HomeMy WebLinkAboutMiscellaneous - 30 HUCKLEBERRY LANE 4/30/2018 (2)9
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number Q98
THIS CERTIFIES
THE BUILDING LOCATED ON L? 0 040
POOP
MAYBE OCCUPIED ASOA*J*- rAhIlly X-W4*WIN ACCORDANCE
W F
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
Oq 6, CERTIFICATE ISSUED TO C gove dj
ADDRESS
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SA US UWIding Inspector
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.........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............. ...........................
has permission to perform ................. ....................................
6�
wiring in the building of .................................................
......... North Andover, Mass.
:� ...................
i.-'Aq ......... ........
............ Lic. No.
ELECTRICAL INSPECTOR
07/01/99 14:39 30-00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Office Use Only
gf 4fl13SSar4U1jtttq Permit No. n
n -el
e Ent of Public —Aafeg Occupancy& Fee Checke
BOARD OF REVENTION REGULATIONS 527 CIVIR 12:00 3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perforrneidli�naccordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oate - V/ -of j;
City or Town of Ad46zeA--, To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant "II -A
Owner's Address
Is this permit in conjunction with a building permit: Yes No P ----(Check Appropriate Box)
Purpose of Building 2�A7� Utility Authorization No.
Existing Service Amps liwj lQwlvolts Overhead Undgrnd Eioe"'No. of Meters
New Service Amps Volts Overhead Undgrnd 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 In-
grnd. 0 grnd. 7
Generators KVA
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 Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local Municipal 0 Other
El Connection
No. of Ranges
No. of Air Cond. Total
tons
No. of Disposals
Heat Total Total
No.of Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No. of No. of
Signs Ballasts
Low Voltage
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER
INSURANCE COVERAGE: Pursuant to the requirements of M
A
pl d
I have a current Liability Insurance Policy including Co
pip
0
have submitted valid �Pof of same to the Office. YES i NO
checking the app9eiate box.
INSURANCE 0' BOND 0 OTHER 0 (Please Specify)
Estimated Value of Electrical Work $
Work to Stan
Signed under the Penaltie of e Jur
FIRM NAME
Licensee -- � � wr� /-3 /, �
�eachus tts general Laws
a
perateions Coverage or its substantial equivalent. YES 11 �NO 0 1
0 If you have checked YES, please indicate the type of coverage by
/IQ - 2-1
- bati)
(Expiration bati;)
Inspection Date Requested: Rough
Address I f J 4-,Y2 A 7 Z;L� �L
OWNER'S INSURANCE WAIVER: I am aware that the Licensee do
quired by Massachusetts General Laws, and that my signature on
(Please check one)
(Signature of Owner or Agent)
Final
L I C. NO. 9/-) �/ 7
LIC. NO.'4;3!V3 � /
Bus. Tel. No. �2 rz -.4 1) tT--
lflAdAlt. Tel. No. — 4 Z 0
Kgh surance coverage or its substantial equivalent as re-
iis permit application waives this requirement. Owner Agent
Telephone No. PERMIT FEE $
x-6565
N2 )- -,2 5
Date ...... //A - 07
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... SA!.P.] . ...... 5.t.i�t ....... ss. C -Q—
...........................
-4:P
has permission to perform ............ Al-co�-o" .......... SX ... 51.!� ..........
%�ring in the building of ....... maft..�'UA ...... L -.,C.. 0 o. �� ....................
3() ...... ..... L -V
at ... ..................... . rth Andoyer, MW.
f 7L��. Lic.No.AX-31L ...............
ee .....
ECTRIC L INSPECTOR
C �, (-� A � >�
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Office Use Only
Permit No.
Etpartinent of Pubtic bafetV /Occupancy A Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:0 3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR�2-
J
(PLEASE PRINT IN INK OR TYPE ALL INIF MATION Date
9 R 6 -YL -
City or Town of 4LE 2).'o To the Insp/ector of Wires:
The udersigned applies for a permit to perform the electrl6al work described below.
Location (Street �
Owner or Tenant
Owner's Address — 1= I
Is this permit in conjunction with at building permit: Yes El . No Y (Check Appropriate Bok)
Purpose of Building Utifity Authorization No.
Existing Service Amps Volts Overhead D ' Undgmd No. of Meters
New Service Amps Molls Overhead C3 Undgmd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
8
No. of Lighting Outlets
No. of Hot Tubs
Total
No. of Transformers KVA
No. of Lighting Fixtures
Above In.
Swimming Pool grnd. gmd. EJ
Generators - KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
Total
No. of Detection and
No. of Ranges
No. of Air Cond. tons
initiating Devices
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
DetectioniSounding Devices
No. of Dryers
Heating Devices KIN
Municipal DOther
LO!!L-�onnectlon
No. of No. of
OW Voltage
Wiring
No. of Water Heaters KW
Signs Ballasts
4
No. Hydro Massagh Tubs
0. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws . YES 0, NO 0 1
1 have a current Liability Insurance Policy including Completed Operations Covarage or its substantial equivalent
have submitted valid proof of same to the Office. YES 0 NO 0 If you have chocked YES. please indicate the type of coverage by
checking the appropriate box.
INSURANCE 0 BOND. C; OTHER 0 (Please Specify) (E 7 iration Date)
Estimated Value of Ele rical)NbrP —JJ�J
Final
Work to Start inspection Date Requested: Rough
Signed undor the Penalties of perjury:
FIRM NAME ADT Sp -cur ry 5aryi Tne. LIC. NO.
LIcensee —Donald A. 2rctaks-_ Signature LIC. NO.
Bus. Tel. No. (413) 737-4400
Address — 111 Morse Street, Norwood, MA --- ___AIt.TeI.No. 4781) -?78-1131
OWNER'S INSURANCE WAIVER: I am aware that the Liconseo does not have the Insurance coverage or Its substantial equivalent as re-
quIred by Massachusetts General Laws. and thnI MY signature on this permit application waives this requirement. Owner Agent
(Please chock one) I e'-,,) J
(Sign3tUfS Of 0WnO( or Agent)
Telephone No. PERMIT FEE -S
X-6555
r/ Date..
NZ
o
0
TOWN OF NORTH ANDOVER
0 -
PERMIT FOR WIRING
8
'nis certifies that ... ............... [ -J.t-.0 ............................ ;A
.......... ..... ... .. .. . .. .... . .. ...
has permission to perform ..... ... ....... RoM.—e . ............................
wiring in the building of ...... ...... Ar. f/ —* .................. �t
at ...... If-)/ .... A....
—1- , North Andover, MassS
Lic. No. ........... te
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
A
office Use
Permit
_r < '059- -5 i
WE R4-5--4em 17 Occupancy & Fee Che&ed
P-" 5,40 -
BOARD OF FIRE pREVENTION REGULAMONS 527 CMR 12:00
APPLICATION FOR PERMIT -TO PERFORM ELECTRICAL WORK
AN work.to-be perfortned in accordance with the Massachusetts EjecnNg Code 527 CMR 12:00
ate � 115—
pmease print in ink or type ail ifftrmau0n? . o the Inspector Wares:
Taiiiin a North Andove
The undersigni..d applies for a permit to pftfcrm the electrical work described Wc'v.
Locafi& (Soed & Nun 6
L im
Oww or Tenant -
_0?
Own;, Addrm_4aU,
is this Writ in corilunction with a building pemj yes I
purpose of
Emsting SwAce -------- Amps Voits
S Amp: LW4Z 0 Yoft
Number Of Feeders and
Locafion and NaWra Of F
No. of
at
at
r tA �A x)-9—
No CJ (Check Appropriate Box)
Utility Authorization No._Z0_L7 �[_)
&erhead 0 undgmd 0 No. of Meters
Overhead 0 UndgMd No. of Meters
A
No. Hyd� Message Tuds
OTHER:
of
M
Pool
Abowe C3 In 0
at
IXT A
Of
FIRE ALARMS No. of Zone
No. of Dete ow and
initiating Devices
No. of Sounding Devices
Noj of Self Contained
DetectionlSojinding De%1C8s
a Municipal 0 Other
of Gi�usetm �Gerwat Laws
1NSU NcE COVERAGE. Pursuant to me requireMenp C41verage or its Substantial equiwient NO
current Uati1jity trisurance Policy includimyle/boleted operations tawjagg tly checlang the appropriate tIOX
I have a biktted valid prcd of same to the Office W= NO = lf yOU-have cheeked-YES please indicate t #1
BOND OTHER = (Plel Specify)
Start inspection Uaw Kwwquestdk_�
Work to oil, LIC.
..___4.._A_+hsbPana of oerlury*_ -,I - / _. - - (" -
LIC.
Licensee ( '.42 -1 1 61/ 7
Bus. Tel
Aft Tel. No. t as required by husetts
= Add substantlai-equivai
_21� �AIVVI��
res at the Lice does not have the insurmce coverage Or its lease Check one)
MaISINSU E I am awe�re n aives this requirement Owner Agent (P
General Laws. And that my signature an this permit appilC3d* T-J..hrIn" No- —PERMIT 1: /S
"Locat ion,3c) k-z�e
Mo. Date
&ORTPI TOWN OF NORTH ANDOVER
0 -
Certificate of Occupancy $
Building/Frame Permit Fee $
0
Foundation Permit Fee $ AD
S CHUS Other Permit Fee $ -CI <
tZ
Sewer Connection Fee
Water Connection Fee
TOTAL
$
$
$ 3-/ -3Z-
I 'j�ilclin
p
)1�16/98 13..08 Inspeg
tor
Div. Public Works
Location
No. D:te
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
Div. Public Works
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6-
Growth Management Bylaw Exemption Statement
Town of North Andover Building Department
This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as requested below.
Naime of Applicant an Building Permit (below) Address of Properl�for Permit (below)
gx,L� &N ;�� P,,k 4 A O�
Map and'Oarcel: Purpo'sr'f A4i aticn (check below)
Phone S F
Nurnber of / plicant - Single Family Two Family
A
l'-ffie undersigned applicant for the above property attest that the attached building permit for which this
flo 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 or any party to this permit
from the requirements of obtaining other permits required prior to the issuance of the Building Permit.
Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building
Department and is only officially accepted when the Building Permit irk issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for 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.
an application for a building permit for the enlargement. restoration, or reconstruction of a dwelling in
of the effective date of this by-law, provided that no additional residential unit is created.
(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
Bylaw.
— This application is for dwelling units for low and/or moderate income families or individuals, where all of the
conditions of 8.7.6.care met and/or represents Dwelling units for senior residents, where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
purposes of this Section "senior' shall mean persons over the age of 55.
— This application is a part of a development project which voluntarily agreed to a minimum 40% permanent
reduction 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 space 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 will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an
adjacent parcel an 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 an 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 cited above. Further I understand that the submittal of misleading and or
inaccurate information, or the checking off of an above item which does not comply, whether done to my
knowledge or ��rc� for;p1l)iisal by the Building Department to issue a Building Permit.
zwgriature ot Owner or Authanzed,*Ae,t who sgni'ed-t ached Building Permit Wate - A
This form must be attached to thi? Building Penp�%021"__
upon application for such permit.
TOWN OF NORTH ANDOVER, MASSACHUSETTS
DIVISION OF PUBLIC WORKS
384 OSGOOD STREET, 01845
JIMILLIAM HMURCIAK, P.E.
DIRECTOR
10
Mr. Torn Hurley
Evergreen Management Corp.
200 Park Street, Suite 2
North Reading, MA 0 1864
Dear Tom;
�Eo
Telephone (978) 685-0950
Fax (978) 688-9573
July 14, 1998
Attached you will find the signed form U for lot 2 Pinewood. It has been explained to
me that Mr. Robert Halpin, Town Manager and your attorney Mr. Mark Johnson has reached
an understanding that the sewer mitigation fee for this site will be paid prior to a certificate of
occupancy being issued.
If your knowledge is different please let me know, by letter.
Very truly yours,
James Rand, Jr.,
Director of Engineering
JJR/hs
enc.
Is
CAAWMPINEWOODLETTER01
FORM U - VERIFICATION 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 lawl,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: 2(,4 4,j -bA Phone 66 LI-36?V
- - ---------- -
LOCATION: Assessor's Map Number. Parcel
Subdivision—i:,:�r=j .ed,4-4r-,s Lot (s)
Street M4 lnr,�
St. Number 30
************************Official Use Only************************
RE -NDATIONS OF TOWN AGENTS:
a- Date'Approved
Conservation A in* t ator. - tMjo"Da e Re'ect d
(S I it
Comments
Town Planner Date Approved
Date Rejected
Comments
Food Ins ctor-Health
Se4litic'—Inspector-Health
Date Approved
Date Rejected
Date Approved 7171?z.
Date Rejected
Comments /t:r� I
Public Work s - sewer/water connections
- driveway permit
Fire Department
JW—
Received by Building Inspector Date
I
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Registry of Deeds
Northern District of Essex County
Lawrence, MA 01840
EVERGREEN MANAGEMENT
# 26 Rec:
Inst 22997
0 27 Rec:
Inst 22998
Total
# 28Payment Check
07/16/98
CT
Type PLAN 13.00
Copies 1.25
Type NOT 10.00
THANK YOU! Thomas I Burke
2025
24.25
P,
joyc�
P'4 -W
TOWN CLP -"K
SA NORTH AND-dV"ER
TOWN OF NORTH ANOOVER
MASSACHUSETTS JuN 17 9 15
BOARD OF AFFEALS
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
PROPERTY: Lot 2, Pinewood Rd.
NAME: Franklin S. Davis, Trustee DATE: 6/11/98
ADDRESS: Pinewood RIty. Tr. ( 200 Park St) PETITION: 022-98
-N. Reading, MA 01864 HEARING: 6/9/98
The Board of Appeals held a regular meeting on Tuesday evening, June 9, 1 M upon the application of
Franklin S. Davis, Trustee, (Pinewood Realty Trust), 200 Park St., North Reading, MA, requesting a
Variance for premises located at Lot 2, Pinewood Rd., North Andover, of the R-2 Zoning District,
from the requirements of Section 8.5, Planned Residential Development, Paragraph 6D, for relief of a
rear setback to allow construction of a residential dwelling within significant wetlands.
The following members were present: William J. Sullivan, Robert Ford, John Pallone, Scott Karpinski,
Ellen McIntyre.
The hearing was advertised in the Lawrence Tribune on 5/26/98 & 6/2/98 and all abutters were notified
by regular mail.
Upon a motion made by Scott Karpinski, and seconded by John Pallone, the Board of Appeals
unanimously voted to GRANT a Variance for a rear setback of 10.4'to construct a residential dwelling
within significant wetlands 58' from wetlands and not in the Watershed Protection District as defined in
the North Andover Bylaw, with the condition that the Planning Board approve the plan submitted by
Atlantic Engineering & Survey Consultants Inc., job #9712-09, dated April 17, 1998. Voting in favor:
William J. Sullivan, Robert Ford, John Pallone, Scott Karpinski, Ellen McIntyre,
The petitioner has satisfied the provision of Section 10, paragraph 10.4 of the Zoning Bylaw and that the
granting of these variances will not adversely affect the neighborhood or derogate from the intent and
purpose of the Zoning Bylaw.
Note: The granting of the Variance and/or Special Permit as requested by the applicant does not
necessarily ensure the granting of a Building permit as the applicant must abide by all applicable
local, state and federal and building codes and regulations, prior to the issuance of a building
permit as requested by the Building Commission,
BOARD OF APPEALS
William J. Sullivan, Chairman
I/
N21 2.0� 71 Date ....... //��A....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .......
... : ..................................................................
has permission to perform ...... ..................................
wiring in the building of ..... Z-5?.
vat ......
-) ....... t.. I ..... .......... NorthAndover Mass--
ms�-
2' -7
Fee ... Lic. No . .... ".I� ........ t5 ............ ....... . ...........
ELEcTRtcAL INSPECTOR
Check v / �, 6
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
lb -9. N THEC19AMONWEALIHUP*Al4NY4(-HUNKIIN uttice use o
DLPARMEWOFPUK1C&4FM Permit No.
BOARD 0FMEPREVEVH0NRE.GffATI0AS527CMR 120 Occupancy & Fees Checked
'VA
UAPPUCATION FOR PERAff TO PERFORM ELECMCAL 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) D a t.L
Town of North Andover To the Inspector of Wires:
"Me undersigned applies for a permit to perfbrm the electrical work described below.
Location (Street & Number) _ �?—o Zk—C 1�k
OwnerorTenant 1Mar*l6-A-,)
Owner's Address
Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box)
Purpose of Building 1-e5fC�e4l?-Ce-- Utility Authorization No,
Existing Service Amps Volts Overhead M Underground No. of Meters
New Service Amps Volts Overhead r-1 Underground El No, of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work * ZV
No. of Lighting Outlets
No. ofHot Tubs
No. ofTransfo—rmers
Total
KVA
N16, of Lighting Fixtures
Swimming Pool Above
F1
Below
El
Generators
KVA
ground
ground
No. of'Receptacle Outlets
No. of0il Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas B timers
FIRE ALARMS
No. ofZones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. ofDisposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of'Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
r7
M
Other—
No. of Dryers
Heating Devices KW
P
Connections
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER -
IhawaamalLiabkhnm=Pobcymk&gCm#,deOPw,-WNCO",WcrAsWA&tdqmWOt YES [Er NO
lhawakmitedvalkipmfofsamelotheOffm YES [ffNO If�xuha%edxdWYESpkmmdc&thetAVCfWArdWbydrdmgthe
dwoviatbox,
INSURANCE [Z BOND OTHER ftmeSpecifiy)
Esftm&dValueofl3ectndWcrk
WorkiciSw hqxctimD*RapesWd Ra# Flol
&%WieSofPajury q 16 3j
FIRM NAME
— Lioms0lb
BusirxssRiNa i? S—,4 P
Al Tel. 2L C 9 Z
owws miRANcEwArVER, lam a%katefalbel-iomdws not themsranxamWontsakswWeWn-dkrtasm*zedbyNlmmdudts Card L7m
andfit,tnTy*ubm,aiftpm-dwpficmmv"",esthlsmw'Kmlat
(Please check one) Owner M Agent 1:1 Telephone No. PERMIT FEE $
DATE ("DONY)
. � CORD-
A CERTIFICATEOF LIABILITY INSURANClitRmohlo
I ,
1 04/04/01
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Norwood Ins. Agency, Inc.
2.91 Main Street
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Groveland, M& 01834
COMPANIES AFFORDING COVERAGE
COMPANY
Phone N 8-372-5921 FuNo.97
g, --27j-! 8-521-0242
A Naticnal Grange Mutual
INSURED
COMPANY
COMPANY
Mark T. Swett
C
3 Pike Street
Groveland Mh 01834
COMPANY
COVERAGE$
THIS is TO CUM" THAT *HE POLICIES OF INSURANCE LISTED BELOW "AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WNCH THIS
CERTIFICATE m.AY ap- issuzo OR MAY Pritum. TV& INSURANCE WOROFID BY T146 POUCIS$ 06SCRISCO IjtREtN IS SVIIIJECT To ALL TH9 TFAMS.
CXCILUVON3 AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
I .
POLICY NVMBRR
POUCY ZFFECTIVE
DATF (MWDDrfY)
POLICY EXPIRATION
DATE (MWDa'M
LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE $200000
A
C.0MM9RCIALGgNER&LuAo)uTY
MPH57622
03/06/01
03/06/02
PRODUCTS - cOmPOP AGG $2000000
CLAWS MADS 7 OCCUR
PERSONAL & AQV 49JVPtY $1000000
EACHOCCURRENC 1000000
OWNERS & CONTRACTORS PROT
x
BOR
FIRE DAMAGE (Any one f1m) 350000
Meg MXF (Any Ono Pmson) $10000
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE J.IMrT 3
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Par Fermi)
BODILY INJURY
(Pef acefdanu
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
GARAGE WAGILITY
AUTO ONLY - CA ACCIDENT S
ANY AUTO
EACHACCIDENT 3
AGGREGATE 3
EXCESS LJARILITY
EAC OCCURRENCE S
AGGREGATE
RUMBRELLA FORM
OTHIM THAN UMBRELLA FORM
WORKERS COMPENSATION AND
FMPLOYERV UABILITY
(WUATU
W MrjS ER
EL EACH ACCIDENT $100,000
THE PROPRIETOPJ NcL
PARTNERS&EXECUTWE Hl
WCH576622
08/18/00
08/18/01
EL DISEASE - POLICY LINUr $500,000
FL OLMASF - EA EMPLOYEE $100 000
OFF) M AR9: EXCL
OTHER
A
ROP
I-IM57622
03/06/ Ql
0310GA2,
DESCRIPTION OF OPgRATIONSILOCATIONMEMCLgSMPECIAL ITEMS
CERTIFICATE HOLDER
CANCELLATION
TOWNOFA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES AC CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Town of Andover
30 mys wfurrEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO ?Mll LEFT,
Electricial Inspector
27 Charles; Street
BUT FAILURE TO MNL SUCH NOTICE $HAAL IMPOSE NO OBLIGAT" OR LIA91LITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRES#NTATIVES.
North Andov0kr MAL 01845
AUTHORrZ.EO REPmEnTA-nvE
:Ar-.t)RG2&6 (1[85).
A L40__-ACORP CORPORATION 108a .
!m
Norwood Ins Agency, Inc.
293 MainStreet Groveland, Ma 01834
978-372-5921 978-372-2685 978-373-5621
Fax 978-521-0242
DATE:
TO:
FROM:
NUMBER.OF COPIES:
MESSAGE -
AU
Location
No. r:;2- Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
6 -�. —
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
r)
f Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVAT�2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING
4UMM" New"
BUILDING PERMT NUMBER: A: C- >7 DATE ISSUED: q ev L-;
(
SIGNATURE: 4�gl#
Building CommissioneE2�jKctor of Buildings Date
SECTION I -SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
0&6
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning Di�_U idt Proposed Use
Lot Area (sf) Frontage (fl)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
ti
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
1.9 Sewerage Disposal System:
lic 0 Priva e D Zone Outside Flood Zone 0
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT
2.1 Owner of Record
!:� �z�
Name (Print) Address for Service:
Signature Telephone
2.2 Owner of Record:
Z9/c -�l
Name Pri Address f�r Service:
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable 0
Licensed Construction Supervisor -
'Number
Ad s
7 -
Expiration Date
Signature Teleph6ne
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
I SECTION 4 - WORKERS COMPENSATION (nG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will resul�
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....... 0 No ....... D
SECTION 5 Description o Proposed Work (check applicable)
New Construction 0
Existing Building 0
Repair(s)
0
Alterations(s) 1K
Addition 0
Accessory Bldg. 0
Demolition 0
Other
0 Specify
Brief Description of Proposed Work:
Elle-lz f5 xi evl
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by penni applicant
OFFICIAL.USE
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters reLat& to work authorized by this building permit application.
Signature of Ovaier Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, �:� &�� 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 N e
SiNature of Ownerient Date
1 811: 1111011111110111111
— — — — --- -- -- SIMMERIN NUNN—
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TITVIBERS I ST
2N') 3n
SPAN
DINIENSIONS OF SILLS
DRvIENSIONS OF POSTS
DINENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS
S17 -E OF FOOTING
X
MATERIAL OF CHD�NEY
IS BUILDING ON SOLID OR FILLED LAND
CONNECTED TO NATURAL GAS LINE
- -,a
FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from
Boards and Departments. having jurisdiction have been obtained. This does not relieve the -
applicant and'or landowner from compliance with any applicable requirements.
.............. 010100110 wasseensom.se noun a uses mango mossommaso Emmons
APPLICANt—a/� PHONE.
ASSESSORS MAP NUMBER LOT NUM13ER
SUBDMSION LOTNUMBER
STREET STREET NUMBER
a 2 d mb a 0, 0 a a a 0 a a memo a. ""emus
0 TAT USE ONLY
Immumm women OWN Sam mmmmmmm�
RECO;:4R�ATIONS OF TOWN AGENTS
I To 9 8 a W a a a a 0 2 0 a 0 a a x 0 0 a a a a a 0 0 a a 0 a a a 0 a a 0 a a a a a 0 0 a a 0 a a 4 a's a 0 a 0
DATE APPROVED
CORSERVATION ADM[NISTRATOR
DATE REJE C D
e_y_+Qfkdf wofV, �y /)6 ol JJ 7 6,44
CONffvffN-M
RECEIVED BY BUILDING INSPECTOR DATE
DATE APPROVED
TOWNPLANNER
DATE REJECTED
CON54ENTS
DATE APPROVED
DATE REJECTED
FOOD INSPECTOR -'HEALTH
V�EPTICJ�NSPECTOR
DATE APPROVED
HEALTH
DATE REJECTED
COXQvIENTS
PUBLIC WORKS - SEWER WATER CONNECTIONS
DRrVEWAY PERMIT
DATE APPROVED
FIRE DEPARTNIENT
DATE REJECTED
CONffvffN-M
RECEIVED BY BUILDING INSPECTOR DATE
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Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 01845
D. Robert Nicetta
Building Commissioner
(978) 688-9545
(978) 688-9542 Fax
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE 3 —2
JOB LOCATION 3e-) _11�11<
Number Street
Map / lot
"HOMEOWNER f�"16AJ LAN6,1�Aj q 79' q 75- '7/ 7 ?115'1) t,4,50 j
Name Home Phone Work Phone
PRESENT MAILING ADDRESS W*/&
City Town State Zip Code -
The current exemption for "homeowners" was extended to include owner --occupied dwellings
Of two units or less an d to allow such homeowners to engage an individual for hire who does
not possess a licens8, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1)
DEFINITION OF HOMEWOWNER:
Person(s) who owns a parcel of land on which helshe resides or intends to reside, on which
there is, or is intended to be, a one or two family dwelling, attached or detached structures ac-
cessory 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.
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 SIGNA
APPROVAL OF BUILDING OFFICIAL
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DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERYISOR LICENSE
Nuiber: Expires: Birthdite:
CS 072490 01/10/2002 01/10/1963
Restricted To: cc
DANA V PRATT
27 EAST ST
TOPSFIELD, flA 01983