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Miscellaneous - 35 BOOTH STREET 4/30/2018
Location 3 gam No. /4,(-( Date 7 U 3 TOWN OF NORTH ANDOVER 0 9 Certificate of Occupancy $ <Mus Eck' Building/Frame Permit Fee $ s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # a C-)- ) 9 16785 *i=1� 36 qp-- M/t( CA,, Building Inspector N LOT 298 20' WIDE UTILITY EASEMENT 90• LOT 299 j 200.00' 00, it�o 11 26.0' d z m rn 01 0 0 0 11 1-513 9 Nb 77.2±' n 24.0' EXISTING FOUNDATION .o° 91.6±' O°O c MAP 98C PARCEL 43 41 N ro 1 200 56' WALLACE STREET P,er\ W ( � a I, � q 1ssU0C> 9-g- aoo3 This plan PYR'the use of the Building Inspector of the Town of No. Andover, for the purpose of determination of zoning compliance. This plan is the result of an as—built construction surve performed on 10/02/03, based upon Land court Plan 32631 recorded in the Registry of Deeds. ID CA Im K M Z ts• 1 75r, I -10 1A AS -BUILT FOUNDATION LOCATION PLAN 35 BOOTH ST., NO. ANDOVER, MA PREPARED FOR R.L.I., CORP. SCALE 1"-40' — 10/06/03 NEW ENGLAND ENGINEERING SERVICES, INC. 60 BEECHWOOD DRIVE NORTH ANDOVER, MASSACHUSETTS °B Y. j�--� `Hey ED (978) 686-1768 joloodsul 6uipl!ng —.-.,q , TV VY $ ldiol $ aa, -A liwJad Jayi0 oQ $ aad liwJad uoilepunod $ aad liwJad awejdl6uipling .5-5� $ Aouedn000 to aleoipliao a3A0®Nd HIUON :10 NMOI o - a l -.jo 'I'll 9r99L a a L Z Z # )l I ON a UOIle30-1 j x Ma rn H114 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:/ DATE ISSUED: CO z I SIGNATURE: L / I Buil7n Commissioner/Ins pector of Buildings Date SECTION i- SITE INFORMATION 1.1 Property Address: 14� CT 1.2 Assessors Map and Parcel Number: 179 C � Map Number Parcel Number i� 3S 1.3 Zoning Information: Zoning District Proposed Me 1.4 Property Dimensions: Lot Ar s Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required- Provide Required Provided Reciuired Provided 3®4110 ao y 9 0 v573- 1.7 Water Sa�pply M.G.L.C.40. 54) Public Q/ Private 0 1.5. Flood Zone Information: ,Zone Outside Flood Zone 1.8 Sewerage Disposal System: Municipal) 57� On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record k LT C Name (Print) n Address for Service: Signature Telephone G 2.2 Owner of Record: Najle Print Address for Service: Si natilre Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature ®®d Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor s Not Applicable ljl/ Company_Name * Registration Number Address Expiration Date Signature Telephone Ma rn H114 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 & 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTION 5 Descri tion of Proposed Work(check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) \ ❑ Addition ❑ Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: r. d-� V' v c -f O- Ago�i S a /� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAt'USE"ONLY 1. Building(a) 73 cS-D Z) Building Permit Fee Multiplier >o K 2 Electrical (b) Estimated Total Cost of Construction 2 / , V 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 S Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf in 1.1 matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,, to the best of my knowledge and belief Print Name e Siature ofOwner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 T91906 2 3 SPAN DIWNSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NO FORM U - LOT RELEASE FORM'°' INSTRUCTIONS: This form is used to verif that all n y ecessary 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____�� , a PHONE 0,n 6 LOCATION: Assessor's Map Number_ 9 IF C PARCEL 4 SUBDIVISION LOT (S) STREET ST. NUMBER_ 3:5 USE .ONLY ***** R MMENDATION OF TOWN AGENTS: CONSERVATION ADM ISTRATOR DATE APPROVED DATE REJECTED COMMENTS flow Ch a r 0.ce-ni U-J1Q_ _ 11f1 " to �. -All Me4 �s �� IDa R s6EP O 4 X03 To NER DATE APPROVED p DATE REJECTED NORTH ANr;r x .,,-, COMMENTS ENT FOOD INSPECTOR -HEALTH 7Z- �9EPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED. DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEW FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9W jm 2 3 DATE r Town of North Andover Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. FOR ROOFING, SIDING, INTERIOR REHABILITATION PERMITS 1) BUILDING PERMIT APPLICATION R _ 3 2) DEBRI REMOVAL FORM as1� 3) WORKERS COMP AFFIDAVIT 4) PHOTO COPY OF H.I.C. AND/OR C.S.L. LICENSES 5) COPY OF CONTRACT 6) FLOOR PLAN OF PROPOSED INTERIOR WORK 3 e)1 Ul FOR ADDITIONS / DECKS 1) BUILDING PERMIT APPLICATION 2) FORM U 3) MORTGAGE PLOT PLAN (MINIMUM) " 4) DEBRI REMOVAL FORM 5) WORKERS COMP AFFIDAVIT 6) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 7) COPY OF CONTRACT 8) FLOOR/CROSSSECTION/ELEVATION PLAN OF PROPOSED WORK WITH SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT (if applicable) FOR NEW CONSTRUCTION (SINGLE AND TWO FAMILY) 1) BUILDING PERMIT APPLICATION 2) FORM U 3) GROWTH MANAGEMENT BYLAW 4) CERTIFIED PROPOSED PLOT PLAN 5) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 6) WORKERS COMP AFFIDAVIT 7) TWO SETS OF BUILDING PLANS (one to be returned) TO INCLUDE SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 8) COPY OF CONTRACT (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the board of appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with application. The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity EdI an an employer providing workers' compensation for my employees working on this job. Company name- Rii L Address 1 City. �� ca br Phone*. If � y"� 3 � � as Insurance Ce_ ( 1 elg-AI/4v U�t/,, � �I/e ��i�v�.1 . PoliclL# Company name: Address Crt Phone #r Failure to se=e coverage as required: under Section 25A or MGL 152 can lead to the Imposition of criminal penalties of a•fine ups to $1.1s and/or one years' impriscriment-as we[Las .penaltiesio3bolixmcta-SJQP fme"iMM)aidWAgainstme understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verfication. I do hereby certdy under the pains and pens/ties ofperjmy that the # for=bw provided above is brae and correct. Signature cel' Date __F / % OJ Print name R.0 b .e,-" L t` r Phone-# Official use only do not write in this area to be completed by city or town dftar City or Town _ EMif -ALM nsirw. Q Su tdlng lel [,Check if immediate response is required © Licenafn Bp [� selectman's Contact person: Phone # Health tlepal D Other e 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. 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 MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 8-20-2003 DATE OF PLANS: or 2 family, detached Other (Non -Electric Resistance) TITLE: LI l 8"ay-�_ Sr COMPLIANCE: PASSES Required UA = 385 Your Home = 370 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS 1040 38.0 0.0 31 WALLS: Wood Frame, 16" O.C. 1248 15.0 3.0 83 GLAZING: Windows or Doors 118 0.350 41 DOORS 42 0.330 14 FLOORS: Over Unconditioned Space 1200 19.0 57 BSMT: 8.0' ht/6.0' bg/3.0' insul. 1248 10.0 144 HVAC EFFICIENCY: Furnace, 85.0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer �$.�1��,,,_ t� Date 7-10 —&.3 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 8-20-2003 Bldg. Dept. Use CEILINGS: [ ] 1. R-38 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C., R-15 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U -value: 0.35 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1. U -value: 0.33 Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location BASEMENT WALLS: [ ] 1. 8.0' ht/6.0' bg/3.0' insul., R-10 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1. Furnace, 85.0 AFUE or higher Make and Model Number THERMOSTATS: [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ l Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: All ducts must be sealed with mastic and fibrous backing tape. Pressure -sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 1250 of the design load as specified in sections 780CMR 1310 and J4.4. 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TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...M A.: �j... �...� l ................. . has permission to perform ../." ............................... . J2 J- 7 - plumbing in the buildings of ................................. . -35 ��...y ............. . Nort Andover, Mass. at....... .. f Fee . `....... Lic. No.1.'3g�. .. J .....i ....t .,! ..' ......... . PLUMBIN 6 INSPECTOR Check # 30 b 4 5782 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building LocationE.464M/'Q�Owners Name Permit # Amount Type of Occupancy New Renovation Replacement FIXTURES Plans Submitted Yes 11 No 0 (Print or type) t Check one: Certificate Installing Company Name m E3Corp. Atic] re s Partner. a �?o 4usmess Te ep one 40 - —� S-� El Firm/Co. r Name of Licensed Plumber: Insurance Coverage: Indicate the -t of insurance coverage by checking the appropriate box: Liability insurance policy 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 Signature Owner Agent I hereby certify that all of the details and information I have mi (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and ins lations rforme nder Permit Iss for this 2Zcion will be in compliance with all pertinent provisions of the Massach se s lumb' ode Ch he • BY igna u o icense u er Type of Plumbing License y Title City/Town icense lNumDer Master Journeyman APPROVED (OFFICE USE ONLY •'a Will (Print or type) t Check one: Certificate Installing Company Name m E3Corp. Atic] re s Partner. a �?o 4usmess Te ep one 40 - —� S-� El Firm/Co. r Name of Licensed Plumber: Insurance Coverage: Indicate the -t of insurance coverage by checking the appropriate box: Liability insurance policy 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 Signature Owner Agent I hereby certify that all of the details and information I have mi (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and ins lations rforme nder Permit Iss for this 2Zcion will be in compliance with all pertinent provisions of the Massach se s lumb' ode Ch he • BY igna u o icense u er Type of Plumbing License y Title City/Town icense lNumDer Master Journeyman APPROVED (OFFICE USE ONLY Date .... ?.F�2.a.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..-...."� —.................... ............................................. has permission to perform ... .. .............. .. .................................................... :A� wiring in the building of ...... ................................................... . ....... 7 ............... ,North Andover, Mass. at . . . ......... . �A-.-.Iel ... .................. �LE-24r;R-1-6k-INSPEMR Fee.S5;!L.. ....... Lic. No .............. ....... Check # 474.5 THECOMMOAVVE4LTHOFI M94CHUSETTS Office Use only DEPARTNIENTOFPUBIICSVM Permit No.. 4-743 BOARDOFFIREPREVENTIONREGU,WONS527CMRI2 010 Occupancy &Fees Checked APPLICATTONFOR 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 To the Inspector of Wire; The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) z -/-1271 Owner or Tenant G N Owner's Address 75 7 Is this permit in conjunction with a building permit: Yes ED No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service Amps�Volts Overhead Underground M No. of Meters New Service 460 Amps/20 12-Vd Volts Overhead gElUnderground � No. of Meters Number of Feeders and Ampacity L/vl Location and Nature of Proposed Electrical Work `7-'E-/7'1 No. of Lighting Outlets I No. of Hot Tubs No. of Transformers Total — KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• Ihav whTiitbdvandproofcfsametodro ioe. YES !6111 0 6 'i " "A I , W ' M C • I• • I•' - WotktoStart hlspeoionDateRegtiested SigIle dunder Rnatesofpetjtuy FIRMNAME _ -%E 7 frivalent YES 0 NO If you have checked YES, plem indicate the type of eovtrjga by iy) EVhafion Date EMtir WdVahreofEb=ca1Wolk$ Rough Final �L !/�,� � C�G✓�. /t� Sigtattue � Lio wNo. /49111Z V7 `� p BusmessTelNo. Q/�� 6S� Syi�'' ArkTtece A1tTe1No. OWNER'S INSURANCEWANER Iamawarethatd&Lwwdoesnothavetheirmartoeoo oritsabstantial v�'age equivakittasregtutedbyMassadrusettsGei>oalLaws anduHmystgnattueonftpmi tapphcahonwatvEsthiswgtmifrlut (Please check one) Owner M Agent Signature o _ wner or Agent OG Telephone No. PERMIT FEE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit FN-ame Please Print _Name.l Location city Phone # '91 t7-/ I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any.capacity I am an employer providing workers' compensation for my employees working on this job. Company name- - - Address Ci Phone #: Insurance. Co. Policy # Company name: Address Citi Phone #: Insurance Co. Policv # Failure to secure coverage as required. under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonmentas -mll_as_civil.penattiesin-thelDrm-dA-STOP MRK-ORDFRAnd a.fine..of..($7DOM)ajday.againstme_ 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under Me pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina. Building Dept E]Check if immediate response is required .0 Licensing Board p Selectman`s OfcE Contact person: Phone #: E] Health Departmen F1 Other .47 RT Of CERTIFICATE OF TOWN OF USE & OCCUPANCY Building Permit Number 167 Date -2 - q— &> cf THIS CERTIFIES THAT THE BUILDING LOCATED ON ---3\ 7 r-= MAY BE OCCUPIED AS t /V -7ou r 0 ,;�Vov" -$,/ C) I - 0- f - Za- B AT�31 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Coe So,&4elo Rd �?tIIVINCA 411 A A C Building Inspector m m C a] C/) 0 m CO) 10 CD Z CD O CL r :v d CD o � a =■ R o v CL cr CO) O CO) n� 0 CO) CD 0 CD CD 9. C4) CD NA ti CD C CD C c ?� Q �.y O Q H d0 m y m c07m C-) C yc'c.a m CD Z =-o y O .do O ti T m CL m CDO m co, p y W O ?m m 2 O m � a a > .00 O O 0 ygo 'O :V W o Ca r CL \ � VI CD N , b � CD m ,oma n d CD 3' 7CA 0 y O. pkj CL \�� r .� I1 m y ��y��o CD �* � =W:a,co ON ZirCD • D o =CD C �c C/) o cul' . CL: 1 0C: .t 0 d n � cn cnCb O (may " :; n1 A�iG x - 7a C x t" G �? y (� :d G -op G IFFrr.�� C/)orf b O cp It to 1^�J�.{ � OTI�s H �` O (� \` N VV M M v 0=3 0 0 c Town of North Andover V%0WTj, , Building Departments `�g *O 27 Charles Street 0 North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 CCs[N [MdfvKM CHU APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS LOT NUMBER SUBDIVISION DATE REQ1JF,ST FILED _, `" 7 - 0 �/ DATE READY FOR INSPECTION - q- 041 TEN (10) 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 D.P.W. — WATER ME < _ DATE J.y� j> D_P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED TO GNATUREi-DPW AIRIZATION DATE. Date.... ................... 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... .... S . . . . e . . ... U . .... -e .................. -?(Q . ...... w. . . -e .. t'-" ............................ ... .. ....... -a) VA has permission to perform ...... P -.P CA-.� .................. +4 ........................................... wiring in the building of .... -De ........... ............................................................ at ....... .. J ......................... ..................................... . Noh AIndover, Mass. Fee....5...9.!........ Lic. No. ........................... . . ................ ELECTRICAL Check # *,I7 3 4840 THE COMMONWEALTH OFA ASSACHUSE7TS=Fee-s DEPARTMENT0FPUBLJCSAFM i BOARD OFFIREPREVEM0NREGULVY0NS527CM12VO APPLICATIONFOR PERMIT TO PERFORMELE=CAL 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 V Town of North Andover To the Inspector t The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 25 (mJ o o 7w � .( Owner or Tenant j ? ryo Roewrat Owner's Address - 175_ 0g7-0 AJ 2; Is this permit in conjunction with a building permit: Yes � No Purpose of Building J FrJ- r✓7 / c-�y (Check Appropriate Box) Utility Authorization No Existing Service Amps �Volts Overhead Underground No. of Meters New Service 200 Amps%�Q� ��}Volts Overhead Underground M No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets 3A No. of Hot Tubs �ofnsformersTt KiNo. of Lighting Fixtures Swimming.Pool Above Below n: GKi No. of Receptacle Outlets No. of Emergency Lighting Battery Units No. of Oil Burners ound i No_ of Zones, 0 No. of Detection and, I No. of Switch Outlets ® KW No. _of Sounding�Devices ' No. of Gas Burners No. of Self Contained No. of RangesNo. of Air Cond. Total KW Local Municipal EJ Connections ^ Oth4 Tons No. of Disposals No. of. Heat. Total Pumps Tons .No. of Dishwashers Space Area Heating No. of Dryers Heating Devices No. of Water Heaters / KW No: of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER h%rdr eCoveage P1v WtotheM4*errnifsofMassxnlsettsGeredLaws Ihareactme1I_dl7dyk sltancePbkykrhjdingC.ompide CoYWdWoritsstbtaritialmpmia>ty� NO Ihav aftl&dvAd ofsmrloth �°0f eOi� YES If}osrhavec�ledrYdYES,pl eii&atethetypeofOD by E . WSURANCE `,, BOND OAR Spera(y) VD�Z �� `�' �f Dale -- Estinl&d Valveof7 l Wc& $ WorktoStatt )' Rottgt, 11irA FIRMNANIE - of S -7-r7/ R, PG'iklz Licer>seNo. Siem LiarNo �'�j �y 7 BusirrssTelNo. / P-�S�>d �elrhxe � C/� �/� /i �d-/ � �i G!%�/�S � � // ��C � �� 6 < � AIL Tel No. Z4Y- S/ OWNER'SINSURANCEWARURlam awatethatthelicensedoesnothavethemarmCemmageoritssubstmtialequivalaltasmgmedbyMassactn sGer�Laws nd that my signahue on this permt application waives this w9mement. Please check one) Owner ® Agent ® �-�y� l Signature o caner or gen Telephone No. PERMIT FEE 1 �•------ No. of Emergency Lighting Battery Units FIRE ALARMS No_ of Zones, Total No. of Detection and, KW Initiating Devices KW No. _of Sounding�Devices ' No. of Self Contained Detection/Sounding Devices KW Local Municipal EJ Connections ^ Oth4 h%rdr eCoveage P1v WtotheM4*errnifsofMassxnlsettsGeredLaws Ihareactme1I_dl7dyk sltancePbkykrhjdingC.ompide CoYWdWoritsstbtaritialmpmia>ty� NO Ihav aftl&dvAd ofsmrloth �°0f eOi� YES If}osrhavec�ledrYdYES,pl eii&atethetypeofOD by E . WSURANCE `,, BOND OAR Spera(y) VD�Z �� `�' �f Dale -- Estinl&d Valveof7 l Wc& $ WorktoStatt )' Rottgt, 11irA FIRMNANIE - of S -7-r7/ R, PG'iklz Licer>seNo. Siem LiarNo �'�j �y 7 BusirrssTelNo. / P-�S�>d �elrhxe � C/� �/� /i �d-/ � �i G!%�/�S � � // ��C � �� 6 < � AIL Tel No. Z4Y- S/ OWNER'SINSURANCEWARURlam awatethatthelicensedoesnothavethemarmCemmageoritssubstmtialequivalaltasmgmedbyMassactn sGer�Laws nd that my signahue on this permt application waives this w9mement. Please check one) Owner ® Agent ® �-�y� l Signature o caner or gen Telephone No. PERMIT FEE 1 �•------ The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations Boston, Mass. 02119 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: � c. Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City'Phone #: . 'Y 1 Insurance Co. _ _ Policy # Company name: Address e Ci Phone # Insurance Co Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,50( and/or one years' imprisonment_as welt_as_civil.penattiesinsbeiorm-d-a_STOP.W. _ORK ORDFR and_a fine_of._($1D0_DQ)_astay .against.me understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. rQ ! do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name. Pbone.# official use only `� do not write in this area to be completed by city or town official' Git`j Q TJiAlt -- - - . Permit/licensing 1 D Building .Dept FIGheck d immediate response is regquked D Licensing Boal D Selectman's O Contact person: ._ `, _\ Phone k _0 Health Departs Other �C ,a IN Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGUIV TIONS APPLICATION FOR PERMIT All work to be performed in accordance with (PLEASE PRINT IN INK OR TYPE ALL INFORMA City or Town of: A/, By this application the undersigned gives notice 6f his o Location (Street & Number) op Owner or Tenant Owner's Address Official Use Only s Permit No. &(, Occupancy and Fee Checked [Rev. 11/991 leave blank PERFORM ELECTRICAL WORK Massachusetts Electrical Code (MEC), 527 CMR 12.00 N) Date: T5 �pcf To the Inspector of Wires: intention to perform the electrical work described below. Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No L (Check Appropriate Box) Purpose of Building / F�-M44 "IQ Utility Authorization No. O 33 -- .7� Existing Service 2-06 Amps &T ()Volts Overhead 21 Undgrd ❑ No. of Meters New Service 2GtD Amps 1'gW Volts Overhead ❑ Undgrd [�JN No. of Meters / Number of Feeders and Ampacity Q LAI Location and Nature of Proposed Electrical Work: 10 t1AA—)&E 0 Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans I-NiwofXof-Tubs No. of Transformers Total KVA No :of�ightin 0-utlets Generators KVA of Emergency Lighting ❑No. RaHnry Unite Date .7-..2.?• 6.....,/........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that -�-```'`"`� a........................................................................................ has permission to perform .. wiring in the building of ....! .' - I� .... '........................................... '` ..... , North Andover, Mass. Fee .��`..-. . Lic. No..............,`........................................... t/ ELECTRICALINSPECTOR IFIRE ALARMS INo. of Zones I o. Initiatin Devices No. of Alerting Devices .......... Detection/Alerting Devices unicipa Local El�.,,.,,,o„*,,,,, El Other No. of Devices or ,communications wiring: No. of Devices or Equivalent ' if desired, or as required by the Inspector of Wires. srformance of electrical work may issue unless ' coverage or its substantial equivalent. The me to the permit issuing office. Check # (Expiration Date) 5366 nicipal policy.) I MEC Rule 10, and upon completion: I certifyi under t/rand pertalties of perjury, that the information on this application is true and complete. FIRM NAME: 5T- F- /-rl-f ? O W LIC. NO.: / Z Licensee: - j-rf/&) �P�J (z/� Signature LIC. NO.: (/f applicable, enter " mi17t " in the licen, tuber line. Bus. Tel. No.: Address: L4 fU;FX-fE7`l Q n Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By myj signature below, I hereby waive this requirement. I am the (check one ❑ owner ❑ owner's agent. Owner/Agent � Signature Telephone No. PERMIT FEE: Location `'� � No. g'3 Date /1)�p7? u-3 l4ORTN TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ '� s• Eta' Building/Frame Permit Fee $ ,+cHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ C) �-- Check # 0 F x f 16839 Building Inspector 00 M M Z O v J� M Q3 z M 0 Mn r v M r r Z 0 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING . BUILDING PERMIT NUMBER: SSUED: % a —�� 7(:7 SIGNATURE: Building CommissioKe'r/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 31 ` f .VV A C17 C �3 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dii;ict Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R,eqttired Provide Reqtlired Provided R "red Provided 1.7 Water Supply M.G I -C.40. 54) 1.5. Flood Zone Information: Public l' Prh%w ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal fi- On Site Disposal System ❑ SECTION 2-PROPERTYOWNERSIIIP/AUTHORIZEDAGENT Historic District: Yes No 2.1 Owner of Record N7&' Namee (Print) Address for Service J� BKJ c �r�ilerr- 3 Signa re Telephone 2.2 Owner of ecord: Name Print L Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ . /e d Lie x4- rl � 5h n I's Licensed Construction Supervisor: ®' 3 q License Number Address^ Signature Telephone ' Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name ti Registration Number Address • Expiration Date Signature Telephone 00 M M Z O v J� M Q3 z M 0 Mn r v M r r Z 0 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 .......❑ No ....... ❑ SECTION 5 Description of Proosed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. 0 Demolition 0 Other 0 Specify \ Brief Description of Proposed Work: ` c t P,p-ck O r. I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be BJ , COVOI(?i�L:� Completed by permit a licant 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of f Construction 3 Plumbing Building Permit fee (a) X (b) (% 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 02 0 — Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behal�f in, �l1matter relative to work authorized by this building permit application. Si tune of Owner ate SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Name Si 6afore of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR M4BERS 1 2 ND 3Ew SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 tC- INSTRUCTIONS: This form is used to verify that -all necessary approvals/permits fry Boards and Departments having jurisdiction have been obtained. This does not retie the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT PHONE 9 E LOCATION: Assessor's Map Number__ PARCEL SUBDIVISION LOT (S) STREET 3 J ST. NUMBER ,7_3 ******* `OFFICIAL USE 'ATION TOWN AGENTS: . DATE APPROVED DATE REJECTED COMMENTS ►� TOWN PLANNER . QATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOWNEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm N . LOT 298 20' WIDE UTILITY EASEMENT 90• LOT 299 N 200.00' 00bo •. I 2F; n' d z '—� 01 0 m 0 M 0 klr' is o O O M EXISTING FOUNDATION - 4*/ 2.a 77.2±' OO 91.6±' ODO c o � to O m O I � � I� 00 rM rn MAP 98C PARCEL 43 �D +I V) Im N K: z 200.56' `10'4' WALLACE ----.`.._ STREET � � n C( r-4- S V)-4 S I is tai" the use of the Building Inspector own of No. Andover, for the purpose of ation of zoning compliance. i is the result of an as—built construction surve d on 10/02/03, based upon Land court Plan 32631 in the Registry of Deeds. AS -BUILT FOUNDATION LOCATION PLAN 35 BOOTH ST., NO. ANDOVER, MA PREPARED FOR R.L.1, CORP. SCALE 1"-40' — 10/06/03 NEW ENGLAND ENGINEERING SERVICES, INC. 60 BEECHWOOD DRIVE NORTH ANDOVER, MASSACHUSETTS RAWN ErY-� -� °"� ED ( 0) 686-1768 , .0a. �,�y �pi��o' r�V-• ♦ � E T e M� klr' is o O O M EXISTING FOUNDATION - 4*/ 2.a 77.2±' OO 91.6±' ODO c o � to O m O I � � I� 00 rM rn MAP 98C PARCEL 43 �D +I V) Im N K: z 200.56' `10'4' WALLACE ----.`.._ STREET � � n C( r-4- S V)-4 S I is tai" the use of the Building Inspector own of No. Andover, for the purpose of ation of zoning compliance. i is the result of an as—built construction surve d on 10/02/03, based upon Land court Plan 32631 in the Registry of Deeds. AS -BUILT FOUNDATION LOCATION PLAN 35 BOOTH ST., NO. ANDOVER, MA PREPARED FOR R.L.1, CORP. 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Z O LLI L) 1- 'm p� m C § CIO C. mO .0 OL N *O O _ C. r=... m :3b co 0 CD 0 z 0 0 y .y CL0 0 TIT O CD 0 cc .7 CO) 0 V CO) c 0 0 w CD CO) c 0 CLI) 3 � �o 0 ® 0 L- 0 0 d cm4 �-• cc O 0 Z Q Cl)CL c c _ _cc C40 raw ui0 (1) crW crW W U)