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Miscellaneous - 328 CAMPBELL ROAD 4/30/2018
Soo Date ....!. $ L.. b .�,�...... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 4 i i ♦ ���_ 444"` ' - `•" • C4rlbs VAUN1`Z This certifies that ' ° .......................................(...../................................................ has permission to perform ....10...c...A.. .......................... wiring in the building ofR.!. C �`� ............... ..........Y ................................................... at ..... a.. .........C.!°. ...... U...... , North dover, Mass. Fee..... 3. ..... Lic.No.Id.�?�,�aS.... `.. !..�..�� .................................. ELECTRICAL IN PECTOR Check # 33 O '5121 THE COWONWE4LTHOFMASS4CHUSMS Office Use only DEPARTALFVTOFPUBLICS MY Permit No. BOARD OFFIREPREVFVY0NRWULAT10AS527CiYfR 12,00 Occupancy &Fees Checked APPLICATION FOR P£Rff TO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE r (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the electrical Location (Street & Number) -3, 8 CAMP P1 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Purpose of Building AF Existing Service Amps / Volts New Service Amps / Volts r Number of Feeders and Ampacity ` t Location and Nature of Proposed Electrical Work �}t.ht: ivo. or Lignnng Uuuets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges *!o. cfDisposals No. of Dishwashers No. of Dryers No. of Water Heaters No. Hydro Massage Tubs No. of Hot Tubs RM ELECTRICAL WORK ELECTRICAL CODE, 527 cMR I2:00 Date h*9 13,2wq below. t 14 40 (Check Appropriate Box) Overhead Underground r7 Overhead Underground 0 Swimming Pool Above P-" Below No. of Oil Burners No. of Gas Burners No. of Air Cond. Total No. of Heat Total Pumps Tons KW Space Area Heating KW Heating No. of No. of No. of Motors Total HP KW To the Inspector of Wires: ity Authorization No. No. of Meters No. of Meters ' 1 00 civrC� iS F 4rG�� No. of Transformers Generators No. of Emergency Lighting Battery Units KVA KVA FIRE ALARMS. No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local a Municipal a Other Connections OTHER �. I Iirn�reCa�age Plast�tttblhetagtmanatts�Gene�a!laws Iha�eaasterdLiabtlRyhtusanoePt�licyarh�drtgCrn>pl� CooriLsstagtmdlatt YES NO Iha,,eabn tedvaWpmofofsartetothe0�YFS&ododYES,pftmmdc*tktetypeefooaam2pbydxdmgthe INSURANCE M BOND n GMER ftmSpe*) WcrktD,1;kn `" 1 � wQ D& Signadunder"iePFntltmdpA Yy. ,{ , FIRMNAME l CIA � 64 Gyi I Lict�..� ..� 7 . Sigr>ature OWNER'S INS(1RANCE W. andfixtmysigrr mmthispem (Please �t eok one) „ Ov EViafim D,* Estar &d Val xdHedrical Wiilc $ Rtxtgh -- t—J I I C c Final C. C i. t r LkaueNa —E 3 , S,3 .—._.__ BtsrmTd.No. _C11. AiT&No. %C4 -U-3 . , 7, S09 wetheinsta�tc�t�a-ag;rori�stiec�av�asrec�¢adbyi�'l�ad'ase�s GatealLaws Agent Telephone No. PERMIT FEE $ • - �' N OF NORTH -ANDOVER. SyST�NI PUIYTI'ING R.ECO R IS 3 2633 -$I*5TFM OWMER & ADDRESS SYSTEM LOCATION (example: left front of house) . R,7 1 - UATF OF PUMPING: QUANTITY PUMPED 06 6 :A.SSI'OUL: NO YES` SEPTIC TANK: NO YES NATURE OF SERVICE; ROUTINE EMERGENCY 00sr- RVATIONS;' GOOD CONIfMOti FULL TO COVER HEAVY GREASE BAFFLES' �H PLACE ROOTS :;' LEACHFIELD IZUJYBACK, EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOYRR HRR (EXPLAIN) i1 -STEM PUMPEb BY: �" t�i''�' •' C_'fl' a c.•ua�l kr FNTS: UN7'(sk'!'S TRANSI?CIMED T0: TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: D SYSTEM OWNER & ADDRESS ,��� 'y 3;?; ,, /v©. SYSTEM LOCATION (example: left front of house) Roy DATE OF PUMPING: '7' R QUANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: /'FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) Date..'!: G?. . :1Mo TOWN OF NORTH ANDOVER A PERMIT FOR PLUMBING This certifies that ..5 7........ f. ................... has permission to perform ... P�' " /. ' ` ` ....................... plumbing in the buildings of.!:.�. .`.� ......................... at ..........., North Andover, Mass. Fee.Lic. No./ ........ ...... YLUMBING INSPECTOR Check # �' t 5719 r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT"'TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location Y � 1' G Awners Name Type of New 0 Renovation 10 Replacement El FIXTURES Plans Submitted Yes Date J (! Permit # Amount No (Print, or type) � Check one: Certificate Installing Company Name I- V E �� rj L 1> � � Corp. Address 0 J ro /9-f�� Partner. Business Telephone --� Q -� r n (� % Firm/Co. Name of Licensed Plumber: S' 211 iJ 1��Lls Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy LI Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Ignature Owner 11 Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac S to Plumb' a and Chapter 142 of the General Laws. BY: Signalure gf0censectr5urn4er ype of Plumbing License Title J � City/Town License um er Master 03 Journeyman APPROVED (OFFICE USE ONLY ■ 211 do -- • --40.. ` C ; I ........................I mmmmmmmmmmmmmmmmmmmmmmmmI Wizolurs � • MMMMMMMMMMMMMMMMMMMMMMMMI ...D „• mmmmmmmmmmmmmmmmmMMMMMMMI , • M-.M-MM-s-MM---MMMM.MM.-I m-lis, • MMMMMMMMMMMMMMMmmmmmmmmmI w-iii'D",-,$—.-EMMMMMMMMMMMMMMMMMMMMMMMMI 1 l v'' mmmmmmmmmmmmmmmmmmmmmmmmI • mmmmmmmmmmmmmmmmmmmmmmmmI (Print, or type) � Check one: Certificate Installing Company Name I- V E �� rj L 1> � � Corp. Address 0 J ro /9-f�� Partner. Business Telephone --� Q -� r n (� % Firm/Co. Name of Licensed Plumber: S' 211 iJ 1��Lls Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy LI Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Ignature Owner 11 Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac S to Plumb' a and Chapter 142 of the General Laws. BY: Signalure gf0censectr5urn4er ype of Plumbing License Title J � City/Town License um er Master 03 Journeyman APPROVED (OFFICE USE ONLY ■ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING (Fent or Type) mass. Date 8r 3v 19 90 Permit a Z - _ _, Butding LocatlonOwners Name A,1. c2aas Type of Occupancy New ar--� Renovation ❑ Replacement 0 Plans Submitted: YesQ No 0 tnstalMN Comparry Name Eastern Propane Gas Inc. Address 131 Water Street Danvers_ E-cc019n Business Telephone 508-774-1930 Name o; Ucensed Numtxr oi'Gas FM, er T .. Chreck one: 0 -/ Corporation O Partnership O Firm/CO. -le e-1/ Certificate INSURANCE COVERAGE: I have a euricnt ha N, Y insurance policy or Its substarl ml equivalent which meets the requirements of MGL Ch. 142. Yes G,! No O If you have checked yes• pease ir-dic.ate the type coverage by checking the approprKte box. A iiablify Insurance policy Q/ Other type of indemn"ty Q Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. Genera! Laws. and that my Signature on this permit application waives this requirement. Check one: OwnerO Agent O SQna:uce o! Omer of O+w,er's 1pent f t+erebyce'lityVat at! of the de:,eits and intimation t have submitted (or enttrcdl in a appiazation are true and aoarrate to the best of my knovAe4!§i and ta" plumbing w:ri and installations performed urde- Lne permit las ,tor this appficztio vn~ be tri iance with all peninerit provisions of V* Massa&-t:set:s Sate Gas Code and Cl.zatei 142 oft ral L*r EY T of �; tale Gamer ;-.24re of Ucensed umber or s rite: Waster License Number L /� $'3,3 otynown .Journeyman APP U U ':; t , SEP - 4 ; � r ¢ cu Z a l yl � .� W az J a era s e o O u¢ N t- z «- _ \Q p~" W c z N S W C O' V d7 C V n < C* d �. W q p ` > % \ Ji t < < W W > ¢ K W C 2 < > 6 N < p 2 0 G O 4t S r i � S S O C I LL ; O d J V C > a 6 !• o a 7 14 sva—aswT. ar+SE►cfNT � � � � ' i IST FLOOR 2ND FLOOR ' 1 SRC FLOOR 4 4TH FLOOR . STK FLCOR GTH FLOOR TTK FLOOR 6TH FLOOR tnstalMN Comparry Name Eastern Propane Gas Inc. Address 131 Water Street Danvers_ E-cc019n Business Telephone 508-774-1930 Name o; Ucensed Numtxr oi'Gas FM, er T .. Chreck one: 0 -/ Corporation O Partnership O Firm/CO. -le e-1/ Certificate INSURANCE COVERAGE: I have a euricnt ha N, Y insurance policy or Its substarl ml equivalent which meets the requirements of MGL Ch. 142. Yes G,! No O If you have checked yes• pease ir-dic.ate the type coverage by checking the approprKte box. A iiablify Insurance policy Q/ Other type of indemn"ty Q Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. Genera! Laws. and that my Signature on this permit application waives this requirement. Check one: OwnerO Agent O SQna:uce o! Omer of O+w,er's 1pent f t+erebyce'lityVat at! of the de:,eits and intimation t have submitted (or enttrcdl in a appiazation are true and aoarrate to the best of my knovAe4!§i and ta" plumbing w:ri and installations performed urde- Lne permit las ,tor this appficztio vn~ be tri iance with all peninerit provisions of V* Massa&-t:set:s Sate Gas Code and Cl.zatei 142 oft ral L*r EY T of �; tale Gamer ;-.24re of Ucensed umber or s rite: Waster License Number L /� $'3,3 otynown .Journeyman APP U U ':; t , SEP - 4 ; O j W IL z N w Q O a d O j x i b6 c 0 fl 0 O r r O C � = Z !s cl O iu S _ ii. L6 2 m 1 < O o c r w < p O � O a r ¢ w IL < a gal c C Z k I a fDate........ .......... r " �`- 14` 4 -"WK OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION A This certifies that ................ .......... . has permission for gas installation .. ................ + in the buildings of .......................................... at ..W... ... . . ......... I ........ ,North Andover, Mass. Fee....~... Lic. No. ......:.................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File C, 92 3 r 4.1 '.' Date .................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............. .......................................................................... has permission to perform 0- ........... : j .......................................... ...... wiring in the building of ............ ........... ...................................................... at ............ ................ ..... .................................... . North orth Andover, Mass. I Fee ... .................. Lic. No. ............. ............... ................. ............................ ELECTRICAL INSPECTOR Check # � I ` ' .2 '72 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts 'Department of Fire Services a._. BOARD OF FIRE PREVENTION REGULATIONS Official Use Only PermI it No. 3 U'F Occupancy and Fee Checked [Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (Iv1ECJ 527 CMR 12.00 (PLEASE PRINT IN LVK OR TYPE ALL INFORMATION) Date: -e'3 70/ City or Town of:A nA41 Q VTo the Inspector of Wires: By this application the undersigned gives notfm of his or her intention�o perform the electrical work described below. .ft .. __ _ Location (Street & N Owner or Tenant A Owner's Address Telephone No. •96yg Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts New Semice Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ Cnnrnletinn n(the fnllnvdno tnhle .,., 9. No. of Meters No. of Meters 17 i.. ,l. T.. .— ,� _�:r.: No. of Recessed Firtures - - -• - •- ._..... No. of Ceil.-Susp. (Paddle) Fans (Transformers _ ._ ... . No. of Total KVA No. of Lighting Outlets INo. of Hot Tubs Generators KVA No. of Lighting Fiztiires S« immin Pool Above m- o ❑ ❑ Swimming °rod. prnd. M. o Emergency igintina b b el Battery Units No. of Receptacle Outlets INo. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches No. of Gas Burners INo. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices b No. of Waste Disposers Thaw Pump Totals: Number Tons JKW INo. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating I�'W . `Local E] Municipal [I Other Connection No. of Di -vers -5-a-7 Heating Appliances KW Security )stems: Na of•Dcvices or E uivalent 0-f Nater KW Heaters No. Of o. of SiQiis Ballasts Data Wirina: Na of Devices or Equivalent No. Hydromassage Bathtubs N'o. of Motors Total HP Telecommunications Wiring: Na of Devices or Equivalent OTHER Attach additional detail if desired, or as required by the Inspector of (Vires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance includin; "completed operation" coverage or its substantial equip alert The undersimed certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work. L (When required by municipal policy.) (Expiration Date) 5 43 Work to Start '6 Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certi&, under the pains and penalties of perjury, that the information on this'application is true and complete. FMM NAME: ADT Security Sen ices 111 Morse Street, Non o MA 02062 LIC. NO.: 1533C Licensee: John S. Bassett Signatur LIC. NO.: 13,33C (If applicable. enter "esempl"in the license number line.) Bus. Tcl. No.: —1 1 1 Address: Alt Tel. No.: -603-594-59H resi OWNER'S INSURANCE WAIVER: 1 ain aware that the Litensee does not have the liability insurance coverage normally ONLY required by law. By my signature bcloiv, I liereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Aacnt Sia' aturc Telcnhonc No.-: PERMIT FEE: .S 35''00-1 c4 tl o i�w�e l ISN f Q FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT_'ME4 Lam LOCATION: Assessor's Map Number_____ SUBDIVISION___ STREET_ -32-__Q -t1 (f'LL–_ Rr2 HONE__ 972 –3% 94/ PARCEL LOT (S) �OST. NUMBER 3.29 ************************************OFFICIAL USE ONLY*********************************** RECOWNDATIONS Of),TQWN AGENTS: CONS`LRVATION ADMINI 2( COMMENTS 9ATOR DAT PROVED M �f.$k be, cJe.I;hect�Q� S T�ae�� Av a n.r.,.i.•c�n_..' VJW sG;e4, ^ l ' , o ora„ � �_��e�u TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED 14 11-4L—,DATE REJECTED SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED — _ DATE REJECTED_1— PUBLIC WORKS - SEWERMATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR________________ __DATE Revised 9\97 Jim !% J Town of North Andover Office of the Health Department Community Development and Services Division William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director Zi)iif/a >"�Pl %//d k -el Q501 k 0"P616 -z6 _6 North Andover, MA 01845 Re: Application for b eAf-t)0Y1' 1 (2�}( Cn< 101E Dear: 11r. f%6Gkfy; Telephone (978) 688-9540 Fax (978) 688-9542 Your application for Gh est p S ion t 3;19 �1&4gas been reviewed by the Health Department. The application was denied on cV-,a 2001 for the following reasons: 1. Missing information 2. ❑ Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable To address the problem(s): If #1 is checked, please supply: Floor plan of existing and proposed addition — A I/ e Certified plot plan showing house, septic system and proposed project in scale If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly:- OR b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Reviewer Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANWING 688-9535 Jan 30 02 09:46P BRIL`LIE&COMPANY (781)944-6112 Cyd; Dpi° . p ZJO —.-►i VI 1-16EL, L ROS THIS PLANIS E THE OFFSETS BASED ON THEREFOREA TAPE SURVEY (NOTAN INSTRUMENT SU , AS SHOWN SHOULD NOT 8E USED TO STABL SH AOPERTYSLINES. R MOAT DQE PURPOSES ONLY. ES3E,Y COUNTY DEED REFERENCE: PLAN REFERENCE E. 1185 PG. 699 PL NO• 6179 CERT, NO. ►'L.13K PL. I hereby certifyPG. Were not in Vilat on of texistin g structures are located approxi fro rn viol$tion enforcement action under, consmate) zoninghe by laws at the time of construction as shown and General Laws. The structures Cha ter 40 F E• M.A. ma are located In p A Section 7 of the rare exempt Map. Note: Zone C represents Zone Mass. FLOOD HAZARD COMMUNITY of minimal pooding, to the following BOUNDARY MUNITY NO 25"op 98 MAP NO�d�O_ B�EFFECTIV 2 E-�` X1.14 PT 1 ' REGI ER ,„ ';,? T ED LAND SURVEYOR IL s .� y DATE PLAN OF LAND IN NORTH ANDWER PREPARED FOR. ACCESSIBLE MORTGAGECORP. �1LL1gh? M. � HE1:DI E.1-IICKEy SCALE IN..100 FEET SAILLIE at CpMPANY LAND SURVEYING 8c R 33 HOWARD STREESEgRCI-I READING, MA. 01867 PHONE:1(781) 944-2767 FAX: (781) 944-6112 P. 1 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. f............................r.............r■■.....r.......................■ APPLICANT LQ -S7 C L 377AK ArCK6 y %PHONE Q72? -2-58 319� y ASSESSORS MAP NUMBER 10 (0 D LOT NUMBER c2 SUBDIVISION LOT NUMBER TREET A'i'l P /p STREET NUMBER 32F .. . S ... ,..............��........................................ OFFICIAL USE ONLY ........................................................................... RECOMA[ENDATIONS OF TOWN AGENTS �..■■....■........■■was ...■r..............r■.............................. DATE APPROVED CONSERVATION ADMINIS TOR jj 1 t DrATE REJECTED 3 I D- COMMENTS OAA ► n 6a[� �4`Q.' `CLAdS p/� S��d� o F7fCr�poSP� Any size- i n +k < f Jr(? TOWN PLANNER COMMENTS FPQD INSPECTOR C�TH ALN � r) SE TIC INSPECTOR - HEALTH COMMENTS 6, U tj PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED 1 DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE 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: Building Commissioner/I for of Bui SECTION I- SITE INFORMATION 1.1 Property Address: 32g CAM Pf3F (- L 1.3 Zoning Information: Date 1.2 Assessors Map and Parcel Number: 1063) a Map Number Parcel Number 1A Property Dimensions: Zoning District Pr os -d Use Lot Areas Frontage (fl) 1.6 BUILDENG SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Sttppty M.G.L.C.lo. 54) 1.5. Flood Zone lnfomutio°: 1.8 Sewerage Disposal System: Public 0 Private 0 1 Zone . Outside Flood Zone 0 Municipal 0 On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record --T Rame (Print) Address for Service q 223 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: License Number Address Expiration Date signature Telephone 1.2 Registered Home Improvement Contractor Not Applicable ❑ ,ompany Name Registration Number ',ddress Expiration Date iQnature 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 ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: ?O �jt, 51- A -LL � /S x 3 �� A �3 oy � C--kcsc�,u (� �©0L SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit a licant k" OICIALI�TSE�OV.I�TLY 1. Building 3> --.�� (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� LL . J� 14Z C �rE; as Owner/Authorized Agent of subject property Hereby authorize to act on My belialf,ml nork authorized by this building permit application. at W-s"-X11L1o'— /-4 Signature of Owlrer Date cni-TTnnr ,7►, nWIVF.1?/ATiTNnRT'7VD At-FNT T1R.C1.ARATTnN I I as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 1 ST 2 ND3 RD SPAN DIN ENSIONS OF SILLS DDAENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CI-11NINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Jan 30 02 09:46p BAILLIE&COMPANY L a T ,2- (781)944-6112 MORTGAGE INSPECTION PLAN Nor r I THIS PLAN IS BASED ON ATAPE SURVEY (NOT AN INSTRUMENT SURVEY) AND IS TO BE USED FOR MORTGAGE PURPOSES ONLY. THEREFORE, THE OFFSETS AS SHOWN SHOULD NOT BE USED TO ESTABLISH PROPERTY LINES. ESSEX COUNTY DEED REFERENCE: PLAN REFERENCE: PL NO. 6179 BK. 1185 PG. 699 PL.BK PL. CERT. NO. BK� PG. I hereby certify that the existing structures are located approximately as shown and were not in violation of the zoning by laws at the time of construction, or are exempt from violation enforcement action under, Chapter 40A Section 7 of Ahe Mass. General Laws. The structures are located in Zone,...,L—According to the following F.E,M.A. map. Note: Zone C represents areas of minimal flooding. FLOOD HAZARD COMMUNITY NO Z !EOC 9 $ BOUNDARY MAP NO.dQO'OC- EFFECTIV 2.7Vry p.l I PLAN OF LAND IN NORTH ANDOVER PREPARED FOR: ACCESSIBLE MORTGAGE CORP. WILLIAM M. & HEIDI E. HICKEY SCALE 1 IN. -100 FEET BAILLIE & COMPANY LAND SURVEYING & RESEARCH 33 HOWARD STREET READING, MA. 01867 PHONE: (781) 944-2767 FAX: (781) 944-6112 �,� mss•` -L:� `r'-, ry/i ., 4 Bacan REGISTERED LAND SURVEYOR DATE p.l I PLAN OF LAND IN NORTH ANDOVER PREPARED FOR: ACCESSIBLE MORTGAGE CORP. WILLIAM M. & HEIDI E. HICKEY SCALE 1 IN. -100 FEET BAILLIE & COMPANY LAND SURVEYING & RESEARCH 33 HOWARD STREET READING, MA. 01867 PHONE: (781) 944-2767 FAX: (781) 944-6112 /I5>Lli 34pm e 4.T �_kQ4f eNb��N SicQt O� �wellltiJ FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** (4,57P HONE__ 9%2 "'al,� —.3%9'/ LOCATION: Assessor's Map Number. PARCEL----- SUBDIVISIONLOT (S) STREET__3;�CA"Hf Ori_ /� t9—_ �OST. NUMBER 329 ************************************OFFICIAL USE ONLY*********************************** RECOM09NDATIONS OJ5,7QWN AGENTS: I CONSERVATION ADMINIST ATOR DATE-APPROVEDOj�T_— E REJECT - � _ 3 I COMMENTS _1 de l,►,i� 5 ft.. ItJaL.J SGiP: prier�o ftp o� d 2IMin2 Uel -fes-�o cv�d�• Ce7eiia.s _ Wert- abaerv0_d or 4 the. pl-Vpe rf TOWN PLANNER DATE APPROVED COMMENT FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMME DATE REJECTED DATE APPROVED DATE REJECTED DA PROVED _ __ DATE -- PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR______________ ------------------DATE-------- Revised 9\97 jm North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts State Board of Building Regulations and TOWN OF NORTH ANDOVER 0— BUILDING DEPARTMENT APPLICATIONn nyl© CHANGE THE USE OF OCCUPANCY OF, OR DEMOLISH ANY /O/� , DINE Oil TWO FAMILY DWELLING Building Permit Number: Date Issued: Signature: Building Ct Date SECTION 1- SITE INFORMATION 1 1r p C dAress- E G19 1.2 Assessors Map and Parcel Number: V Map Number Parcel Number IA Zoning Information: 1.4 Property Dimensions: Lot Area (sq) Frontage(ft) Zoning District Proposed Use 1.6 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 107 Water Supply 9M.G.L.C.40.4 54b 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public X Private Zone -� - Outside Flood Zone a Municipal a On Site Disposal System 2.1 Owner of Record LLt CkfY Name (Print) Address: 3018 CR-*1pd6� �q, )JON719 p+uDov� v Ao Signature t� �t/ ,� Telephone X7'8 - 2S8 - 319 y 2.2 Authorized Agent: Name (Print Address Signature Telephone CF ('TIf1N T !'l1N CTr]ri!`TIL1N CFA Vr(`CC CL1D PD/l lC!`TC rCCC Til AU � 3.1 Licensed Construction Supervisor: Not Applicable Q Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone The Commonwealth of Massachusetts CkEle State Board of Building Regulations and TOWN OF NORTH ANDOVER Standards BUILDING DEPARTMENT Massachusetts State Building code 780 CMR Address APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OF OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Building Permit Number: Signature Date Issued: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 14 p ^ ,iiress: O� 1.2 Assessors Map and Parcel Number: l• j� Map Number 1 Parcel Number IA Zoning Information: 1.4 Property Dimensions: Lot Area (sq) Frontage(ft) Zonint� District Proposed Use 1.6 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 107 Water Supply 9M.G.L.C.40.4 546 1.5. Flood Zone Infonnation: 1.8 Sewerage Disposal System: Public J9 Private Zone _n r- Outside Flood Zone O Municipal a On Site Disposal System 2.1 Owner of Record L L174 M t CkEle Name (Print) Address: 3018 CAPd�� R�, NoR�N p+u�ov�,p Signature 0 ') /{,l Telephone 7-2$ _ 2S8 ` 319 y 2.2 Authorized Agent: Name (Print Address Signature Telephone SFCTInN't CnNRTR1If TION WRVICVF, FnR PPOTFf TS I RSS TH AXJ 1F nn0 CTIntr RF>. T nV RN!`1 nQVn Quem 3.1 Licensed Construction Supervisor: Not Applicable Q Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Not Applicable Q Company Name Registration Number Address Expiration Date Signature Telephone tcevlseo IVV/ imt_ SECTION 6 - DESCRIPTION OF PROPOSED WORK (check all applicable) New Construction ❑ Existing Building ❑ Repairs ❑ Alteration(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed : _pn /d is % yQ� SECTION 7 - USE GROUP AND CONSTRUCTION TYPE USE GROUP Check as applicable) A Assembly A-] A-2 A-3 A-4 A-5 B Business ❑ E Educational ❑ F Factory ❑ F-1 F-2 H High Hazard ❑ 113 1 Institutional ❑ I-1 I-2 1-3 M Mercantile ❑ 213 R Residential R-1 R-2 R-3 S Storage ❑ S-1 S-2 U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS. ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index (780 CMR 34) SECTION 8 - Building Height and Area BUILDING AREA Number of Floors or stories include basement levels Floor Area per Floor (so Total Area (so Total Height (ft) CONSTRUCTION TYPE ]A ❑ 113 ❑ 2A ❑ 213 ❑ 2C ❑ 3A ❑ 3B ❑ 4 ❑ 5A ❑ 513 ❑ Proposed Hazard Index (780 CMR 34) Existing (if applicable) SECTION 9 - STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ❑ SECTION I Oa - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I herebv authorize my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date revised oiag rormistate jiviu Proposed No ❑ As Owner of subject property to act on th RTF4. °�� Zoning Bylaw Review Form K Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone 978-688-9545 Fax 978-688-9542 Street: 3 a -(?a m e Map/Lot: D Applicant: / i d m /� �cQ �' %!/ '.4e Request: / i�Yi-�` iS*i- / Sf o,- T� �' x �,,, s . a ti Date: Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Lonina Remedy for the above is checked below Item # Special Permits Planning Board Item # Site Plan Review Special Permit C� Access other than Frontage Special Permit Frontage Exception Lot Sp ecial Permit Common Drivewa (Special Permit Congregate Housing Special Permit Continuing Care Retirement Special Permit Independent Elderly Housin S ecial Permit Large Estate Condo Special Permit Planned Development District Special Permit Planned Residential Special Permit -- R-6 Density Special Permit Watershed Special Permit Zoning Board -Conforming Use ZBA cial Permit ZBA not Listed but Similar 3ign reexisting The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must application form and begin the permitting process. file a new permit (� a- 3 uilding Department Official Signal.ure Application Received - Application Denied Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting 2 Frontage Complies 3 Lot Area Complies g e 1b 3 Preexisting frontage eS 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed y >• s G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies e S 4 Special Permit Required 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height y s 4 Right Side Insufficient Insufficient Information 5 Rear Insufficient I Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies 5 D Watershed 3 Coverage Preexisting 1 Not in Watershed G/ S 4 Insufficient Information 2 In Watershed j Sign 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required N 2 Not in district y e S 2 Parking Complies 3 Insufficient Information 3 Insufficient Information 4 Pre-existing Parking Remedy for the above is checked below Item # Special Permits Planning Board Item # Site Plan Review Special Permit C� Access other than Frontage Special Permit Frontage Exception Lot Sp ecial Permit Common Drivewa (Special Permit Congregate Housing Special Permit Continuing Care Retirement Special Permit Independent Elderly Housin S ecial Permit Large Estate Condo Special Permit Planned Development District Special Permit Planned Residential Special Permit -- R-6 Density Special Permit Watershed Special Permit Zoning Board -Conforming Use ZBA cial Permit ZBA not Listed but Similar 3ign reexisting The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must application form and begin the permitting process. file a new permit (� a- 3 uilding Department Official Signal.ure Application Received - Application Denied Plan Review Narrative The following narrative is provided to further explain the reasons for DENIAL for the APPLICATION for the property indicated on the reverse side: Referred To: Fire Health Zonin Board Conservation DPlane artment of Public Works Other Historical Commission Other Building nPnnrtmcn+ Jan 30 02 09:46p BAILLIE&COMPANY (781)944-6112 MORTGAGE INSPECTION PLAN N lif �t-'tUM THIS PLAN IS BASED ON ATAPE SURVEY (NOT AN INSTRUMENT SURVEY) AND IS TO BE USED FOR MORTGAGE PURPOSES ONLY. THEREFORE, THE OFFSETS AS SHOWN SHOULD NOT BE USED TO ESTABLISH PROPERTY LINES, ESSEX COUNTY DEED REFERENCE: PLAN REFERENCE: PL NO. 6179 BK. 13:66 PG. 699 PL._BK PL. CERT. NO. _9R__~— PG, I hereby certify that the existing structures are located approximately as shown and were not in violation of the zoning by laws at the time of construction, or are exempt from violation enforcement action under, Chapter 40A Section 7 of the Mass. General Laws. The structures are located in Zone„L-according to the following F.E•M•A. map. Note: Zone C represents areas of minimal flooding. FLOOD HAZARD COMMUNITY NO Z TO0 9 S BOUNDARY MAP NO.000'OC- EFFECTIVE; z?hN I Ab.5. t„ _'00� REGISTERED LAND SURVEYOR �'' o � ie. � stl�v��`�i`• DATE����•._ I p.1 PLAN OF LAND IN NORTH ANDOVER PREPARED FOR: ACCESSIBLE MORTGAGE CORP. WILLIAM M. & HEIDI E. HICKEY SCALE 1 IN.=100 FEET BAILLIE & COMPANY LAND SURVEYING & RESEARCH 33 HOWARD STREET READING, MA. 01867 PHONE:,(781) 944-2767 FAX: (781) 944-6112 Town of North Andover Office of the Health Department Community Development and Services Division William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director Zi)///rcz r'v ///d `" ei( �5a � 6Yxw'pa ---z North Andover, MA 01845 Re: Application for b eA fi bom eX CnC 10 L Dear: /71/eKfy. Telephone (978) 688-9540 Fax (978) 688-9542 Your application for Gh e)tf �S1©h t 3� g 6a�f�P as been reviewed by the Health Department. The application was denied on gr a g� 2001 for the following reasons: 1. Missing information 2. ❑ Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable To address the problem(s): If #1 is checked. please supply: Floor plan of existing and proposed addition — a1 11 e-; X /s Certified plot plan showing house, septic system and proposed project in scale If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Reviewer Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 IMPORTANT MESSAGE For LIlJI h.� Day -711 lJ f 3 /� U s A. Time ��' M. M Of � 617 2F 1LE AZ;Cl/ o t7( c) Gbc� ? pension Area Code Number Extension Telephoned Returned your call RUSH Came to see you Please call L, Special attention Wants to see you Will call again Caller on hold Message unfversal'48023 uTHo IN U.S.A. To: William Hickey From: Alison McKay, Conservation Associate Re: amp -aliRoad onset rp quirements for building per provajj CC: ❑ Urgent Fax: (ai 7 A 5 ff— 3 737 Date: 3/1.9/03 Pages: q ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle Please let me know if you have any further questions in this regard e10RTry Zoning Bylaw Review Form - Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 °4en° .fi 45 Phone 978-688-9545 Fax 978-688-9542 Street:.. . . G -re- at . 1>mr,&- jjzoA !7 - Map/Lot: 3 C. 1 (-, Applicant: Uj AIS S K 'D o w a 1,q 11 0 t- Request: - Date: 3 / ri / p Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zoning /?- 3 l�egv 1�^e S oZ S o m0 a9' 5i. P -A, e / '30—Q-0-30 Remedy for the above is checked below Item # Special Permits Planning Board Item Notes Setback Variance 3 Item Notes A Lot Area Common Driveway Special Permit F Frontage 1 Lot area Insufficient Lar a Estate Condo S ecial Permit 1 Frontage Insufficient y e.g 2 Lot Area Preexisting R-6 Density Special Permit 2 Frontage Complies 3 Lot Area Complies L-te. 5 3 Preexisting frontage 4 Insufficient Information 4 Insufficient Information B use 5 No access over Frontage 1 Allowed G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required �-j c S 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information M c g C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient Information 4 S 5 Rear Insufficient I Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information e 5 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed 4 Insufficient Information y e- 2 2 In Watershed t,1 e S j Sign to 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district Ljeg 2 Parking Complies 3 Insufficient Information 3 Insufficient Information s 4 Pre-existing Parking Remedy for the above is checked below Item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit Setback Variance Access other than Frontage Special Permit Parking Variance Q- Frontage Exception Lot Special Permit tot Ar' Arian ce Common Driveway Special Permit Variance Congregate HousingSpecial Permit Continuing Care Retirement Special Permit endent Elderl Housin S ecial Permit 'ning BoardInde itn-Conformin Use ZBA M Lar a Estate Condo S ecial Permit a ecial Permit ZBA Planned Development District Special Permit S ia! Permit Use not Listed but Similar Planned Residential Special Permit eciai Permit for Si n R-6 Density Special Permit Special permit for preexisting nonconforming —Q, Watershed Special Permit The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new permit application form and begin the permitting process. Building Department Official Signaturie' Appli tion eceived Application DeNed Plan Review Narrative The following narrative is provided to further explain the reasons for DENIAL for the APPLICATION for the property indicated on the reverse side: Referred To: Fire Health Police Zonin Board (i) Conservation De artment of Public Works Planningt_�) Historical Commission Other Building Department Location��-�/� No. 1/J Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 97 1 7442 'Building Inspector I SECTION I- SITE INFORMATION I 1.1 Property address: TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Number: Parcel Number ;;?� SeMiio for (?#fU, Dai BUILDING PERMIT NUMBER: / DATE ISSUED: SIGNATURE: G c Frontage (ft) Building Commissioner/I for of Buildings Date I SECTION I- SITE INFORMATION I 1.1 Property address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: --v S. F� Lot Ar s Frontage (ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reqwred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 34) Public 0 Private ❑ 1.3. Flood Zone Information: Zone outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System C SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Pri t) Address for Service : Signature Telephone 2.2 Owner of Record: Name Print Address for Service: SECTION 3 - CONSTRUCTION SERVICES "' 3.1 Licensed Construction Supervisor: Not Applicable (}� Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone .40 3.2 Registered Home Improvement Contractor Not Applicable �ompany Name Registration Number kddress Expiration Date denature Telephone glWrTTON d - WORKERS COMPENSATION (M.G.L C 152 6 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 Descrition of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other Specify A^ t . Brief Description of�Proposed /��Work: /\�/' �/'(��''J+ cif" AJ S _ LL / S I S- l %� {..J l� v� 7 Poo L eS "'M 4'rF t? z6c A-T--Zo M414 P SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant a_ wMOEITHEa 1. BuilQI. g / 00 L' W (a) Building Permit Fee Multi lier 2 Electrical �O (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 AUTHO ZATION 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 relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,-22(-L-J74k 6"t, ��C kL' !q as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print N of 4 -- Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD SPAN DD ENSIONS OF SILLS DIMENSIONS OF POSTS DiIvIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CITNINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover Building Department p 27 Charles Street North Andover, MA. 01845 sR�Nt4� , D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE ✓ / �� JOB LOCATION Number Street Address Map / lot W_37C-L-zA-o. M J-��k 97�' 0- Jqq � 7-053 —1 �3% "HOMEOWNER ,F%`'I 3 Name Home Phone Work Phone PRESENT MAILING ADDRESS 0*g City Town State The current exemption for "homedwners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one 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 a requirements and that he/she will comply with said procedures and requirements. 11"\ HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC Zip Code 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. folio mossonommorsuffies WE APPLICANT ►JELL (�� 1'Cr<"� PHONE �7� -���� -31� ASSESSORS MAP NUMBER /() LOT NUMBER SUBDIVISION NUMBER STREET STREET NUMBER ...................... ■ .... ■ ■ ........... ■ .............................-. OFFICIAL USE ONLY ........................................................................... RECOMMENDATIONS OF TOWN AGENTS L. DATE APPROVED CONSERVATION AD &STRATOR TOWN PLANNER COMMENTS FOOD INSPECTORt - HE ALTH SEPTIC INSPECTOR - HEALTH tk,0 a \ ` PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS RECEIVED BY BUILDING INSPECTOR DATE REJECTi'. _ 1-4 'vFn,3 1"11 Itr-�-�� Aar � Ef�s�'�n C.EaylffO�S I n�`ia (� DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED I REJECTED O tL' DATE APPROVED DATE REJECTED VI m m m m X m N mm CO) CD 5Z z CD O 06d O o p CD CL c� s CD O a: cm to CD CD CA co 0 CA d d O y C9. O y CD CD CD a, CO) CD CO) O St CCD 0 CD O a. y -C m CO) •m C m !'! CD o CL m 2 •� �-C H 1 0. /_-► = ,dr m 0 T =r CLEr m ? °� o y m �O m H p O .► o fog- a > > O-0 o b m �o��: 1 O yA CD :� CID =ry 7R C 0 Qm /r U/^i O =r7 : i cn m m N m 0 CD : : O m m 1 er. O d H l+ Z^ N d d v -CCD ems•+. N CD o O O h : (� o 0 N 'C O �a I D m � :• W co): 6 0 Er : r: m : O M 1 °� w aha Cri .d �. o�c b n b b x O M 1 } Z M CL E O U 03 W H J J M m D G7,P z I f, 0l r CLi f, 0l J z O w y O a a w 0 cccc O i Ir O Ci IL U, oz LU J wC, mw Oa �¢ a OZ Q J 5:.m w �a Crw �o z LU w N ¢w OD �z 0 a<J r> OO z >- CO3 w3i ¢ o t co(l) w(1), aQ F- F aw z(0 OLL ' wO U)w CID z¢ ao Jw aQ LO :Em ki LL L 0 z Q � o G� LL 0- W ClW cc a I, -0 O cc E c C x 3 3 m o f� m ca T L of V O c 0) 2 E2rZ -r=0 p W o o 00 ON "q-_ N U a0 0 fl Z m O0 > a m Q tn W�m 0 E'vcEN U } LL JJ �CD 2m«oo W �-- W L1 a. co cc aN (d a LL LL OW j mcoob O U J vOc 5 o � � Z� 0) y m C o a to C 0 W 4S m V x m c? m GO 00 x U t3 m:fl;0Bc UZ stn Z W c EO ; Y C 0 0 0- mN W i6m4 0 Q Q� W LL OR -P o � 2 (D N } W (i Z > ¢ ci 0 r oE = Q }- tmi c 0 coJ 00 W CC �.00 Dc>� m �g 0Z Cl 0 m U t 2C7tWi m 3 I, ■ CA m X m m N m m y d C d � O az y O �. � ? O C2. = CO) a(O O v CD CD O CL CCD O Cep C O rA dv y —• o ca CD v H O 'O Z CD o CD C CD f`? w R (n C b7 � =r m = o _ � .c d %&a: m y m !7 0 co) .nh X O� =mC .0-► � IL FO H T ? oa►?m 3 y m �00y O =r O : p O = O O O m O ro O O H O '.:� �y �. Ch CL a mcg; 4 m ate..: O ?�: O H C COL 1 CD d/ N ♦� N O = m N A m it; ;•l .-* C.) co: mol t C o m : gym:. D 32. H 1 Wim: A C-) c.) to O O O m w R (n C b7 ':7 "fid yC ',.rJ ;z ?7 n ox 's7 Va `=7 p CL R GJ 0 N :J CdC ro �i 0 M M V I z 0 c A Date ..... TOWN OF NORTH ANDOVER 0 #- PERMIT FOR WIRING SACMUS This certifies that . .. .................. has permission to perform .. ..... ....... ....... .............. wiring i e ilding of at'30 ......... .. . .. . Fee... .. ........... Lic. D Check # \1 1� 5291 North Andover, -�t/ass. ....................................................... ELECTRICAL INSPECTOR '\ HY09A :'I0AffE4LTI10FAUMCHUSMS Office Use DEPARTAffiW0FPUBLIC&4FM PerNo. BOARD OFFIREPRE�EMONRWTATIONS527CtifR Permit No. 12:1X1 ' Occupancy & Fees Checked APPUCA77ON FOR 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 4 To the Inspector of Wires The undersigned applies for a permit to perform the ele ctricall(work described below. Location (Street & Number) �QZ C)*10I1125ELL � Owner or Tenant U.��LJ76M R. 1—VR-KF 4 Owner's Address _ 22 C &POCC.L, fe 0 Is this permit in conjunction with a building permit: Yes ® No ® (Check Appropriate Box) Purpose of Building .-UVF GOZOUAW i%pL SWytz- g Utility Authorization No. s Existing Service Amps / Volts Overhead Underground a No. of Meters New Service Amps / Volts Overhead Underground [=3 No. of Meters -....� Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work A— k_L'0jk Pao Lr 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 eround 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 Ne of Ranges No- of Air Cond. Total Tons "13. AtiGti:.0:an. No. Gf Hct T, -.,al 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 Other �� Ne. of Dryers Heating Devices KW ` E Connections M No. of Water Heaters KW..,,- No. of No. of Signs Bailasis 14c. Hydro Massage Tubs No. of Motors Total HP OTHER' -, ItCo Ilrtsirartlatheragireanatts�Ga�aalLaws IhawaameritLmhlayhm==PobcymA&gCa Vkte Caerdg�erits aoualatt YES ED NO IhawsutxnAadvalidpmcfofsa=iotheOffm YES M NO [11--'--Kf culmedodcedYES,pkzear5c*ttxtWofwmmybyBakirgthe INSIAANCE BOND O OIIfER ftweSpeaE) EsCh Date Vairdmechital WC& $ I �7 WCt1clost3t fr h;pxtitnD;3eRaVesWd Roto LA) k-� � � 6 l I Feral I `` Licensee � lJ 0�-:, t� S3V11 7 - Signattue LirzwNb BzhssTdN16, 41)--(oro'7F�t� — Ai.TeLNa 693.-.7Z:_�—� OWNER'S iNSURANCY-WAIVE,tarrnothmmtheirnra=amm_wa ass. le#vaiettasm#adbyNfazadwseZCeneaILaws anddxtmysgrainrnihispetntittVptirtott dwrapuiernal .Please the k ')ONer Agent ' �,,(,,� . � jj, Telephone No. � `► PERMIT FEE $