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HomeMy WebLinkAboutMiscellaneous - 356 RALEIGH TAVERN LANE 4/30/2018 (2)Date .... .v...... .....e. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....../. e .e ./7. "f.... .................1. �, �r v�........... ..... 0 has permission to perform Z% !?�! ............ fi. G........:��.:°... wiring in the building of ..........� '� < 1=�..t:...................... at ... 3AX...... North Andover,, Mass. Fee... z.. ..... Lic. No. ��.3.�. F..'� .!/✓le, LECTRICAL INSPECT10i Check N X 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. 143, § 3L. Permits shall -be limited as to the time of ongoing constructii acffivity, and may be.deemed-by theJnspector_of Wires abandoned -and -invalid -if he---. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. . The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending"through August 15, 2012. le — Permit/Date Closed: Z / ***Note: Reapply for new per 0 Permit Extension Act — Permit/Date Closed: ® MAPFRE Commerce INSURANCE - March 28, 2015 The Commerce Insurance Company'"" Citation Insurance Companyw 11 Gore Road, Webster, Massachusetts 01570 508.949.15001 www.commerceinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL NORTH ANDOVER MA 01845 Board of Health or Board of Selectmen Town/City Hall RE: Our Insured: THOMAS DI STEFANO / DONNA DISTEFANO Property Address: 356 RALEIGH TAVERN LANE Policy#: BBYCDJ Date of Loss: 02/15/2015 File#: JYHJ47-HPVXK3 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. LISA LEAHY Telephone: (508)949-1500 Ext: 15846 Sr Claim Representative, Property Toll Free: 1-800-221-1605, Ext: 15846 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. March 28, 2015 CIC 254 (Rev. 4/95) MAIL 788 _C_\ Official o�ccl�a�acaffa Ofcial Use Only 71 irvUaParfineni o`,.tiris �orvicmr Permit No. r7 0 OccWancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be poformed in accordance with the Massachusetts Elec uical Code (MEC), 527 CMR 12.00 (PLEASEPRINTININK OR TPPEALL INFORMATION] Date:- P City or Town of: Q P f g n doh el • To the Inspector of Wires. By this application the undersigned gives notice of his or her indention to perform the electrical work described below. Location (Street & Number) 356 )ea ) s h 1 g o e f n. L g h e Owner or Tenant Owner's Address M no Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Boa) Purpose of Bmldiug 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: GIS T—t� i" h 4 Ce -�- f f/C , 3 T o i , f�ecep td,_Z_, � err 6on4 U M,e' olt ' o-aZ C -r e h 4 _ Co leffon the . table nm be waived by the Inspeaor of Wires. No. of Recessed Luminaires No. of Ce&Snsp. (Paddle) Fans 140.01 otal Transformers JCVA No. of Luminaire Outlets No. of Hot Tubs Generators ICA No. of Luminaires Abo swimming Pool ernd e ❑ & ❑ 1. Bao Unitsmerg��' g No. of Receptacle Outlets No. of Of Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burn ` InitiatinD�— °- ° eteg an evices No. of Ranges No. of Air Cond. 1 q °ons o. of Alerting Devices Disposers No. of Waste users eat P TotalsI um er ons o. o on talued DetectionfAlertingDevices No. of Dishwashers SpacelArea Heating KW Local❑ Municipal Connection 0 Other No. of Dryers Heating Appliances gyy' SftUNa of evices or Eguivalent No. of Water KW Heaters o. o Si o. ° Ballasts Data Wiring. Na of Devices or Emulvalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications uwgg Nommnevice Na of Devices or E ivalent OTHER: Auau" glum" cros"u l) "U&Sr % Ur ( rt fq Y Glf Vr (IIG JIF)f/GWa/. J .. x w. Estimated Value of EleWork:(Whce required by municipal Policy) Work to Start: o) M P 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 suchcoverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) `2 k titch lis u rgr�t e I aeWfy, under the pains and penalties ofperjury, that the info on this appfleadon is true and comFlete- FIRM NAME: ��1 �? E'3 e® Y LIC. NO.V_3,Pt9 7 Licensee: Signature LIC. NO.: (!f applicable enter erupt -in the license mmrber Tim.)), / Bus. TeL No.: R 7 S -8.S C Address: I p e k4-41 %14- /t'I.erni cl e h �Atl y L/' Alt Tel. Not 7 5-Z *Per M.G.I,_ c.147, s. 57-61, secu ty work requires Department of Public Safety "S" License: Lie. No. owNEWS 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 requiremeaL I am the (check one) ❑ owner ❑ owner's a nt_ Owner/Agent Telephone No. PERMIT FEE. $ Signature P H°M o� .RTo;•1tio ° F. .o ,SSACMUS� This certifies thatId . has permission to perform ... T. ...................... plumbing in the buildings of .I .S�'.!C q". o .................. at .. � ...............�. North Andover, Mass. Fee Lic. No.. YA ....... ...... PUUMBING INSPECTOR Date. TOWN OF NORTH ANDO R _PERMIT FOR PLUMBING r.4.. ..�`. i....... Check # 2, 3 i i � • a C MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING CitylTown: /y®✓ D'"/V�%Jail11� MA. Date: Permit# o O� Building Location: �`� ��� 9d,/�2�Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement:x, Plans Submitted: Yes ❑ No� FIXTHRFS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing worK ana instauations perrormea unaer the permit issueo Tor [ms appncauon wm oe in compnance wan au Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. A ./ By CitylTown APPROVI Type of License: I (f/( v PI ffi ber Signat re of Lice ed Plumber aster ❑Journeyman License Numb r:/ 09 �y Z Z Y O U > w Z N Z F Q to J L) cit- ` to P W f W O W U) ZQ Cn Y Z W n. Z Q 0 Q N Z O m 1 M W fn >., W o Z W ga Z cW N , l a x LL Q J Y= M Q 3 g Q O p t— 3 x z a O - 3 a W Y Q= Z 0 CL W W W t�i U Q F- = Q Cn n. W H v>> N j Q O F- g g O O= O O Z QQ z to Q Q H. Q m ca o o IL O s Y W fn fn ►— � 3 0 SUB BSMT. BASEMENT 15T FLOOR 2 NoFLOOR 3 FLOOR 4 FLOOR 6TH FLOOR `6 FLOOR IJTF FLOOR 8 FLOOR Check One Only Certificate # Installing Comp ny Name:xe-r—rl�� ACorporation Address: �� ll # CitylTown: P State: ❑ Partnership p c(} r� 9�� -��� Business Tel: /%� � 0 /' C�� � Fax: �� ❑Firm/Company Name of Licensed Plumber: 1 nha1—d Teo INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing worK ana instauations perrormea unaer the permit issueo Tor [ms appncauon wm oe in compnance wan au Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. A ./ By CitylTown APPROVI Type of License: I (f/( v PI ffi ber Signat re of Lice ed Plumber aster ❑Journeyman License Numb r:/ 09 �y J I' N 0 s z w i Z U. V' x U O x c. J z m w O Ow z ¢ z O ❑ x o i � p � N F � z rii u � z O GJsIv o, F v� Li1 Z_ i z J I' N 0 Date. . . ......... Of NORTH TOWN OF NORTH ANDOVER PERMIT FOR-GASINSTALLATION A This certifies that .....................4 ...... has permission for gas installation F �' ............... in the buildings of ......................... at ... ... A!� I ;North Andover, Mass. Fee.3!. Lic. No. /4 :z GAS INSPECTOR Check# )-3 ?/ 6753 A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FI T T ING Building Locatic mer Date: vhlaj�9 Permit# 3J(p HiQ/Pj�G��J //9lPal;/_�_ Owners Name: /✓ri® Type of Occupancy: Renovation` Replacement: x FIXTURES Institutional Residential X Plans Submitted: Yes (9 i. Check One Only Certiticate v stalling Company Name: �I YI !YIQC c%c�Ile » Q loi'C Corporation Cq q q7C Address: f� 12 Jr; j 'City/Town: e vP� State: MA Partnership Business Tel:. %_� Daoiy Fax:78-��07-37d Firm/Company. . Name of Licensed Plumber/Gas Fitter:' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes'x No If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy x Other type of indemnity ,. Bond f OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and instanations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By Plumber Gas Fitter Title Master Journeyman *%P ROVED (OFFICE USE ONLY) I LP Installer W, ' • • • ' • • • • • • • • • • • i. Check One Only Certiticate v stalling Company Name: �I YI !YIQC c%c�Ile » Q loi'C Corporation Cq q q7C Address: f� 12 Jr; j 'City/Town: e vP� State: MA Partnership Business Tel:. %_� Daoiy Fax:78-��07-37d Firm/Company. . Name of Licensed Plumber/Gas Fitter:' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes'x No If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy x Other type of indemnity ,. Bond f OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and instanations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Signature of Lic 7 used Plumber/Gas Fitter License Numbe /097,,S.. Type of License: By Plumber Gas Fitter Title Master Journeyman *%P ROVED (OFFICE USE ONLY) I LP Installer Signature of Lic 7 used Plumber/Gas Fitter License Numbe /097,,S.. 1 77 c� `.I �1 Date.:'?.".�.r,— 7 . TOWN OF NORTH ANDOVER .a - PERMIT FOR PLUMBING M i ; ,n Dom.. SACMUSE� This certifies that ... has permission to perform ......... plumbing in the buildings of . . ..`... .......... at. .:;7" ........ �G ... ,. North Andover, Mass. Fee .?f�? :. Lic. No.... �/U .. .... �%............. . �; _. (/ PLUMBING INSPECTOR Check # 12e'ei 7395 I1_ { �,i1tx Cut t, FL ik 1 Is •( f, t � r,i E ., .. 5._' I � t c._ f t rS. . ) f lil F F •fie ✓ (� L7 J(r' �/ �/ �� �f✓ j'4' f. ` �. F 1.. L � ..._ •� ` .... .:� >.:�y_i=ova... '^ �%// ��V`� Z �'"e�`vs- - �..,, 7 .6: EeE'ls Ste% a Itr_, ! . z SUR --FSS FAT, 8A SE1AENT z, E Mi 2-6 rte- x � ��o-t-� ea �t� , .w d �- C P x m oa[SiF Pyf ¢ �f 0 �' FLOOR 2NDFLOOR 3RD FLOOR J 4TH FLOOR P g STH FLOOR P GTH FLOOR [ P 1 F@Y"E.n., H FLcloR r p r E InstallingCLIMATE DESIGN HEATING and Company Name 5 South Summer Street AIR CONDITIONING, LLC a f Address Bradford,. MA 01835 .Check one: (-ertificate 978-372-9999 hone yCorporation1. Ci +' 978-372-0882 (fax) .u --- —Pa rtner shipBusiness Telephone Pm • Name of Licensed Plumber IRSL.:RANCE COVERAGE; I have 3 current liability ins t nce P0Gc+,� Or Fts substantia! e0utValerit Which meets ttte Yes k?`1" Nc ❑ reculr_m-nts of WGL Ch. 142, It ycoU have checkeed fes. please Indicate the fype coverage by checkl-w the appropriate box. A liability Insurance policy f� other a�E�� p� tyle of Indemnity p - (3or�d ❑ P t.�°trtrr'dER`S INSURANCE J d IbER: l atr, a °are utat the licensee does not have L:�Sj�lpp-nn—aaltureeo--(, ter ; 42 of tFae 1,t6ss. Genei�l i.avds, ar�d that rat �I r�ture on this tt ftt_ insurance coverage uir' ed by MY �' permit s application tvatve PRl s this retlulrerncrz4. Check one: Clwner or- t},vner's kgent Owilef ❑ Agent [] i n}erwF,y �wra,i jr fh t!l of tE3a details and in4a„ststior� I tti� strbrrtittad tvr anteredi in abaoe i noa�lmdge mnd th�f all pturrabing work arra installation s` Loartn�nt pro4�siorts of pyrlo ff r application err; true and '=irate. to Pile bast of my Massachusett, Sate PM41U. �i , 6 rtttit i�uad for this appli-auon vrill b i1 Compliance with all 9. 42 of t, Ga 2 an`c' neref La4as. E Title - ...� atu of urnher Tj” ot'_l:icertsa: t4fasiarr . ' Journeymrrie Date .. 3� TOWN OF NORTH ANDOVER ° 9 PERMIT FOR GAS INSTALLATION it of ° n .•.Sg J' W� This certifies that ...�:. ............ has permission for gas installation -...:.... , in the buildings of .f ..... >......................... at North Andover, Mass. Fee.��''�.'.. Lic.�No..:'?��'/�... `�.. r�,�:............ GASSPECTOR Check # 12 521 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING. - �---� (Print or Type). /J�r9/ i,!� Z. Mass. Date j ®Gi 7 Permit # d . / - Building Location C, �, � �1 vim= e,v. Z-AOwner's Name. %v,v Type. of Occupancys New ❑ Renovation ❑ �. Replacement Pians Submitted: Yes❑ No ❑ CLIMATE DESIGN HEATING and AIR CONDITIONING, LLC Installing 5 South Summer Street v Address Bradford, MA 01835 9.78-372-9999 (phone) + 978-372-0882 (fax) Business Telephone Lic. Plumber: Tc�f� i�:. ice• l-I�uO�a %j Name of Licensed Plumber or Gas l=itter Check one: Certiiicate '`Corporation514 Partnership Firm/Co- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial .equivalent which meets the requirements of MGL Ch. 142. Yes 10 No G If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy ,® Other type of -indemnity C1 Bond Cl.-' OWNER'S INSURANCE WAIVER: 1 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: Owner❑ Agent ❑ Signature of Owner or Owner's 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 ri"- knowledge .and that all plumbing work and installations performed under the perm Tissued for this a licati ill be in coinplianca with all pertinent provisions of the Massachusetts Stale Gas Code. -and Cha.pter.1:42.01 the General;Laws 8y— Tie of. License: 'umber ?,.natL�ffeof licen ?Lumor s Fitter ..Title : Gasfitter . Mas{ec.: License kumber GtyFTo�vn _ burnernan APPf30vED WFICE USE ONLYI 9 'N s h W N 1' Z Q N N N U Q i- S W ¢ O f - U m 1,- = 77 O d f- a} z z O F Z O •u Q ¢ ¢. 0 :3 O W F Q W O a o > W W N 0 Z V W = S N a fZ W O a a W C7 I.Z 0'f J J F- Q Z W S W S O > LL }- U W _j Uj Z W a C ~ F- Q } N m z O z G O N = Z w> O c c7 W 2 LL Z. 3 s a a< d J o U O C w > p a _ O _ s"u B- as MT• BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR _ I 4TH FLOOR i STH FLOOR 6TH FLOOR 7TH FLOOR CLIMATE DESIGN HEATING and AIR CONDITIONING, LLC Installing 5 South Summer Street v Address Bradford, MA 01835 9.78-372-9999 (phone) + 978-372-0882 (fax) Business Telephone Lic. Plumber: Tc�f� i�:. ice• l-I�uO�a %j Name of Licensed Plumber or Gas l=itter Check one: Certiiicate '`Corporation514 Partnership Firm/Co- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial .equivalent which meets the requirements of MGL Ch. 142. Yes 10 No G If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy ,® Other type of -indemnity C1 Bond Cl.-' OWNER'S INSURANCE WAIVER: 1 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: Owner❑ Agent ❑ Signature of Owner or Owner's 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 ri"- knowledge .and that all plumbing work and installations performed under the perm Tissued for this a licati ill be in coinplianca with all pertinent provisions of the Massachusetts Stale Gas Code. -and Cha.pter.1:42.01 the General;Laws 8y— Tie of. License: 'umber ?,.natL�ffeof licen ?Lumor s Fitter ..Title : Gasfitter . Mas{ec.: License kumber GtyFTo�vn _ burnernan APPf30vED WFICE USE ONLYI 9 Location - /-7/6-k/ Tl4P/FXIA No. ��. �� % Date /C/22A/ .. TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ y7***Ana' E<'�' Foundation Permit Fee $ sACHUS Other Permit Fee $ Z`/( PAOU j s ction Fee $ Water Connection Fee $ No. And -over Collector- Building Inspector Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAF' KVO. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING I iL , L 'e OWNER'S AME NO. OF STORIES I SIZE � ) �E r C _ OWNER' ADDRESS S •7 BASEMENT OR SLAB ARCHI .. CT'S NAME SIZE OF FLOOR TIMBERS 1ST i Xh 2ND 3RD SPAN 8�(_ �e BUIL R'S NAME DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS 1Y BTW DISTANCE FROM LOT LINES - SIDES7S` 1+5Ip REAR 17 �� �, GIRDERS r 11 AREA OF LOT FRONTAGE43W 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 Es IS BUILDING CONNECTED TO TOWN WATER �{ BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER Q IS BUILDING CONNECTED TO NATURAL GAS LINE S 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 I ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FI SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED 12- ig OWNER TEL, CONTR. LIC. OCT 8 fool 1 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST q,?st 1 co EST. BLDG. COST PER SQ FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY 1k a 4 i BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN /0'00�� "eoo 1900 oumjjfim�OR t' OCCUPANCY 12 SINGLE FAMILY Si OR1ES MULTI. FAMILY APARTMENTS CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE B I 2 13 CONCRETE Bl. K. BRICK OR STONE HARDW PIERS PLASTER DRY WALL _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T AREA _ 14 1/1 1/1 FIN. ATTIC AREA N_O BM'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4µ WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 �_ 3 _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDV✓'D ASBESTOS SIDING COMMCN ASPH. TILE VERT. SIDING _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR I�POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE GAMBRELMANSARD I I A HIP BATH (3 FIX.( 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 _ _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 8 COLS. _ STEAM STEEL BMS. 8 COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS A IL B'M'T I2nd I_ ELECTRIC ist 3rd NO HEATING 1 �, I BUILDING RECORD 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. � 's x � oe W L ad u cc � t Lti -. x d > v O a .0 '> O E•y O ° a O � O rim 00 > • G Q u W W O Z Z W W d. ? o z Z u o[ ce cc ce O u CID an m rn E a m m W :3 c w o Q c o c cc ii o m c cc ii o c cc ii m E m U U- cA CO � v W L E•. �i u ar ALL � t Lti -. x d > v O a .0 '> O E•y d ° a � O rim 00 > • G ~ '•' A L E•. �i o •�j ar ALL � t Lti -. x a N > v O a .0 '> O E•y cc t ° a Z LJ z 0 V) W __j Sbl r SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) .PERMANENT A STREET APPLICANT _WA 9� DATE OF APPLICATION PLANNING BOARD FORbi U TOWN OF NORTH ANDOVER LOT RELEASE FORM ESS (ASSIGNEq BY D.P.W. TOWN PLANNER CONSERVATION CONASSION CONSERV�rTION ADMIN. BOARD OF HEALTH TOWN USE BELOW THIS LINE PHONE DATE APPROVED DATE REJECTED DATE APPROVED %a � Af DATE REJECTED DATE APPROVED /,O///g/ HE 1'�I S i ARI DATE REJECTED lVo X v©1or70X,, 4 C DEPARTMENT OF PUBLIC WORKS DRIVEWAY PEIUIIT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. MORTGAGE INSPECTION PLOT NORTHERN ASSOCIATES I PLAN ` NC. 630 TURIYRIKE STREET N. ANDOVER HA. 0184.5 TEL. 506-975-7l 17 MC" MA Gar& rHOW S ® DGWVA D rq rEFANO L OCA rrCVt 966 RALEI6/j rA VEW LANE 'rrY, SrA re N. AAVcve7 , MA DA 7F: AUO/ 24 / 9.f , DEED REF. 5290 / 6P PLAN REF, 6959 SCALE. f � 60 ' ✓OB 91/ 4776 N J f1V�(v ti NOTE: This mortgage inspecllon was prepared speclfically for mortgage purposes and is not to be relied upon as a survey. Noe Associates, Inc, accepts no retpontlbiGty for damages rosulling from said reliance by anyont► other than the tald mortgagee and Its assigns In connection with Its proposed mortgage AnancI a i sold mortgagor, This mortgagell inspection was with the Technical prepared in accordance In$pocpons a$ ado 1pd btnndmds for Mongago loan P Y the "'ll"chusOtts Associotion el Lund Surveyors and CIYil Enginoert, Inc. RALEIGH TA VERN LANE I FURTHFr; S rATE THAT IN MY PROF�SSIONAI OPINION die principle structure/$ and accessory outbuildings CONF with Uro setback roquirOmonts of the ocal zoning ordinancos, and that there aro no tmprovoencroachments of major monts eithor way y across Property linos except as Also 7-5"l '-Z)0/0 � voe fl ■ 1. Property is not in a Flood HatardArea. 0 2. Property is in a Flood Hazard Area. 1 Informalion Is insufficiont to determino Flood Hazard Flood linzard dolerminod from Intesl Federvl Flood Insuranco Ralo'A30 Pannll ATI 0 or/) Fal Oto /4 l� r, ZRIOLL I 518 �cog Zx� C.e+ ►.4G 16 0t 1 �11N�f,. J1O)hlC�' 31 ' cu-csr I � JSP �.�Suv�`►�► '� IL � r� s �R O.C. �� 2 �X alsT - Date. 4:�.?..c. x ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...fir ..1... �: ! Z........ ................. has permission for gas installation ....).P..! :.r ................ in the buildings of ... P .-..�. !.. !............................ . at .....I ). (.... I.Z . '.�......,. ... :. ; , North Andover, Mass. Fee. 1..>.:... Lic. No.. C, . ... ..., ...t ........ ....... GAS INSPECTOR Check # 4282 4 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date 2 d 3 NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New ❑ Renovation ❑ Replacement 3/ Plans Submitted ❑ Permit # L Amount $ (Print or type)I c n eck one: Certificate Installing Company Name - �`1 ) 6/ 6P�/'vf -� - ty Corp. Address❑Partner. Vt o yr-44 Business Telephone 6 4 /) 0-6m/Co. Name of Licensed Plumber or Gas Fitter J f 6f9" (e xiU cif . INSURANCE COVERAGE Check �one: I have a current liability Insurance policy or it's substantial equivalent. Yes No 0 Ifyou have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy f 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 -1 Agent r_3 ► nereoy cemty mat an or the aetans ana mrormanon I have submitted (or entered) m 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 Massachusetts StajGas�Code anhapter of theral Laws. VED (OFFICE USE ONLY) L Signature of Licensed Plumber Or Gas Fitter O' Plumber 42 -� 6 ❑ Gas Fitter Icense um r Master ❑ Journeyman