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HomeMy WebLinkAboutMiscellaneous - 290 WEBSTER WOODS 4/30/2018N 115 1 V/, 7 This certifies that DateJN!./**.1*S .......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING /�cX4 eves es .......................................................................... 1has permission to perform ...... plumbing in the b ildins of ..... ......................................................................... at..C�'-)qo �J;g e_�, ...................................... .............. North Andover, Mass. Fee��q . . ...... Lic. No2o.6.�1` . ................................................................................. PLUMBING INSPECTOR Check # 3 �0 � WE MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK k%t ylol CITY No✓TG, AAS MA DATE PERMIT # I JOBSITE ADDRESS 6 tAJe- j,57 Xr (/t%pW/S 61ou OWNERS NAME ��1//"V eel-lxl jr OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT PLANS SUBMITTED: YES ❑ N0 FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 1 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER C INSURANCE COVERAGE: I knave a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESk NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY X OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER F-1AGENTE]SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for [his application will be in complia ce v'th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME% /e�„e A vers LICENSE # ����� SIGNATURE MP ❑ JP1k CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME ) Lf� �L / /ZehADDRESS _ TaX YJ - CITY_ 4A,ely%lev— STATE Ah” ZIP C2/P TEL FAX CELL EMAIL f �e+✓ �C �OanGi$S j�'r� ��{ Vim\ WE w V O � Z Z p Z 00 V � a a C. z � Loll� � o Z V Z z Z O � v c w � a a. Ln o. z z Z O (11 O O W z E -- V t: w CY_ O W n o z O a w m m w Date.................................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION c— �.........................`L/This certifies that ........ ............ / ............ ............ , .has permission for gas nstallation ............. . ..................... in the buildings of ZI ^J .......................................................... jj at ...... ........ ........... North Andover, Mass. Fee,W6- '.. Lic. No.2qec�',i ......... . ............... .... ..................................................................... GASINSPECTOR Check # 1 b'3 2. �'--` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK f4MR—IN IT TYPE OR PRINT CLEARLY CITY _%i���-�h AA✓ Aim MA DATE PEP,MIT # ��� lT 7 f JOBSITE ADDRESS t �Q �e�JS? �00dS � OWNER'S NAME 14l/ VIN I—//1, ._. OWNER ADDRESS _ 5AM _ TEL FAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: ❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES ❑ N0 APPLIANCES I FLOORS— BSM 1 2 3 4 5 6 7 1 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER. DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOkHEATER ' WATER HEATER i OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES)q NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW .r LIABILITY INSURANCE POLICY, OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: t am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER El AGENT ❑ SIGNATURE OF OWNER OR AGENT 1 herebv cerlifv that all of rho riPlniiG nnrl i ,( .. G t w..— -- _-•_-- � --- - ... .. .. - - - ___- _........,.,..-u--„...' ...y....a,..v.. me ..uc .'- ot. .,-'c w t-= uUpl UI my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance vA!p all Per inEnl provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE if 02�$3 g SIGNATURE % MP ❑ MGF ❑ JP JGF ❑ LPGI ❑ CORPORATION [:],I PARTNERSHIP ❑ II LLC ❑ / - /, i� COMPANY NAME,42) !Ctel”j Vees pL y f o4t Maj ADDRESS 4 J;oe ILA I` �1i�� CITY �N�O.JGr STATE AM ZIP � � TEL _ f7' :P1c � l6j �' fes. FAX _ CELL EMAIL AXIA'elfl>/ 6 v� O z z 0 U w G z_ E z_ L-. � z z cv } O w O �- a z sVa = � 5 W z Q w > cn a w � w O � z �- Lu -( u U U z a Q � C � a v F- a. a Q � lil 2 LLl I- LL 8 z z 0 v w C- Z: V) Q U W U O M 0 Town of North Andover .4 NORTN q Building Department �2o ttteo 6 d� o 27 Charles Street ti North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 �o �► t0<MKH1wK• 1' SACHUS���� APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS �70 LOT NUMBER 4-29 SUBDIVISION DATE REQUEST FILED DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURRt_OE� NOT MEET ALL APPLICABLE CODES. SIGNATURE OFF IAL USE ONLY ROUTING CONSERVATION D.P.W. — WATER DATE L /Wn I Oe ioj-yr414r> W- i2- o� 71)1) DATE -,,u D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. /* 4 Z3_0 SIGNXiURVIPPW AUTHORIZATION N2 2817 Date. Z.—Z4 ...... '0 TOWN OF NORTH ANDOVER 0 )0* PERMIT FOR WIRING This certifies that .......... ................................. ............................. ................. has permission to perform...- ..7 ... . .............................................................. wiring in the building of .............................. .. at ............ / /,' ...... ............ ............ ,North Andover, Mass. Fee."V'/:`% ..... .... Lic. No..7!'; ................................................... Check # / '/ 41-� F ELEemcAL lNspEcmit WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ��� lIILWIYl[YlVl �II/:r]�.lLl vl' 1►yxaarx�.i.rvua:l s,v � DEPAR7N1 VTOFPUBLICS4FM Permit No. BOARD OFMEPREVEWONRWULATIOAN527CMR 12:010 UVA- Occupancy &Fees Checked PPLICATIONFOR PERMIT TO PERFORM ELECTRICAL 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 The undersigned applies for a permit to perform the electrical work described below. Location (Street � Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction wit Purpose of Building Existing Service New Service. a building permit: Yes M No r7 (Check Appropriate Box) Utility Authorization No.l 0-20-1O Amps Vo is Overhead 1:3 Underground No. of Meters Amps O—d . ' Volts Overhead M 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. of Lighting Fixtures Swimming Pool Above M Below 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 Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal a Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP A OTHER. 1n&xa L c Lam Iha�eaaitterrtLiabtlilyhtstr�czPobcyetdt>d�gCariplete�,aa�oq^�Paaageor9ssti>��alec�tival�# YES NO Iha�est�mh3dvandptoofafSMW1Dlhe0>T>oe YES 1 til' IvaJ 0 Ifjouhawdr*W plrsetypeofwmagebydmkingthe app�bcx r7 INSURANCE OH-IER S, 17 D#Am EstaruWd VahredUecftid Wak $ WotkioStart hmecimD&Regttested Rough lanai SigrwuaxiaTiePFmiksofpetjtay FIRM >` Gl/S C /^/ C- I�oa�seNa /a33 ?4 Bt>SinessTaNa 9 0 %% U Ah.Tel. Na OWMIR'SMURANCEWAIVER;I.nnawa<ethattheLio=dDmnot the instranw orits l e#vilatasre#WbyMamdmos;GeneralLaws and thatmy sternibis purnk appfiicabm wanes dus rtx4manad. (Please check one) Owner M Agent ` O Telephone No. PERMIT FEE $ L;// N2 4716 Date."...� ..`.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............. ................. . has permission to perform .... . '..... ..`.:: P .............. plumbing in the buildings of .. 1. ! . `..... :................. . at .......................... .......... , North Andover, Mass. Fee" `... Lic. No .......... ............................. . 37? PLUMBING INSPECTOR Check # J / WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS qDate Building Location r� �C. Owners Nameifi Permit # Amount of Occupancy � � —�- New JV Renovation Replacement riPlans Submitted Yes ❑ No FIXTURES (Print or type) Check one: Certificate Installing Company Name 4" ❑Corp. Address ❑Partner. Business Telephone L —5 ❑ Fimr/Co. Name ofLicensed Plumber- Insurance lumberInsurance Coverage: Indicate t4e type of insurance coverage by checking the appropriate box: Liability insurance policy [S Other type of indemnity ❑ Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have anyone 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 installationspeyformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stat umbing Code Md C �4 faf the General Laws. APPROVED (OFFICE USE ONLY Type of Plumbing License 4eramer Master 14 Journeyman ❑ ��074 u Date...,/... i ............. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION r, This certifies that ....... �'................ --r............... has permission for gas installation .. !:..'..:... ............ in the buildings of ... 1. r.. r . f ....................... at ................................ . North Andover, Mass. Feer �:... Lic. No........... .....•...... .,:........ . 70 GAS INSPECTOR f WHITE: Applicant CANARY: Building Dept. PINK: Treasurer /IASSACHLTSETTS ni TFORM APPLICATON FOR PERMIT TO DO GAS FITTING or print) twM1r1 ANDOVER, MASSACHUSETTS Building Locations 0e�# 261 ( Owner's Name Newfl Renovation ❑ Replacement ❑ Date 214419 Plans Submitted ❑ Permit 9 Amount S d (Print or type) Name Address Business Telephone Name of Licensed Plumber or Gas Fitter 7 Check one: Certificate Installing Company ❑ Corp. ❑ Partner. Firm/Co. INSUR.-k iCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ Ifvou have checked ves_ please indicate the type coverage by checking the appropriate box. Liability insurance policyla Other type of indemnity ❑ Bond ❑ Owner`s Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter I42 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 ❑ ,-Agent ❑ herebv certify that all of the details and information l 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 Massachuset tate Gas Code ind 142 of the Gene ral Laws. i B v: Title CityiTown APPROVEDwFrtc:: usF')Nl.v) Signature of Licensed Plumbe/Or Gas Finer ❑ Plumber &;�7 7Y' ® Gas Fitter icense Numoer ivlasiff Journeyman :r (Print or type) Name Address Business Telephone Name of Licensed Plumber or Gas Fitter 7 Check one: Certificate Installing Company ❑ Corp. ❑ Partner. Firm/Co. INSUR.-k iCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ Ifvou have checked ves_ please indicate the type coverage by checking the appropriate box. Liability insurance policyla Other type of indemnity ❑ Bond ❑ Owner`s Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter I42 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 ❑ ,-Agent ❑ herebv certify that all of the details and information l 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 Massachuset tate Gas Code ind 142 of the Gene ral Laws. i B v: Title CityiTown APPROVEDwFrtc:: usF')Nl.v) Signature of Licensed Plumbe/Or Gas Finer ❑ Plumber &;�7 7Y' ® Gas Fitter icense Numoer ivlasiff Journeyman t c as � o 4, L�ca.ion !� No.Date TOWN OF NORTH ANDOVER 0 Mi s Certificate of Occupancy $ Building/Frame Permit Fee !` CMUg <� $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1166 14355 J 'Building Inspector HOV F 't-00 THY 1 7 : 1 9 S . E . Cumm i soc i oL P . 02 i - CERA/ED PLOT PLAN S.E. CUMMINGS & ASSOC/A rES P.O. BOX 1337 PLA/STOW, ma D3866' TELEPHONE (60J)-882-5065 /SAX (803)-382 -5216 WEBSTER WOODS, LANE .to,QO' S 03100101" E 74.19 1 R%60 EXISTING F0t1NDATION (SILL = 140.6') Z 4 O CO 00 LOT 22 m 43,560 SF�F W � � �o �o w ^� COD q AIL SCALE 1" =60' OA TE: NOVEMBER 9, 2000 I HEREBY CERTIFY TO TOWN OF NORTH ANDOVER, MA BUILDING DEPARTMENT THA T THE EXISTING FOUNDA TION DRAWN ON THIS PLAN IS L OCA TED AS SHOWN AND THA T IT DOES COMPL Y TO THE MINIMUM BUILDING SETBACKS TO PROPERTY LINES. ?e"+o'600 ars_ ®� f) - ALFIEfTr T. TRUDEL , No. 96869 o, CAMPBELL FOREST NORTH ANDOVER, MA TAX MAP 210 BLOCK 106. B LOT 22 MINIMUM SETBACKS.• FRONT -- 30 FEET SIDE -- 30 FEET REAR - 30 FEET rWS N° Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that �... C.2 . has permission to perform _.:....... �..................................................... wiring in the building of.~r3 .... �- (........................................ 2,P ........................................................... North Andover, Mass. Fee`. 4 Lic. N . ?%!/ .......... ..................................................... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer De�iwtteraecrl oa �u�lie Sa� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 v111udi ususe only Permit No. c7CO c�-(g Occupancy & Fee Checke�� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to Location (Street & Owner or Tenant Owner's AddreW Date i�" _0 (:�) To the Inspector of Wires: Is this permit in conjunction with a building permit Purpose of ?el) Yes ❑ _ No ❑ (Check Appropriate Box) Existing Service Amps Voits New Service 12 - L% Wits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Overhead ❑ Overhead ❑ Authorization No. R -;�S Undgrnd ❑ No. of Meters Undgmd C No. of Meters No. of Lighting Outlets No. of Hot fuse Total No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Receptacles Outlets. No. of Oil Burners No. of Emergency Lighting Batte Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Initiating Devices No. of Sounding Devices No./ of Self Contained Detection/Sounding Devices ❑ Municipal ❑ Other Local Connection No. of Ranges Total No of Air Cond Tons No. of Di osal Heat Total Total No. Pumps . Tons KW No. of Dishwashers Space/Area Heating KW / -No. of pryers 1 Heating Devices KW No. of Water Heaters KW No. of Signs No. of Low Voltage Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including pleted Operations Coverage or its substantial equivalet Y — NO = have submitted valid proof of same to the Office NO = If you have the ked YES please indicate the typ e oferage by checking the appropriate box. INSURANCE = BOND = OTHER = (Plea a Specify) ,, l Estimated Value of Electrical Wor (Expiration Date) /$ Work to Stan` . � Y Inspection Date Resquested Signed under the Egaqlties of perjuryry FIRM NAME 5, 169 c4U LIC. NO.- 12 317' ? /I LIC. NO. Address7( ` V �� ice)/ I�� Bus. Tel No. Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) OD 7 3 , (signature of Owner or Agent) Telephone No. PERMIT fEE $ Location ,(G�° �� GAP s4ff No. a / Date ,.ORTI TOWN OF NORTH ANDOVER O " o, 'g . Certificate of Occupancy $ ,,• �'�b'•^�'�'�� sJ�cHusE Building/Frame /Frame Permit Fee $ 9 � o Foundation Permit Fee $ Other Permit Fee $ $— TOTAL # 0011D Check %? 14 3 18 Y / bldin nspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: C &*A-or�. Building Commissioner/In for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: tee// 1.2 Assessors Map and Parcel Number: `0 6 `� J Map Number Parcel Number �9a weAs"+-er &)o6,,/,sly-n--e 1.3 Zoning Information: R� G/� �i`� ; C� Zoning District ProposedfJse 1.4 Property Dimensions: X13, S6y i Sy Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 301 33 ' 301 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSE IPIAUTHORIZED AGENT 2.1 Owner of Record Name (Printf Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - &KSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address ro '".3G0 Signature Telephone s<Y 7 — ,Ii; 0 Not Applicable ❑ 06 0 6 �.2,3 License Number Expiration Date 3,2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone T M z t. a SECTION 4 - WORKERS COMPENSATION (M.G.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 permit. Signed affidavit Attached Yes ...... V No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) " New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / F XV nZEM& s -sun Z'ei 6 �'f��✓6v►C -e /—,/0 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building 77 O 6 (a) Building Permit Fee Multiplier J try 2 Electrical (b) Estimated Total Cost of Construction > Qf 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5) 7 Z, © O Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 77b OWNER/AUTHORIZED AGENT DECLARATION I,� J X15 s C as (mer/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 Na Si ature of Owner/AgeriLX Owner/AgeDate -NO. OF STORIES A5L SIZE 312 KSS' BASEMENT OR SLAB 69 SIZE OF FLOOR TIMBERS Isl gV2 T S 2ND g/ 3RD SPAN DIMENSIONS OF SILLS CP DIMENSIONS OF POSTS fe'e C DIMENSIONS OF GIRDERS /L "Its fie—e G HEIGHT OF FOUNDATION ' /d " THICKNESS O H SIZE OF FOOTING /O X 20 MATERIAL OF CHIMNEY (.v fs'O'� IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE CS ,ti ! LA FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verity 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 or requirements. * ***{*{*********************APPLICANT FILLS OUT THIS SECTION*********************** 67,S-7- 6-76 0 APPLICANT Cc�ri��21'� /—nrec GLC' PHONE G 7 - 3o 6> LOCATION: Assessors iVlap Number___6014B PARCEL 1-71 SUBDIVISION �`�,e��r'�7� LOT (S) o2,2 STREET GU,0�S�-e'r ST. NUMBER,:;00 USE ONLY*************************** RECOVM,FMp RTAS OF TOWN AGENTS: N —VA`—TION ADMINISTRATOR DATE APPROVED DATE REJECTED_ COMMENTS s ! � `��� � �Gj �l z ER TOWN PLANN COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED. DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm DATE The .Commonwealth of Massachusetts Department of Industrial Accidents Office or Investigations Boston, plass. 02111 Workers' Compensation insurance Affidavit FName Please Print 1 Name: Location: City Phone # ❑ I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. r'mmnanv names• ��J��e Address 212,31 S� �fe/ //S�, j` - S v f City /V c'�/ fyt /°d'�l�oy c'tr /V� a? O f S -KS Phone # (9 2 5) G 8 7 Insurance Co 0/7i Ae Z / c?C/ �/c -zSIS, C:� Policv # /! Uj S%/ �/ �/ % — v e Comoanv name: Address Citv: Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties or a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the farm of a STOP WORK ORDER and a fine cf ($100.00) a day against me. I understand that a copy cf this stateme a forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify underAe paint and penalties of Signature. Print name that the information provided above is true and correct. o/ nota %/5/1 d Y Phone #S S 7" —?60 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone 9: C] Heaith Department 7 Other BUILDING DEPARTMENT 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 licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Si` e o ermit Applicant :.y 7//z4, -10d Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i 0 Growth Management Bylaw Exemption Statement Town of Nortft Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 3.7.6 of the Town of,North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant an building Permit (below) Address of Proper',,/ far Fen ;it (below) -��/ Z"/ c�2-9L') 4) este,- ,vc k& Gam. Map and Parcel :fO�a Purpose of Application check below) Phone Number of ApplicanSingle Family Two Family !ods 7—_ -3yo — 1 the undersigned applicant for the above property attest that the attached building perm it far which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me cr ary party to this permit from the requirements of obtaining other permits required prior to the issuance of the _uiiding Permit. Further I understand that my interpretation of the E<EMPTiON status is subject to review by the Building Oepartment and is only offictally accepted when the Building Permit ig issued. Based an section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied far on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstructten of a dwelling in existents as of the effective date of this by-law, provided that no additional residential unit is created. ZytawThe lots) were/was created prior to May 6, 1996 are exempt from the provisions of ,his Secticn 8.7 of the Zoning . This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.oare met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section "senior' shalt mean persons over the age of 55. it This application is a part of a development project which voluntarily agreed to a minimum 4011. permanent reiuctton in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open scam and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that wilt ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the Parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as 'ted above. Further I understand that the submittal of misleading and or inaccurate information, he c. :ting off of an above item which does not comply, whether done to my knowledge or not, is gr unds �refat by the Building Oepartment to issue a Building Permit. igna ure of Owner or u _ erit who signed the Attached Budding Permit Date This form must be a4aned to the Building Permit upon application for such permit. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 069234 Birthdate: 05/09/1954 y Expires: 05/09/2002 Tr. no: 23903 Restricted To: 00 ALAN G RUSSELL_/ 400 MAIN ST GROVELAND, MA 01834 Administrator TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William Hmurciak, Director Timothy J. Willett StaffEngineer Telephone (978) 685-0.950 Fax (974) 688-9573 Additional conditions for lots 6, 19, and 22, Campbell Forest March 14, 2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lots 6, 19, and 22 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for these lots so that the construction of these three homes can begin at this time. The conditions are as follows. 1. No sewer service shall be installed into either residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike. Street. At this time, the construction of these items has not been completed. 2. No water service shall be installed into either residence until all off site sewer facilities are approved by this office. Any via granted. Mesiti DeVpment Corp conditions will void both water and sewer connection permits. No refunds will be .�-Oz�C 02-5. 5 ez5/ Printed Name \1 /nJ� W( Division of fublk Works Printed Name CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin "A Date Date 491 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass.�� Application by the undersigned is hereby made to connect with the town sewer main in z�)e 5�er � � �� 4r'.� subject to the rules and regulations of the Division of Public Works. The premises are known as No. (/�� ��/���� �C?�%�� Za-v Street or subdivision lot no. 2-2. sC/J4p/ �c- Owner �l/le�2i � j /. v Contractor Address Address "Applicant's Signa ure PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to �J2/t �Gf��7 L L C Cly/ l(%Olr�� to make a connection with the sewer main at Stieec subject to the rules and regulations of the Division of Public Works.. Division of Public Works gy i2�� Inspected by Date See back for rules and regulations N2 956 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. i `GfC �� « 49– a Application by the undersigned is hereby made to connect with the town water main in ��� ��'�' Z, St et subject to the rules and regulations of the Division of Public Works. ,// �/�yZ-f The premises are known as No. � � �yWJ`�W ��� 5 Za W tL Street or subdivision lot no. log� Owner Contractor Z�l 5) Address Address Applicant's Sig ure PERMIT TO CONNECT WITH WATER MAIN C� The Board of Public Works hereby grants permission to ,,po-e/` Z,-� to make a connection with the water main at ��� 422 SVeg subject to the rules and regulations of the Division of Public Works. Inspected by Date Board f Public Works By See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 Telephone (508) 685-0950 Fax(508)688-9573 DRIVEWAY PERMIT Date: �3 -/13 - 6>0 LOCATION: 2 �p BUILDER: phone: OWNER: el�4,14 k el/ phone: e North Andover Superintendent of Highway Utilities & Operations MUST be notified of the ide and set -back from street established in any driveway entry onto any street or way maintained by TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. 1 Remarks: Approval: ZZ Mesiti Dev broup Hpr 24 LUUU 1L;00 r.U4 FROM : MCKENZIE ENGINEERING GROUP, INC PHONE NO. : 6179412662 Apr. 24 2000 11:26AM P4 � mJAI • '27.40; 1 yVM�$ Nto 74 ra rl1 f X 54T box � 0-9£4 9� r/ Rop, WN ` 5'9£1 1M3 p�BENS •0 � I WA ' OVT M OUT y \� \'O\T\ L 43,40 S --- . Ca 1 Mesiti Dev Group Fax:978-55?8160 Hpr 24 1000 12:6b r.U4 FROM MCKENZIE ENGINEERING GROLIp, INC PHONE N0. 6179412662 Apr. 24 2008 11:26AM P4 � a =27.40; �. e j 4 • � .� 1 � to oa -� owe r 1 2 1154' b*X p- �� 9 `s 3 ,. / Rail, sFl� l ! T EtFY. 132, wotl AK�OUT i ~� L� 43,g o CRAS ,,43,5 S --- 1 aj� �M a)® 0.n a� a it 0 CL ® a) M :3 C� 0 .0 n M M C. c Ul n c (MD E Cr M U3 cu D aM.-Q- M CL 0 14.0 F 77 al M ®. E 0 C 0 5 0 O 6 0-0 M O �Q O E.W a cQ cc c as 0 N O CL N PON IV M 3 0� ° y y C �D lD 0 SOC 3 CD n H 0 N O 0, C = CDQ d 0 0 3 7p CD ocD� fD o' g o 1 a cD 3 O O N � CD CD d 0Po 0 CD n � a ;�• 3 CD .mmew _ CL GO -� GA 0 z o• L Cl) m C m m cn 0 CO) cl) 0- Z CD O d r co O ? CL a' nco .p O o p aQ c cc w- wa .. i-1 d C7 O r� CDD CD a, y CD CO) I cn cn n O cn c?�o m S Cm H ow H 6V_a0 —0 y 40Om m n Z >••p vi _1 O 01 O_ y m CD niCL m = y O H p N �Erpo�cn S > >-c o do c O O ,.+ O z5.0 0 -, O H C2 CD CA 0 as o =r =r: O O O H m 0 CD CL d o 3 � CO) Ca: :� � C? C., dd�C •- o CL O pcl m:3P. N '�' O d VO/ ra CD o w �m � +Q `o o .% N 0 OWam: 0 c o o cd pc z o� ra C7l r ►n na o 1^ c Qo x omq 0 c Building Value Calculation - for Property at..... 'MMA r3 Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 22 16 352.00 5 $ 22,880.04 Living Room 21 14 294.00 19,110.00 Dining Room 16 14 224.00 $ 14,560.00 Family Room 26 16 416.00'5 $ 27,040.00 Study 9 10 90.04 $ 5,850.00 Laundry 10 7 70.00&5 $ 4,550.00 Garage 23 38 874.00 $ 30,590.00 k M ��� F Entry 18 12 216.00 i� $ 14,040.00 Basement FinishedDeck 05 - .y� J I $ Screened Porch 16 12 192.00 �a $ 6,720.00 Breakfast Nook 2 4 8.00 �t�,$ $ 520.00 Bedroom 1 38 16 608.00 A la= $ 39,520.04 Bedroom 2 16 14 224.00 x$ $ 14,560.00 Bedroom 3 14 15 210.40 13,650.00 Bedroom 4 13.5 15 202.50 $ 13,162.50 Bedroom 5 18 12 216.00'4g $ 14,040.00 Bathroom 1 7 7 49.00 $ 3,185.00 Bathroom 2 12 14 168.00 $ 10,920.00 Bathroom 3 8 10 80.00 $ 5,200.00 Bathroom 10 10 100.00 Fs�3f�k �.�� ������ $ 6,504.00 Bathroom 5��� Es47 7 r. eusgxMS $ 266,597.50 -.1 -,,,, CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 6-170 peva 6e- 0 - o0 THIS CERTIFIES THAT THE BUILDING LOCATED ON .�©�aa W e &0 0S 1,U I MAY BE OCCUPIED AS i'' ill /'n 1 /y ✓ w / �'�' / IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. y� CERTIFICATE ISSUED TO CA m A A e - l/ / o'"'- G� � k c ADDRESS 04 's a • - q ,�'ACHU Building Inspector C/) m m Cf) cn m L—� CO) d - d O CO) CO) o --A CD O CO) CD 0 O CD 0 CD I /A A V I ON 4 O cn Cc O —• H O CT NJ°1 O. O < O CO) k a o n m C, yc�n� m Z •p �� H 0 10 RL ,,,, s n -• n � m O O O CO) O H O ? m C co > > C COQ mO O OZy.an, .mccO CL as a � sr m o CD mH C-)= O m COL C� coo<3d y n�r C7 cc a =- 'A CCML— C S c. SO CO)03 CA O CA O � 1 �m�NAM co Vm Ila CA co SZ `O O .� y z 0 0 o - �S x n o o ° G� c o � Lr c a d ., o x n o o ° �tTl H O 0 .� Gam' omi 0 9 V I;0