HomeMy WebLinkAboutMiscellaneous - 29 WINTERGREEN DRIVE 4/30/2018Location%
No. 7 Date %.z
RECEI
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TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
7 Foundation Permit Fee
AYMEI Ther Permit Fee
APR 2
Sewer Connection Fee
Water Connection Fee
OTAI '
mo. Ando orCol'eotr,
C K. -A 2043
5124
Div. Public Works
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Town of North Andover `
Y
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE
JOB LOCATION a W f j 1,eeV1
Number treet Address
"HOMEOWNER"
Name
Home
PRESENT MAILING ADDRESS al 0i
dont �r
Cit T
Phone
"V1 .
ection of town
,0 k - 96 0 -X96 .S_"
ork Phone
y OWI1 5 tate Zip code
The current exemption for "homeowners" was 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 HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
reside, on which there is, or is intended to be, a one to six family dwell-
ing, attached or detached structures accessory to such use and/or farm
structures. A person who constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
to the Building Official, on a form acceptable to the Bulding 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
.North Andover Building'Department minimum inspection procedures and
requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNER'S
APPROVAL OF
SIGNATURE
BUILDING OFFICIAL.
Note: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
Control.
CEERF/ED PLOT PLAN
LOC.�TED /N .. N o, ��»•cv �,-:��
.SC4LE••
ClIRISTIANSEN E SERGI , INC.
//00 SUMMER STREET -)gAVERNILL , MA.
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CLIENT • � ArN..4,E6M ..1 R91.A........................................ .
/ C67RT/FY T#.4T T116c OlcF5 ET5 51/0PVN 4,eE FOR T�/5 L OT
BUILDING 51101t/N ON 7_1115 ZONING DETE12M/N4 TION /5 Np-(71N
PL 4N COW cOleO5 TO THE ONLY 4ND 446E NOT -TO BE 4 FLOOD
ZONING B)" -1_4W5 OF TWE U5 ED TO E574BL/511 ReO - 1/4Z4eD
OF!`!�•. A^!: ;�: PE,2TY L /N5,5. ZONE.
WHEN CON5T2L1CTED.
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Im
FORM U - IAT 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:
LOCATION: Assessor's Map Number hq/3 Parcel
Subdivision i Lot (s) _3
Street ��li►�1-k'v ( ap✓1 �Y St. Number �2 y
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved l6 Z
Conservation Administrator Date Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Date Approved G< 7 4 -
Date Rejected
Received by Building Inspector Date
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Date .. `3..7'.. °.......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that . ; ,....r.................................................................
has permission to perform .....,.. .......................................
wiring in the building of . ':.....!r c.. ..............................
at �Z ... :.......... . North Andover, Mass.
Fee. ................. Lic. No. 4. .A"........ i...,:................... o .................
�GLEcrmCAL INSPECMR
Check # r 9c)
sogn
THE COMMONWEALTH OF MASSACHUSETTS
Deportment of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 521
APPLICATION FOR PERMIT TO
All work to be performed in accordance with the
(Please Print in ink or type all information)
Town of
The undersigned applies for a permit to perform the electrical work
Location (Street & Number C-�l 9
Owner or Tenant_
Owner's Address 5/9-9% e-,
Official Use Only
Permit No. � Q
CMR 12:00 Occupancy & Fee Checked""
A ELECTRICAL WORK
Electrical Code 527 CMR 12:00
Date 9-/7-01
To the Inspector of Wires:
Is this permit in conjunction with a building permittes No • (Check Appropriate Box)
Purpose of Building Sin��� �y ��{%ei�%� �� Utility Authorization No.
Existing Service d0 D Amps Qc30 Vofts Overhead -,-� Undgrnd • No. of Meters
New Service Amps Volts Overhead • Undgrnd • No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work b"Irl kwoA—Z"O'g
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES = NO = if you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify)
Estimated Value of Elecfiical Vljork$ 11-2,000 (Expiration Date)
Work to Stark—3 `> ' ®4 Inspection Data Resquested Rough Final
Signed under the Penalties of perjury: ao2
FIRM NAME _ n n ,� LIC. NO.
Lkemsee
Do,, kf.,0 1IJ2 Li CG eSignatureU ` LIC. NO. %3 D C
Y n k f�// //-- / Bus. Tel No. Z -P�,i �,� —% Sa
Address //5 AXOC,66e1- iIL1'i /Ili Aft Tel. No. V 7 7SD -s i 4! 7
OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does not have the Insurance coverage or Its substantial equivalent as required by Massachusetts
General Laws. Ed fh" sI natu jon this permit application waives this requirement. Owner Agent (Please Check one)
No. 52D -6O -7 /7 LJ PERMIT FEE i
of Owner or
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above
In
No. of Lighting Fixtures
Swimming Pool gmd
gmd
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Di sal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
• Municipal • Other
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Whin
No. Hydro Massae Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES = NO = if you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify)
Estimated Value of Elecfiical Vljork$ 11-2,000 (Expiration Date)
Work to Stark—3 `> ' ®4 Inspection Data Resquested Rough Final
Signed under the Penalties of perjury: ao2
FIRM NAME _ n n ,� LIC. NO.
Lkemsee
Do,, kf.,0 1IJ2 Li CG eSignatureU ` LIC. NO. %3 D C
Y n k f�// //-- / Bus. Tel No. Z -P�,i �,� —% Sa
Address //5 AXOC,66e1- iIL1'i /Ili Aft Tel. No. V 7 7SD -s i 4! 7
OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does not have the Insurance coverage or Its substantial equivalent as required by Massachusetts
General Laws. Ed fh" sI natu jon this permit application waives this requirement. Owner Agent (Please Check one)
No. 52D -6O -7 /7 LJ PERMIT FEE i
of Owner or