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Miscellaneous - 35 SANDRA LANE 4/30/2018
0 6 co w b 0 g 0 0 0 Date............ ©............. TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ..., This certifies that .. ;1 �G :.......... ..........: .............................. .has permission to perform ..... ah' e' ................................................. P .wiring in the building of ......................:.................................................... at .............�.'..................................... , North Andover, Mass. ora Fee . ........... Lic. No. ftl.F�. .14 ...... �. - � ...... . ................ ��LE@TRICAL INSPECTOR Check # 5278 r Z. LU W CL z �� itG� �p w� 50 CO CL z� z 1 Lu0 V. U Oy u�0 Commonwealth .of Ma Department of Fire BOARD OF FIRE PREVENTION APPLICATION FOR PEF All work to.be performed in accord (PL F:- E PRINT IN INK OR TYPE ALL IN, City or.Town of:�c-h_.�, By this application the undersigned gives nonce Location (Street & Number) official Use only Permit No. Sd 70 TIONS icy and Fee Checked v.. 11/991(leave blank IT TO PERFORM ELECTRICAL WORK with die Massachusetts Electrical Code (MM 527 CMR 12.00 ;MAT10119 Date: k.P G L4 To the Inspector of Wires: islor her intention to perform the electrical work desc nW below. No. !'% -)R -- ci-1S" - Owner's Address Ia this permit in conjunction with a building permit? Yes 2— No ❑ (Check Appropriate Boz). Purpose of Building I���� -� "EX.�,.�,,: �� o- Utility Authorization No. Ezisd g Service '1,8°p . Amps lei i / Y.1 -(t7 Volts Overhead []----Undgrd ❑ Na of Meters New. Service Amps / Volts Overhead ❑ Undgrtt ❑ No. of Meters Number of Feeders and Ampaccity Location and Nature of Proposed Electrical WQ4w Completion athr- `'Ill table be waived the 1 or of Wires. No. of Recessed Fixtures No.,bf CeiL -Susp. (Paddle) Fans No: of Hot Tabs of r ots Tnsformeta KVA n No. -of Luminarie Outlets (iienerators KVA 4 Emergency Upting Bette Units FIRE ALARMS No. of Zones ofof Detection -a ad laitia " ° Devices of Alegi Lkviges No. of Luminaries , Swimming Pool Above ❑ �] end. ptrnd. No, of Receptacle Outlets Nin of Oil Burners No. of -Switches Np. of Gas burners No. of Ranges No. of . Waste. Disposers18t N& of Air CondTons Totals• Number ons _ - " -- Space/Area Heating KW _ - ^ ^ liK K r ancex vi o. to, _ — signstte� orsolcontalls tectioa/Aferti De No. of Dishwashers Loesl ❑ Cnection d .Other No. ofrs Drye No. =or Equivalent No. of Water KW Heaters . Data Wuing: Na of or at No. Hydromassage Bathtubs No. of Motors Tot .dL FFP Telecommunications Na of Devices or tdivsknt OTHER: Attach additional detnff-yCALVe4. or as required by,.the Impector of Wires. 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 ,cov is in force, and has exhibited proof of same to the permit issuinggoffice " CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Na f A k y � �a (Expiration Date Estimated Value of Electrical Work (When required by municipal policy.) Work to. Start: \v O Inspections to be requested in accordance with NEC Rule 10, and upon completion. I ceidfy, under the pains andpenddo ofpedury, that tke infornw1on on this appbicadox is hue and cow FIRM NAME: LIC. NO.: \Ulm► $1 Licensee: , S L&SU A�(\ o Signature w LIC. NO.: (If cpplicablA enter "am t" 11n the license number line.) Bus. TeL No.; b Address: `--V� -v— 5111- . O \CI` A AlL`TeL No.. - OWNEWS INSURANCE WAIVER I an 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 (deck one) ❑ owner. rl owner's anent. Owner/Agent FERIKIT FEE: $ Signature Telephone Na Location�,- f v No. U i Date - t HQRTq TOWN OR NORTH ANDOVER # Certificate of Occupancy $ ;'SSACMus ` Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �f •5 �S r 17218 �� Building Inspector +1 L 0 pla TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING PAW OW BUILDING PERMIT NUMBER: 0(L13 DATE ISSUED: SIGNATURE: BuUn7g Commissioner . /Imeector of Buildin2 Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 00,53 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: -3))Property 6 / - 2-; Zoning District Proposed Use Lot Area (sf) Frontage (ft) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required I Provide Required I Provided Required Provided 32 1 62 6 .?-b I 'q*5-' 301 9D 1.7Supply M.G.L.C.40. § 54) UPP 1.5. Flood Zone Information: 1.8 Sewerage Disposal Sys Public Private 0 Zone Outside Flood Zone Municipal On Site Disposal System 0 -14 9 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT L—Historic District: Yes No Owner of Record Na nt) Address for Service SikaWAe— Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1jficensed Construction Supervisor: Not Applicable 0 Lice ,Zl Construction Supervisor: License Number Address U12�'-S--5- 335 �) Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 L 0 Company Name Registration Number Addre's YA Expiration Date Si nater Telephone L 0 pla SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 -4 2506) 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 rmit. .Signed affidavit Attached Yes ...... No ....... 0 SECTION 5 Description of Pro osed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar) to be Dollar ( Completed b permit applicant 4 3 }F ICIAiXSE ��ti�� ONLY { � u.. : 1. Building (a) ' Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction Sl O mo 3 Plumbin Building Permit fee tel x(b) S~®� 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) V C/ V Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN -OWNERS OR CONTRACTOR APPLIES FOR BUILDING PERMIT >AGENT I, �C .� �.) ! M �✓ ��� as Owner/Authorized Agent of subject property I Hereby authorize to act on Nyy-bgl►al , in all matters a ive tow k author y this building permit application. �) 7L §rgrtaf�tur`er Date SECTION 7b OWNER/AUTHORIZED AGENT (DECLARATION I, r_ 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 P%a � Si a er ent 'Date k ...x ,. NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR THvIBERS I 2 3 SPAN i DIIvMNSIONS OF SILLS DHAENSIONS OF POSTS L DH ENSIONS OF GIRDERS — HEIGHT OF FOUNDATION '~r u THICKNESS '1 SIZE OF FOOTING L - X t MATERIAL OF CFDNMY N IS BUILDING ON SOLID OR FILLED LAND 71�t IS BUILDING CONNECTED TO NATURAL GAS LINE I 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. @.aa.a0aa.a.■a.r..r..■■..aaa■a..■aa..as■.aa■aar.raaa.aa■...ar.a.rsaSam raa.uaswas APPLICANTPHONE 6 fG v -- ASSESSORS MAP NUMBERU LOT NUMBER OJ) 5 SUBDIVISION LOT NUMBER STREET ��--c��- -0 STREET NUMBER ` 3 I...,...:.................saaa........aaa■ma■eaa-a..raa.aa.a.a.:a.aaaa.raa.-...:-- OMCUL USE ONLY �■arrr.aa a.raaassaa.ass.aaagar.:.asaas.aRara■a.au-aaaa.■■a:...•s-.arsara�,r.-■a...r.a■ RECOMMENDATIONS OF TOWN AGENTS a.sa.■.■.a■.■.aaa•aaasaa.�.■.a�.a■r..as�aa.■�.aaa.sem■araaaaras.a0 a was a.rra.aa.■ CONSERVATION ADMINISTRATOR DATE APPROVED COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR - HEALTH SEPTIC INSPECTOR - HEALTH COMMENTS PUBLIC WORDS — SEWER / WATER CONNECTIONS COMMENTS RECEIVED BY BUILDING INSPECTOR DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED 4 DATE APPROVED DATE REJECTED 1170 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print City t�� ..J`� 1 ,�-:-, Phone # L b � 0 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. O Address City- Phone #: -3 Inca r�nnc r`n -\ n SOA V" bCC > Pnlinv # AA. U L'ie 7/ Company name: Address City Phone #: Insurance Co. Policy # 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 wetl_as_civil,penattiesinlhefnrmofa_ST_OP WORK_ ORDER..and.a fine_of .$1D.0.00)_a-day against -me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ceJ6,,V,der the pgMan4 penalties of pery�..th. at -the information provided above is true and correct. Print name �lp.�\�Ll 4Y, Phone.# l YJ�33 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing 0 Building Dept ❑Check if immediate response is required p Licensing Board p Selectman's Office Contact person: Phone #.• F-� Health Department 0 Other 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 /d"ebris will be disposed of in: Location of Facility) Signature mit pplicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector MORTGAGE INSPECTION PLAN %6f ` AT 35 SANDRA LANE NORTH ANDOVER, MA. NO. ESSEX REGISTRY OF DEEDSIt It.' BK. 3690 PG. 328 CERTIFIED TO.'PLAN N0. 4705 8 5948 AWRENCE SAVINGS BANK SCALE.' / = 60, DATE: FEBRUARY /9, /998 47g3A.. Ski �q4 qS' ! DWCw 03 e: w LOT 12 36,750 SFI Z NOTES.' /) THIS /S NOT A PROPER Y SURVEY, DO NOT USE THIS PLAN TO ESTABLISH PROPERTY LINES OR TO ERECT ANY STRLCTGRc 2)PROPERTY LINES ARE DETERMINED FROM COMP. -LED /NFORMAT/ON TO BE USED FOR MORTGAGE PURPOSES OA L Y, CERT/F/CAT/ONS.' BASED ON MY KNOWLEDGE, INFORMATION AND BEL, -F, / HEREBY CERTIFY THAT THE PERMANENT STRUCTURES WD/CATED ARE LOCATED ON THE GR UND APPROX/MATEL. Y AS SWWN AND ARE CONFORMING TO THE -ZONING SETBACK REOUIREVEA S OF THE APPL /CARL E MUN/C/PAL/T Y WHEN CONSTRUCTED OR MAY BE EXEMPT cER MASSACHUSETTS GENERAL LAW CHAPTER, 40A, SECTION 7, AND THAT : HE STRUCTURE SHOWN /SNOT LOCATED /N A FL 000 HAZARD ZONE PERfEDER.CL EA�l�CYMANq�c��c�y�. COMMON/Ty NO. 250098 EFFECTIVE DATE' 06- 02-93ZANE,X JOHN ABAG/S B ASSOCIATES, PROFESSIONAL LAND SURVEYORS /37 CHANDLER ROAD, ANDOVER, MA. 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If t { C If ' Date . "oR,,, TOWN OF NORTH ANDOVER 3a .� 0 iWWAh WA p PERMIT FOR PLUMBING ,SSACHUS� This certifies that ......... has permission to perform ....� .. ................. plumbing in the uildings of ................................ at .2,5-- .. ....... , North Andover, Mass. Fee" // t .... Lic. No: ° .... Y7 . �/ .. ........... COMBt I PECTOR Check # / � � (//,� 6027 4 MASSACHUSETTS UNIFORM A' LICATION FOR PERMIT TO DO PLUMSIN (Type or print) NORTH ANDOVER, MASSACHUSETTS j Date S L Building Location .S S/�h ��//� yl Owners Name Ltd. S 1 Permit # U a Re 5 Amount is c,//._5 e RfC Tvpe of Occunancv New Renovation Replacement Plans Submitted Yes No El FIXTURES (Print or type) Installing Company Name . � Addre ed rt4116 4- �^ Business Telephone Name of Licensed Plumber: Insurance Coverage: Indicate the type Liability insurance policy — ance coverage by check Other type of indemnity Check one: Certificate Corp. Partner. Firm/Co. to box: 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 ® 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 Mas hurts t PI Cod and Chapter 142 of the General Laws. By:7;lgnamre oi Licenseal-jumBer Type of Plumbjng License Title l/ 3 Z—f City/Town lcense 114UMDer Master El Journeyman APPROVED (OFFICE USE ONLY.