HomeMy WebLinkAboutMiscellaneous - 29 FAULKNER ROAD 4/30/2018 (2)§
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3505 Date ...
V,ORTk TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ................... �12'
has permission for gas -installation-/�,.—I-'A.
1--j
--4 - � 5. . V
in the buildings of �'� ...... ................
0// North Andover, Mass.
at 7. ......... ........
Fee,-��q. Lic. NoO.& ....
...........
V
'E
GASINSP OR
�IAppllcant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Pr t T
MA Date Receipt# - Permit# �C--
7r. -- 2z��w 1-< I I 1CQq
OwneesName 0
Building Location —Qaf �au 0 NJ
Map:_ Lot:— Zone:_ Typeofoccupancy
New Renovation U L��snt �U� Plans submitted: Yes U No U
Installing Company Name
Address I.A I - LO!�Lb-- �r--
EstimateValueof Work:
Business Telephone 0 0 —
Nameof Licensed Plumber or Gas Fitter
Checkone: Certificate
19 Corporation
U Partnership
0 Firm/Co.
INSURANCE COVERAGE- 142
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. -
Yes 11f No U
If you have checked ves, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 5( 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 0 AgentQ
Sianature ot owner or ownees Agent
I hereby cer* 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 underthe permit issued for this application will be in compliance with
all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GenKI E�W-S.
By Ty e of License: s Fitter
Plumber Signature of Licensed Plumber o
Tide Gasfitter
Master License Number
City/Town Journeyman
JAPPROVED (OFFICE USE ONLY)
NONE
-MEN
MEMO
—EMEMMEMEMEMEMMEMEMEM
MEN
OEM
so
MEEMEMOMMEMEMEMEM
EMEMMEMEMEMEM
INESOMMEMEMEN
MEMEMEMEMEMEME
EMEMEMEMEMEMEME
EMEMEMEMEMEME
MEMENMEMMEMEM
M
MENNEN
MMEMO
MMEME
EMEMN
EMMEN
MESON
MMMMN
MEMO
ME
NNE
;,=NNE
*&-
IMMEMMEME
Installing Company Name
Address I.A I - LO!�Lb-- �r--
EstimateValueof Work:
Business Telephone 0 0 —
Nameof Licensed Plumber or Gas Fitter
Checkone: Certificate
19 Corporation
U Partnership
0 Firm/Co.
INSURANCE COVERAGE- 142
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. -
Yes 11f No U
If you have checked ves, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 5( 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 0 AgentQ
Sianature ot owner or ownees Agent
I hereby cer* 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 underthe permit issued for this application will be in compliance with
all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GenKI E�W-S.
By Ty e of License: s Fitter
Plumber Signature of Licensed Plumber o
Tide Gasfitter
Master License Number
City/Town Journeyman
JAPPROVED (OFFICE USE ONLY)
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Date. .
. . . . . . . . TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ...... ..............
has permission to perform '0-�
.................
plum�in� in the buildings of ..................................
at. North Andover, Mass.
jlv . . . ?'T * - * * / - - - - < .. ... . . . . . . . . .
Fec�� . Lic. No .......... ..
---PLUMBI�GASPECTOR
Check 42-f �p /
WHITE: Applicant CANARY: Building Dept PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location
11 � F-4
04
Date
Name &FIr- me Permit
Type of Occupancy RP-Stj I Amount 9:A:1 -
New ry I I Renovation ri Replacement Plans Submitted Yes No
IAI
7—
(Print or type) Check one: Certificate
Installing Company Name—E f- P P I tivn b, ri El Corp.
Address 37- �jA-trerc i� -0 Partner.
Firm/Co.
Business Telephone 7 74 ? 4
Name of Licensed Plumber.- bJL 11 1 &M JOZ4-9e
insurance Coverage: Indicate the type of insurance covera-ge by -cliecking the appropriate box:
Liability insurance policy P Other type of. indemnity 1:1 Bond
Insurance Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner F1 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Mffsachusetts State Plu Code and Chapter 142 of the Gene'ral.Laws.
jBy:
Title
City/Town
APPROVED (OFFICE USE ONLY
Type of Plumbing LicensiE—
L I to Z19' Master Journeyman
License Numoer I'al 1-1
wa-her oyfly
OISR56A) PR6PAlvC- -
6k5 / FlvF-tl
W141 �11*
WIN I: I a 094
(Print or type) Check one: Certificate
Installing Company Name—E f- P P I tivn b, ri El Corp.
Address 37- �jA-trerc i� -0 Partner.
Firm/Co.
Business Telephone 7 74 ? 4
Name of Licensed Plumber.- bJL 11 1 &M JOZ4-9e
insurance Coverage: Indicate the type of insurance covera-ge by -cliecking the appropriate box:
Liability insurance policy P Other type of. indemnity 1:1 Bond
Insurance Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner F1 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Mffsachusetts State Plu Code and Chapter 142 of the Gene'ral.Laws.
jBy:
Title
City/Town
APPROVED (OFFICE USE ONLY
Type of Plumbing LicensiE—
L I to Z19' Master Journeyman
License Numoer I'al 1-1
wa-her oyfly
OISR56A) PR6PAlvC- -
6k5 / FlvF-tl
6 0
4K
Zoning Bylaw Review Form
Town Of North Andover Building Department
27 Charles St. North Andover, MA. 01845
Phone 978-688-9545 Fax 978-688-9542
Street:
Q,0j Ea -v I 7� —e- v— JR
Map/Lot:
4q/al
Applicant:
Wet'c
Request:
r, cc, �A-, c.
Date:
F
Please be advised that after review of your Application and Plans that your Application is
DENIED for the following Zoning Bylaw reasons:
Zoning
L 4 1 Zone to be Determined— i 1 .7 -1--qjnn rl.nmr%li—
juewpede(3 buppg
Item
Notes
ffu—luuEld
Item
Notes
A
Lot Area
411e9H
F
Frontange
I
Lot area Insufficient
1
Frontage Insufficient
2
1 Lot Area Preexisting
5
2
Frontage Complies
3
1 Lot Area Complies
.3
PreexipVng frontage
Lte- 5
4
Insufficient Information
4
Insufficient Information
B
Use
5
No'. access ov"er Frontage
1
Allowed
G
Contiguous Building Area
2
Not Allowed,
I
Insufficient Area
3
1 Use Preexisting
2
Complies
4
Special Permit Required
Ll 5
3
Preexisting CBA
5
Insufficient information
4
7fn—sufficient Information
C
Setback
H
Building Height
I
All setbacks comply
I
Height Exceeds Maximum
2
Front Insufficient
2
Complies
3
Left Side Insufficient
s
3
Preexisting Height
4
Right Side Insufficient
4
Insufficient Inform ation
5
Rear Insufficient
I
I Building Coverage
6
Preexisting setback(s)
I
Coverage exceeds maximum
7
Insufficient Information
2
Coverage Complies
D
Watershed
3
Coverage Preexisting
e 5
I
Not in Watershed
Li e- S
4
Insufficient information
2
In Watershed
-41
j
Sign
3
Lot prior to 10/24/94
Sign not allowed
L 4 1 Zone to be Determined— i 1 .7 -1--qjnn rl.nmr%li—
juewpede(3 buppg
19410
UOISSIWWOO JeOpOls1H
ffu—luuEld
sjjoAA oilqnd ;o juewpede(]
U01jeAJ8SU00
Pie% buluoz
90110d
411e9H
all=]
:OJL PoijejoH
Rica , eview Narrative
Thb Ilowing narrative is provided to further explain the reasons for,DENIAL for the
ICATION for the property indicated on the reverse side:
Pe
MI,
Pl
To iw,A-) Oarv-h Acky�e,,
1,�4 0 1 C
o P .9.5 e- c.,l
r a t2±—
jJ, 4 dalt
o
c- T;4-
';',V IV A�
Zoning Bylaw Review Form
Town Of North Andover Building Department
A�l 27 Charles St. North Andover, MA. 01845
Phone 978-688-9545 Fax 978-688-9542
I, ' -, �� - - , , " I I
__� �eet' �
Q 'I Fa u 1 1( &!� e- r- jka
-Map/Lot:
�q /a I
Applicant:
Wet'ctj 4- 'R. 10 ep,-J, ' C 6 - A-0
Request:
Date:
n I—
GQ R "l, 44Qc. se AJJ, I CA.) V- C C -a-4- t C' __0
r" caza Dc auvibud that aner review OT your Application and Plans that your Application is
DENIED for the following Zoning Bylaw reasons:
Zoning —R
Remedy for the above is,checked below.
Item # Special Permits Planning Board Item #
Item
Notes
Setback Variance
Item
Notes
A
Lot Area
Common Driveway Special Permit
F
Frontage
Variance for Sign
I
Lot area Insufficient
Large Estate Condo Special Permit
I
Frontage Insufficient
Special Permit Use not Listed but Similar
Special Permit for Sign
2
Lot Area Preexisting
5
2
Frontage Complies
3
4
Lot Area- Complies
Insufficient Information
3
4
Preexisting frontage
Insufficient information
C4, e- _C7
B
use
5
No -access over Frontage
1
Allowed
G
Contiguous Building Area
2
Not Allowed
I
Insufficient Area
3
Use Preexisting
2
Co plies
4
Special Permit Required
Lt&_ 5
3
Preexi Ing CBA
'14,
5
Insufficient Information
4
Insufficient Information
C
Setback
H
Building Height
1
All setbacks comply
I
Height Exceeds Maximum
2
Front Insufficient
2
Complies
3
Left Side Insufficient
3
Preexisting Height
4
Right Side Insufficient
4
Insufficient I nformat-io- n
5
Rear Insufficient
I
Building Coverage
6
Preexisting setback(s)
I
Coverage exceedi-m—aximum
7
Insufficient information
2
Cove age Complies
D
Watershed
3
Coverage Preexisting __4
e
1
Not in Watershed
Lj e- S
4
Insufficient Information
2
In Watershed
j
_Sign
3
Lot prior to 10/24/94
1
Sign not allowed
4
Zone to be Determined
2
Sign Complies
5
Insufficient Information
3
Insufficient information
E
1
Historic District
In District review required
K
I
Parking — -_
More Parking Required
A) LA
2
Not in district
2
Parking Complies
3
Insufficient Information
3
Insufficient Information
4
Pre-existing Parking
Remedy for the above is,checked below.
Item # Special Permits Planning Board Item #
Yariance
Site Plan Review Special Permit 40-3
Setback Variance
Access other than Frontage Special Permit
Parking Variance
Frontage Exc�ption Lot Special Permit
Lot Area Variance
Common Driveway Special Permit
Heig t Variance
Congregate Housing Special Permit
Variance for Sign
Continuing Care Retirement Special Permit
Independent Elderly Housing Special Permit
Special Permits Zonina Board
Special Permit Non -Conforming Use ZBA
Large Estate Condo Special Permit
Earth Removal Special Permit ZBA
Planned Development District Special Permit
Planned Residential Special Permit
Special Permit Use not Listed but Similar
Special Permit for Sign
R-6 Density Special Permit
Special permit for preexisting
nonconforming ),tr,,,cJo i -e- 4- Lo,�-
Watershed Special Permit
The above review and attached explanation of such is based on the plans and information submitted. No definitive review and
or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to
provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent
changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the
Building Department. The attached document titled "Plan Review Narrativd' shall be attached hereto and incorporated herein
by reference. The building department Will retain all plans and documentation for the above file. You must file a new permit
application form and begin the permitting process.
BtAilding Department Official Signaty're Application Received Application Denied
Plan Review Narrative
The following narrative is provided to further explain the reasons for DENIALfor the
APPLICATION for the property indicated on the reverse side:
Referred To:
lFi -re
P�o--Iice
Co-nservation
�Iannin�g
Other
Health
fo—nii�q--Board
U111,
Partment of Public Worl�—S
Historical COMMission
Buildina Dpn;;rtrn.r,+
Arl
�A
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ................... ...
has permission for gas installation .......
in the buildings of . . A���0717-le ........................
North Andover, Mass.
at -a.� .... 77-AkVi7 .......
Fee. P?S�7.. Lic. No.4)01190 . ........................
GASINSPECTOR
Check #e�y-
5.0170
P%
MASSACHUSETTS UNHORMAPPUCATONFORPERNUrTODO GAS FrrnNG
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations /-L� I K Yi el y—
(.9 Owner's Name
New Renovation
Replacement Plans Submitted
Date
Permit -69,zf
Amount $
(Print or type) 11�
Name �-V /7 e,�'S 4-e r% j I e T-
Name of Licensed Plumber or Gas Fitter 7—S a rilt L) Yin 1P_
Chhe k
._a, one: Certificate Installing Company
U—Corp-
Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1 No13
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:3 Other type of indemnity 13 Bond 13
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:
Signature of Owner or Owner's Agent Owner 13 Agent
T h.—k, —+;A, +t— -11 C L !--
mivainaLlUli I MYC NUU111itteu kor emerea) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations p formed pa<er Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Stat�G� Code(indmapter 142 of the General Laws.
By:
Title
ROVED (OFFICE USE ONLY)
Sign�ture oj Licensed Plumber Or Gas Fitter
[3 Plumker I L i2 - I I
[:] Gas FitYtr License Number
0 Master
0 Joumeyman
z
W
-<
z
z
I -
z
G
z
>
z
-<
z
W
Z
g
0
>
Z
LT.
0
>
SU B-BASEM ENT
>
0
B A S E M E N T
IST. F L 0 0 R
i N D . F L 0 0 R
R D F L 0 0 R
4 T H IF L 0 0 R
5 T H IF L 0 0 R
13
6 T H F L 0 0 R
7T H IF L 0 0 R
,8T H F L 0 0 R
(Print or type) 11�
Name �-V /7 e,�'S 4-e r% j I e T-
Name of Licensed Plumber or Gas Fitter 7—S a rilt L) Yin 1P_
Chhe k
._a, one: Certificate Installing Company
U—Corp-
Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1 No13
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:3 Other type of indemnity 13 Bond 13
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:
Signature of Owner or Owner's Agent Owner 13 Agent
T h.—k, —+;A, +t— -11 C L !--
mivainaLlUli I MYC NUU111itteu kor emerea) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations p formed pa<er Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Stat�G� Code(indmapter 142 of the General Laws.
By:
Title
ROVED (OFFICE USE ONLY)
Sign�ture oj Licensed Plumber Or Gas Fitter
[3 Plumker I L i2 - I I
[:] Gas FitYtr License Number
0 Master
0 Joumeyman
I A
.k No. 6,5-3 Date .6--9-03
0.1 40*Tpl TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
Building/Frame Permit Fee $
CHU
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
1 7�-50 Building Inspector
I
No
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
A"LICATIONTOCONSTRUCrW,tJ&RENOVATE,
OR DEMOUSH A ONE OR TWO FAMILY DWELLING
711-
BUII,DING PERMIT NUWML-
DATE ISSUED:
SIGNATURE: "Aw
Building gqMM���wr of Buildings Date
SECTION I- SITE INFORMATION
1.1 PropenyAddress:
Z9 Qkna P -J,
1.2 Ammon MV and Parod Number
L/ �z
Map Number Parcel Number
1.3 Zoning Lafonmition:
e
Pralmed use
1.4 Property Dimmsi%w.
77 &0
FA Area (d) frorltw (11
1.6 BURDING SETBACKS (R)
Front Yard
Side Yard ReaT Yard
RegWred Providc
RoqWrcd I'lovided Regilired Pwvi&d
3o 17, 1
/S- 3 3-0 3"?
1.7 Wita SoMly KQLCA0. tl 54)
pubuo 4. nwm 0 74w
I.S. Flood Zone Infoannion: 1.0 Saympl)bpoulSystem:
- outtARFIM171M n maniciml srtem 0
SECTION 2 - PROPERTY OWNERSER/AUTHORIZED AGENT
2.1 Owner of Record
,k)6Q.J W',
Name (Print)
,��t � �/d, -
Address for Service:
271Y-7Pel-1736 -
Signature
Telephone
2.2 Owner offlecord:
Name Print
Address for Service:
Signature
Telephone
SECMON 3 - CONSTRUCTION SERVICES
3.1 Licensod Construction Supervisor.
Licensed Cmstruction Supervisor
Address
Signature
Telephone
Not Applicable a
License Number
Expiration Date
3,2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
RogNtration Number
Address
F.*ration Date
Signature
Telephone
Is
M
0
z
M
0
r
M
r
r
z
0
I SECTION 4 - WORKERS COMPENSATION (KG.L C 152 6 25c(6)
Wmkas Compensation Insutanct affidavit must be completed and submitted with this application. Failure to provide this affidavitAill result
in the denial of the issuance of the building permit,
Sig!� affidavit Attached Yes ....... 0 No ...... D
SECTIONS Description Proposed Work (cdhmec&k applicable)
New Consuution 0
Exi sting Building 0 RopWs)
13
ovs(a) 0 1
Addition
Acces;sory Bldg. 0
Demolition 0 Other 0 Spec4
Brief Description of Proposed 'Mork-:
I %'xao' AU;+ion
EJP Reor
,E,P-cf
o n 11nJ
Anu C+V V- e a 'sic r �cs [.,) ke-jI4
tz-A . �61) 6�rjw�
an�
<11rVcJ,Jn /q'XAq, tf)-�ize-
SECTION 6 - ESTMATED CONSTRUCTION COSTS
Itein Estimated Cost (Dollar) to be
'OFFICLAL.PSEON�f
Completed by perrnit applicant
I. Budding
(a) Btfflding Penmit Fee
Multi li
2 Electrical ac
(b) Estimated Total Cost of
Construction
3 Plu,�R
Building t fee (a) x (b)
If
4 Mechanical (HVAC) X/ 0.040
5 Fire Protection
6 Total (1+2+3+4+5) )G rx--,
Check
SECTION 7a OWNER AUTHORIZATION TO HE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERN[IT
I,
as OwnerlAuthorized Agent of subject property
Hereby authorize
to act on
My behalf, in all matters relative to work authorized by this building pernift application.
Sipature of Owner
Date
SECTION 7b OWNERIAUTJHORIZED AGENT DECLARATION
1, '-Rc)L_).er+
as Oww/AuthoTized Agent of subject
property
Hereby declare that the statements and infonnafion on the foregoing application ate true and accurate, to the best of my knowledge
and belief
Print N
Z/ -Z-4
Sianature of O%vnedAaent I
Date
NO. Of STORIES
S17,E L J� X aO
BASEMENT OR SLAB —1S0'5U-rMJ'-
SIZE OF FLOOR TIMBERS If ay'�K
2ND 4i r—z-.�- To M
SPAN In"-nll
-0
DDAENSIONS OF-SlLLS x f,
D]MENSIONS OF POSTS 14 concrete �-)
11A 701. C6 I "Inz
DMEENSIONS OF GIRDERS Rxg
0
HEIGHT OF FOUNDATION eP6�"
THICKNESS
SIZE OF FOOTING -J
holl x
MATERIAL OF CHIMNEY Alo 46F
A
IS BUILD]NG ON SOLED OR FILLED LAND -S n I I
d
IS BUILDING CONNECTED TO NATURAL GAS LINE
Aj�Q
Nu �,� VN -1-1
6
FORM U -1 LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits f . rom
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with anya'pplicable or requirements.
*APPLICANT FILLS OUT THIS SECTION******,&
--�APPLICANT,�/e/d/'
LOGATION: Assessor's Map Number
SUBDIVISION
STREET
CONSERVATION
COMMENTS
TOWN PLANNER
COMMENTS
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMMENTS
USE
AGENTS:
TOR DATE APPROVED
DATE REJECTED
DATE APPRO-VED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE- REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPE
Revised 9197 im
PHONE -79
PARCEL --SR/_
LOT (S)
ST. NUMBER
M ___j
DATE—.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
FN�ame Please Print
Name:
�2
Location: (w11k1L,64"- /<�
ek'-�A / 1td1f6'<-6V-- IVA'Phone # ?-7e�- 7�,cl- 1754:5,
M
I am a homeowner performing all work myself.
F-1 -- I am a sole proprietor and have no one working in any capacity
F-1 I am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
City: Phone #:
Insurance Co. Policv #
Company name:
Address
Cily: Phone #:
Insurance Co. Policv
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00
and/or one years' imprisonment -as -well-as-civiLpenalties in1he fan dA.-STOP.W.ORK.ORDER,.and..a.fine -cf.,(.$1,0.0.00.)-aday.against-me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
/ do hereby certify under the pains and
--� Signatu
Print name
lies of peilury that the information provided above is true and correct.
Date
Phone # � 7/- 79'q -/ 73�,
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
Building Dept
E]Check if immediate response is required E] Licensing Board
F-1 Selectman's Office
Contact person: Phone #.- Health Department
Other
Tel: 978-688-9545
Please print.
DATE 4/—JL� _0V
JOBLOCA
"HOMEOWNER
Number
Town of North Andover
Building Department
27 Charles Street CHU
North Andover MA 01845
HOMEOWNER LICENSE EXEMPTION
I nn� 14- I�
Street Address
�25- 7�V-173 6
Home Phone
Section of Town
976 -688 -mo
Work Phone
PRESENT MAILING ADDRESS_Luj_9__ raulktl�o� K9 1
0 1 eq6-
City Town State Zip Code
The current exemption for "homeowners" wa& extended to include owner -occupied dwellings
of six units or less and to allow such homeowners to engage an individual for hire who does
not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1. 1)
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 is intended to be, a one to six family dwelling, attached or detached structures ac-
cessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such "homeowner' shall submit to the Building Official,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
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 SIGNATURE
APPROVAL OF BUILDING OFFIC
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40'S 54, a condition of Building Perrnit
Number . is -that. the debris resulting from this work shall be
disposed of in a proper.1y licensed solid waste disposal facility as defined by MGL
c 11, S150 A..
The debris will be disposed of in: 0C-JMP3+Q(—
Go* M( . �-f 10 - G en cA e .+0(J
(Location 6OFacility)
Sgignatuji!:of Perm . it Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through. the Office of the Building Inspector
Town of North Andover
This is to certify th-
..'y � I CZYS
have elapsed from date of decision, filed Office of the Zoning Board of Appeals
without filing of an appeal.
Date �%Commumity Development and Services Division
a ftradshaw 27 Charles Street
Town Clerk
North Andover, Massachusetts 01845
D. Robert Nicetta
Building Commissioner
Any appeal shall be filed
within (20) days after the
date of filing of this notice
in the office of the Town Clerk.
Notice of Decision
Year 2004
Telephone (978) 688-9541
Fax (978) 688-9542
at: 29 Faulkner Road
ATTEST:
A. Tr u e Copy
T
1 own Clerk
NAME: Robert P.* Micoyne, Jr. REARING(S): March 9,2004
ADDRESS: 29 Faulkner Road T I
PETITION: 2004-003.
TYP
North Andover, MA 0 1845 TYPING DATE: 03-11-04
,The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, at
7:30 PM upon the application of Robert P. Kikoyne, Jr., 29 Faulkner Road, requesting a Variance
from Section 7, Paragraph 7.3 & Table 2 for the left side setback and the front setback; and a Special
Permit from Section 9, Paragraph 9.2 of the Zoning Bylaw in order to extend a pre --existing structure'."
by constructing a proposed 2 story addition and covered stairs on a pre-existing, non -conforming lot...
,The said premise affected is property with frontage on the East side of Faulkner Road within the R4.
Zoning district. The legal notice was published in the Eagle Tribune on February 23 & March 1,
2004.
The following members were present: Walter F. Soule, Ellen P. e, Joseph D. LaGrasse, Jci�_ -
E. Smith, and Richard J. Byers. M�T
,d
Upon a motion by Joseph D. LaGrasse and 2 by Richard J. Byers the Board voted to GRANT a
dimensional Variance from Section 7, Paragraph 7.3 and Table j of the Zoning Bylaw for relief of
2.5' from the front setback and 12' from the North side setback in order to construct the cover for the
front stairs, the I story garage, and 2 story addition per Plan of.Land location 29 Faulkner Road,
North Andover, MA, prepared for Robert & Heidi Kilcoy-rie, Date: January 14, 2004 by Frank S.
Giles, II P.L.S. #48793, Scott L. Giles, Frank S. Giles Surveying, 50 Deermeadow Road, North
Andover, MA 0 1845. Voting in favor: Walter.F. Soule, Joseph D. LaGrasse, Joe E. Smith, and
Richard J. Byers. Voting against: Ellen P. McIntyre.
Upon a motion by Richard J. Byers and 2'd by Joe E. Smith the Board voted to GRANT the Special
Permit from Section 9, Paragraph 9.2 of the Zoning Bylaw in order to allow.for the construction of
the cover for the front stairs, the I story garage, and 2 story addition per Plan of Land location 29
Faulkner Road, North Andover, MA, prepared for Robert & Heidi Kilcoyne, Date: January 14, 2004
by Frank S. Giles, II.P.L.S. #48793, Scott L Giles, Frahk S. Giles Surveying, 50 Deermeadow Road,
North Andover, MA 0 1845 and [architectural drawings by Michael L. Port for] Kilcoyne Residence
Addition, Faulkner Road, North Andover, Massachusetts, date 1-03-04, Sheets A-], A-2, and A4.
Voting in favor: Walter F. Soule, Joseph D. LaGrasse, Joe E. Smith, and Richard J. Byers. Voting
against: Ellen P. McIntyre.
Board of &ppeals 979.698.-9 541 Building 979-699-9545 Conservation 08 -68? -9530 Health 978-698-9540 Plm')ing 978-r6�.8-95a5�
:1
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Michael Liporto
From:
Michael Liporto
Sent:
Thursday, December 11, 2003 9:57 AM
To:
'Mike McGuire'
Cc: 'Heidi Kilcoyne';'kilcoynebob@hotmaii.com'
Subject: Project Review
Michael,
I am working with Heidi and Bob Kilcoyne on developing plans for an addition to their home on Faulkner Road. I
have included a narrative and supporting drawings for your review. These drawings are preliminary and do not
necessarily represent exactly what will be submitted for permitting.
The project is defined as an "addition" to a single family residence located at 29 Faulkner Road, North Andover,
Massachusetts. The addition consists of a 14'-0" x 24'-0" single story garage, a 18'-0" x 20'-0" two story structure
including a living room (ground floor) and master bedroom suite (second floor) and the addition of two +/-6'-0"
wide dormers on the front elevation of the house. See the attached site plan, building plans and elevations for a
graphic description of the project.
It is my understanding that the application for a building permit will lead to a denial letter based on the fact that the
lot is "non -conforming" and that the single story garage is in violation of current zoning bylaws (sideyard setback
requirements). The drawings will then be submitted in the form of a "Special Permit" for the two story structure
and a "Variance" for the single story,garage.
Do you have any general comments on the project? We would like to determine if the project should be split into
two distinct additions (two sets of drawings) such that two permits can be filed, denied and then submitted as a
"Special Permit" and "Variance", independent of each other. This may allow the two story addition to move
forward quicker than the garage addition if it encounters any opposition.
We would appreciate your thoughts on the above.
Regards,
Michael Liporto
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DATE: SCOTT L. GILES
MAY 11, 2004 FRANK S. GILES
REVISIONS:
1INCH=20FEET SURVEYING
ol 20' 50 DEERMEADOW ROAD
NORTH ANDOVER, MA 01845
TEL. (978) 683-2645
PLOT PLAN OF LAND
LOCATION
29 FATJLKNER ROAD
NORTH ANDOVER, MA
PREPARED FOR
ROBERT & HEIDI KILCOYNE
ADDITION
TOTAL AREA = 675 S.F.
MAP 44, PARCEL 22
CRANE REV. TST.
MADELYN D CRANE 4F
37 FAULKNER RD.
IRON
ROD
r OF 4,14-
8,
,* rF!RS� ti
i� NC_-
2,-44t*� . �
gin,G
I
ZONING DISTRICT R4
MAP 33, PARCEL 21
RALLO,
SALVATORE & BETTY
36PARKERST
N 47035'30" W
M" 44
PARCEL21
AREA=7769.79 S.F.
0.1784 Acres
SUBJECT PROPERTY
LEGAL REFERENCES
MAP 44, PARCEL 21
29 FAULKNER ROAD
KILCOYNE JR, ROBERT P
HEIDI L KILCOYNE
Area=O. 18
Bk.5640,Pg.277
d.o.s.=1948
MAP 33, PARCEL 20
B&CBR&CW
ACKROYD RTY TRT
30PARKERST
IRON
ROD
1 STORY WITH DORMERS.
20t
0
13F
13,
0 �,
.40. 2.s,
Us v
402'
DPEN ENTRANCE!
ROOF OVERHEAD
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ROD ? .
09"29'36"
')r,Q qq -A f
44.46 arc len
*SEE VARIANCE GRANTED.
�n
41
BND.
FND- 04056-57"
368.00 rad
31.79 arc len
1
IRON
ROD
RQAD
00
THE OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR
ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING
CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED.
C
MAP 44, PARCEL 20
KNOWLES, JOHN
ANITA & LINDA
ZAGORSKI
21 FAULKNER RD.
Town of North Andover -rij
Office of the Zoning Board of Appeals jo
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845 C 0
D. Robert Nicetta
Building Commissioner
Telephone (978) 688-9541
Fax (978) 688-9542
Any appeal shall be filed Notice of Decision
within (20) days after the Year 2004
date of filing of this notice
in the office of the Town Clerk. Property at: 29 Faulkner Road
NAME: Robert P. 101coyne, Jr.
HEARING(S): March 9,2004
ADDRESS: 29 Faulkner Road
PETITION: 2004-003.
North Andover, MA 0 1845
TYPING DATE: 03-11-04
The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, at
7:30 PM upon the application of Robert P. Kilcoyne, Jr., 29 Faulkner Road, requesting a Variance
from Section 7, Paragraph 7.3 & Table 2 for the left side setback and the front setback; and a Special
Permit from Section 9, Paragraph 9.2 of the Zoning Bylaw in order to extend a pre-existing structure
by constructing a proposed 2 story addition and covered stairs on a pre-existing, non -conforming lot.
The said premise affected is property with frontage on the East side of Faulkner Road within theR4
zoning district. The legal notice was published in the Eagle Tribune on February 23 & March 1,
2004.
The following members were present: Walter F. Soule, Ellen P. McIntyre, Joseph D. LaGrasse, Joe
E. Smith, and Richard J. Byers.
Upon a motion by Joseph D. LaGrasse and 2 d by Richard J. Byers the Board voted to GRANT a
dimensional Variance from Section 7, Paragraph 7.3 and Table 2 of the Zoning Bylaw for relief of
2.5' from the front setback and 12' from the North side setback in order to construct the cover for the
front stairs, the I story garage, and 2 story addition per Plan of Land location 29 Faulkner Road,
North Andover, MA, prepared for Robert & Heidi Kilcoyne, Date: January 14, 2004 by Frank S.
Giles, 11 P.L.S. #48793, Scott L. Giles, Frank S. Giles Surveying, 50 Deenneadow Road, North
Andover, MA 0 1845. Voting in favor: Walter F. Soule, Joseph D. LaGrasse, Joe E. Smith, and
Richard J. Byers. Voting against: Ellen P. McIntyre.
Upon a motion by Richard J. Byers and 2 d by Joe E. Smith the Board voted to GRANT the Special
Permit from Section 9, Paragraph 9.2 of the Zoning Bylaw in order to allow for the construction of
the cover for the front stairs, the I story garage, and 2 story addition per Plan of Land location 29
Faulkner Road, North Andover, MA, prepared for Robert & Heidi Kilcoyne, Date: January 14, 2004
by Frank S. Giles, 11 P.L.S. #48793, Scott L Giles, Frank S. Giles Surveying, 50 Deermeadow Road,
North Andover, MA 0 1845 and [architectural drawings by Michael L. Port for] Kilcoyne Residence
Addition, Faulkner Road, North Andover, Massachusetts, date 1-03-04, Sheets A-1, A-2, and A4.
Voting in favor: Walter F. Soule, Joseph D. LaGrasse, Joe E. Smith, and Richard J. Byers. Voting
against: Ellen P. McIntyre.
Pagel of2
Board of Appeals 979-688-9541 Building 979-688-9545 Consmation 979-689-9530 Health 979-699-9540 Planning 978-i68.9-953.5.
Town of North Andover
Office of the Zoning Board of Appeals
Community Development and Services Division
V Charles Street
North Andover, Massachusetts 01845
D. Robert Nicetta Telephone (978) 688-9541
Building Commissioner Fax (978) 688-9542
- VqFKW
The Board finds that the applicant has satisfied the provisions of Section 10, paragraph 10.4 of the
Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or
derogate from the intent and purpose of the Zoning Bylaw. Also, the Board finds that the applicant
has satisfied the provisions of Section 9, Paragraph 9.2 of the zoning bylaw and that such change,
extension or alteration shall not be substantially more detrimental than the existing structure to the
neighborhood per the testimony of several abutters.
Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the
date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing.
Furthermore, if a Special Permit granted under the provisions contained hereinshall 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, it shall lapse and may be re-established only after
notice, and a new hearing.
Page 2 of 2
Town of North Andover
Board of Appeals,
-Agt/
Walter F. Soule, Vice Chairman
Decision 2004-003.
M44P21.
Boardof Appeals 978-698-9541 Building 978-689-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535
Town of North Andover
Office of the Zoning Board of Appeals
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845,
D. Robert Nicetta
Building C6mmissioner
Telephone (978) 688-9541
. Fax (978) 688-9542
Any appeal shall be filed Notice of Decision
within (20) days after the Year 2004
date of filing of this notice
;� fhA nffit-,- nf thp Tnwn Clerk Pronertv at: 425 Waverlev Road
NAME: Charles Hope Co., LLP, 370 Great Pond Road
HEARING(S): 11-18-03, 1-13,2-10,
& 3-9-04
ADDRESS: -415 Waverley Road
PETITION: 2003-040
North Andover, MA 01845
TYPING DATE: 03-11-04
The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, at
7:30 PM upon the application of Charles Hope Co., LLP, 370 Great Pond Road, for premises at:
425 Waverley Road, North Andover, MA requesting a Finding from Section 9, Paragraphs 9.1 &
9.2, and Section 4, Paragraph 4.122 of the Zoning Bylaw to extend the footprint of a previously
allowed Special Permit for a pre-existing non -conforming residential (four family) structure. The
said premise affected is property with frontage on the West side of Waverley within the R-4 zoning
district. The legal notice was published in the Eagle Tribune on November 3 & 10, 2003.
The following members were present: Walter F. Soule, Ellen P. McIntyre, Joseph D. LaGrasse, Joe
E. Smith, and Richard J. Byers.
Upon a motion by Ellen P. McIntyre and 2 nd by Richard J. Byers the Board voted to GRANT a
Finding from Section 9, Paragraphs 9.1 and 9.2, and Section 4, Paragraph 4.122 of the Zoning Bylaw
in order to extend the footprint of the previously granted Special Permit 2002-048 for a 4 unit
structure per Special Permit Plan located in North Andover MA., record owner & applicant Charles
Hope Co., LLP. 370 Great Pond Road, North Andover, MA. Date: 10/5/03, rev. 10/20/03, 11/11/03,
and 3/3/04 by Michael J. Sergi, P.L.S. #33191, Christian & Sergi, 160 Summer Street, Haverhill,
MA. 0 1830; Landscape Plan and Details, project: Charles Hope Co. LLP, Waverley Road, Date:
3.5.04 by Christian C. Huntress, Registered Landscape Architect #1178, Huntress Associates, 17
Tewksbury Street, Andover, Massachusetts 01810; and Damarc Design, 98-11 Main Street, North
Andover, MA 0 1845 [drawings for] 425 Waverly Road, North Andover, MA The Charles Hope
Companies, sheets GS, 1-4, D I - D4, and A I — A5 on condition that:
1. The applicant shall install a granite post showing the Post Office street addresses.
2. The signage for Waverley Road Condominiums shall conform to Section 6 of the
Zoning Bylaw.
Voting in favor: Walter F. Soule, Ellen P. McIntyre, Joseph D. LaGrasse, Joe E. Smith, and Richard
J. Byers.
Pagel of2
Board of Appeals 978-688-9541 Building 979-689-9545 Conservation 979-699-9530 Health 979-699-954(3 Planning 9-19-�89-9535
Town of North Andover
Office of the Zoning Board of Appeals
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
D. Robert Nicetta
Building Commissioner
Telephone (978) 688-9541
Fax (978) 688-9542
The Board finds that the applicant has satisfied the provisions of Section 9, Paragraphs 9.1 & 9.2 and
Section 4, Paragraph 4.122 of the zoning bylaw and that such change, extension or alteration shall
not be substantially more detrimental than the 4 unit, structure, granted by Special Permit 2002-048,
to the neighborhood.
Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the
date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing.
Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to
have lapsed after a two (2) year period fr ' om the date on which the Special Permit was granted unless
substantial use or construction has commenced, it shall lapse and may be re-established only after
notice, and a new hearing.
Town of North Andover
Board of Appeals,
Walter F. Soule, Vice Chairman
Decision 2003-040.
M22PI30.
Page 2 of 2
Board of Appeals 979-689-9541 Building 979-698-9545 Conservation 978-689-9530 Health 978-688-9540 Planning 978-689-9535
Town of North Andover
Office of the Zoning Board of Appeals
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
D. Robert Nicetta Telephone (978) 688-9541
Building Commissioner Fax (978) 688-9542
Any appeal shall be filed
within (20) days after the
date of filing of this notice
in tbe. nffice nf the Town Clerk
Notice of Decision
Year 2004
Pronertv at: 122 Farnum Street
NAME Karl Arakelian
HEARING(S): March 9,2004
ADDRESS:122 Farnum Street
PETITION: 2004-008.
North Andover, MA 01845
TYPING DATE: 03-11-04
The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, at
7:30 PM upon the application of Karl Arakelian, 122 Farnum Street, requesting a Variance from
Section 7, Paragraph 7.3 & Table 2 of the Zoning Bylaw for the left side setback in order to enlarge
an existing sun room and deck with a proposed 2 story addition on a pre-existing, non -conforming
lot. The said premise affected is property with frontage on the Northeast side of Farnurn Street
within the R-2 zoning district. The legal notice was published in the Eagle Tribune on February 23
& March 1, 2004.
The following members were present: Walter F. Soule, Ellen P. McIntyre, Joseph D. LaGrasse, Joe
E. Smith, and Richard J. Byers.
Upon a motion by Ellen P. McIntyre and 2 nd by Richard J. Byers, the Board voted to GRANT a
dimensional Variance from Section 7, Paragraph 7.3 and Table 2 of the Zoning Bylaw for relief of
the left side setback of 10.6' in order to expand an existing sun room and deck into a proposed 2
story addition and deck per Variance Plan, 122 Farnum Street, North Andover, MA prepared for
Karl Arakelian, Date: Feb 11, 2004 by James E. Franklin, P.L.S. #37045, New England Engineering
Services, 60 Beechwood Drive, North Andover, MA and Electrical & Floor Finishes Plans, the
Arakelian Residence, Date: 03/21/02, 8/09/02, sheet no: A 1.2 and Floor Plans, the Arakelian
Residence, Date: 02/20/02, 10/20/03, sheet no: A05 by HDG, The Harris Design Group, 4550
Montgomery Avenue, Suite 320N, Bethesda. Maryland 20814; with the following -condition:
1. The applicant shall provide a floor plan of both floors for the record in the Zoning Board
files. Voting in favor: Ellen P. McIntyre, Joseph D. LaGrasse, Joe E. Smith, and Richard J. Byers.
Walter F. Soule abstained.
Upon a motion by Ellen P. McIntyre and 2 d by Richard J. Byers, the Board voted to find that the
phrase "pre-existing, non -conforming lot"in the legal notice is incorrect. Voting in favor: Ellen P
McIntyre, Joseph D. LaGrasse, Joe E. Smith, and Richard J. Byers. Walter F. Soule abstained.
The Board finds that the applicant has satisfied the provisions Section 10, paragraph 10.4 of the
Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or
derogate from the intent and purpose of the Zoning Bylaw.
Pagel of2
Boardof Appeals 978-688-9541 Building 979-698-9545 Conservation 978-699-9530 Health978-698-9540 Planning 978-699�9535
4
Town of North Andover
Office of the Zoning Board of Appeals
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
D. Robert Nicetta
Building Commissioner
Telephone (978) 688-9541
Fax (978) 688-9542
Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the
date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing.
Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to
have lapsed after a two (2) year period from the date on which the Special P * ermit was granted unless
substantial use or construction has commenced, it shall lapse and may bere-established only after
notice, and a new hearing.
Page 2 of 2
Town of North Andover
Board of Appeals,
Walter F. Soule, Vice Chairman
Decision 2004-008.
M107AP73.
Board of Appeals 919-699-9541 Building 919-699-954S Conservation 979-699-9510 Health 9'18-699-9540 Planning 979-6gs-9535