Telephone No. PERMIT FEE $
If " � :714—
A
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
A PPLICATION TO CONSTRUCT REPAI!� RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
I
BUILDING PERNUT NUNIBER., DATE ISSUED:
SIGNATURE ALA
I iiu-ildini Commissionjj��r of Buildings Date 41 -/d - "Pe
SECTION I- SITE INFORMATION
1.1 operty Addr
1.2 Amessors Map and Parcel Number:
Map—N—,fmber Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
LAArea Frontage 00
1.6 BURDING SETBACKS 00
Front Yard Side Yard
Rear Yard
Required Provide Re�red Provided
Re�red Provided
1.7 Water Supply M.G.L.C.00. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public 0 Private 0 zone — Outside Flood Zone 0
Municipal 0 On She Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
12—t V., z- 1w 71
Name (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 Construction Supervisor: Not Applicable 11
Licensed Construction Supervisor:
117'2,-4 License Number
—,;?
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable 0
�111'lz �� e�,; A:
Company Name
Registration Number
Address
Expiration Date
Telephone
roe#
SECTION 4 - WORKERS COWENSATION (MG.L C 152 § 25c(6)
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 22rmit.
Signed affidavit Attached Yes ....... 0 No ....... 0
SECTION 5 Description o Proposed Work (check applicable)
iTe—w Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) 0 Addition 0
Accessory Bldg. 0 Demolition 0 Other 0 Specify h A A
I V.
Brief Description of Proposed Work:
-7c; A—
/&/0
r
-7 &'�00Q
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
MAIL
N
AN&M:NLLSM
Mzffn
Completed by permit applicant
1.
Building
(a) Building Permit Fee
Z2 2 67clo
Multiplier
2
Electrical
(b) Estimated Total Cost of
Construction
3
Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAQ
5 Fire Protection 41
6
Total (1+2+3+4+5)
07 7
Check Number
SECTION 7a OWNER AUTH ATION TO BE COMPLETED WBEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUrLDING PERMIT
as Oxvner/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 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 knowledge
and belief
Print Name
Signature of Owner/A ent Date
MMEM I I IMMMEMEM
NO. OF STORIES SIZE
BASENIENT OR SLAB
SIZE OF FLOOR TAMERS 1ST 2 ND 3m
SPAN
DMIENSIONS OF SILLS
DMIENSIONS OF POSTS
DEMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHHvINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
0
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/I / 1) �/- /
No. Date
,tO*Th TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Mus
Foundation Permit Fee $
Other Permit Fee $
*A '2
TOTAL $ r7�1
Check #
146'! 7 Building lnspector��
6;
I SEUTIUN I-SI'IE I-NYOKMATION
1. 1 Property Address:
TOWN OF NORTH ANDOVER
Number:
Parcel Number
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING
A�
Name (Print) Address for Service:
BUILDING PERM[IT NUMBER DATE ISSUED:
Frontage (ft)
1.6 BUIELDING SETBACKS (ft)
2,
,P- Owner of Record:
A. .0
law P7".
SIGNATURE:
J--A,6,1�-
Builchni
Commissionerfl±]J�Stor of Buildings Date
I SEUTIUN I-SI'IE I-NYOKMATION
1. 1 Property Address:
1.2 Assessors Map and Parcel
Number:
Parcel Number
1.3 Zoning Information:
Zoning Djar�d- Proposed Use
Name (Print) Address for Service:
1.4 Property Dimensions:
Lot Area (sf)
Frontage (ft)
1.6 BUIELDING SETBACKS (ft)
2,
,P- Owner of Record:
Front Yard
Side Yard
Name Print Address for Service:
Rear Yard
Required Provide
Required Provided
RequiiEl
Provided
Not Applicable 0
7 3�<
Licensed Construction Supervisor:
1.7 Water Supply ;.G.L.C.40. 5 54)
Public 0 Private 0 zone
1.5. Flood Zone Information:
— Outside Flood Zone 0
1.8
Municipal
Sewerage Disposal System:
0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHWIAUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Address for Service:
Signature Telephone.
2,
,P- Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 License I d Construction Supervisor:
Not Applicable 0
7 3�<
Licensed Construction Supervisor:
(�r
7—'
License Number
Address
--2 ro
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
S Telephone
go
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SECTION 4 - WORXERS COMPENSATION (ALG.IL C 152 § 25c(6)
Workdrs 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 22rmit.
Signed affidavit Attached Yes ....... 0 No ....... 0
SECTION 5 Description of Proposed Work (check aH aMicable I
New Construction 0 1 Existing Building 0 1 Repair(s) 0 1 Alterations(s) 0 1 Addition 0
Accessory Bldg. 0 Demolition 0 1 Other 0 - Specify
Brief Description of Proposed Work:
/AP_ / 712 �/ 6? Z� i ,4N
SECTION 6 - FSTYMATF.1) CONSTRUCTInN MSTS
I ' '7— 1 "
.11 1-7 t-
i -
Item Estimated Cost (Dollar) to be
:J
Completed by permit applicant
ME ho'.
0,7'-
I Building
_1 � .
(a) Building Permit Fee
2
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing 67& 612
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5)
Check Number
bLUJLJLUIN-/aUWJNEMAUltiOWAI'IUN TUME UUMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUrLDING PERMIT
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.
of Owner
4 7b OWNER/AUTHORIZED AGENT
Date
TION
/1Y —,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/
4'/ -
Date
NO. OF STORIES SIZE
BASENENT OR SLAB
SIZE OF FLOOR T1rVMERS I ST 2 ND 3KD'
SPAN
DE'vENSIONS OF SILLS
DMIENSIONS OF POSTS
MIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
TMATERLAJ, OF CHEMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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No. Date 2-2 1!9 X?
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
—Foundation Permit Fee $
.11
Permit
0 t, t f6c_ tee $
Sewer Connection Fee $ -------
Water Connection Fee $
$
Build ing'l nspector
6318 Div. Public Works
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
�/PAGE I
I
MAP +40. 1-7 1)
� LOT N . t; A-
2 RECORD OF OWNERSHIP jDATE
BOOK
PAGE
ZONE -
SUB DIV. LOT NO.
T-�-,-CTION
M4
PURPOSE OF BU'LD'NG:flk'�r
'I R jj'V2�2_k4
OWNER'S NAME
Geo mA.- st F, lu d k4L— 4
NO. OF STORIES �SIZE Pool LVi+L
OWNER'S ADDRESS
al 1
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDE REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
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
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 1 3
PAGE 2 FILL OUT SECTIONS I t2
ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILE AND APPROVED BY BUILDING INSPECTOR
DATE FILED 730
1 1
OR AUTHORIZED
.. F E E i s 0 ,
PERMIT GRANTED
19
OWNER TEL.# -(4&
CONTR. TEL, #
CONTR, LIC. 4
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COSTf:2G)()-o
EST. BLDG. COST PEW SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH I
PLANNING BOARD �
BOARD OF-SELECTMENI
- 4& ��
71NOPK-CTOR
I OCCUPANCY
SINGLE FAMILY
TILE -FLOOR
. RIES
MULTI. FAMILY
OFFICES
APARTMENTS
6 FRAMING
I I HEATING
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
a 1 2 13
FINE
HARDW D
PLASTER
CONCRETE
CONCRETE EILX
BRICK OR STONE
PIERS
FORCED HOT AIR FURN.
_�RY WALL
TIMBER BMS. &
STEAM
UNFIN.
3 BASEMENT
AREA FULL FIN. B M T AREA
1/1 1/2 1/1 FIN. ATTIC AREA
t!O 8 M T FIRE PLACES
HEAD ROOM MODERN KITCHEN
4 WALLS 9 FLOORS
CLAPBOARDS
DROP SIDING — _�ONCRETE
WOOD SHINGLEi EARTH
ASPHALT SlbING_ — HARDV,'*D
ASBESTOS SIDING COMMCN
VERT. SIDING iSPH TILE
STUCCO ON MAilONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR
WIRING
FRAME
5 ROOF 10 PLUMBING
GABLE _dlP BATH 11 FIX.) _1_1
r.AMRQFI MANIARI TOILET RM. (2 Fix.)
T
gUILDING RECORD
12
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. ,
TILE -FLOOR
IL DADC,
6 FRAMING
I I HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
GAS
7 NO. OF ROOMS
OIL
�WT 2nd
B
ELECTRIC
3,d
NO HEATING
DATE:
SOS - C�Zl 3331
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FEATURES:
El All Aluminum Construction
eliminates rust forever
El Patented Interlocking
Wall Sections make
Esther Williams the
strongest pool available
El Extruded Aluminum
Anchor Plates and
Extra Thick Tie Bars
are stronger to keep
your pool straighter
El Patented Deluxe
Beaded, 22 Mil. Virgin
Vinyl Liner resists mold,
mildew and bacterial fungi
[I 60 -Year Warranty
0 New, 50" Wall Height
and larger pool sizes
add more swimming
area . . . for more fun
and comfort
OPTIONS:
El POOL FENCING
• Top Quality, Durable,
Extruded Aluminum
• Meets or exceeds
most Building Codes
and Standards - Including
BOCA, NSPI, UBC, SBCC
*Virtually Maintenance Free
Ej PATIO DECKS
Extruded Aluminum
Interlocked Panels
Welded for maximum
strength
Virtually Maintenance Free
Comfortable,, Color
Co-ordinated Weather,' -
Resistant Carpeting
Includes'Swing-Up
Entrance Ladder and
Stainless Steel In-
PoolLadder
e Available: Large Patio
End Deck or Side Deck
11 WALK DECK
eSpacious 18" wide
(including coping)
• Durable Extruded
Aluminum
• Duracron Slip -
Resistant Finish will
not crack or chip
Ask Your Dealer About
Special Prices on
Deck and Fence Packages
CARNIVAL
New, 22 Mil. Virgin
Vinyl Liner with
20 -Year Warranty
New Pool Fencing
meets or exceeds
mnat hidlefinn rntlaq
&. W,'bz'.Oa�
,, s, ., , , Q..,,,,.
Stainless Steel
In -Pool Ladder
Swing -Up
Entrance Ladder
Strong, Extruded
Aluminum Buttresses
Thick, Interlocking New, Larger Coping
Wall Sections with Duracron slip -
strengthen your pool resistant finish
OVERALL POOL SIZE
SO. FEET
MAXIMUM
OPERATING GAL.
DIMENSIONS:
CAPACITY (GAL.)
(Excluding Buttresses)
Q 4 -7n
�x 2 2�2
3 �5
7,325
446
6,446
16' x 24'
312
9,725
16' x 30'
402
12,531
11,027
19' x 34'
524
16,334
14,373
HEIGHT. 50" Wall Height,
TOP RAIL: 7 Inches
Specifications Subject to Change
T 1892-29-D
MADE IN
mr�
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*****************
APPLICANT: GgL�_ Phone US aSF7H
Q
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street DLX�q -S 0� 6" St. Number
************************official Use only************************
OMEENDATIONS OF TOWN AGENTS: Date Approved
Date Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
Food Inspector -Health
Septic Inspector -Health
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Date Approved
DateRejected
Date Approved
Date Rejected
Received by Building Inspector Date
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BOARD OF HEALTH Town of North Andover
Office of the Planning Department
C
ommunity Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
Heidi Griffin Telephone (978) 688-9535
Planning Director Fax (978) 688-9542)
PUBLIC HEARING NOTICE
NORTH ANDOVER PLANNING BOARD
In accordance with the provisions of M.G.L. Chapter 40-A, Section 11, the North
Andover Planning Board will hold a public hearing as follows:
Purpose of Public Hearing:
Application for Watershed Special Permit under
Section 4.136 of the North Andover Zoning Bylaw to
permit the reconfiguring of an existing driveway and
related work, including reducing the size of the existing
deck and restoring vegetation bordering a wetland
resource.
Applicant/Petitioner:
David W-. Palmer
284 Salem Street
North Andover, MA 01845
Address of Premises Affected
284 Salem Street
Assessors Map and Lot:
Map 37D Lot 39
Public Hearing Date & Time
Tuesday, December 4, 2001 7:30 p.m.
Location of Public Hearing
North Andover Public Works Garage at 384 Osgood
Street, near the High School entrance
Information Available
A copy of the plan and application is on file in the
Planning Board office at 27 Charles Street, North
Andover, MA, and may be inspected Monday through
Friday 8:30 a.m. to 4:30 p.m.
Any person interested or wishing to be heard on the proposed plan should
appear at the time and place designated above.
John Simons, Chairman
North Andover Planning Board
Publish: Eagle Tribune Friday November 9 & November 16, 2001
BOARD OF ATPEALS 688-9541 BILTILDING688-9545 CONSERVATION 689-9530 fIEALTH688-9540 PLANNING688-9535
$ Town of North Andover
Office of the Planning Department
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
Telephone (978) 688-9535
Fax (978) 688-9542
C�
Notice Of Decision S�2
C::) �0 CD C-) 7.)
An appeal shall be filed rn
y
Within (20) days after the C--) -;�j
-0 In r
Date of filing this Notice CD rn C::) rr,
C) -;0 U) C3
In the Office of the Town
Clerk
Date: December 19,2001 -j
Date of Hearing: December 4, 2001 a
December 18, 2001
Petitionof- David W. Palmer�2-84-Salemgt�reetNorth Andover, MA 01845
Premises Affected: 284 Salem Street, North Andover, N1A
Referring to the above petition for a special permit from the requirements of the North
Andover Zoning Bylaw Section 4.136.
So as to allow: the reconfiguration of the existing driveway, related landscaping and
reduction to the existing deck within the Non -Disturbance Zone of the Watershed Protection
District.
After a public hearing given on the above date, the Planning Board voted to APPROVE,
the Special Permit for Watershed Protection District, based upon the following conditions:
Signed: A, ) P" 5-1,
j n S
iert(l
n S*n6, Cliairm-'-86
Cc: Applicant A o Angles, Vice Chairman
Engineer Richard Nardefla, Clerk
Abutters Richard Rowen
DPW Felipe Schwarz
Building Department
Conservation Department
Health Department
ZBA
BOARDOF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH688-9540 PLANNfNG688-9535
284 Salem Street
Special Permit - Watershed Protection District
The Planning Board makes the following findings regarding the application of David W.
Palmer, 284 Salem Street, North Andover, MA, 01845, submitted on November 2, 2001,
requesting a Special Permit under Section 4.136 of the Zoning By -Law to allow the
reconfiguration of the existing driveway, related landscaping, and reduction of the existing
deck within the Non -Disturbance Zone of the Watershed Protection District.
FINDINGS OF FACT:
In accordance with 10.31 the Planning Board makes the finding that the intent of the Bylaw,
as well as its specific criteria, are met. Specifically the Planning Board finds:
1. The specific site is an appropriate location for such a use, structure or condition; the
changes to the site will not affect the use of the site as a single-family residence.
2. The use as developed will not adversely affect the neighborhood; the reconfiguring
of the driveway will increase the turning radii and make the neighborhood safer for
pedestrians and other vehicles. 750 square feet of vegetation will be used as a buffer
from the resource area. The new fencing will help prevent unintended debris from
entering the abutting resource area.
3. The proposed use will not result in a nuisance or serious hazard to pedestrians or
vehicles; the reconfiguration of the driveway will benefit pedestrians and other
vehicles by providing safer access to the site by providing an area to turn around in.
4. Adequate and appropriate facilities will be provided for the proper operation of the
proposed use; the site will continue to operate as a single-family residence. A slatted
fence will be placed on the site to help reduce the likelihood of degradation of the
groundwater and Lake Cochichewick. The infiltration units and water trench
management system will control storm water runoff.
5. The use is in harmony with the purpose and intent of the Zoning Bylaw; the storm
water management infiltration trench will help preserve the purity of the local water
source, Lake Cochichewick, while conserving the natural environment to maintain
the filtration and purification functions of the land.
In accordance with 4.136 the Planning Board makes the finding that the intent of the Bylaw,
as well as its specific criteria, are met. Specifically the Planning Board finds:
6. That as a result of the proposed construction will not be any significant degradation
of the quality or quantity of water in or entering Lake Cochichewick. The Planning
Board bases its findings on the following facts:
a) The topography of the site will not be altered substantially.
b) The work will not contribute to the overcrowding of land.
c) The proposal encourages the most appropriate use of the land by furthering the
safety of the residents in the area and protecting the abutting resource area.
d) The expansion of the driveway will help reduce hazards by improving ingress
and egress.
e) The proposed fence will help control the use of a small stream behind the site.
f) Approximately 750 square feet of lawn will be converted to restore the buffer
zone to a more natural state this is to mitigate the removal of 250 square feet of
natural vegetation east of the driveway.
g) A deed restriction will be placed limiting the types of fertilizers that can be used
on the site.
Upon reaching the above findings, the Planning Board approves this Special Permit based
upon the following conditions:
SPECIAL CONDITIONS:
1) This decision must be filed with the North Essex Registry of Deeds. The following
informationis included as part of this decision:
a) Plan titled: Site Plan
284 Salem Street
North Andover, MA 0 1845
Prepared for: David W. Palmer
Prepared by: Design Consultants, Inc
265 Medford Street
Somerville, MA 02143
Scale: 17= 20'
Date: July 20, 2001
Plan Titled: Fax sent by Design Consultant's Inc dated December 18, 2001
Revision to Silt Fence Detail.
b) The Town Planner shall approve any changes made to these plans. Any changes
deemed substantial by the Town Planner would require a public hearing and
modification by the Planning Board.
Ii
2) Prior to Start Construction:
a) A performance guarantee of five hundred ($500) dollars in the form of a check
made out to the Town of North Andover must be posted to insure that construction
will take place in accordance with the plans and the conditions of this decision and
to ensure that the as -built plans will be submitted.
b) All erosion control measures as shown on the plan must be in place and reviewed by
the Town Planner.
c) The use, or method of application of, any lawn care or garden product as sited in
Section 4.136(c)(iii)(4)(5) (fertilizer, pesticide, herbicide) that may contribute to the
degradation of the public water supply are prohibited. 'The applicant shall
incorporate this condition as a deed restriction; a copy of the deed shall be
submitted to the Town Planner and included in the file.
3) Prior to release of the Performance Bond:
a) The applicant shall submit an as -built plan stamped by a Registered Professional
Engineer in Massachusetts that shows all construction, including stonn water
mitigation trenches and other pertinent site features. This as -built plan shall be
submitted to the Town Planner for approval. The applicant must submit a
certification from the design engineer that the site was constructed as shown on the
approved plan.
b) The Planning Board must by a majority vote make a finding that the site is in
conformance with the approved plan.
4) In no instance shall the applicant's proposed construction be allowed to further impact
the site than as proposed on the plan referenced in Condition # 1.
5) No open burning shall be done except as is permitted'during burning season under the
I Fire Department regulations.
6) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation.
7) The provisions of this conditional approval shall apply to and be binding upon the
applicant, it's employees and all successors and assigns in interest or control.
8) This permit shall be deemed to have lapsed after a two- (2) year period from the date
on which the Special Permit was granted unless substantial use or
construction has commenced.
cc. Applicant
Engineer
File