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HomeMy WebLinkAboutMiscellaneous - 35 HUCKLEBERRY LANE 4/30/2018N 11% Date ..... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... !�� ......... . ........ ......... has permission to perform wiring in the building of ....... ................................................ at ............. .................................. .. A—e-� .. North Andover, Mass. Fee.'.x.6 . .. . ....... Lic. ........ ELECTRICAL INSPECTOR Check # 834.0 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 1? -3 LO Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) � S- NU(, (6-tca L911:( - Owner or Tenant ^�� n fp Telephone No. Owner's Address SG v't e Is this permit in conjunction with a building permit? Yes a3� No ❑ (Check Appropriate Bog) Purpose of Building RtS; at K4 1 , Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ . Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Rand a nd f- I%A'a70 j ,�J t/,0;,( Eb rJ1 Cmmnb-tion nithv Mllnwino tnhlo mm ho ,. -d 1— #I.., 5.......,..t.,-,"TfI.'..,... No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators K -VA No. of Luminaires Swimming Pool Above ❑In- rnd. gyrnd. N . ot Emergency Lighting atteEy Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS TNo. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number„ .Tons KW........ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area b IC1�' S ace/Area Heating Municipal Local El ❑ Other No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Imo' Heaters No. of No. of Signs Ballasts D Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 3 (500 (When required by municipal policy.) Work to Start: &0\4 Tr Inspections to be requested in accordance with MEC Rule 10, and upon completion. 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 including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE MOO'BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:/- CT. Pazralear,.o Gj ) LIC. NO.: aolal Licensee: UtoP rc, Pfh(Z Signature LIC. NO.: (If applicable, enter "exempt " in the license number line) Bus. Tel. No.: 9 �fi `�19- 9hb7 Address: Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. F P FEE: $ Signature Az"e-doo, Ao- Z Xa* I—wc_ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): G' PiV& 6— kc lrf c, Address: ( S Or T A"( k A Q City/State/Zip:L_fAy,,,j A4A- O(�U�f Phone #: q9 f— �— %$ � Are you an employer? Check the appropriate Brox: l �. �am a employer with 3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors '.. F_1 I am a sole proprietor or partner- Iisted on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition —10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.K -Other Doo J -Tiny appucant mat cnecxs box 41 must also till out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. �) 1 Insurance Company Name: %7 Gr J Urc.� Policy # or Self -ins. Lic. #:- V c- 6 Expiration Date: alul I C) Job Site Address: 35 IIvc k6 en y:, bin City/State/Zip:AJ,7JM/- Zd�1— Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that.a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. n_ n 0 Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: This certifies that Date.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING M F Q .......................................................................................... CU has permission to perform........ W ....... ...... Uv .... .................................. wiring in the building of ... ................................... at j,-.0tJ..t....72. > ...... U..u/ .North Andover, Mass. Fee..1.576 ...... L i c. No. l.4............................................................. ELECTRICAL INSPECTOR C— H d or, 3 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 4 �:�lje C�9MInnllWeattlj of tt��ttcijunl:ttn r `-,1.F - 0epartttteut of Public eufetU BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only 5 Permit No. Occupancy A Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date « -1;717 City or Town of _ NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Caf /!z # Ss Owner or Tenant Owner's Address Is this permit in conjunction with et building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building 2_ &A Utility Authorization No. Existing Service Amps _/ Volts Overhead ❑ Undgrnd f❑ No. of Meters New Service Z�• Amps L'V / ZVV Volts Overhead ❑ Undgrnd ,tel No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- ❑ ❑ grnd. grnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices LocalMunicipal El Other ❑ No. of Dryers Heating Devices KW Connection No. of No. of Lew Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Compl ted Operations Coverage or its substantial equivalent. YES j.+A NO ❑ 1 have submitted valid proof of same to the Office. YES g NO D If you have checked YES, please indicate the type of coverage by checking the appjopriate box. INSURANCE fL BOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ Work to Start 42 ",/? -2 Inspection Date Requested: Signed under the /Penalties of perjury: FIRM NAME G 9X&,J **111" Rough 4A// l/ mac. & Final LIC. NO. Licensee «/`i S SAL IIA-9etQ&ltd_ Signature "C4AW-f-0 •„� SIC. NO. - Bus. Tel. No. ___ 0Diff-0 CS`1!6 Address 9 .�N 4=- -AiA oe , 't;2�4_ Alt. Tel. No. OWNER'S INSURANCE WAIVE I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) c ZI J Telephone No. PERMIT FEE $ (Signature of Owner or Agent) x•6565 Date .................................. ;7' N-oJed' • 5 5 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that f :.." '- has permission to perforin ' _'— vtnnngto the building of::......................................:.......................................... Fee`'��........ Lic. No ��....... rT ........ , North Andover, Mass. ................. LE .......... NS ... TO ................. { ELECTRICAL INSPECTOR 03/0?�/� 10:07 35.00 RAID WHITE: Applicant CANA ullding Dept. PINK: Treasurer The Commonwealth of Massachusetts =No,- 1 Cnl. �.Departmentof f'ubtic Safety BOARD OF FIRE PREVENTION REGULATIONS 52Z CMR 12:00 M -m?S- ---0) APPLICATION FOR PER841T TO PERFORM ELECTRICAL P.rt wgrk to M Pertnnned in accordance w;tn in' v*1"Cnu,erta elf ctnem Coos. 527 CMA 12:w WORK (PLEASE. F!IINT IN INK OR TYPE ALL INFORMATION The undersigned applies for a perm Location (Street $ Numhart . -?, Owner or Tenant to perform the electrical work described below. .To the Inspector Of Wires: Cwner's Address t� U �T ��- sl -y- ------- �� Is this permit in conjunction with a building permit - � g /I1f 3 Q��` Purpose of Suildin (Ch";k Appropriate Box) Authorizatior• N°, Existing Service __.-_-}lmps�__-_-Volts Overhead !] New Service _____•,--____- Undgrd ❑ No. of Meters.__ Overhead ❑ Undgrd ❑ Number of Feeders and Ampaclty--_ No. of Meters_..._— Location and Nat --,e of Proposed Electrical Work--&Cuftr' ' ------ ---- fLi. of 11 htinq Outlets ------_ No- of Hct Tubs of Lighting Fixtures --�� Above In INC. of Transformers TOTAL 11VA ((���� (('�� Swimmin Puot ornd. l -J arnd LJ "'--) ---- fJ�. of Receptacle Outlets Generators _ No. of C11_Bur_n_ers KV No. of Emergency Lighting No. of Switch Outlets --------- - Battery Units _ No. of Gas Burners-----• "'-------- --__ No. of Ran es TOTAL No. of Air Conditioners FIRE ALARMS No. of Zcnes No. of Detection and No, of Disposals HEAT --'---' TONS TOTAL TOTAL Initialing Devices __ No. of Purnps_ TONS Kyy - fro. o Hashers - No. of Sounding Devices - No. of Self Contained Space/Area Heating_ KW __.. - Detection/Sounding Devices No. of Dryers -"-'----~ Heatin Devices KV/ -I—Na.-of !! �---N-07f—viceLocal fJo. of Water hicaters Municipal - ❑ Connection ❑Other _ f(W ]Signs Ballasts Low Voltage NO. of Hydra Massa;t• Tubs -------- No. Wirin of M°tors Total HP OTHER: ` -- .L� J- INSURANCE COVERAGE Pursuant to the requiremen a current ts at ft;ass.tchusens General Laws I id ity Insurance Policy proof of same to ng includiCompleted Operations Coverage or its substantial valid this office. YES a Co C1 NO C1if you have chocked YES, please indicate the type of coverage equivalent. YES ❑ NO [DI haave submitted by Checking the appropriate box. INSURANCE 0 BOND ❑ OTHER ❑ (Please Spe.,ify) —_- Estimated Value of Electrical Work S (Expiration Date) Work to Start_ Signed under the penaltles ofpry a 'u Inspection Dato t?'quested: Rough_ < A n' ° Final r-171-4"� NAME .0A ���fiC� ��� a.�r.a�.��' Lit i,.,e9 LTC. NO. � hGH. O Signature's�� Address O• �n�._ uC. r1o. lel Na.�P.= z- 4'��. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have g f�assachusens General Laws, and that m i nature on this a Alt. Tnl. No. the insurance cever'a a or its substantial equivalent as required by y ' g pplicatlon waives this requirement. Owner Agent (Please check one.) of (Signature Ow— n., m 7-1 Date.../..: /% 5; �......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thaw .. " has permission to performr�� wiring in the buildin of--.. ....•.......................................................................... at ....... . f` ...... ....! ... �-: ...........! � ..'",North Andover, Mass. Fee- f�...... Lic. N0 .// g.. ............................................................... .......................................... 04/ f --k -/ � n ELECTRICAL INSPECTOR Q 09/16/97 13:04 p9.00 PAID CANARY: Building Dep . PINK: Treasurer WHITE: Applicant 01le (&0MJHV11Wralfl1 of ttootttlluoetto lkpartutt:ttt of I-iublic iufrtU BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use O " Permit No. e� Occupancy & Fee Check6d_-2a7q_� 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date % `& 7 City or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit rto perform the electrical work described below. )7 Location (Street & Number) C�,' / . y� ./O 2 41 In Z42 4Z o Owner or Tenant Owner's Address.�-0_n 'C�-+�✓ �� Q 7'� 4J rz t L Ect,4 i Is this permit in conjunction with a:��llbuilding permit: Yes SNo El(Check Appropriate Box) Purpose of Building /�`'� c�(wp w, Utility Authorization No. 1,7— _31 Existing Service Amps _/ Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service -20.0 Amps 2-96 Volts Overhead ❑ Undgrnd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- 1:1grnd. ❑ grnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices LocalMunicipal ED Other ❑ No. of Dryers Heating Devices KW Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Co plated Operations Coverage or its substantial equivalent. YES NO ❑ 1 have submitted valid proof of same to the Office. YES NO ❑ If you have checked YES, please indicate the type 9coverage by pp checking the apriate box. INSURANCE BOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ � Work to Start g -�� �% Inspection Date Requested: Rough �nf /t�G.GI Final Signed under the Penalties of perjury: FIRM NP Licensee Address re Bus. Tel. No. Alt. Tel. No. LIC. NO. / /7 L 7 LIC. NO. ak-e�,-Sf -K'8 Ild OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Qt/ Telephone No. PERMIT FEE '— (Signature of Owner or Agent) x-6565 Location No. — Date Aa �j1lo, /,q/- /¢ 7 7 a TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ �- 125Z Sewer Connection Fee $_� 75'Z Water Connection Fee $ /o$2.aro TOTAL I uiidi Inspe r 12/16/97 15:37 1,000.04 Div./ bpi Works V1 N Q OL W O .o z x oc O z _J CO O H <H { K W CL oc z O a _u J d CL Q 0 z F `n Rf W a W A 2 � I J' j a i � w I 66 0 or W W 0 ' I IL O I Q 1 CL z I Z a z W W n 1 z 6 W r x Z r z I r 1 J � . fa W W Q Q r F 0 r Q < N J ; H W Z i I W O J 0 0 Z L IQ► Q 0 } J W Jr W O r O _P Z J g Q o J J J a g Z v F 2 � „ W Z u m IrD � ; k i 0 z IL 0 0 O J Z = 0 Q W V W W O W 2 YI i i T W � C It z 0 Q i z W W n 1 6 W ,RhV Z r z 0 r W J 0r fa W W Q Q r F 0 r Q < N J ; H W Z i I W O J 0 0 Z < < IQ► 0 J 2 Z W W W O _P O O z z Z O J J J „ W m m 0 Yrl IrD z W � A 0 m� IL w z) km 0 0 � o} 2 Z -z w «a f §th) $ �z� mho 'Qj � \j IL . \ \� \ ` :J* � ■, � a I■w . zo■ � e�- tvi •<f� xk. £!�#O {: �»In e§tlliwi 22k @«. wz. X52. 2 22< w -ja .::N 3 0 )\2 . .z-�.�)&® _ 0 2 0-�.gz 2 ;- § K=�� ©\�§ )2§iI 7�o3�q;\ �\ 2 © �2k=, S!/S< < a) -!P!!; UH u z TT \ 2 2 7. °°-' § .4 2,2 °* `zo §};;_- z �� - 7 �a �� < < �I- ) �° , 89k§;-zz tG z :z )4.2 §3;a;%0 3003 } 3"0$=.,� v§z7 -7�= "\0 ■ OZ»2R-■»9w 2820 °7«!■R |,| . ■<-zm Go&q2;=; 2�� K/ �} S .k(} / \ }; &} -�°§k)�\�§(9 | _ 2 k ) \\_ \ 77 2 — \\k r §; W\ �..�` .. . \/\% ■ O z N W W LLJ am c c O H w `•mc O w a a ts a A E Cq u C C Av O CO o i� �2 °o N a Q o o o vto U c w Ra m w F W o°G c w o w u. 00 cn o cn LLJ am 0 z 0 U w 0 cm i O LA co O •E m m CD ca � CD Q Lam' fv G O O a• tZ CL v�aC C O � C fa C.2 CL. 02 C Z co CD CL C3 CO) O C f: C cc y is c c `•mc ts V V C C O CO CD c f CD o C 4 �oL Wim= E M ig Q O m � � N N y cn m y.. N C � � C y 2 y c o N a�co 1 m c O a N aCt O O 'Cm = cc vi o �Z c .: ev c�a C v' c ~ m N C •O ~ y0„ m VD C ev = m w •N re A OC I.— -C •� Ct 3 V •� CS O m y C m� C2._ _ A m ` N % C C* -m:10 0 z 0 U w 0 cm i O LA co O •E m m CD ca � CD Q Lam' fv G O O a• tZ CL v�aC C O � C fa C.2 CL. 02 C Z co CD CL C3 CO) O C f: C cc y is �0� 2�2 Z- 0 7' �4 /S -o r. F r r r i y � „ wf0 • N 7.93 t tion �� R°zsza.00' c R97.�3 2,37' �OAI� j7iQp�OSCp Ap,.n' 4dewT/44'/ 4N10 f'`o r /o4.AAy ��O • rQNOrI reaE?r ///rO SS , oOlay.' ell // 77 t ■ GL 0OP410 !' .srr r �asoorrre% .hu,�vc,�-�se-rrs c�g�o FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law regulations or requirements. , ****************Applicant fills out this section***************** APPLICANT: Gi2 �O,c n.csflr9°Jb� De C Phone_�-3�77ZI LOCATION: Assessor's Map Number Parcel Subdivision YJ Lots) Street St. Number_ ************************Official Use Only************************ RECOTDA NS 0 AGENTS: Date' A roved �Z3 onservation Administrator pp ff11 Date Rejected Comments U�i1 �YVJ, Date Approved A2�-•- Town Planner Date Rejected Comments Date Approved Food Inspec o Health Date Rejected Date Approved Septic Ins ector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit c( �f`—�e� 7 Z3 g .e�Qarcrt A-,gA,1 ,W,,WfC1 s' -W !il77r7Xie s a;'/ Fire Department &i,:UL S'I�•!�/ii,E�,(s'.r�rri,�4i�,,o,�iA �c,/�L,L�n�'�,L, �/�,•� PD • Received by Building Inspector Date . .. Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Propefor Permit (below) Map and Parcel: Purpose o Ap ation (check below) Phone Number of Applicant:_4,,-Single Family — Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any parry to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is, issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in exlstencqAs of the effective date of this by-law, provided that no additional residential unit is created. ByThe lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning law. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c -are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or not, is grounds or r sal by the Building Department to issue a Building Permit. ignature olowner or Authorize thAg who signed the ched Building Permit Datt This form must be attached to e B ilding Permit toop application for such permit. CERTIFICATE OF USE &OCCUPANCY Town of North Andover s Building Permit Number, THIS CERTIFIES THAT THE BUILDING LOCATED ON 35 huckleberry In Date JUM 11,1998 MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. �gORTq CERTIFICATE ISSUED TO PhvwOOd Dev •� � �• °c 200 Park St ADDRESS N0' ,,�14CNU ilding pector _C2, CIO d C � COD Cl) CD 'O O C.1 Z CA CLO n� � � c CZ CA O O CD 0.� O cr M CD CCD O CCD ww 23. C CD y CD CL O CO) CC CD � O CA10 O CD oCD CD0 V J O V Jcn 9 0 cn I. ��3w r Aw H go 0 omh C/) rx O 90 010=r 1 0 0 Z O -44OQ aO m N -0y C) to es CA m Z =r -S H _I O O =m m = O O C m O O Z S. 3 O C Er 5'a N C MA m c O O CO) CD o 1 nC CDL C_ C O1 N N d d C o UPa O 'V H W CO) :O ?m7 N `� a N � so O m :Yi CA m 2� 0 0 �o =r mo b 39 C.) o ip ^^ = f3A N M MM a,S Co �m r Aw H go 0 omh C/) rx O '17 gj HT1 o' y g C) CA GO). M.. ►v C> O O r - R Lco • STEPHEN �(o rye/ LOT 14 AREA=26,150 S.F. =0.6003 AC. N35°52'22"W 81.50' EBERR� N�CK� L_9'7 63, R,ZS� 00, 0 51OR� 2 rn W�3o. �F GK Lu }} N I00 o 00 � 3.9' z 0 cn o� LA 00 00 cp co 0 POOL UNDER CONSTRUCTION ti Dsl�- SHED PLAN OF LAND IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR JAMES A. & THERESA G. DIETZ 35 HUCKELBERRY LANE NORTH ANDOVER, MA SCALE: 1"=40' DATE: OCTOBER 22, 2008 i_m,m m5 m a m m 1012210 66 MERRIMACK ARK ENGINEERING SERVICES R. L. S. DA TE ANDOVER, MASSACHUSETTS 01810