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Home My WebLink AboutMiscellaneous - 29 CHERISE CIRCLE 4/30/2018C2 CD C:) 0 F- 6 m Non j (,% 1 4 .- , ............... Date../ -/... '. -) TOWN OF NORTH ANDOVER PERMIT FOR WIRING P- I L This certifies that . ................. 1- .... ; ........................................................................ I/ �11' .10 ................ ...... has permission to perform A.:!�� .......................... wiring in the building of . ........................................................... ...... ..... at ..... .......... --f ......... ................................. . North Andover, Mass. Fee-7;tll-� - .. ............... e -VI — ' ' Lic. k ............ ................ ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 77 -LE C0MV0AWE4LTH0FA"MCHUSE77S Ue I DEPARTAffiNTOFPUBLICS4= Permit No. 07— BOARO OFFB?EPREVEV77ONREGUL47TOAN527(NR IZ-09 Occupancy & Fees Checked f A.rrLJC.A1-1U1V PUA -r.L1VVU1 I UJ-jMVrUIUVI-ELEL-IiUL-.,4i.L VVL11XAN ALL WORK TO BE PERFORIvED 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 Ins . pector of Wires: The undersigned applies for a permit to perform the electrical work described below. MAP PARCEL � I i Location (Street &.Number) MYLO/J'V5 OwnerorTenant JA-)1&UM-M IhVD MM -q BaRL Owner's Address Is this permit in conjunction with a building permit: ^ Yes Purpose of Building �o r7 (Check Appropriate Box) Utility Authorization No. Existing Service —t7trt.,� Amps/,& 2,9�) Volts Overhead r7 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 Moog, S --g2.12 6,1 I � No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures swimming Pool Above M Below M Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumcrs rM- ALARMS No. of zones 'NV. 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 Davices �Vo. of Dishwashan Space Area Hcating KW No. of StAf Contained Detection/Sounding Devices Local Municip�l 1:1 r-1 Other No. of Dryers Heating Devices KW 1 Conncetions L ---j No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER - I Itmeaw=LzbkyhsL==Poky=kdngCmVi&'OMMcr]sCmemWcrZskswtmle4zvdiuI YES NO ihneskni&dmihdpudefsm=tothrOffiD-- YES M NO YyuuhaNedmimdYESpkasemdc*thevADeot=erWbydukingtr Wpupdatebox NKRANM []!r BOND 011-M Oam Esft�VahEdUoJncdW6k $ WdktoSw kqeMenDatRapested Rao Frial I Sigrrdundcr&FUmh=cfpqW FffZMNAlvE 1 29 2,64 5L 96 a/,*- Al TeL 14a OAT��SR4SURANUWAIVER,Iarnaw&edyltdioLmalsedoesnuthawdruBum=omemWcrt3sibsMribaleqmrdientasreqxedbyNbsmdxB&C-,=mlLaNks andd-Amy*ntmcnd�spmiiiaFpb'catimwa*�mdismgimmi (Please check one) Owner M Agent E] Telephone No. 928 ( PFcP9 (3 ? 0 —PERMIT FEE $ --Signature of U�wner or Agent 0 V-4 P ui CL fail 0 CO .0 cm E co co > M 40 —j 0 :20 Cc gm E co js 1>0 = =C, IT cm CM CIO A: 0 cm s c 0 CD CL ;C2, C, 0 CD CA co,) 9 c: L.0 b— C -D cm C, co cc C) U ow 0 u iN, w Qr --a z z P -W I w C� r_w A CP, CIO IL cz V4 D u 0 0 :,� I ; z V) C/) ui CL fail 0 CO .0 cm E co co > M 40 —j 0 :20 Cc gm E co js 1>0 = =C, IT cm CM CIO A: 0 cm s c 0 CD CL ;C2, C, 0 CD CA co,) 9 c: L.0 b— C -D cm C, co cc C) cl) cm E CD CL CO) CIO co co co 0 co co co G) m CL 00) Cc CD :z ts co CL CO) 014, U u cl) cm E CD CL CO) CIO co co co 0 co co co G) m CL 00) Cc CD :z ts co CL CO) 014, z ow o > 0 0 MO LU Cl) 0 U. Z 0 ". LLI 0 0 F - cc LU C.) f 4) 0.0 CD .0 E z E 0 IL cm C MR C4-: 1 1�1- PER111T NO. �z I ?— MAP 4-40. ZONE 'o Il APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE I INSTRUCTIONS SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY REGULATED BY PARA. 114.8-S. B.C. PAGE I FILL OUT SECTIONS 1 3 PAGE 2 FILL OUT SECTIONS 1 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING DATE IC4NS-�- FEE PAID ISM ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE eff OWNER OR AUTHORIZED AGENT FEE PERMIT FOR FRAMUBUILDING PERMIT GRANTED 19 DATE: FEE PAID: - 3 PROPERTY INFORMATION LAND COST �b EST. BLDG. COST 92_ EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 659 4 APPROVED BY 0 ING INSIPMOR v v VO OWNER TEL. # 3 rv,4 CONTR. TEL. # 66 3 V CONTR. LIC. # �Q� :2 H.I.C.# 20 410% 7t-5 ct — t3tb LOT NO. c� 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE SUB DIV. LOT NO. 117 LOCATION ' �2 ee-i4 e- C j,c I e PURPOSE OF BUILDING C-4 OW114ER-S NAME Q e i.., e, top NO. OF STORIES a - S17F 1 ;2 9 )( k/ OWNER'S ADDRESS Z 0,15r Q 1) 1-14-,Je BASEMENT OR SLAB &eeln�' Lv� oa- Ze LZ ls� ARO.�HITECT-S NAME SIZE OF FLOOR TIMBERS ISTa IC) IND 3RD 2 0 611 LDER'S NAME covik.cri- SPAN DISTANCE TO NEAREST BUILDING J'o DIMENSIONS OF SILLS DISTANCE FROM STREET lz 9 " POSTS ;2 DISTANCE FROM LOT LINES - SIDES REAR 2-0 GIRDERS AREA OF LOT 676� FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING 16 x IS BUILDING ADDITIOrY 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 PERMIT FOR FOUNDATION ONLY REGULATED BY PARA. 114.8-S. B.C. PAGE I FILL OUT SECTIONS 1 3 PAGE 2 FILL OUT SECTIONS 1 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING DATE IC4NS-�- FEE PAID ISM ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE eff OWNER OR AUTHORIZED AGENT FEE PERMIT FOR FRAMUBUILDING PERMIT GRANTED 19 DATE: FEE PAID: - 3 PROPERTY INFORMATION LAND COST �b EST. BLDG. COST 92_ EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 659 4 APPROVED BY 0 ING INSIPMOR v v VO OWNER TEL. # 3 rv,4 CONTR. TEL. # 66 3 V CONTR. LIC. # �Q� :2 H.I.C.# 20 410% 7t-5 ct — t3tb BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY SiORIES I— MULTI. FAMILY APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE PIN 3 1 2 13 CONCRETE BIL K. BRICK OR STONE PIERS PLAST R 6RY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M'T' AREA 1/1 1/2 % FIN. ATTIC AREA �!O 8 M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING HARDW D COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR CONC. OR CINDEi BLK. WINING STONE ON MASONRY STONE ON FRAME_ RIOR POOR ADEQUATE 1-1 -NONE 10 PLUMBING 5 ROOF GABLE I BATH 13 FIX.) G A M :BR:E:L] A MANSARD TOILET RM. 12 FIX.) FA L T SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURE TILE FLOOR TILE DADO 6 FRAMING HEATING OOD JOIST PIPELESS, FU NA - FORCED HOT AIR FURN. TIMBER 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 ROOM$ S OIL B'M'T I_hd Ist 3rd ELECTRIC NO HEATING 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. I / Location o ils e- Q '(zo- LL= - N o. z - Ll Date RTpf TOWN OF NORTH ANDOVER Certificate of Occupancy $ 41 Building/Frame Permit Fee $ Area CHUS Foundation Permit Fee $ iL-%iT-,,Other Permit Fee $ Sewer Con nection Fee $ Water Connection Fee $ TOTAL $ CA,�A� Buildin6-tms—p�ctor 25.00 PAII 9502 Div. Public Works Locaflon No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 4:53 4088-00 PAID Div. Public Works Location 29 34EZkSF- C, CrJe- No. Date -3, %OR TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee TOTAL $ Building Inspector '50- 00 PAID Div. Public Works Location No. IS7 1 -2, Date A10 :3W /j� 7 Q-/- -9d TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ -------- Water Connection Fee $ &)77,fip -rr%'r A 1 0 1 r k-1 'IN , "-7 N C,V B0 inrq;dnspect 11/16/95 14:54 1,077-50 PAID ; I 111�,,Ilvel , , I -1;W 7 V-12 -- DZJ�Ibli 20orks - - " k4 e CN T-4 C%l "4 uj u? I 0 z W, CA oq t52:!� Zia cc ui C. n ci 09- co 0.0 1 i,; 0 CO 0 47,p u CV, CJ -a Q) 72 E 0 co 0 LE Cf) 0 0 0 0 E C%l "4 uj u? I 0 z W, CA oq t52:!� Zia CL M CO3 cm co cm cz CD NJ CD C) C3 5 Idol 43% �10, P-4 u r n a 451 cz E co co 0 COD C33 CO3 CD .CO2 co g cm cm CD CD C13 >,. co CM CD Lm CL CO) Cc C.) *FL C* co CD CO) CO3 LL. LLI cc LLJ cc LLJ C) C-) cm LL. LL. ui < Lo LU a- cn .r- 60 (1) t LO cc ui C. n ci co E E 0 CO 0 CJ 0 co CA E CD co cm c D cl CE CL. 2 cc) co C4 C, 0 co co mu ca E CL= 9 :Z; w I.. Q CO cm L� co C* -0 = CIO = fA co -5 CD -5 cc .0 OM= C* CL M CO3 cm co cm cz CD NJ CD C) C3 5 Idol 43% �10, P-4 u r n a 451 cz E co co 0 COD C33 CO3 CD .CO2 co g cm cm CD CD C13 >,. co CM CD Lm CL CO) Cc C.) *FL C* co CD CO) CO3 LL. LLI cc LLJ cc LLJ C) C-) cm LL. LL. ui < Lo LU a- cn .r- 60 (1) t LO 2 F6RM 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***************** -1- 1 APPLICANT: u -K C �A -Z� t- Phone :2 2 Y' LOCATION: Assessor's Map Number Parcel Subdivision -LA-AJ)--C "?- � —*-7 Lot (s) Street C St. Number ************************Official Use Only************************ RECOMMENDATIONS��TOWN AGENTS: Conservation ACn, in"ittra-tor Comments -.VA - (A�� Town Planner Comments Food Inspector -Health Sept -i -C Inspector -Health Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Reject e d Date Approved -24A!Z- Date Rejected Public Works - sewer/water connections --/� �",A - d-riveway permit =/AkV-; Fire D�Partment 0 ?-� z Received by Building nstlector OCT 1 2 Date M 134, SERKE 30, pFop w 15��oo T TOP FYW FT 2,5' 13a Jill 00 Z5 40 55 Lc, GAL - 55' 1500 P, is' V5' P -)z z jjo f14 cs -A 10' GV q 10 NIF T1?L1.1 I -A L T Y wt?Elvc� A LCO Iq r A SEPTIC S YS TEI�f DESI(3N �075 NORTH 4 ND 0 VER r4Q SCO TT CONS TRUC T MASS I 12 ION INC RD HA!�Epl 160 1?1S TIA �IVSEI� 7 (�, ��n or, 20 1 1 1 FOUNDATION LOCATION PLAN CLIENT. JPD DEVELOPMENT THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. LOCATION: NORTH ANDOVERkA. LOT 7 CHERISE CIRCLE SCALE.- 1" = 40' DATE.- OCTOBER 19,1995 PROFESSIONAL ENGINEERS CHRISTIANSEN &SERGI LAND SURVEYORS f6O SUMMER ST. HAVERHILL.MA. 01850 TEL. 508-575-0510 19) 1995 BY CHRISTIANSEN & SERGI INC. I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO TRE HORIZONTAL SE7BACK REQUIREMENTS OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CER70CATION DOES NOT CONSIDER ANY OTHER RESTRIC77ONS SUCH AS COVENANTS.WETLANDSEASEMENTS, ORDERS OF CONDITIONSETC.) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ABOMEXCEPT WITH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC FURYNERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIBITED.CHRISTIANSEN & SERGI TAKES NO RESPONS191UTY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR- MA77ON CONTAINED HEREON. BASED ON SCALED DATA ONLY THE PRIMARY STRUCTURE SHOWN IS NOT LOCATED IN A FLOOD HAZARD ZONE AS SHOWN ON FEEMA FLOOD INSURANCE RATE MAP. COMMUNITY NO.: 250098 OGOX&AA&"JF.-612193 0 DRAWING No. 93067016 ory- svz- 11 m Eli: Fil a-*- V)_ 0 F-( u IS At ct c x� R u Z 0 C4 Cd c X. u w V) it �z I 0 u w 0 P, - co c a - CL Fil a-*- E24 U Cl) C/) C/) 0 r Cl) 0 C/) co 0 E 0 *.0 ci CA CD cm 0.— co co E cc cc CD ow co CD 0 0 -1-- C Cc 'FL CD C.2 CD CA CO2 At CL Cc CD- cr-. CE 42 -CD CL C* 0 CM CD ca ca 0 co ca > =C, S ca Cc 0 ca CD 0 CL CD CD :cc>o, rm w Co. a) CD 0 t-4 0 4; CD 0 CC,00) -a m 'g LAJ C=, CD ca '0 C.3 cm CD h- CD 0 o IOD EE = CL W.5 =:a -0 o C) o L- . CL. cc E24 U Cl) C/) C/) 0 r Cl) 0 C/) co 0 E 0 *.0 ci CA CD cm 0.— co co E cc cc CD ow co CD 0 0 -1-- C Cc 'FL CD C.2 CD CA CO2 (U �00 0 "o L4 070 ggo 4., uj co c a pp ca ca co 39 C/J R:5 g COD M2 w ui = 79 33 a, uj &— C.) cm C.) ID OPOSS CL. C* CM7S *.- =cc W cm C2 cm C2. f*4 LLJ "I z 0- C/) 7. 0 U C/) Cf) I i2 C - C2 S U - D CS -q: —4 C.3 CD :c :K.16 tc. z 11 LE u co Lu 1 E: .CA cp z Cc ggo 4., uj co c a pp ca ca co 39 C/J R:5 g COD M2 w ui = 79 33 a, uj &— C.) cm C.) ID OPOSS CL. C* CM7S *.- =cc W cm C2 cm C2. f*4 LLJ "I z 0- C/) 7. 0 U C/) Cf) I CJ C2 S U - CD CD cn ob CS -q: —4 C.3 CD :c :K.16 tc. CD ggo 4., uj co c a pp ca ca co 39 C/J R:5 g COD M2 w ui = 79 33 a, uj &— C.) cm C.) ID OPOSS CL. C* CM7S *.- =cc W cm C2 cm C2. f*4 LLJ "I z 0- C/) 7. 0 U C/) Cf) I C2 S U - co Lu .CA cp Cc > a' 0 co 43 >- Co co Q cts CD CL E: CMCZ cc C.3 G3 .4-0 --1 LL CO 0 CL CO) U3 U Location Date �:' -17 --,9 I AORTPI TOWN OF NORTH ANDOVER 0 4, i as -=z Certificate of Occupancy $ CHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �,'Check # Building In 601or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUELDING PERNUT NUMBER: DATE ISSUED: SIGNATURE: C,.� Building Commissioner/IMKctor of Buildings Date SECTION I- SITE INFORMATION 1. 1 Property Address: a9 C*+FIZ tse (A IR CLE 1.2 Assessors Map and Parcel Number: 661 0�7�p Map Number Parcel Number Qq�R KA 01945 1.3 Zoning Information: �.ib At X Zap I T' "j-_Xj- 54AC.0utc- Zoning Dim_xict Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage (fl) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide R�red Provided Required Provided 11 1.7 Water Supply M.G.LC.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 OW.NERSIUPIAUTHORIZED AGENT 2.1 Owner of Record U)l co�,R Che Ir ( SR Ctrd en, 9. An d N tot --J Address for Service: ,,Z(Print) 4 . jor 07 9- &.00.a qso 7 0 Signature U Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: -_J 0&e 6 U11A/ Licensed Conitruction Supervisor: ji� 6 J�- Address Si97 Telephone Not Applicable 11 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone T M X ic —1 z 0 L M IL W 0 z M 90 0 Mn ic M G) I SECTION 4 - WORI(ERS COMPENSATION (XG.L C 152 § 25c(6) I Workers Compensation Insurance affidavit must be completed and submitted %ith 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) —[��ition New Construction 0 Existing Building 0 Repair(s) 11 Alterations(s) 0 Rr- Accessory Bldg. 11 Demolition 0 Other 0 Specify Brief Description of Proposed Work: 1?e m o y(f je, � 5 1/'4/ 4; c�c )L, 4 oelu ryl L '/0 01/- 15J/A/4 �b CIS C I SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed t permit applicant OFFICIAL USE ONLY I . Building 'X0 0 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) I 4 Mechanical (HVAC) 5 Fire Protection K94 Total (1+2+3+4+5) 'T I Check Number .6 SECTION 7a OWNER AUTHORIZAT16N TO BE COMPLETED WBEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BURDING PERMIT I'loilitool iguet as Owner/Authorized Agent of subject property Hereby authorize \Jof_ -)b'V4(-)ffA) 0,06),5 � (�o to act on My beha�f, in natters re�tive to wpr� authorized by this building permit appliq1tip. Z Qp luave k&&t AVY0 P�l 21004 Z'e Signature of Owner C/ U Dat� 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/Agent Date NO. OF STORIES SIZE BASENIENT OR SLAB SIZE OF FLOOR TAMERS iST 2ND 3RD SPAN DDAENSIONS OF SILLS DU\,ENSIONS OF POSTS DM&ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FULED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U — LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necleszary approv2lslpermits from - Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner f�orn compliance with any applicable or requirements. *APPLICANT FILLS OUT APPLICANT�31 LU A VM'I�U V+ PHONE q18 �901 - q9,70 LOCATION: Assessor's Mao Number 0(0 -�PARCEL CONSERVATION ACMINISTRATOR CATE AP PROVED L4 DATEREIECTED_ - (n wee COMMENTS (2' TOWN PLANNER CATE APPROVED PRD CATE REJECTED COMMENTS FOCC INSPECTOR -HEALTH CATF-APPROVED CATE RE-JECTED. I NS P EC�TCR-H�2ALTH 0AT`E APPROVED DATE REJECTED -/MOLI COMMENTS—. a k /4 I PUELIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE CEPARTMENT RECEIVED EY EUILDiNG iiNSPECTOR Revised 9�27 im 1^ CATE a ,V/;U./`>0 SLIECIVISION LOT (S) STREET Ci CHsgisE 64p, olle ST. NUMEER ------------------- OFFICIAL USE Rek"* %a �e_ cyjs lfws 0 40 F-10 D 2 C_ K y. ? REC MMENDA —iJ0N5_0F TOWN AGENTS: CONSERVATION ACMINISTRATOR CATE AP PROVED L4 DATEREIECTED_ - (n wee COMMENTS (2' TOWN PLANNER CATE APPROVED PRD CATE REJECTED COMMENTS FOCC INSPECTOR -HEALTH CATF-APPROVED CATE RE-JECTED. I NS P EC�TCR-H�2ALTH 0AT`E APPROVED DATE REJECTED -/MOLI COMMENTS—. a k /4 I PUELIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE CEPARTMENT RECEIVED EY EUILDiNG iiNSPECTOR Revised 9�27 im 1^ CATE a ,V/;U./`>0 => n ca jo EA V� r rn r, -, vf) T - C7 c, -th tA _;Lj =7--= 7:=j, Nj 71 'gi K CNZ) 91 BUILDING DEPARTIMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly dc.-nsed solid waste disposal faciEty as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility U Signature of Permit Applicazit "tate NOTE: Demolition permi t �xoni the Town of North Andover must be obtained for this project through the Office of the Building aspector A d( 0 Z cL C) C>'A e� ZI: �o OD 01 rn rn r, r, t, ILI; --t r, a So rz (n �b. 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