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yd 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. GI 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. c. 143, § 3L.
Permits shall -be limited as to the time of.ongoing construction activity, and may be.deemed-by-theInspector-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 -tern economic recovery and the Permit Extension Act furthers this
puipose 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, anypermit or approval that was
"in eftect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012.
+
tule 8—Permit/Date Closed: -- C 2 ., �1-� * ** Note: Reapply fo w permit EIK
rmit Extension Act—Permit/Date Closed:
A
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
............... ' '..�-/
.............
has permission to perform ..:
................................................
j
wiring in the building of ...1
at .. :7:�... a � .. - .................... ..... . North Andover; Mass.
Fee Lic. No�-��/.^� .............
...... ........... ............... .........
ELECTRICAL INSPE
Check # r `j
6%�1
i
i
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. — Gp7 91j
BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked=
[Rev. 1/07] (leave blank
1
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in acwrdance.with the Massachusetts Electrical Code (MEC) 527 CMR 12.00
(PLEASE PRINT EV WK OR TYPE ALL INFORMATIOl9 Date: �—
City or Town of: NORTH ANDOVER To the Inspector of ices:ntention t
By this application the undersigned gives notice of his or her io perform the electrical work described below.
Location (Street & Number)'
Owner or Tenantv5
----.— Telephone No. qJg�;��
Owner's Address
Is this permit in conjunction with a building permit? Yes No
❑ (Check Appropriate Box)
Purpose of Building_ �/i kG1 Utility Authorization No. 7 ��
E5-2
xestmg Service Amps / Volts
New Service .� Amps �/ /lam Volts
Number of Feeders and.Ampacity
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd R No. of Meters
Location and Nature of Proposed Electrical Work: O�
No. of Recessed Luminaires
om xenon of the o[tomn
No. of Ceil: Susp. (Paddle) Fans
No. of Luminaire Outlets
No. of Hot Tubs
No. of Luminaires
Swimming pool Above 11 ❑
rnd.
No. of Receptacle Outlets
No. of Oil Burners
No. of Switches
No. of Gas Burners
No. of Ranges
No. of Air Cond. Total
Tons
No. of Waste Disposers
Heat PSP Number ons KW
__._.._._
............._.. _.___.
Totals:
No. of Dishwashers 1
Space/Area Heating KW 1
No. of Dryers
Heating Appliances KW
No. of Water
Heaters KW
No. of o. of
Si s Ballasts.
No. Hydromassage Bathtubs
No. of Motors Total HP
OTHER:
table may be waived by the Inspector of Wires.
transformers KVA
Generators KVA
FIRE ALARMS !No. of Zones
No. of Alerting Devices
Local ❑ Mumcipat
Connection ❑Other
No. of Devices or
3ata Wiring:
No. of Devices or
of
Estimated Value of Electrics
Attach additional detail if desired, or as required by the Inspector of Wires.
Work: (When required by municipal policy.)
Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE C VERAGE: 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 covers is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Spec
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: ��/�eJ � C<fser r ,Y �L�C�•"2�i c�-L, LIC. NO.:
Licensee: Signature C
(If applicable, enter "exempt " in the license number line) LIC. NO.:
Address:!`'- /,rrG C r��, Bus. Tel. No.:?
*Per M.G.L c. 147, s. 57-61, security work requires Department of public Safety "S" License: Alt. L cl 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. PERMIT FEE: $ r�
v
nil
O:
The Common wealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
{ '
www .mass 90v1&a .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectricians/Plambers
Applicant Information Please Print Le-vibiv
Nanle (Business/Organization/Individual):_
Address:
City/,State/Zip:
Phone #: .
Are you an employer? Check -the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part_time).*
2. ❑ I am .a.sole proprietor or
have fired the sub -contractors
listed x
partner_
on the attached sheet
ship and have no employees
These sub -contractors have
working for me .in any capacity.
[No workers' comp. insurance
workers' comp. insurance.
5. ❑ We are a corporation and its
required-]
3. ❑ I am a homeowner doing
officers have exercised their
all work
right of exemption per MGL
myself. [No•worke'rs' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required..]
Type of project (required):
6. [] New construction
7. 0 Remodeling
8. Q Demolition
9. ❑ Building addition
10.❑ .Electrical repairs or additions
11.0 PIumbing repairs or additions
12.[] Roof repairs
13.❑.Other
-- R
t Hom1„� wso nu out me section below showing their workers' compensation policy information,
eowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
4conttacton? that check this box must attached an additional sheet showing• the name of the sub -contractors and their workers' comp, policy infomtation.
J ant an employer that is providing:workers' compensation haurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self4ns. Lie. #: Expiration Date:
Job Site Address:
' CitylStaie2ip:
Attach a copyOf 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
`� Si lure: D
y itC:
,a Phone #:
F[6.Other
only. Do not write in this area, to be completed by city or town official
n• Permit/License #
hority (circle one):
I. health 2. Suildittg Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
son: Phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all emp foyers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 'however the
owner.of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states `Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the cor►trracting authority."
Applicants
Please fill out the workers' compensation affidavit complentely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es). and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' cornpensabon insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the .application for the permit or license is being requested, notthe Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the nur.nberlisted below. Self-insured companies should enter their
self insurance Iicense number on the appropriate line.
- City or Town Officials
Please be sure that the affidavit is complete andprinted legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permittlicense number which v►-iII be used as a reference number. In addition, an appiicant
that must submit multiple permit(license applications in any given year, need only submit one affidavit indicating -current
policy information (.if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit
The Office of investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give as a call.
The Department's address, telephone and fax number:
The CommonweEdth of Massachusetts
Department of industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE
Fax # 617-727-7744
Revised 5 -26 -QS Www-mass.gov(dia
Date. ///: //..?...... .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that f s .... /. ?r�
has permission for gas installation .. r�o4� y.�................
in the buildings of l
at ... 3 .. ��.�?�.`...: f..........., North Andover, Mass.
Fee.. 1. Lic. No../. (X ! .... ... ....... ...... .
(GAS INSPECTOR
Check # j)' �- /
T; 0
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FrrTING
(Type or print) DateZ�l 26
NORTH ANDOVER, MASSACHUSETTS y
Building Locations -?l<;-�' J 4 �� /V ��� G��� Permit # �
Amount $ L ��
Owner's Name L 7717
New ❑ Renovation Replacement Plans Submitted
(Print or type)n k�� Check one: Certificate Installing Company
LLJ
Name {f"
El Corp.
Address l Ap;,' e'. *" C't X ""L
Partner.
A "
usmess Telephone Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1 No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 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 Agent
_ =ll.=c.Vy L. l lily L114L 411 U1 LIM LLGLU11J allU II110rmation 1 nave $uDmined for 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 Massachusetttltate Gas Code and Chapter 142 of the General Laws.
tel' �
-ter•
Title
City/Town
IIiYYKV V MJ (OFFICE USE ONLY) '
Signature of Licensed Plumber Or Gas Fitter
Plumber &/42
0Gas Fitter lcense Number''
Master
Journeyman
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SUB-BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type)n k�� Check one: Certificate Installing Company
LLJ
Name {f"
El Corp.
Address l Ap;,' e'. *" C't X ""L
Partner.
A "
usmess Telephone Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1 No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 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 Agent
_ =ll.=c.Vy L. l lily L114L 411 U1 LIM LLGLU11J allU II110rmation 1 nave $uDmined for 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 Massachusetttltate Gas Code and Chapter 142 of the General Laws.
tel' �
-ter•
Title
City/Town
IIiYYKV V MJ (OFFICE USE ONLY) '
Signature of Licensed Plumber Or Gas Fitter
Plumber &/42
0Gas Fitter lcense Number''
Master
Journeyman
ll�
LAWRENCE H. OGDEN, P.E.
198 EAST MAIN STREET
GEORGETOWN, MA 01833
978-352-8318 fax 978 —352-2858
cell: 978-502-5921
December 1, 2009
Fred McCarthy
357 Dale Street /
.A.ndover;-Ma. 01845
RE: McCarthy Residence, 357 Dale St. North Andover, Ma. 01845
Dear Mr. McCarthy
As you requested I visited the site to review the installation of the Engineered
Materials consisting of LVL Beams utilized in the framing of the above project. These
are shown on plans prepared by Martha Macinnis Dated June 2112008,with sheets 8 & 9
Framing Plans certified by me July 1, 2008.
Based on the above site visit and based on what I could visibly see I can certify
that to the best of my knowledge the LVL members utilized in the framing as shown on
the drawings are installed properly and meet the loading conditions of the Massachusetts
State Building Code for 1.&2 Family Residences. This certification assumes that all other
framing requirements of the code, including but not limited to materials and nailing
schedules, were properly complied with by the licensed construction supervisor
responsible for the project.
In addition as we discussed at the site you need to install the Simpson TS22 twist
straps at each rafter sitting on a raised plate as shown on the drawings. This strap is
required to resist the trust at the bearing end of the rafter and replaces the Rafter/Ceiling
Joist Heel Joint Connection required in Table 5802.5.1(9) of the Building Code.
Should you have any questions please do not hesitate to call.
Yours truly, H OF
�/ 90
AWRENCE S'
Q opo IL's J09
Lawrence H. Ogden P.E. Structural 277650
Location 3 S
No. o�?n3
Date it;,- L% -0 3
NORTH TOWN OF NORTH ANDOVER
L
i
Certificate of Occupancy $
s�CHU <�' Building/Frame Permit Fee $ Q
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ '00
Check # 41
CI
16817
A A (L", --
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING
5 .
BUILDING PERMIT NUMBER: n DATE ISSUED:
SIGNATURE:
Building Commission for of Buildin Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Numb
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS 00
Front Yard Side Yard
Rear Yard
Required Provide R red Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomnation:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
Historic DIsbft Yes ...yo
2.1 Owner of Record
Inc '04?,I-i G.� J �? C-41
Name (Print) Address for Service
Signature T lephone
2.2 Owner of Record:
Name Print Address for Service:
a
Signature Tele hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 aistered Home Improvement Contractor
leg
Coi pang Name
Not Applicable ❑
Registration Number
Address
Expiration Date
Signature Telephone
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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 Proposed Work check all ticable
New Construction ❑ Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑
Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify
Brief Descriptionof Proposed Work:
CG,ys?//j leg
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1 SF,CTION 6 - F.STTMATF.D CONSTRUCTION COSTS I
Item Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building
c o
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
4 Mechanical (HVAC)�-
5 Fire Protection
6 -4 .t y . - ""'m; 77t
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , as Owner/Authorized Agent of subject property
61 3
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
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
Signature of 0r/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
RD
SIZE OF FLOOR TINMERS 1 2ND 3
SPAN
DIMENSIONS OF SILLS
DINIENSIONS OF POSTS
D11VIENSIONS 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
�s-
FORM; U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits frc
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 ,Le qp .� ��i12ll PHONE
LOCATION: Assessor's Map Number (D PARCEL v 1
SUBDIVISION LOT (S)
STREET ST. NUMBER . 1
****OFFICIAL USE ONLY
RECdMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINIPATOR DATE APPROVED �y 422
DATE REJECTED
COMMENTS ��T'Srde. �cLt�e/ 70I)e. 600` `.
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED.
DATE REJECTED
'UBLIC WORKS - SEWERAVATER CONNECTIONS
DRIVEWAY PERMIT
'RE DEPARTMENT
CEIVED BY BUILDING INSPECTOR
✓ised 9\97 jm
DATE_
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No. Date 5�` _ G
�a�TM TOWN OF NORTH ANDOVER
Of "'O '•,�O
OL
S
Certificate of Occupancy $
�,SSACMUSEt� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ a S
Check #
4 % 7 c 7 Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI RENOVATE,OR DEMOLISH A ONE OR TWO FAMILY DWELLING
a
BUILDING PERMIT NUMBER:DATE ISSUED: ��,�� ow
011 1SIGNATURE:
om C
Building Commissioner/InTector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Numb4 Parcel Num
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Re4pired. Provided
RecMired. Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private 0 Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner Jof Record
Name (Print) Address for Service
n..2 A e-,
Signature Jelephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
1i
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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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 Proposed Work check all applicable)
New Construction ❑
Existing Building ❑
Repair(s)
❑
Alterations(s) ❑ TAddition
❑
Accessory Bldg. ❑
Demolition
Other ❑ Specify
Brief Description of Proposed Work: �)
J7e nAg2 Lt,--L45-A) o
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to beC?FFICIAL
Completed by permit applican
USE ONLY
1. Building
(a) Building Permit Fee
Multiplier
--�
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (,b)
a
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLW FOR ING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
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
Signature of Owner JA ent
NO. OF STORIES
Date
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR THSABERS 1
2 ND3
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
Town of North Andover tyORTH
O �tLID ib�ti
Building Department
27 Charles Street o
North Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
T D•9_ COC MCMK• _ 1` �/
Building Demolition Affidavit
DATE i� O
OWNERS NAME & ADDRESS �► .2,� D rc.� +� 127 0—
PROPERTY LOCATION
ri7
CONTRACTORS NAME & ADDRESS
DEPARTMENT SIGN -OFFS
D A ccs / �x� n •r�R S -
ELECTRIC
41LE-PHONE
GALE,
AN I PI :4 1 M, V WITZ.,
DUMPSTER- ON/ OFF STREET
DIG SAFE NUMBER
BLDG. INSPECTOR DATE RECD
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.
APPLICANT 752�-On �/ !� cC,,1�7a 4j PHONE
ASSESSORS MAP NUMBER Z' LOT NUMBER
SUBDIVISION LOT NUMBER
STREET �J� % `s STREET NUMBER
OFFICIAL USE ONLY
INNOMMMENOWEEN
RECOMNIENDATIONS OF TOWN AGENTS
DATE APPROVED 0c)
CONSERVATION ADMINISTRATOR
DATEREJECTED
commENrs
00r
DATE APPROVED
TO R ILI, c
DATE REJECTED
CONMIENTS
DATE APPROVED
FOOD INSPECTOR - HEALTH DATE REJECTED
DATE APPROVED
SEPTIC INSPECTOR - HEALTH
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR DATE
F red H_ -L v
`1 Hal Z--
Town of North AndoverNORTH
OF t�, � o "A/'
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Building Department o
27 Charles Street * _
North Andover Massachusetts 01845 _^
(978) 688-9545 Fax (978 688-9542 A_�' `oc_II,
�LAI
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DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit # the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a.
The debris will be disposed of in /at:
Facility location
Signature of Applicant
4! /� G
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
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No.Date
NORTH TOWN OF NORTH ANDOVER
Off•,.■° ,�ti.
+ s
Certificate of Occupancy $
SACNUS Building/Frame Permit Fee $
Foundation Permit Fee $
U Other Permit Fee $
TOTAL $
Check # �(
(1A
4, i Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: - DATE ISSUED -
SIGNATURE:
Building Commissioner ' for of Builds Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
7
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
ReqWred Provide Required Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ - Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Address for Service :
Signature elephon - — >
t,_� � z
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2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
ress
Si, Ature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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SECTION 4 - WORKERgrCOMPENSATION (M.G.L. C 152 § 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 permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
cli) C144
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SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OM, COAL USE ONLY•
_. MRS,
1. Building
J
12 (� G' �l , Q o
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical HVAC
5 Fire Protection
5 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES JOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize A to act on
My behalf, inall natters =rkSutho% by thi ilding nnit application. /
Signature of Ow er % Date
SECTION 7b OWNERJAUTHOR17TW 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
Signature of OxAmer/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR T MBERS 1 2 3 RD
SPAN
DIMENSIONS OF SILLS
DIN ENSIONS 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
r
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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..
APPLICANT K,041'i %/`�Jl'�� PHONE ?� ' 29 � /ply
ASSESSORS MAP NUMBER 0 0—!Z LOT NUMBER
SUBDIVISION
LOT NUMBER
--x( STREETD.4 d S
A/ STREET NUMBER S'
OFFICIAL USE
ONLY
I..........■ ..............................■
RECOMMENDATIONS OF TOWN AGENTS
■......................■ ■...■
P ��I n� �`E �`{ �3� COz JA
DATE APPROVED
C ' NSERVATION ADMINISTRATOR
DATE REJECTED
COMMENTS
DATE APPROVED
TO ILANNER
DATE REJECTED
COMMENTS
DATE APPROVED
FOOD INSPECTOR - HEALTH
DATE REJECTED
,�aV
DATE APPROVED 2P �v
SEPTIC INSPECTOR - HEALTH
DATE REJECTED
CONIIvfENTS
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
CONUvfENTS
RECEIVED BY BUILDING INSPECTOR DATE
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that _... ............. .. .....................................................
has permission to perform.... < t .......................................................
is
wiring in the building of .... ................... . ... ......... .................................
f
at ................ .4,Y .......................................... . North Andover, Mass.
Fee� ............. Lic. No�7!!Qk. ...........................
Check # '41-c'-?l'<_�LEcrpuc� INSPECTOR
ThECOMUOIVWE4LTHOFIACS40YUSEITS Office Use only
DEPARTXENI0FPVBLICS4FE7Y Permit No. 37��
BOARD OFFIREPREi ENTIONREGUL4770AS527CNR 12 00 �'-
Occupancy &Fees Checked
APPLICATION FOR PERART TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED W 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 Wires:
'The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 35-7 P19 f E -
Owner or Tenant
Owner's Address 7
Is this permit in conjunction with a building permit: Yes No F-J (Check Appropriate Box)
Purpose of Building 6/972 /►/l L Utility Authorization No.
Existing Service Amps / Volts Overhead Underground F-1 No. of Meters
New Service Amps i Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work &1d'GCZXQZ &&q"G
No. of Lighting Outlets
No, of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
round
round
No. of Receptacle Outlets
i
/
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Bttrners
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
htiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. ofSelFContained
—--�--
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating.Devices KW
® Connexions
I
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
,OTHER
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INSURANCE BOND `MIE�Z• - ' t_J PeaseSpecify)
Expiratim Dat
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(Please check one) Owner Axe;It i
Telephone No. PERMIT FEE $ '7�0 • _
4
Date. f 1 : /). -. G . z.....
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that . !.--..../`x' ./.?!? �.. ............ .
has permission for gas installation ... � !� X .1q. Z ........
in the buildings of ... z r .....................
at ...?) . ? ....0 � ................North Andover, Mass.
Fee.. 2.�-... Lic. No..Ie!'..s ... .... .. M� ... .
GASINSPECTOR
Check # r
4240
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Printo>rpe r
. // w c to ��� Mass. Date � -1>--e-L--Ig
Building Permit#
"6 �4 Location 367 Og Ir- S-,"- Owner's 6n e2 002C
Name
New I/ Renovation ❑
Plans Submitted Yes ❑ No &-"
Type of Occupancy:
Replacement`, '' Fee ❑
Print or Type Check One
Installing Company Name oo ❑ Corp.
Address�3 c- ❑ Partnership
�� �� ° ' ' d'� ❑ Firm Company
Bus.iness.T.elephone ' Name of Licensed Plumber or Gasfitter
Certificate
I hereby certify that all 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 installation performed under Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage..
Signature of Owner Agent
I have a current liability insurance policy to include completed operations coverage ❑
For inspections, call: Steve Cormier TYPE LICENSE
Littleton - 486-8434 VGasfitter
lumber Signature of Licessed
7:30 AM - 9:00 AM Plumber or Gasfitter
❑ Master
❑ Journeyman
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Print or Type Check One
Installing Company Name oo ❑ Corp.
Address�3 c- ❑ Partnership
�� �� ° ' ' d'� ❑ Firm Company
Bus.iness.T.elephone ' Name of Licensed Plumber or Gasfitter
Certificate
I hereby certify that all 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 installation performed under Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage..
Signature of Owner Agent
I have a current liability insurance policy to include completed operations coverage ❑
For inspections, call: Steve Cormier TYPE LICENSE
Littleton - 486-8434 VGasfitter
lumber Signature of Licessed
7:30 AM - 9:00 AM Plumber or Gasfitter
❑ Master
❑ Journeyman
/°',j �S
License Number
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Town of North AndoverNORTN
OFFICE OF?°ytt .o °�ti°L
COMMUNITY DEVELOPMENT AND SERVICES °
F 9
27 Charles Street
North Andover, Massachusetts 01845 �9SSn�NuS�t�h
V nLUkM J. SCOTT
Director NOTICE OF DECISION
(978)688-9531
Fax(978)688-9542
Any appeal shall be filled
within (20) hays after the
date of riling this Notice
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in the Office of the Town
--a -<
—+*rnm
Clerk._
�X-co�
Date: May 12, 2000 .�
<�Nv
Date of Hearing. May 2, 2000
mix
Petition of: Frederick McCarthy
O
Premises affected: 357 Dale Street
Referring to the above petition for a special permit from the requirements of the:
North Andover Zoning Bylaw Section 4.136
so as to allow: the removal and replacement of a garage and the addition of a farmer's porch to
an existing dwelling located in the Watershed Protection District.
After a public. hearing given on the above date, the Planning Board voted
To: APPROVE the: Watershed Special Permit
based upon the following conditions (attached):
CC: Director of Public Works
Building Inspector
Natural Resource/Land Use Planner
Health Sanitarian
Assessors
Police Chief
Fire Chief
Applicant
Engineer
Towns Outside Consultant
File
Interested Parties
Signed
Alison M. Lescarbeau, Chairman
John Simons, Vice Chairman
Alberto Angles, Clerk
Richard S. Rowen
Richard Nardella
Planning Board
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
357 Dale Street
Special Permit - Watershed Protection District
The Planning Board makes the following findings regarding the application of Frederick
McCarthy, 357 Dale Street, North Andover, MA 01845, dated March 28, 2000, requesting
a Special Permit under Section 4.136 of the Zoning Bylaw to allow the removal and
replacement of a garage in the Non -Disturbance Zone and add a farmer's porch to an
existing dwelling within the Non -Discharge Zone of the Watershed Protection District.
FINDINGS OF FACT:
In accordance with 4.136(4) the Planning Board makes the finding that the intent of the
Bylaw, as well as its specific criteria, are met. Specifically the Planning Board finds:
1) That as a result of the proposed construction in conjunction with other uses nearby, there
will not be any significant degradation of the quality or quantity of water in or entering
Lake Cochichewick. The Planning Board bases its findings on the following facts:
a) The proposed project is located on a septic system and the replacement of the garage
and the construction of the farmer's porch will result in no increase in flow to the
existing septic system.
b) There will be no change in the flow characteristics except that they will be less since
the proposed garage is in the same location as the existing garage;
c) The removal and replacement of the garage will bring the garage further away from
the wetlands than was previously permitted therefore the project will have less of an
effect on the wetlands. The proposed garage is a significant reduction in square
footage than the garage originally existing.
2) That there is no reasonable alternative location outside the Non -Disturbance Zone and
Non -Discharge Zone for any discharge, structure or activity, associated with the
proposed project because the existing garage was already located in the Non -
Disturbance Zone and the proposed farmers' porch will attach to the existing dwelling
which was already located in the Non -Discharge Zone.
In accordance with Section 10.31 of the North Andover Zoning Bylaw, the Planning Board
makes the following findings:
The specific site is an appropriate location for the proposed use as all feasible storm water
and erosion controls have been placed on the site;
A. The use will not adversely affect the neighborhood as the lot is located in a residential
zone;
B. There will be no nuisance or serious hazard to vehicles or pedestrians;
C. Adequate and appropriate facilities are provided for the proper operation of the proposed
use;
D. The Planning Board also makes a specific finding that the use is in harmony with the
general purpose and intent of the North Andover Zoning Bylaw.
Upon reaching the above findings, the Planning Board approves this Special Permit based
upon the following conditions:
SPECIAL CONDITIONS:
1) This decision must be filed with the North Essex Registry of Deeds. The following
information is included as part of this decision:
Plan titled: Modification to Existing Structures for Property Located at
357 Dale Street, North Andover, MA
Location : 357 Dale Street, North Andover, MA 01845
Owned by: Frederick McCarthy
Scale: 1" = 207
Date: March 1, 2000, Revised 4/13/00
Prepared by: New England Engineering Services, Inc.
60 Beechwood Drive
North Andover, MA 01845
The Town Planner shall approve any changes made to these plans. Any changes deemed
substantial by the Town Planner would require a public hearing and modification by the
Planning Board.
9) Prior to any work on site:
a) A performance guarantee of five hundred ($500) dollars in the form of a check
made out to the Town of North Andover must be posted to insure that construction
will take place in accordance with the plans and the conditions of this decision and
to ensure that the as -built plans will be submitted.
b) Erosion control measures as required must be in place and reviewed by the Town
Planner..
c) The site shall have received all necessary permits and approvals from the North
Andover Conservation Commission, Board of Health, and the Department of Public
Works and be in compliance with the above permits and approvals.
-PVAM�IIHG.B�A80..
TOWN OF NORTH ANDOVER
MASSACHUSETTS
Any appeal shall be filed
within (20) days after the
date of filing of this Notice
in the Office of the Town
Clerk.
This is to certify that twenty (20) days
have elapsed from date of decision filed
without filing of an appeal,
Date Dee / fes_
Daniel LongLong— , i
Town Clerk
NORTH
atj �: .• I••MOL
F R
a i
��SS�cNu5E�4h
NOTICE OF DECISION
,.. '53
ATTEST:
A Tme COPY
TW= Cie*
Date.. November. 12 f. 1993.
October 19, * 1993
Date of Hearing November.2, ,1993,
Petition of Christopher. King .. . .... . .. . . . . . .. .
Premises affected 585 Dale street ..... , .... .
Referring to the above petition for a special permit from the requirements
District
of the North. Andover, Zoning. Bylaw. . Section. 4: 136, Paragraph. 5. , Watershed. Protection
..... ....... ..... . ... ....... . ... .... .. . . ......... ...
so as to permit the construction of an addition to an existing, structure within
.... ..... ... .. ............
the Non -Disturbance. Zone, of, a, wetland, resource, area. which, is a, tributary, tq
Lake Cochichewick.•. .... .. ....... ........ .... ..... .... ........ ...... Q
rn
C12
After aublic hearing given on the above date, the Planning Board voted
CONDITIONALLY
to ........ . ..„ APPROVE the SPECIAL PERMIT
.............................................. N
co
CGS
based upon the following conditions:
cc: Director of Public Works
Building Inspector J
Signed
Conservation Administrator �L ft // .�✓�C`� �/ _�
Health Agent Richard Nardella, Chairman
Assessros................................
Police Chief John Simons, Vice Chairman
Fire Chief ................................
Applicant Josejph.Mahoney, .Clerk..._.....,.
Engineer
File Richard Rowen
Interested Parties
.......1Si�.;.,;,�., iig•,ra ........
10) Prior to release of the Performance Bond:
a) The applicant shall submit an as -built plan that shows all construction, including
sewer lines, storm water mitigation trenches and other pertinent site features as
shown on the approved plan. This as -built plan shall be submitted to the Town
Planner for approval. The applicant must submit a certification from the design
engineer that the site was constructed as shown on the approved plan.
b) The Planning Board must by a majority vote make a finding that the site is in
conformance with the approved plan.
11) In no instance shall the applicant's proposed construction be allowed to further impact
the site than as proposed on the plan referenced in Condition # 1. .
12) No open burning shall be done except as is permitted during burning season under the
Fire Department regulations.
13) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation.
14) The provisions of this conditional approval shall apply to and be binding upon the
applicant, it's employees and all successors and assigns in interest or control.
15) This permit shall be deemed to have lapsed after a two- (2) year period from the date
on which the Special Permit was granted unless substantial use or
construction has commenced.
cc: Director of Public Works
Applicant
BUILDING PERMIT o* 1401
TOWN OF NORTH ANDOVER o?
APPLICATION FOR PLAN EXAMINATION f-
Permit NO:
Date Received
� �gQq,T.o
�1 SSACHI
Date Issued: v
I PORTANT: Applicant must complete all items on this page
LOCATION ,3`S 7 �Q -t- -STT
PROPERTY OWNER ,�2 13P� l c-�C, lWc- CA --e 7-�r ?�
r Print
MAP NO: b PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
or Print Clearly)
OWNER: Name:
Address:
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License:
Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER 140AP11-Yt4 ZnCZI>' 11S' Phone: � %
Address: - Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ ��f� , �0l� FEE: $
Check No.:' —4 10 Receipt No.: 0?.// r4 --
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
ignature of Age bw--ner ure of contractor
3.7 se—
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ -Photo ofH:I:C� Aid-G-S:L--Luer s ' � ��''^-`-. Ox C_ ---,e 171L.?
.
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
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 the building application
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
N
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
Well
Tobacco Sales
Food Packaging/Sales
Private (septic tank, etc.
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
`CONSERVATION Reviewed on Signature
COMMENTS_ ,'PRdj-e67 Pe7z rerj5•ff-V4--r/!lj1j (jAd652-
/)>c- e66j b /7/d iJS ,
HEALTH Reviewed on Signature
COMMENTS
14,
IVnina Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
--kWater & Sewer Con nection/si nature & D _ Driveway F
DPW Town Engineer: Signature:
4
Located 384 Os c
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
rz�Ll0
J Street
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 section 21A —F and G min.$100-$1000 fine
Doc.Building Permit Revised 2008
4
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Location- %
No. Date a a'
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
C, --
Building/Frame Permit Fee $
Foundation Permit Fee $ y
Other Permit Fee $
TOTAL $ J,
Check #
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\`I
t NORTH TOWN OF NORTH ANDOVER
°•'"" '`,"° OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
s,,; •,,...�t� North Andover, Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
Please ndut
DATE: 0 10s,
JOB LOCATION:
Number Street Address � �7
HOMEOWNER O d cs
Name home Phone work ne
PRESENT MAILING ADDRESS�-�-
Old
Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the
owner acts as supervisor). State Building (Code $eCtion 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended
to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not
be considered a homeowner.
The undersigned •"homeowner" assumes responsibility for compliances with the Stage Building Code and other
Applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Ravised 10.2005
Form Homeowners Exemption
BOARD OF U'PEALS 699-9541 CU.\SERVVT'10\ 638-9530 ITE.1L111688-9.540 PL.INNING 688-9535
Affidavit
I, Frederick J McCarthy of 357 Dale Street, North Andover MA 01845 agree to remove the
existing home after completion of a new single family dwelling.
The time frame is approximately 1 year from the start of construction in June 2008.
Frederick J McCarthy-Xn �:�'j K4
Signed under the pain and punishment of perjury. May 2008.
'�IAIV IN202z 9G
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