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HomeMy WebLinkAboutMiscellaneous - 380 WINTER STREET 4/30/20180 0 W 9D 0 0 O 0 0 Date.... "ON TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..................... 1) ...... SlY1�4.g:f- 0 ............. I ............................... has permission to perform ........... '50-'f htr e- ....... . ..... ... wiring in the building of ............. . ..................................................................... .t ........ 3. (f4? .... W A ......... 57- North Andover, Mass. Fee .. SS.......... Lic No, ....33 ............. . . ....... . ELECTRICAL i�]� CAL * ................... 6�f I INSPECTOR . Check 7722 f Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No, % 7Z 7Z-, Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pertonned in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /U - /G -el City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perforin the electrical work described below. Location (Street & Number) 3 rcl rl, ',,7 21(- n -(/I-- Owner or Tenant �, // /jg , s f{,.f Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 9 -----(Check Appropriate Box) Purpose of Building f, f le ,�4� ,�/y Utility Authorization No.j y3 6 5—JF-2 Existing Service mps 12-- l zY-vVolts 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: Completion of the following table may be waived by the lnenectnr of Wires No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of ilo-to Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- E] rnd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. oT Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons K No. o Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. o Water KW Heaters No. of Na. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: #' — / r —U 1 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is ' force, and has exhibited proof of same to the permit issuing orrice. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: —zn/ 2�e LIC. NO.: 1;4yf33 Licensee: �i,, / % Signature LIC. NO.: /1j 9 3.3 (If applicable, en r "ecempt�in the license number line.) g„p,; jr�—Z�U Address: 'ii ate° Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department cf Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) (:] owner ❑ owner's agent. Owner/Agent PERMIT EE: 8 SignatureturaTelephone No. -4 Date ... 3.— . I . 6 . . .0 . 4 .. .. ... .. ... ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... �t� ...... Slt . .......................... has permission to perform ............Tc- ..................... ... .................................... wiring in the building of ....... a ........ . ..................... at ........ V! .... 01 ........S T ........ . ..... . North Andover, Mass. Fee.;.�. ....... Lic. Nol.4�..V.33 ......... ............ ELECTRICAL' ? Check # A �.rr.war.wsrw. � s • i�•.+rwwasw.r rvt uu�� (Rev. 11199) ✓lJIIfsAiiii O�J:� ..Jt�'y1t41 pel7[IItMldlbBC: O=pawy & Fee BOARD OF FIRE PREVF-j%MON REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK-10BEPERFORMED41fITi TIM MASSACfi11MISaECrRICALCME STSCMR 42'00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: 3 — - U - City or Town of: A/ TO the Inspector of Wires: By this application the undersigned gives notice of s or her intention to perform the electrical work described below. Location: (Street & Number) 3 YO Owner or Tenant: �. /� !tea 17 -7 Owner's Address: %fes c. C - Is this permit in conjunction with a Building Permlf? Yes No a (Check Appropriate Box) Purpose of Building: ,./%f�rf+ /y Utility Authorization 1-r- # of Metes Existing Service: 24Pr/ Amps 17-'v t ZVO Volts Overhead 8"-- Underground.O New Service: Amps f Volts Overhead Q Underground.D + of Meters: Number of Feeders and Ampacity, / Location and Nature of Proposed Electrical Works No. of Recessed Fixtures No. of Call: Susm (Paddle) Fans No. of Transformers Total KVA No. Of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool: Above ground n In Ground o # of Emergency lighting Battery Units No. of Receptacle Outlets/G No. of OA Burners Fire Alarms # of Zones of Detection & Initiating Devices # of Sounding Devices' # of Self Contained DeteotionlSounding Devices Loral a Municipal Connection c :liner No. of Switr;mes Z V No. of Gas Burners No. of Ranges No. of Air Conditioners TOTAL TONS: No. of Waste Disposals Heat Pump Totais: Number. TONS: KW: Security Systems.. No. of Devices or Equivalent No. of Dishwashers Space !Area Heatirxf KW Data wrong, No_ of Devices or Equivalent No. of Dryers _ . Heating Appliances KW Teiscommunications Wiring: No of Devices or Equivalent No. of Water Heaters KW No. of Signs: # of Ballasts: OTHER; $ of Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of alecti* work may issue unless the licensee provides proof of fiabftity insurar including 'completed operation' coverage or its substantial equwW The undersigned certifies that such coverage is in force, and has exhibited proof of same to the issuing office. CHECK ONE: INSURANCE BOND o OTHER a Please specify: Estimated Value of Electrical Work 5 (When required by municipal policy) Work to Start 3 / U — inspections to be requested in accordance with MEC Rule 10, and upon com:ol I certify, under the pains and ponaltias of perjury, that the Infonnation an this application is true and compiets. p LIC. #-/ f 33 uc_#-9 9' 3 33 . 0' AIL Tel. r OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabft insurance coverage normally required by law. By my signawm oelaw, i nt waive this requuemeni. t am the (check one) Owner 0 OR Agent 0 Date 3/! A.C.... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .... r./ �.. � ... 14.i /". /? /�................... has permission to perform ... h. S.............................. plumbing in the buildings of .... pv?: t :.: .<.................... . at...'�..-� �. �..*c�... C'`�'......:..., North Andover, Mass. Fee. .3 v Lic. No.. �1.. 0. ... �. `.I .......... f PLUMBING INSCTOR Check # 5 r, )- Z MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date a'6 Building Location Owners Name Permit # Type of Occupancy Amount 1 New Renovation , Replacement Plans Submitted Yes ❑ No ❑ It (Print or type) Installing Company Name Check one: Certificate ❑ Corp. Partner. Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the tyKof insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond u Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature IOwner ❑ Agent ❑ I hereby certify that all of the details and information I ha best of my knowledge and that all plumbing work and in compliance with all pertinent provisions of the Massach OVBD (OFFICE USE ONLY (or entered) in above application are true and accurate to the D ed under Permit Iss this ap lication will be in nde� t t e General Laws. Type of Plumbing License License mer Master Journeyman 1' 4W ..................mm W MM I 9 9 ...M ................... .- • p11.E mrsmmmrmmmmmmmmmmmmmmm MM 'Vi 11' MMMMMMMMMMMMMMMMMMMMMM MM W1111-10IFT-61UMMMMMMMMM MM M M MMM���� i 11:' MMMMMMMMMMMMMMMMM M MMMMM W i 11' MMMMMMMMMM MMM mmmmmmm MM miallairt-0 mmmmmmmmmmmmmmmmmmmmmmmmm w.li.-Iort--$.,-IINMMmmmummmmmmmmmmmmmmmmmm (Print or type) Installing Company Name Check one: Certificate ❑ Corp. Partner. Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the tyKof insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond u Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature IOwner ❑ Agent ❑ I hereby certify that all of the details and information I ha best of my knowledge and that all plumbing work and in compliance with all pertinent provisions of the Massach OVBD (OFFICE USE ONLY (or entered) in above application are true and accurate to the D ed under Permit Iss this ap lication will be in nde� t t e General Laws. Type of Plumbing License License mer Master Journeyman amxdw BOARD OF FIRE PREVENTION REGULATIONS Perm, t um PPermitNumber_ fivatber.Occupancy & fee APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK fALL overran U PERFORMFM wtnr THE MAMMMUM-M Et.H =CAL CODE M CUR tz:ooj PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: e. —� — City or Town of. ,�'�/� ti Aa :;-a 4To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perforin the electrical work described below. Location: (Street & Number) ZV, iv ti, -r ST Owner or Tenant ZI s t e- >L Owner's Address:./ Is this permit in conjunction with a Building Permit? Yes � No a (Check Appropriate Box) Purpose of Building: ,S�� Utility Authorization M / Existing Service. 24--ClAmps%7-41 1 ayO Volts Overhead �� Underground. 11 m of Meter`s New Service: Amps ! Volts Overhead D Underground.D n of Meters: Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Woric: Lr/ - Z� h No. of Recessed Fixtures No. of Call: Susp. (Paddle) Fans No. of Transformers Total KvA No. Of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool: Above ground n In Ground c.. # of Emergency Lighting Battery Units No. of Receptacle Outlets /U v No. of 01 Burners Fire Alarms # of Zones # of Detection & lnitiating Devices of Sounding Devices:ers # of Self Contained Detection/Sounding Devices Local o Municioal Connection o Omer No. of Switches Z v No. of Gas Burners No. of Ranges � Na of AirCarniitimters TOTAL TONS: No. of Waste Disposals Heat Pump Totais: Number. TONS: KW: Security Systems.. No. of Devices Of Equivalent No. of Dishwashers Space JArea Haatin¢ KW Data Wang. No. of Devices or Equivalent No. of Dryers _. Healing Appliances KW i eieeommunieabons Wiring: No of Devices or Equivalent: No. of Water Heaters KW No. of Signs: # of Ballasts: OTHER; A of Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proal of liability ins=r including 'completed operation' coverage or its substantial egtavaThe undersigned certifies that such coverage is in force, and has exhibited proof of same to the r issuing office. CHECK ONE: INSURANCE kfi' BOND ❑ OTHER 0 Pease specify: Estimated Value of Electrical Work 5 / (When required by municipal policy) Work to Start 3 G _ � �% inspections to be requested in accordance with MEC Rule 10, and apron anal I crrrVfjr, under the pains and penaff3as of perjury, that the Information on this application is true and complete. LIc. # 144!9" 3'� UC. #. /993 . All. Tel. # OWNER'S INSURANCE WAIVER: l am aware that the Licensee does not have the fiabillty insurance coverage normally required by law. By my signature below, I ne waive this requirement. I am the (check one) Owner 2 OR Agent o Location 16 L No. 794 Date Check # 13755 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL ✓ Building InspecSVV TOWN OF NORTH ANDOVER Y BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING t sw .. +hi� ��'+�t x^ r�,` a:; ;' , r ' ,j[ii,_`. a • r �6-v BUILDING PERMIT NUMBER: f /� DATE ISSUED: _ AC SIGNATURE: Building Commissioner/lLspedor of Buildings Date SECTION i- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Nlip Numb Parcel Number i v 0 , 1.3 Zoning Information: Zonin District Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Rewired 4—Provided R red I Provided 1.7 Water Supply M.G.1-C.40. 34) 1.5. blood Zone Information: Public ❑ Private ❑ zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT rlc : es No 2.1 Owner of Record game (Print) Address for Service: �. �T6- 623--9207 Signature Telephone 2.2 Owner of Record: t/S Lta�F L N--) E ` �t� iSiy 3�� F.J ►� TF CZS t 4yo .4N-)Jjo - Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: r n.icensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ RECEIVED Company Name Registration Number SEP 2 0 2005 Expiration Date ING, Dep-r_ Address Signature Telephone I— SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 21 Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ...... :0 SECTION 5 Description of Proposed Work check all a ble New Construction ❑ Existing Building ❑ Repair(s) ❑ with this application. Failure to provide this affidavit W41 result Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: n 1'z2dC e� 02 W C-( ( S I eVe-TTnN 6 _ W4ZT1MATF11 rnNCTRtirT10N rnCTR I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY •: 1. Building .20 0 c:. O (a) Building Permit Fee Multiplier 2 Electrical 3000 (b) Estimated Total Cost of Construction 3 Plumbing 100 o Building Permit fee (a) x (n) X70 �- / 4 Mechanical HVAC — 5 Fire Protection _- 6 Total 1+2+3+4+5 00 0 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize vv�,,-sc �� to act on My Khalf,,,u� allmattersjelan work aurued by this building pemut application. Signature of Owner Date rcrTnniv,7ti nW?V1CD/A1TTAnD17rn A[_.TiNT nIPrT ARATinN I as Owner/Authorized Agent of subject property Herebv declare that the tements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS ] ST2 ND 3 RD SPAN DIMENSIONS OF SU,LS 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 *'IN FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTIOi = *Z , „-, , A** - *-%* W 0--L t 2— p. i 3 4 r" ri t SrFozL, LOCATION: Assessor's Map Number 10'114 SUBDIVISION STREET 1 OFFICIAL USE ONL TOWN PHONE `/ 7'? - G g 3-- !� g 1% PARCEL (206 '�_ LOT (S) ST. NUMBER CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED. _ COMMENTS It I Fr4 #v" e p<i<� wrdt'4� 4iK' W".4 -'.r5 ' TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED RECEIVED BY BUILDING INSPECTOR Dt R*VhW 9%97Im BUILDING DEPT. NORTh TOWN OF NORTH ANDOVER o� OFFICE OF p BUILDING DEPARTMENT a 400 Osgood Street North Andover, Massachusetts 01845 D. Robert Nicetta, Building Commissioner HOMEOWNER LICENSE EXEMPTION Please print DATE: %Z��®S JOB LOCATION:�- Number Street Address Telephone (978) 688-95454 Fax (978)688-9542 Map/Lot HOMEOWNER CJ.'31 *r*`vr:5+F—�Z— Name Home Phone Work Phone PRESENT MAILING ADDRESS 3-K0 L,. 1 '�3E-tL t, 4 N6 o zzz- oqA- 0 l T Y(5- City 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 Section 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 State 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 requirements. � � � HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL HOARD OF APPEALS 6,"-9541 CONSFRVATION i,88-9530 11KALI1{ 6SX-9540 PLANNIM; W"-0135 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 at: -L- 3*:)J t ('-3t �� JT, is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: L' C-3 C-1. 0 oA-� -'k) EK2 F K) -3 F4 4 vo f7n if J K (z- (Location of Facility) Fire Department Sign off: Dumpster Permit Signature of Permit Applicant c�vt-� Date 1 9A w -W C) Q N 2 LU ui pL v�p LL) N EY) o 0 :z Lu J) � N P O Q W 4-- O z 3 lC in _ cO iv N d` .I r WN L Nl W Q 1— F- z Q w C) a. O W- 1 �- z a Ol of Ll I 00 3 W 1 J Z <'y I w A w 4 X VN D� `0 41 0 z o J d o � V� i 0 V IBJ N d` .I r WN L Nl W Q 1— F- z Q w C) a. O W- 1 �- z a Ol of Ll I 00 3 W 1 J Z <'y I w w X D� a w > z o �a i 0 E.L. c! y LLJ i .„ V z °•-�' Ct) y m x m m X m y v m CO) CCD Z D CLd O.� n� .p o o p CL cr cc Cos 10 CCD 0 d C2 0 CD CD 3• F CD I �71- CCD 0 CD 41C cc 010 C Z-% O o/ _ O -�NOQ' N SnO <m .o y 21 m m m c7 o o nCL 3 m z M mg� w 0 ��.O.►m O 17 ? o � m z y m �O m N p O ? m m = 7 7 m N O O m O 3 m O ZKO O N 0 .• rn m o orcro (92 o m C� yt Ao y d0 ' Q �J c to N m ...r m N CD o � 40 n o �m o ` « C/) Z 3: • N 0 N . m CO) 0tom CL= C C* b � 0' � C2 �!► ' �, 3(� z oz 7n o C) �? o tz X o x n z a 0 Wx ( o a� O 0 0 c e ' Location No. 614 Date -�) 0 N°"'" TOWN OF NORTH ANDOVER 3?o',"'O r•,�O�c p Certificate of Occupancy $ L7 D. U D * _ Building/Frame Permit Fee $ ).A A sS C14 SES Foundation Permit Fee $ •_f ` Other Permit Fee $ , Sewer Connection Fee j(3er Connection Fee $ "\4-OTAL r Building Inspector 3 tJ 79, Div. Public Works V, 2 I � iI J /1 p fC M J 0 z N 2 i N N fC W m F J fC � o LL LL 0 Z N ii N y a N 0 Z_ F 0 0 LL LL 0 w N N N 9 N 0 9 U 0 Q 8 � 1 f H � � E i M 0 N N l 0IL Z f f O m r c P Z m° I g EE w po N 1� Ir' f W } F� EL L Q i x Z J W 0 J_ F u F u u Z f O a N F 0 j O F rr w m < 0 a c o 0 d a W < < 3 N < fL t U m m m V �{ `l J 2 Z > z F F F J J 0. 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A m rnm DD JAL Zv M Z N x 2 c Z z O A O y� Z T I II I A Z Z A N ���J II I��)I yy1 I,, I N I I I I IG m I I -1LI�1—'-J_ iI S xl lXl l I l l lyll I I I I I I IW -79.1-1' U 830 01' Sl"E 125.4x' M t s D02 C) i' mmn LA,_ yDZ Cpx Lu TO xM .04D m opo Nva 13, Mim mX 6` INn N0� AZ2 mN3 �Oz �N mv0 U NCz F i• ego o z r rN- rn r•1 ?*z -� v =v N 0Z in mm • m 00 . DO t s �7 r C/) rTl m a z O � o D c-n�_ fl r O z o K > o z o D1 m Kp0D <� v � Z m D O o Z z • z m 0 C m M cn� �CD N D z S _Y m r3 m M cn m z C) �.� cn D r -4 -4 D G m x -ac Mm rn " z"'\ am zo m C:l _ vD n �zm z -� (AD W O z O-< r -n D 0 t m l ° -n �rn�_ -a �I. = v m Noc„un -I zzc� oz < c m ► > cc m m a �7 W rTl zr 00 O D fl _ m D D D �2 o -4 o K > o z o D1 m Kp0D <� v � Z /` O D o -4 z Cl)N m 0 C -� M Goin m N D N W OJ O D fl D A � /` O 0' Cl)N m 0 C -� D � N CAP 0l' 5/"E 125.4tc' I , 1 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone LOCATION: Assessor's Map Number Parcel Subdivision Street Lot (s) 3�0 C -J S-�-- St. Number 3qO ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: �', �>& eAF Conservation Administrator Comments FAX.302,01_� fl/a l • - i Comments Health Agent Date Approved Date Rejected Date Approved J Date Rejected Date Approved Date Rejected Commentsm&k) iN - t F/G� Public Works - sewer/water connections - driveway permit Fire De rtment Received by Building Inspector S?J )V -C -A Date Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE S�i ��, 3 JOB LOCATION 3K0 t,� I K-, c~z 5-v . K)0 .'Rti,so,=2 M A , CIVY T Number Street Address Section of town '.'HOMEOWNER" L= � e - 1 w,,,y -k2c>-� ,� ; r-� rZ & 3 fie' 6 q2- 0 TS S Name Home Phone Work Phone PRESENT MAILING ADDRESS 4s A City/Town State ip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six 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, Section 109.1.1) 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 to six family dwell- ing, attached or detached structures accessory to such use and/or farm structures. A person who -constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Bulding Official, that he/she shall be responsible for all such work..performed under the ;building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State 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 requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. 0 ok rb tP H x w � i O T a a o w z o '� 04 vto U w a w 7 w a � � w w�' > cn m w a o U w O2 w z" v c c4 cn v O cn OEM". ui z r 5 0 a� c L c vAb Ccv Ila CD G �o •EQ t `4% o S CD ca CD v0 cm +SCD c E 0.� L ca cm m 1p y C C � 'O m ' C c y O O �ac�L m �_= o W"r�= c oQ L)CA m �m o� c a Q � y o c o = m y L u C 4;:s m �.. _... O � AD U� m r.. �y G.,= O C Z ac �E 5 oy o LU m omc g VaF. m D --0= O:5 S Wm OM= O F- � Z.- CL O -+L• m CC/ 71 0 l U v7J O U ERW GD O MMO 0 Z O p CO) CD CO) CD L CL co s C O CD Q m raw CO2 0 0 v CO2 C O V cc CIO is O U C F- c CD CL a COD C .O ¢ — Z H cp C cm O2 Lt O •� p •2LLJ � a CL) mm C) z c Ll o � CO U C G O p. .O V' cc -o O O � Z J u OCL Z_ CO2 L F C3 ` Z z c Z � C �c