HomeMy WebLinkAboutMiscellaneous - 30 WOODLEA ROAD 4/30/2018f
Date .....
... .. ... .. .... ....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies thatY ............ A67-
/ ...............................
............................................
has Permission to perform ...........
wiring in the building of ........... .................................
at ........ .................. /Rorth Andover, Mass.
4 to
Fee..... .... Lic. No.../ ..................................................INSPECTOR
Check # co
8506
r-- Official Use Only _
.• � �o�s;ysatth• o� //la.iic.c,•..u.i.61
Perm it No. `}
Occupancy and Fee Checked
SOARD,OF FIRE PREVENTION REGULATIONS [Rev. 1/071 Icavc blank)
a '
APPLICATION FOR PERMIT To PERFORM ELECTRICAL WORK ;
All wor to be performed in accordance with the Massachusetts Electicai Code (MEC), 527 CMR 12:00
(PLEASEPF.IN7'ININKORTY? L ORd�IriTI011� Date: /��' -�( _
City or Town of: G7 � 9�'�' To the Inspector of Wires:.
By this application the undersigned gives notice of his or er intention to perform the electrical work described below.
Location (Street &Number
3e) r,✓w
Owner or Tenant
Telephone No.?
- 6240
Owner's Adress
t
Is this permit in conjunction with a building permit? Yes ❑ No TC -heck Appropriate Boz)
Purpose of Building Utility Authori-7.atien No. _
Existing Service Amps / _Volts Overhead ❑ Undgrd ❑ No. of Meters -
New— S : _ Amps f Voit_s . Overhead �I Undgrd ❑ No. of Meters
ervice
Number of Feeders and Ampacity:
Location and Nature of Proposed EIectrical Work:-L�C.r,LL"•t a r fG �:
SLj 5 -re rj
Completion of theollowlTota
table may be waived 5 the Inspector of Wires.
e.
N of Recessed Luminaires No. of CeiL-Susp. (Paddle) Fans . Transformers KVA
o.
_Generators KVA
i`1o. of Luminaire Outlets Z40_ of Hot Tubsrina
No_ of Luminaires
No. of Receptacle Outlets r
No. of Switches
No. of Ranges
No. of Waste Disposers
No. of Dishwashers
No. of Dryers-
[ o. of Water
. Heaters -
ADOYe n in-
wimming Pool••yrnd. Ernd.
No: of Oil Burners
• —Na. of Cas Burners
No. of Air Cond. 'Pons
eat ump umber Frons
Totals:
Spacc/Area Heatitio KW
Heating Appliantts k -W
o_ o N o. of
KW s; ,,,� gallasfc
No. -Hydromassage Bathtubs INo. of Motors Total HP
❑ •�u. va .,.... oma. _J _-o----- c
$atie. . Units
FIRE �;LARMS No. of Zones
t D. of erection an
:..ziatin- Devices
No. of Alerting Devices 3
tq o. o. e - ontatne
'- n-t,-e-mn%Alerting Devices
❑ (Municipal Other
°�f Connection.
No. of Devices or Equivalent
lata Wiring:
No. of Jcvices c- E uivrl_nt
e ecommunicacionsinng:
No of Devic!sL Equivalent
,OTHER' 14? 7— o1 SSLS
Attach additionald rat! ,! desired or as required by the Inspector of lYv�e
s.
Estima.ed Value of Electr' 1 Work_- Zi g C90 _ (When required by.munici7al .policy:)
Work to Start: Itispections td be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE ERAGE: Unless waived -by the owner, no permit for the pertonnance of electrical work may issue unless
tltglicerisee provides proof of liability insuianiee including "completed. operation" coverage or its substantial equivalent. The
u e.licegtied certifies that'such coverage is in force, and has exhibited proof of same to the permit issuing Office -
CHECK ONE: INSURANCE ® BOND; ❑ OTHER ❑ (Specify:)
f;t rtify, under the pains and penalties of pedis y, that the information
on this application is true and cvmplet�
Sir. V[C.es � LIC.NO.: -5-3 ':3
FIRM NAME:-
Signature- " LIC: NO : �Q
Licenser. %(-P N K �' !(,D Bus. Tel No.•
ifaPPticable, enter ex pt" in the Itcensi mrm er line.) , uH Q3pqp Att. T=I_ No.:
Address: X L I army 06 l9
*Per M.G.L. e. 147, s. 57-61; security work requires Department of Public 5afcty " S'' License:. : Lic. No. • S C=G'
OWNER'S INSURANCE WAIVER: I am aware that the Licensee doer not have. the liability insurance Covuage normally .
required bylaw. By my signature;below; I hereby waive this rcquiremenL I. am the (check one).
EJ owner owner% anent.
Owner/Agent Telephone Nc. — PERM1T FEE.' ✓� _ � .CJ
Signature
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Date....,`." P� :.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............. ...........................................
has permission to perform ......:.`S .........................................
,rJN, La,t ii/1�
wiring in the building of ..:�! ,��....��<!� ...�._.�...........�..............
at ...........30.. .!.4 ! / ...... ....................... . North Andover, Mass.
C+ Q9
Fee .............. ..-.............
'ELECTRICAL INSPECi'oR ............... . •,
��............. Lic. No O?,S*�-.
Check #
$6�)4;
May 25 06 03:38p Jeffrey n. Gaudet 781-365-1360 p.1
Commonwealth f ,.__ _.._...__.._....-....__-------• _
V;l' o Massachusetts � t Aliti.,{ t • < ►rt Department of Fire Services 1 IL'rfillr �Ip,10,BOARD OF FIRE PREVENTION REGULATIONS IRcv, tt o;J
Ile.n� hl:oakl _
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
tll :t.uk to sac �rtpltltaJ in 1c�unL•InCt aaith Ih. \Cr��l►utiu� Clcctri�rl Grtic 1 \11i('I. j!'t "\1A 1 _.1'N)
rI'LE.I.SH PRI.\TI.N,'I.\'K OR T}*114%ILL 1\FUlf.1l.ITltl.>'� pate: j�� 0(�
Cilli or Cawp of ,}t r Tl, /Ire lntrr.fr►rid fltires:
1)y Ihis application Ihtt (mdLrsgyicd Ales 114,11ce ul'htr' or her itttcnlitat to perform ill%: al vtrical tsork deserih.•d 110ow.
taxation (Street & NumherJ 30 wck:!104�,.l
lAvnrr Ar TenantA.1ts�G `_
K` n�><S•1 �� ~ I'cicphone No. /j fif
0%ner's Address Zit :.�,,
•." I. . ��
It Ihis permit in epnjunctioa with a building permit'! Yes Vo El tCheck ,appropriate tion)
Purpose or Mraading CS i P
�—
Al `S_L.
(:ririlr
.\utNuriiallNtn Vo.
Existing Servi�?):1mps I �¢' 1 Z•a( 'trlts Overlic:ndnn
�.J
Unatgrd fff list. 1
Vew Service Amps —�--.
/ Vttlts Overtlrad �
nrNirtcn
�t ndgrd ❑ No. uf'Neters
Number or Feeders and A mpacil7
t.ocation And Noture of Propo:ted Electrical
Wurk: ,
�S
�
No. of Rrct:aed Luminaires �(%
r u•„st,.rim/!:v 1. a. i..l..••../
NO. of Ccit-Susp: (Puddle) Funs • No o
No. of l,nmiaaire Outlets
Ifo of Not Tabs
ulu
Transformers KIVA
Generators K VA
*40, of luminaires /
Swimtbint! Pool to a
rat! •rttal•
u. r1 larrgcnci tfi to fir
❑
No. orReeeptarlc Ogtlets /
!!a or Oil Rurners
Rattr�U:nits- _
ti1RE
:1LARIIS Yo. tor/ants
No. of Switefies
ya urcas Burners
u, a Detection as
Vo. or Ra es ,�
Na a mr c.d. t►fal
lairi{1t Utwlces
7 ons
a No. of Alerting Devices
No. ufltfa%k Dispoxers �-
ens orp um ler tins
rolsrlg:
ryo-a> 1 • unta.ne
No. otDithtvoxher} -'
Spsoe/Am lie-ating Kw
• t]ctectiari/.�tcrti��n ��De�"iee�
~�unr'clper
Local ❑
Cuatseetion Other
sec
VtA of --
Dryers
►Iet►ting Appliances NSW
�- �
�ecaX"W 1ystrtns• . `"
, o. o ater KW
licateas
Not, of0`
of Ueviees or l atuiwilent
Data Vtr'tiring:
No. HYdromaskrge (-t(btubs-~
.•
ti" ny f;altacts
roq nr �latora Tmai IlP
Vo. or Dei Ice or E uivakut
rciccrommutucttmos arinR: - -
VQ of rleviccq a.r Ewa:a
Jl 1
ftia.Illrt::La:.ltl(..v:u'.ts.rl,/.N::i:r./,..P..+ t.:t,,.rc.i::. .ilr (•...�.+.a.r. f: ...
rgttad V:tIpL' t ClrlC:11 \Y,tl k: - (WIFIVI tcqulm l by municipal puke:%.)
1�urk to Hart: js_� Its pccticata 1.r W tqua•;tcal in :+t:.vnlathc ttitf, MFf Ruk IO, ulx3 upon completion_
IN!j1.R�Yt E CUYE/L\GF: [.+ileys a�air.d by the va.ut r. till punuit sur dao �rlunnitncr t+i a k�trical aaNk ma) r:iuc unlc�_
t{tc lies ttti.. t•tttbiales
rot)
.tl' liahilitt iu.ur utcc inn (uatUm_ ^•ytnlplttad nlfardb.nt" „tta Cts ,or its wh>lantiri a a(nitulrnt. 'fit
!tr
•:udce:i: nail c�r►i{ir :. !ka s,rch c,tt.tia •e i:. in I::rcc- ilki tt t> a ,hihitty! (rout a:f CN:H• !11 Ilia. Ccrtillt Ll U1lr: ,.rra• .
''I11;(:Ku�rrL_
M-10 RANM'G t/ Itoxr) Q !ll"FI1:R Itipccil'ya
•'.i•,/ijj+,•:hjcr rlrr,vnirrs .,ndptrt•rii±.•s ,J�iju�y+, :gnt!br infi►r•m!I±rnt .:n .Yiir�ytp/ltulirul rt .'nfa N!MI r•N'!grl.:bt
6*11Itx1l v.��lf.:
l,'.: ,.iL-.r-f. •.l.r .. ry.l.. r r1.• :.a.,.: ,_.nri•.:.:,:..^ '—
lddress:_ '7 Arl7c.tt :Jr 1--�MA 61Y D 3 ;(uc "t _I. va : �..��0`
4caarity Sy .team Omit; dor . c tet tt! c icaµtii cd six t611 tusk; tt'r+pp(ic.tbla n� tc wA nanlbarth
t/W \F.IC•S IVy('R,�`IC"E �t.t l�'ER: t alts
I%,,; fro: That dla: I_icenwc •%.,•. q.a inn's the liabilit} is+;tn:utct ,'•t•: _rnL rt. r.iW0� .. .
kilditcd by laar, BY In} •::_•rultltrn bclott• I h.•r.h) waive 111i:a ntluimitkitt f am the /.h.> l:.ana ? uts►nr ❑ unrt.r'r..t:, ;tit.
(lwn<r::�p�,eot
�Aat4tt '
PF4Af/T F-Wr. t
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3415
Date. ° ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .. .........1.... ............. .
has permission for gas installation .....
in -the buildings of . -%4 ' ° G ..................... .
at .3.....L.t..t.... �............. .... North Andover, Mass.
Fee..? Lic. No....�.} . L�
GAS INSPECTOR .........
V
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
301-)
ffmNmn 17
• 3�z,
MASSACHUSETTS LNIFORM APPUCATON FOR PERMIT TO DO GAS F=G
f
�Type or print) ate 61 L-" .
NORTH ANDOVER, MASSACHUSETTS
Building Locations .3c)
Id
Owner's Name
New Renovation ❑ Replacement ❑ -
_ Permit 9
3lflJ�
�r Amount S
Plans Submitted ❑
(Print ortypes Check one: Certificate Installing Company
Name r1m�.9y� �' /%�l`�. S�/E' Corp.
Address �Sl' ❑ Partner.
Business Telephone 78i y ryel.� ❑Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑
If you have checked ves, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond El
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 ❑ AQent ❑
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 pertbrmed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Viassachuse State Gas Codd Chapter 142 of the General Laws.
,41 e an
Z9- . Af
By:
Title
GityiTown
APPROVED (oFi-ici- USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
QKPlumber
❑ Gas Fitter License ( umoer
❑j '"Master
❑ Joumeyman
i�
(Print ortypes Check one: Certificate Installing Company
Name r1m�.9y� �' /%�l`�. S�/E' Corp.
Address �Sl' ❑ Partner.
Business Telephone 78i y ryel.� ❑Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑
If you have checked ves, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond El
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 ❑ AQent ❑
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 pertbrmed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Viassachuse State Gas Codd Chapter 142 of the General Laws.
,41 e an
Z9- . Af
By:
Title
GityiTown
APPROVED (oFi-ici- USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
QKPlumber
❑ Gas Fitter License ( umoer
❑j '"Master
❑ Joumeyman
Date. -.S. . `.: -. G u
N° 4421
:S, TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
�. s .
This certifies that .. �/.�?�. � .. ...../- / . . ............. .
has permission to perform .... f :✓.
plumbing in the buildings of..e-1) ..............
at ..... /A ....... r\... ,�JVorth Andover, Mass.
Fee.Lic. No.... �( i..2. ,�L-�j/� ....... .
1PLUMBING INSPECTOR
V
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
13 .0 7
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
` Date
Building Location 3o o �% �'/D Owners N �cll,c�t7 (�.�r��'.`StJ/sem Permit # y yA
Amount
Type of Occupancy smrIE
c!�
New 011' Renovation rl Replacement ❑ Plans Submitted Yes [] No
(Print or type) ! Check one:
Installing Company Name p'i,,, %/ y!/iia/C 8 / %G'. z�r/l` Corp.
Lj Partner.
11 Firm/Co.
Certificate
1912
Name of Licensed Plumber. ? �..��.�/��dl�a�/� i
Insurance Coverage: Indicate the type of ins rance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity El Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not, have any one of the above
threeinsurance
Signature Owner Agent 0
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 Massa setts tate Plumbing C e and Chapter 142 of the General Laws.
By: Signauire oi Licenswriumver
Type of Plumbing License
Title
City/Town License iNumoer Master Journeyman El
APPROVED (OFFICE USE ONLY
It .
Y
t
••
,
_
■■■■■■■■■■■■■■■
■
(Print or type) ! Check one:
Installing Company Name p'i,,, %/ y!/iia/C 8 / %G'. z�r/l` Corp.
Lj Partner.
11 Firm/Co.
Certificate
1912
Name of Licensed Plumber. ? �..��.�/��dl�a�/� i
Insurance Coverage: Indicate the type of ins rance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity El Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not, have any one of the above
threeinsurance
Signature Owner Agent 0
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 Massa setts tate Plumbing C e and Chapter 142 of the General Laws.
By: Signauire oi Licenswriumver
Type of Plumbing License
Title
City/Town License iNumoer Master Journeyman El
APPROVED (OFFICE USE ONLY
It .
Location k-Ifox`36 X002)� Cl [?dlNo. - Date
NORTH
TOWN OF NORTH ANDOVER
O�t�ao .•,,t,0
po
Certificate of Occupancy
$
4CMUSE<�;
Building/Frame Permit Fee
$`
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
_
$ �--
V Check # t�
r
,f '/
0 r�
n G Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVAT5 OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE: G 6-4-�
Building Commissioner for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address: �y
1.2 Assessors Map and Parcel Number:
noU
Map Number Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4. Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Repired Provided
ReqWred Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
&j"u,X>,Rl yy�'�/'—
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
z`�i�14✓
Licen,-yd Construction Supervisor:
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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 .......0 No ....... 0
SECTION 5 Desch tion 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:
L.
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be+i3FFICIAL
Completed by permit applicant
VSE ONLY �� �g
1. Building
Y
(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
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 7b OWNER/AUTHORIZED AGENT DECLARATION
I,/�%}ji 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
Si ure of Owner A ent
NO. OF STORIES
Date
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINMERS 1
2ND 3RD
SPAN
DINIENSIONS OF SILLS
DIMENSIONS OF POSTS
DINIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING
X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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.
APPLICANT ANW00,0 6,�S CA Y-- PHONE
ASSESSORS MAP NUMBER LOT NUMBER
SUBDIVISION 4J0 0A, -4 U� %, LOT NUMBER
/a
STREET 6✓ood4_ 10 Ad STREET NUMBER ->' 6
...........................................................................
OFFICIAL USE ONLY
...........................................................................
kECOMMENDATIONS OF TOWN AGENTS
sun
DATE APPROVED ( @%
/40SERVATION ADMINISTRATOR
Q� � (DATE REJECTED �f
COMMENT ( -1S (CC f't �}. C A Ard
TOWN PLANNER
COMMENTS
FOOD INSPECTOR - HEALTH
SEPTIC INSPECTOR - HEALTH
COMMENTS
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
RECEIVED BY BUILDING INSPECTOR DATE
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2350 5 0 Date...%.
t pORTI♦ ,
i o TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
SSS CHus�
' — C
This certifies that .......... / /� P.,I f.. S C)f!t L f..:..................
has permission to perform ......�V.c,s �....f�?N!�. e......................................
wiring in the building of .........! i.vw?.P 5.........................
at............ North Andover ass.
J..V...l..t..�.UCS.�..IQCn................... 1<.�...„M
a —
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Fee.�d�:�...... Lic. No..>�..27-�W ............... ...................
OELEcTRicAL�INSPECT R
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
THE COMMONWEALTH OFMASSAC7JUSEUS
DZ7MJ?TAfi�%T0FPVBUCSA %W
BOARD OFFREPREVEIV77ONREG JL4HO1VS527CAM12-00
Office Use only
Permit No. 9, 3-5
Occupancy & Fees Checked
A-rI�LICATIDNFORI- I-ILJVVIIT TOI'ERFURIV1 PLPLC11UCAL 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)
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below
Location (Street & Number) ge52,
Owner or Tenant
Owner's Address�J' ,l/�� /r /l/!✓ L/�% /(/� //
Is this permit in conjunction with a building
Purpose of Building Sj
Existing Service Amps il Volts
New Service j&,P12 Amps �Volts
Number of Feeders and Ampacity
L�aation and Nature of Proposed Electrical Work
Yes ED -No
Date
To the Inspector of Wires:
PARCEL
(Check Appropriate Box)
Utility Authorization No.
Overhead Underground r--1 No. of Meters
Overhead Underground ffr No. of Meters_
No. of Lighting OutletsNo.
of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures%
Swimming Pool Above
Below
Generators
KVA
and
and
No. of Receptacle Outlets
W
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
13-
No. of Gas Somers
FIRE ALARMS
No. of Zones
No. of Ranges /
No. of Air Cond. Total
C �S
Tons
No. of Detection and
No. of Disposals `
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
)*o. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Other
�o. 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
OTHER
I .` I .I •- '� 1. I I al .. • o -.:r • •:.u.•. , v - • •. II, ` •..I a :. I : I
` I•. Ip::• . L• • ••' •' vl .• I •-116- .� • 7 - • :•�:/ •:"!. `- II •IMIi- 1 /• 1' .• : • . :►•1 I
.I/• ••1:I- N
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Fsfarl dValtiodEbotricalWuk$
MIT,
Final
� LdF11lG1 W.
Btna mTelNo.
ar�llr� Alt Tel. Na
OWNER'SINSURANCEWAIVER;IamawmedittheLiwdoesmthamtheit>stad=anuaFcr&sulstnialegxv-dalasragltmadbyN CtnmdLaws
andtha<mysi rAutetndmpemlitapFhmbc nvmrwsdwregm' anari.
(Please check one) Owner Agent r `
Telephone No. PERMIT FEE $ �dd V
Signature ot Owner or Agent
r.. .^:. h --.;r.+F'•`�aa-,rr"^'*•ifs �iK..rr" -sir'-'s..•�-.y'...,w_..yy,°y...s.V'!i•..
/ Y+
ocatior
%+lo Date ID !o
E
. :V►GRTN, TOWN OF. NORTH ANDOVER
3? �,'` •.,_oo`
c p Certificate of Occupancy $
Building/Frame Permit Fee $ H
CMUS Foundation Permit Fee $ 4
M. Other Permit Fee $
Sewer Connection Fee co
!/, , 70� Water Connection Fee 00
TOTAL $
Buildi Ins ector.
1 y09/9p 1, 287.00 PAID? i
1 b 1
Div.Plic Works
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FORM U - VERIFICAT 10tJ 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: (�lJ/mil o ���(� Phone b 41 - by
U v .a
LOCATION: Assessor's Map Number - Parcel
4
Subdivision �DSJ�- /����-s Lots)
Street 1,A.,1® c)� %fja- /ZZ St. Number 316
W''
* ificial UseODAT3e S GENTS:
Date Approved
Conservation Admi lis rator Date Rejected
Comments
Town Planner
Comments
/ Food Inspector -Health
v
sep is Inspector -Health
Comments
Date Approved
Date Rejected
Date Approved
Date. Rejected
Date Approved y .7'
Date Rejected
Public Works-,sewer/water/connections %! Ge 40 A7
driveway permit � � `?7
Fire Department? ►1 "✓�� (1J r �e c�"�L(
--L
Received by Building Inspector Date
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CS 061.913 1!!171199] 0111711943
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i'
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.
Name of Applicant on Building Permit (below) Address of Property for Permit (below)
2 �De-co-w9n �J'C.1� Cly. /� Z.
Map and Parcel: Purpose of Application (check below)
Phone Number of Applicant: . Single Family _ Two Family
X -6Y '6
I the undersigned applicant for the above property attest that the attached building permit for 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 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 iq 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.
This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in
existence as of the effective date of this by-law, provided that no additional residential unit is created.
C<ylawThe lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 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.ciare 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 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 cited above. Further I understand that the submittal of misleading and or
inaccurate information, checking off of an above item which does not comply, whether done to my
kno a or not, is un for refusal by the Buil g Department to issue a Building Permit.
C>
re 9f 00qer o Authorized Agent,*h-4 si he Attac ed Building Permit Date
This 13PIfmust he Ittached to the B Idi g PermitupsQ_ag3lication for such permit.
CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number / Date
THIS CERTIFIES THAT
THE BUILDING LOCATED ON ed -10 #30 a)o ob E -k
MAYBE OCCUPIED ASe
—iN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO _A SA o o o d 411 t.' �
ADDRESS
67-
CHUS wilding Inspector
114
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Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978)688-9545 Fax(978)688-9542
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'9� <OLKIC �WK• 1'
APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION
ADDRESS _?6 6V��001raG? /1i02.
LOT NUMBER /0 SUBDIVISION /,boAg-4
DATE REQUEST FILED 1
DATE READY FOR INSPECTION ?- / D w
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 STRUCTURE DOES NOT MEET ALL APPLICABLE CODES.
SIGNATURE
OFFICIAL USE ONLY
ROUTING
L
CONSERVATION DATE
PLANNING . DATE '
D.P. W. —WATER METER "� / ''S ``�4DATE
G
Op.
D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
PRIO INSPECTION Q ST DATE.
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SIGNATURE / DPW AUTHORIZATION
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