HomeMy WebLinkAboutMiscellaneous - 34 COLUMBIA ROAD 4/30/2018N
;� qq
Date.... .... ...z ....
NORTH
ti O
TOWN 6F RTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation
in the buildings/of .::. ! .......................
North Andover, Mass.
Fee�� . Lic. ...... .
GAS INO-ECT6
Check
69.1
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date 3(�
NORTH ANDOVER, MASSACHUSETTS
Building Locations
1054,
Owner's Name
New ❑ Renovation ❑ Replacement
Permit # Y3 /
Amount $ "4
e�
Plans Submitted
(Print or
Lti
Address
Business Telephone -TT=77
Name of Licensed Plumber or Gas Fitter / / /Mx5lZ
v.
Check one: Certificate Installing Company
Corp.
Partner.
® Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 13NoIf you have checked yes, please in icate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ent 13
I hereby certify that all of the details and info tion I have submitte entered) in abov app ' tion are true and accurate to the
best of my knowledge and that all plumbing rk and installations perfo e d I or this application will be in
compliance with all pertinent provisions of the Massac use Chapt 4 o the General Laws.
(Title
City/Town
(OFFICE USE ONLY)
Signature of icensedKumber Or Gas Fitter
Plumber /J�30 /
Gas FitteriL cense Nurnber
,ErMaster
0 Journeyman
`...,.•....rrfEc wed OJ N1a55aCf111S�C
k�
i'�f. De�arirnerrt of frufus2ri Accidents
;, ! Vice of Ir�esizQafion,� • .
60 r=hhTMfi Street
Boston
, MA 02111
Workers' Cam ensatioa _ wrv�v_ sgnt�/dig ;
P f�tsurnaee �� Randers/can .
�niieaat Iaf�►r�ation _ tradars/Eiectriciammiamberrs
01....__ ., .
Name $w_in=ODrpai on/Individual)' -
Address:
`4� am eMPICOW? Ci eek.the s ro
i,� PP P��'boz: ,
ham e I
emP oYe with _ 4• (] I am a general contractor Type °f Pte+}act (regni*:
2.Q =nPloYMS (fun and/orpart-time).* have himd the sub- end . 6.. [�
T em.aeole . cardiactars New construction .
pmprietor or partner- Iisitd on. file attached diems 3 7.
S* and have no employees Thome Q Remodeling .
;c)
g far me .in stt}i-contractors have
�' Q Demoliti
o work=z' comp. insurance• 8• °n
risers' co ias�usnee 5. M iUe arc Z. catporaiion and its 9• Q But7dirig addition
d j eel s have crcerccised tiz* I Q.Q ,Eieetricai3 • ❑ homeowner doing all work ri repairs or additions
myseI£ [No•wCai=I i� of exemption per MOL I IQ pium
�p c i 2, § I (4� and we have na n►g TaPaim or additions
insurance •rz t Q Roof
d-� .. • pICpYe. L [No workem' I2. rc*m
`Amy apptimafiar cher. h,.'I#i m+,s� gip• �t�act required j I3.Q.p&=.
also fit! outtEecsection below Rhuwiag &eirwarkatt' bo ansetioapoi* infonnetion
t KOmG°�€ who sebmit this - ; e�davit indicting th
Coahacfors tltat tFrecic fills b °y a� � � x'OP1t'end � hce octtaide aonusctors '
rnusratteeb� an acid iiaarJ sheeraiiowing. the name of tip cub cv � submit a naw afndnvit rndiceti sicatt
uifa� mapioyer aut is prnsdarrtb:park a ` :: mon.
7
�'
�•'.S@
Below�rQUA40i
Instaancc Company Name:
Poficy # or Salf-ins Lie. #:
Sob Site / n, Expiation Dale:
Address:. (6� i . ./ V
Attach a copy of the wortters' co CrtylStat~/� p.
_ mPe�ation Poiie� declaration page (showing the policy number and e
Far'Iur o to sere coverage as required under Section 2 -SA of xPiration date} .
fine up to s1,5DQUO and/or one-year im SOL C. 1 SZ MM lead to the iznpositian of urinal
of up ° as wail :es civ11 P=d im in the form of a SMP WORK p of a
�3' against the vioiainr. fle
Vesligations of the for roar ce c� v fa• coPY of this statement may be forwarded to tiM O {fi= f a fine
al tifrat the "IformrWoa pn,yAded a ac,r h,
-Si na fte and aont'rt
Phone
ase only. do not write in fhrr area, to he comptermd zy or town
OffjMW
City or Town:
Issuing AuMority (cir•cie one): PermWLicease #
1. Board of Heattb Z Eumi Cr
6.Other �par'Ement 3. City1T`"'R aerk 4. Electrical Inspector 5. Plumbic., Iaspeciar.
Contact Person:
Phone #:
intormation a na instructions,
Massachusetts General Laws chapter I S2 requires all Millp I dyers to PMVidt workers' wmpermition for their, employees.
Pursuant to this stattft, P em*Yar is defined as "..:avert' person in the Szzrvicie of another under any contract of
express or implied, oral or writtrL"
Am inAyer is defined as "an corporation or othar legal entity, or arty two ormon
Gftht'fMzPing Migaged in Rjoint Mftprise, and fi10Jud!iTkg,the legal representatives of a. declamd. employer, brihe
r=iver ortmste.-of an individual, partnership, associa6c>m or other legal -amity, cinpipying cinployee& 'Howem the
owner * -of a dwelling ham having not more that three zpmxtrn=ft and who resides then* or the occupant of the
dwelling house of anod= who employs parsons to do ma-imtenance, oonstroc6on orrepar wciric M such dwellirchouse
or on the grounds or building appurtcnam thereto shall na-t b=a= of such cz-aployment be d=ned to be an cmploy=.*
MGL chapter I 5Z §25C(6) aim states fiW "every state a a.- local scensing Agency shallwithhold the ismaom or
renewal of a licanse or permit to operate a baseness or to construct balWhip in the commonwealth far any
applicant who has iot produced acceptable evidence.0-e compliance with theinsurance coverage required."
AdditionEk, WGL chapter TSZ §25CM stzdw -Neither giltcommonwealthnor any of itspolificgl subdivisions Shall
enter iota BAY contract for the pm fannin ce of public WP4,- tastt7 accapfaiile evidence of contpiience with the into
requirammits of this chapter have been prescitmd tD.th: m3tritr=firig authority."
:Applicants
Pleast, fill out 16 workcrs',campensation. Lffidavit completely, by &=king the balms thid apply to. your situatim and, if
n=wxy, supply kib-contractnr(&) name(s), RddrM5Kms):amd phone number(s) along with their canifica*s) of . .
insumn= Linitted'Liability Companies (LLC) or Limited Liability. Pertnatships (LLP) with no-amploycocs othertlum the
members -or parh=s, are not required,to =ry work=, e%no-Tnp=mdiDD h,Lu,, = Ifan LLC or UP does have
=Ploy=, a policy is required. Be advised that this afficLavit may be submitted to the Department of Induswial
Accidents far coufu,n cmofinsuranctcoverage. Mal sate to sip and -daft the afre&vt The Rffidavftshould
be retuned to the OhY. Or team that the EPPROStiOn fO * rfim peva or Timm is being requested, notli.m Department of
Industrial Accidents Should you have any quem
stirePa-ding. the law or if you are required to obtain a work=,
OompenSELtion policy, please -call the Department Atthe-ntaxiberlisted 6low. Self-insured oompmies-should D=t . heir
scif mstauncic'Hexxim a=bw on 6M*zpropHft H=
City or Town Officials
Please be sure ft the affidavit is campleft and printed 6-gibly. The Dapiatneit has pivvided a space at the bottom
of the affidavit for you to fill out in, the vvzW the Office of Investigations has W 0011= YOU regarding 1ht appli=i
Please be mm to fill in the p:rmit/lic:n= n=bcr which w,1-11 be used as a. reference number. In addition, an aRkud
that must submit Multiple jM=nhffi== applications in 8rt3, given only submit ane -affidavit indicating-cuzIT-Nven y=, need
policy'infbrmatim (if necessary) and under "Job Site Addr-=- the appiic= should weft "all iocafions i.
—(city or
town). A wpy ofibe affidavit that has be= officially stamped or marked by the city 'or town may be provided to the
applicant as proof thata valid affidm.is an file for fu ' bm permits or licenses. A new affidavit must be Ord out each
year. When R homy owner or citizen is obtaining a lic-M= or permit not mhifmd to any business or comin=zial vmh=
(i.e. a dog li6anse or permit to burn ImMS etc.) said Pml6n is NOT.requimd to-winplett this dm-drviL
The, Office of Investi Would &Z to thank you in ad -.,w= Should ii have any questions,
Witions fOr.YOUT CDOPtrIttiOn an. you
please do not• heshatt to give us a =11.
Tim Dzpsrtm=it's address, telephone and fax nwnb--r.
The Commoner lth of assm . u—sa—ft
DcParftim f Of lmdustrW Ac.6d=U
Officeofrmveiifigstfions
600 Wa&inggton Stj=t
Boston, MA 02111
TeL W 617-727-4900 ei= 406 or 1-977-MASSAFE
Rz- . vised:5-2&-05 Fax 4 61 7-727-774�
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Location 34 C` ovum Qt A
No. 524- Date �
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 33Z
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
M
N
Water Connection Fee $
TOTAL
L -A-17 -000---
Q$ Iz
B'linglnspector
! �'
9279 Div. Public Works
_% y
J
PERMIT NO. ZA4-
0
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
� PAGE 1
OAP i4O.
LOT NO.
I
2 RECORD OF OWNERSHIP (DATE
BOOK 'PAGE
ZONE
SUB DIV. LOT NO.
�I
I
LOCATION �V mn �^ �Q
PURPOSE OF BUILDIN
OWNER'S NAME j /p olj
NO. OF STORIES SIZE °- X 3 b
OWNER'S ADDRESS 34 C�lIw, . c�d
BASEMENT OR SLA p�ltR`
ARCHITECT'S NAME < 1 �����
SIZE OF FLOOR TIMBERS IST22N��3RD
BUILDER'S NAME `% c
SPANI I
I -- —
DISTANCE TO NEAREST BUILDING -A
DIMENSIONS OF SILLS
DISTANCE FROM STREET rc AJ�lM t (,A
POSTS -a,W t C 1 _ C t_. t.�,�,-j
DISTANCE FROM LOT LINES - SIDJAES ` REAR `
" GIRDERS
l�
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS I+
IS BUILDING NEW Ny
SIZE OF FOOTING !] t X l
IS BUILDING ADDITION ll� �,.
MATERIAL OF CHIMNEY A )Gcd,,,v,-
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND L v0
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Yes
IS BUILDING CONNECTED TO TOWN WATER (L --o s
BOARD OF APPEALS ACTION. IF ANY QS �-
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE (J
:M Q INSTRUCTIONS
ti
CLc-
SEE BOTH SIDES 6 1
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DAT"D D \
SIGNATURE OF OWNER OR AUTHORIZED AGENT
'F E E 3'J z
PERMIT GRANTED
O Zv 19 CLS -
OCT 101 1955
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST <;-/1 ! SU
EST. BLDG. COST PER SQ. IrT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
INO INSP[CTOII
OWNER TEL. #
CONTR. TEL. # '� 9 -5-335-
CO NTR.
5-33SCONTR. LIC. # 05 3di f M
�
H.I.C. # ( n TJ l Lt
v�
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY STORIES
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND.DISTANCE FROM ,
MULTI. FAMILY OFFICES LOT, LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA -
APARTMENTS \1�
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
S—a—,f— xc7a cLa-04
� G
C( C (S l e, v--)
1
A
CONSTRUCTION
2 FOUNDATION
_I
8 INTERIOR FINISH
CONCRETE
PINE
d
1 2 I3
CONCRETE BL K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULI
FIN. B'M'TAREA
FIN. ATTIC AREA
_
_
NO B`W T
HEAD ROOM
FIRE PLACES
MODERN KITCHEN
_
4 WALLS I 9 FLOORS
CLAPBOARDS
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
CONCRETE
EARTH
B
1
2 3
HARD%4'D
COMMCN
ASPH. TILE
VERT. SIDING
_
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. & FLOOR I_
CONC. OR CINDER K.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIORPOOR H—
ADEQUATE I NONE
5 ROOF
10 PLUMBING
GABLE-tip
BATH (3 FIX.)
GAMBREL
MANSARD
TOILET RM. (2 FIX.)
FLAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING!
_
TAR 8 GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
FLOOR
PILE
ILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
1st '� 13rd I
ELECTRIC
NO HEATING
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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 local or state law,
regulations or requirements.
****************Applicant fills ou this snnection*****************
APPLICANT: 2.� ��J i"( phone
LOCATION: Assessor's Map Number Parcel
Subdivision // 11 Lot(s)
Street3 �( L.�OI `�,�,e� w�� St. Number T
************************Official Use Only************************
RECOMMENDA ONO AGENTS:
"'otJ , Date ApprovedAl 10—
Conserva ion ��A��dminis��trator Date
/((Rejected
Comments - A4 wl9e s S'4a'V4 d, i°it 4AJ A&4 rr zKJ
Town Planner
Comments
Food Inspector -Health
Septic Inspector -Health
Comments
Public Works - sewer/water connections
- driveway permit
1.1 ire Department
Received by Building Inspector
OCT 10190;
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date
y appeal shall be filed
within (20) days after the
date of filing of this
Notice in the Office
of the Town Clerk.
This is to certify that twenty (20) Jays
have elapsed from data of decision MM
without MV
/y /99�
Joyce A. Bradshaw
Town perk
10SS
TOWN OF NORTH ANDOVER
MASSACHUSETTS
BOARD QF APPEALS
NOTICE OF DECISION
W 4..%t 15 PG 2
RECEIVED
JOYCE BRACSHAW
TOWN CLERK
NORTH ANDOVER
JUL 25 '95
A 2131;
AT a Copy
Town Clark
Date 7-24-95
Petition No. 031-95
Date of Hearing June 13
July 120, 1995
Petition of Kenneth & Janet Strobel
Premises �ffecte.34 Columbia Road
Referring to the above petiticn for a variation from the require-e-ts
of Section 7, para. 7.3 and Table 2 of the Zoning Bylaw so as to permit
relief of 8.96 feet from the left side setback requirement of 15 feet,
relief of 8.24 feet from the right side setback requirement of 15 fee
and relief of 25.3 feet from the rear setback requirement of 30 feet.'
The applicants are also seeking a special permit under Section 9, (
para. 9.2 of the Zoning Bylaw so as to permit an addition onto a lega:
non -conforming structure. —
cr.
After a public hearing given on the above date, the Board of Ap:ea.s
voted to GRANT_ the Special Permit &yar;are and hereby 0
y• o T--==ectcr to issue a permit to: r
au norize the Bu4la�=1� is z
Kenneth & Janet Strobel
based upon the fo]-.
for the construction of the above work, �
conditions: The applicant will construct a 6 foot high wood stockade
fence, prior to construction, from the South easterly corner of thefk
property to a point opposite the southerly face of the existing m
building as shown on the plan dated 5/12.95 as prepared by Scott Gile �&
0
The Board finds that the applicant has satisfied the provisions of
Section 9,para. 9.1 of the Zoning Bylaw and that such change, extensio
or alteration or alteraton shall Board of Appeals,
not be substantially more detri- � A
mental than the existing non- John Pallone
conforming structure to the Joseph Faris
neighborhood. Robert Ford
Ellen McIntyre
r
y
;: > -j s> a:.a REC E . IE D
JOYCE BRADSHAW
TOWN CLERK
NORTH ANDOVER
Town of North Andoer1 Ot MORT4 ,
OFFICE OF Jail L� 25 �� 3� ...°
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
KENNETH R. MAHONY North Andover, Massachusetts 01845 'SSACNusYt
Director 1(508) 688-9533
Kenneth & Janet Strobel Decision
34 Columbia Road Petition # 031-95
North Andover, MA 01845 '
The Board of Appeals held a regular meeting on June 13 and continued until July 11,
1995 upon the appeal of Kenneth & Janet Strobel requesting a variation of Section 7,
para. 7.3 and Table 2 of the Zoning Bylaw so as to permit relief of 8.96 feet from the left
side setback requirement of 15 feet, relief of 8.24 feet(garage) from the right side
setback requirement of 15 feet, and relief of 25.3 feet for the rear setback requirement
of 30 feet. The applicants are also seeking a special permit under Section 9,
paragraph 9.2 of the Zoning Bylaw.so as to permit an addition onto a legal non-
conforming structure located at 34 Columbia Road.
The following members were present and voting: John Pallone, Robert Ford, Joseph
Faris, and Ellen McIntyre.
The public hearing was advertised in the North Andover Citizen on May 24 & 31, 1995
and all abutters were notified by regular mail.
Motion by Robert Ford to Grant the Special Permit and Variances conditioned upon
the applicant constructing a 6 foot high wood stockade fence, prior to construction,
from the South easterly corner of his property to a point opposite the southerly face of
the existing building as shown on the plan dated 5/12/95 as prepared by R.P.LS.
Scott Giles, Motion seconded by John Pallone. Vote: unanimous. Voting in favor:
John Pallone, Robert Ford, Joseph Faris and Ellen McIntyre.
The Board finds that the petitioner has satisfied the provisions of Section 10, para.
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.
The Board finds that the applicant has satisfied the provisions of Section 9, para. 9.1 of
the Zoning Bylaw and that such change, extension or alteration shall not be
substantially more detrimental than the existing non -conforming use to the
neighborhood.
BOARD OF APPEALS 688-9541 BUILDING 688-9543 CONSERVATION 6M9530 HEALTH 688-9540 PLANNING 68&9535
Julia Parriao D. Robert Nicetta Michael Howard Sandra Starr KaUom Bradlay Colwell
8K 4315 PG. 219
s Board of Appeals,
John Pallone
Joseph Faris
Dated: July 24, 1995 Robert Ford
Ellen McIntyre
ri
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OWNED BY..,
",
KENNETH FJANET
STROBEL
SCALE.'I"=20' DA TE.5 M 195
0
SCOTT L. GILES R. R L. S.
0. ANDOVER, MA.
NORTH ANDOVER
ZNZ BOA167101 OF APPEALS
CN
'�SES9fS. to 52
.8.05
"IDA TE ONO
F F/U'
DATE OF HEARING'
0/ATE OF APPROVAL:
. . . . . . . . ...
X
Z -ZONING DISTRICT' is
N
THE PROPERTY LINES' SHOWN. ARE
THE 'LINES DIVIDINGEXISM0 OWNER-
TH UNE$�.`Ajrl
SH PS AND, E, r. MD,
WA)t."sNowv,i,A0t,,I TH M?;P90,
STREEMI0R,�' AY0.`,`ALREADY
PR/ VArt'
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16 A Dtkk'.% , TMIC Di AM
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5-12- 95
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EXIS77NG
F,
OWNED BY..,
",
KENNETH FJANET
STROBEL
SCALE.'I"=20' DA TE.5 M 195
0
SCOTT L. GILES R. R L. S.
0. ANDOVER, MA.
NORTH ANDOVER
ZNZ BOA167101 OF APPEALS
CN
'�SES9fS. to 52
.8.05
"IDA TE ONO
F F/U'
DATE OF HEARING'
0/ATE OF APPROVAL:
. . . . . . . . ...
X
Z -ZONING DISTRICT' is
N
THE PROPERTY LINES' SHOWN. ARE
THE 'LINES DIVIDINGEXISM0 OWNER-
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SH PS AND, E, r. MD,
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16 A Dtkk'.% , TMIC Di AM
31F r
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5-12- 95
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Lq�ato
No. �% d`"' Date
s 4�
T.
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
ermit- Fee
Othe rmit Fee
OCT 1BUonnection Fee
W,t/�rAwtion Fee
N0. Mdo ��rr TbTAL
$
$ /\�'0 v
A, -Z,
Building Inspector
Div. Public Works
PEltli li NCA �/ L )--- APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. AGE 1
MAP 4-40.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK ;PAGE
ZONE
SUB DIV. LOT NO.
LOCATION �G
PURPOSE OF BUILDING
7
OWNER'S NAMENO.
/'%11t
OF STORIES SIZE
_
OWNER'S ADDRESS
/
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND
3RD
BUILDER'S NAME '
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
- "" POSTS
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING +� J
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FI
SIGNATURE OF OWNER OP -AUTHORIZED AGENT
FEE ZS - y C)
PERMIT GRANTED l ��
19 --�
t ' 6
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
BUILDING INSPECTOR
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY
I STORIES
MULTI. FAMILY
OFFICES
APARTMENTS
__
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
CONCRETE
PINE
B
1
2 13
CONCRETE BL K.
BRICK OR STONE
HARDW D
PIERS
PIASTER
_ DRY WALL
UNFIN.
3 BASEMENT
AREA FULL
FIN. B'M'TAREA
_
'/. 1/2 '/
FIN. ATTIC AREA
_
NO BMT
HEAD ROOM
FIRE PLACES
MODERN KITCHEN
_
4 WALLS I 9 FLOORS
CLAPBOARDS
B
_
1
2
3
_
_
_
DROP SIDING
WOOD SHINGLES
CONCRETE
EARTH
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_
HARDIIJ'D
COMMON
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK N MASONRY
BRICK ON FRAME
ATTIC STRS. 8 FLOOR I_
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I -I POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
I HIP
BATH Q FIX.)
TOILET RM. (2 FIX.)
WATER CLOSET
_
_
GAMBRELMANSARD
I
FLAT
SHED
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LAVATORY
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SLATE
NO PLUMBING
_
TAR 8 GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
TILE DADO
6 FRAMING
I 11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
GAS
7 NO. OF ROOMS
OIL
B'M'T 2nd _
Isr 13rd
ELECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGB 1
MAP NO.
LOT NO.
12 RECORD OF -OWNERSHIP iDATE
BOOK PAGE
ZONEI
SUB DIV. LOT NO.
LOCATION *31y i�,O n �pot
C1�Q-
AP
PURPOSE OF BUILDING /e7 o
G'�
OWNER'S NAME Q`"-t/t
/l
o t4 ST --e 6,z / !
NO. OF STORIES SIZE
OWNER'S ADDRESS !,3 n
?♦ n� I
f C 1'C
BASEMENT OR SLAB %a. _,_ _ '�•
�1S✓T
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS
/l/l�b/'o 2ND
�
3RD
BUILDER'S NAME •'%�Q��
SPAN
DISTANCE TO NEAREST BUILDING �t-�TQ_ a
DIMENSIONS OF SILLS .9/4 /, y /
(q
--_
DISTANCE FROM STREET No
,POSTS
DISTANCE FROM LOT LINES - SIDES ff� f "'I� REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION 9 THICKNESS /ASi
IS BUILDING NEW
SIZE OF FOOTING ' X
r &�J
IS BUILDING ADDITION ✓l Z
`
MATERIAL OF CHIMNEY ,fl y 1
V
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
J i'%
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 04
l�'/+
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY
IS BUILDING CONNECTED TO TOWN SEWER If
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
1_ / ---
DATE FILED
SIGNATURE dF/OWNER OR AUTHORIZEb AGENT
F E E 020, &0
PERMIT GRANTED
1� 19
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER BY FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
BUILDING INSPECTOR
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