Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 386 GREAT POND ROAD 4/30/2018 (5)
MW oar location�i--f '-_- No. Date NORTq TOWN OF NORTH ANDOVER 9 4' Certificate of Occupancy $ MusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # V10 3 Build in inspector X r1P!\tt71LT !\T 1T!\1r1hT1r7 ♦ 1TT 11��T i� 1VWlr VV 1NVK1HA1'NVVVLK BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING , BUILDING PERMIT NUMBER: DATE ISSUED: Q 4) SIGNATURE: "Idow cc"Ou� Building Commissioner/IngWor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 32Co 7 ,4 3 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: q,& o2aLf. 2 - Zoning Zonin District Proposed Use Lot Areas Fromm e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided .r 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record MAc Le eo non �oZCo re lZa� t 1jame (Print) Address for Service Signature V Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supmisor: Not Applicable ❑ " !?A&�V H . t JA,� Licensed Construction Supervisor: 65 �j S10 License Number Address a g� Z— l o11 o2e�o a Expirat— n Date igna r Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ c NAY I�'S4pG . TA c-- 1I Q 8 Company Name �j (n (K -M "( e (c� G i r� VUI` ( 1/l Met o t ao Registration Number ba aab-0 o j Address p '761 " 70 �U � Expiration Date gignatire Telephone 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 ....... 0 SECTION 5 Description of Proposed Work check all a Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: d n �k 1 c�beled "PDAs FAcW T a 'Fla-�or a��X,s+���3��^������3`��, .ice eae t L K) T1 G lS� -Eloo I-• W tylc, rte` 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE, ONLY _. 1. Building /go, oa CD (a) Building Permit Fee Multiplier 2 Electrical D 000 (b) Estimated Total Cost of Construction 3 Plumbing / - Qp c7 Building Permit fee (a) X (b) 4 Mechanical (HVAC) 16,000 5 Fire Protection 1ez , 6 Total 1+2+3+4+5 OQO 1 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I>_ A �, , ' 4 We-LeA(18 rA as Owner/Authorized Agent of subject property Hereby authorize RM.40 t -E l N r4Y to act on My behalf, in all rrIatters relqtive to work uthorized boy this building permit application. X W E-�t nnA(o ao Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, J4, Jq/4) as OwnerAuthorizedA ent f 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 VA:14 4. N,IU Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2 ND3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DUVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION AVI+ THICKNESS SIZE OF FOOTING X MATERIAL OF CHMNEY ^014 IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE n FORM - U - LQ.- T 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 fy L /lc PHONE GSS "—"77 ( 3 yASSESSORS MAP NUMBER 97 NLOT NUMBER 3 SUBDIVISION LOT NUMBER STREET C4_0faJ�&A `� I` STREET NUMBER —SZ—(P— a , ................ q . Is ■ .... ■ a ............... ■ ............................... ■ OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS "/lN a IN 6 8 IN 41�11 mc 0 a a 0 0 a a a 0 a IN IN IN a a 0 0 IN a a IN IN a a a a IN a a a a 0 0 IN a a a a a a a a 0 0 a a an a DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED TOWN f_ FOOD INSPECTOR - HEALTH SEPTIC INSPECTOR - HEALTH CON RENTS PUBLIC WORKS — SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT CON SENDS C)(J.- DATE APPROVED b jej 6 DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DA w s ✓1e L�anantnar[uaal� � •�%a4aac�u4el7r4 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 055510 Birthdate: 12/21/1957 Expires: 12/21/2000 Tr. no: 5573 Restricted To: 1 G RALPH H NAY _ 2 WOODHILL LN C —e4rrA- BOXFORD, MA 01921 Administrator I � 07. eaoon�namvwld o�✓if.,aur�iivaelYe HOME IMPROVEMENT CONTRACTOR Registration 112068 Type - PRIVATE CORPORATION Expiration 02/22/01 R. H. NAY ASSOC. INC. RALPH H. NAY G��o,,,Qo7� �o��ltdrARFIELD CIR ADMINISTRATOR BURLINGTON MA 01921 Town of North Andover a* Na RTF{ qti t1 67 0 Building Department o 27 Charles Street ` North Andover Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 �A Q�AAT* 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 nbe disposed of in /at: Facility location Signa e of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 6-12-2000 DATE OF PLANS: 6/1/2000 TITLE: MacLennan PROJECT INFORMATION: MacLennan residence phase 1 COMPANY INFORMATION: R.H.Nay Assoc. Inc. NOTES: Add second floor to existing36x27 3 car garage COMPLIANCE: PASSES Required UA = 210 Your Home = 208 Permit # Checked by/Date 326 Greatpon 6 Garfield C Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1320 38.0 0.0 40 WALLS: Wood Frame, 16" O.C. 780 15.0 3.0 52 GLAZING: Windows or Doors 235 0.350 82 FLOORS: Over Unconditioned Space 1040 30.0 34 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer Date !V12_106 The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations , Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: `` r/✓11i� rr Location: 0( d City /\/,r Phone -6e3 —77 13 am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity am an employer ''providing �workers' compensation for my employees working on this job. Company name: C-Z"''� �t /�TSOc. ��,w�._ Address to r�flc e-[ J City: V1 /✓l�F O t 80� Phone #: Company name: Address City Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage ver cation. I do herby certify under the pains an¢ penalties of perjury that the information provided above is true and correcL Signature uate( v Print name �a c,� %���.•�i/ Phone # %8l o7710'Y86d Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION s I R-H.-NAY-11�ssociates, Inc. 6 Garfipld Circle Burlington; MA 01803 Submitted (781) 270-4880 • FAX (781)'270-0165 To: Mark and Wendy MacLennan 326 Great Pd:nd Road No. Andover, MA 01845 s Page No. ` of Page PROPOSAI All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt' from registration by Provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108. (617) 727-8598 JOB NAME/NCI. Phone Date JOB LOCATION 978) 683-7713 5/31/00 We hereby submit specifications and estimates for work to be performed and materials to be used: MACLENNAN RENOVATIONS TO 326 GREAT POND ROAD, NORTH ANDOVER AS PER SPECIFICATION, AND PLANS BY ABLES AND ASSOCIATES ARCHITECTS, INC.., DATED 6/1/00. WORK WILL CONSIST AS PHASE I ONLY. * Add 2nd floor over garage with 3/4 bath and laundry. I ' ' Renovate ist floor including kitchen and 1/2 bath. TOTAL RENOVATIONS $ 218, 000. 00 Please Note: This does not include paint other than exterior priming. z rA si xGO o o w a cn lz O O z c o w to o a: E x U �, c w' a O a �°° o a' q w O w W �°° o w C w U � o c4 C w W w m o V) R co Cm I p� CD O O A4 � m m CD O CD CLI.— L ca � O � CL) co 0 0 cc o a C,* C O +�-� ccC •C. O Cl? c Z CD 0 CL �..± CO) cc c Q. E LLJ 0 Cn LLJ Cn irW w w U) cm o ' m c o c H I U CJ L o � 0 PLO h m CO �. Y CS m CL r C D ��smc E N R m m�co � N �` N W. is m.5 N 3 c G cc N43 �+ a� m t = O cm = C O Q 'O moi: p, C r CCD om Ln z o�"a cm cs ao ti � N c m (a m c CL 0 m ~ m W L c fl Z r-• C!.6 fNA o' 2 z 400 N •C' C#3 C3 OF cm m .5 O = S N o H �(m CL yL., Ln :No R co Cm I p� CD O O A4 � m m CD O CD CLI.— L ca � O � CL) co 0 0 cc o a C,* C O +�-� ccC •C. O Cl? c Z CD 0 CL �..± CO) cc c Q. E LLJ 0 Cn LLJ Cn irW w w U) N2I i v Date ....... ....... ........4J. 4 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 7 This certifies that .............................................. ... 00;7 has permission to perform ..... - ................................... ej ell '254 , - - .; wiring in the building of . . ... ... ..../`k .................................. orth Andover, Mass. ... ......... . at .......... 34�� Fee..Z . ..... Lic. No ............................................................................. ELECTRICAL INSPECTOR 07/07/93 I-Jju WHITE: Applicant CANARY: Building Dept. PINK: Treasurer "E:--0=-- 0 Use Only �+ • �!£ GJ�'yJ�yjt�'yn(/£j�Lr%%lrr�$51�c:+SL�'l�%S Fee Checked 9�r,�,r..u.c ^6 P•� S•6ar BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORMSIELLECTRzCA�L WORK R 12:00 All went to be Performed in accord Date % / -257 all information) To the Inspector of Wires. (please Print In ink or type Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Locabcn (Street & Number 4 T 7A Owner or .a " Owner's Address B ) Is this permit in conjunction with a bulkring perrrm t Purpose of Buddin f �h � E,dsting Se:rv,ce Z6QAmps4 ye New Service EQO—SPS ` 4?//� Number of Feeders and ArnpacitY� I Location and Nature of proposed Electrical Work. No o_ f L� i ht8n Outlet �a No. of L nting Fixtures Vo No. of Rete tacies Outlets ' No. of SMtch Outlets No of Ran es NO. of DipObat No. of Disnwasners N0. Of D r9 No. of Water Heaters KW No. Hydro Massage Tu^ , Yes No ❑ (Check Appropriate as Volts Overhead ❑ Volts Overhead C3 of Hot fuse Above ❑ In ❑ mmmg Poolqmd ❑ 9md of Oil Bumers of No of Air No. Of Total Ton. Heat Total Pump_ S 0-n- Np of Bailase Total F Utility Authon7on No. Undgmd Undgmd No. of Meters I— No. of Meters ,-.__ Total KVA Generators KVA No. of Emergency LUgnting NSURANCE COVERAGE. Pursuant to the requiremen8ts of Ntassachusetts General Laws -) NO = YES please indicate the type coverage by checking the appropriate box I have a current Lability Insurance Policy indican mNo�° Operations you have Ch racked age or its substantial ate the n valid proof of same to the Oftl NSURANCE J= BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of E cal Works "� v Rough Final Work to Start 18K Inspection Date Resquested Signed undefthe �� ` f perjury: LIC. NO. FIRM NAME o LIC. tJcenaee Signature �lnXbd� , �/� Bus. Tel No. I �/p( I Alt Tal. No. Pddress ltJ OWNER'S INSURANCE WAi I am aware that the Licenses does not have the Insurance coverage or Its safes P�eaae Check one) required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner %ti9 ( +� Telephone No. PERMIT FEES (Signature of Owner or Agent) RE ALARMS No. of Zone o. of Detection and itiating Devices q o. of Sounding Devices No./ of Self Contained etectiorvSounding Devices ❑ Municipal ❑ Other ocal Connectionow Voltage NSURANCE COVERAGE. Pursuant to the requiremen8ts of Ntassachusetts General Laws -) NO = YES please indicate the type coverage by checking the appropriate box I have a current Lability Insurance Policy indican mNo�° Operations you have Ch racked age or its substantial ate the n valid proof of same to the Oftl NSURANCE J= BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of E cal Works "� v Rough Final Work to Start 18K Inspection Date Resquested Signed undefthe �� ` f perjury: LIC. NO. FIRM NAME o LIC. tJcenaee Signature �lnXbd� , �/� Bus. Tel No. I �/p( I Alt Tal. No. Pddress ltJ OWNER'S INSURANCE WAi I am aware that the Licenses does not have the Insurance coverage or Its safes P�eaae Check one) required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner %ti9 ( +� Telephone No. PERMIT FEES (Signature of Owner or Agent) P N -or l U f Date ........r% ......... ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................... "` .� /.�'`�'�''�"� ................:................................................ has permission to perform -1-- rte.-'-.. . ...F" �' - '� ............ .. ,>~ wiring in the building ...... `�h ........... .................................. ............................... at ......../.............:...-.: /�..................................... , North Andover, Mass. Fee%"o...... Lic. Nb. .'� ........... .......... ........................... .... ...... ..... ELECTRICAL INSPECTOR 04/29/98 10:00 187.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office Use Only Permit Na 1, V Occupancy 8 Fee Checked iJc�t+r.+ret � r'�a61/e Sa6cty BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CM 12:00 (Please Print in ink or type all information) Date To th Insipfictoro W . Town of North Andover The undersigned applies for a permit to perform the electrical work described below. / Q Location (Street & Number. Owner or Owner's Address S" P Is this permit in conjunction with a building Purpose of Yes �/ No ❑ (Check Appropriate Box) Existing Service C/ l/' 0 ,Amps ;2o2 V Voits New Service C/- ,10 1-3 Amps 2-2v Volts Number of Feeders and Location and Nature of Proposed Electrical 4 Gr c) r 2 " Y^ „ K 6r— 0 F% Overhead ❑ Overhead ❑ Authorization No. Undgmd EYI No. of Meters Undgmd 25 No. of Meters e � a 01 Cli7 e-1 ,-7,f L-,- �GG 4'nZ J f'—,r_,c-Q OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) �C�o o c� _ u G� (Expiration Date) Estimated Value of EI tri I W tk5 T Work to Start Inspection Date Resquested Rough Final Signed underthe naltles of perjury: FIRM NAME - LIC. NO. NO. 11-2 1' � I /t ,,( / Bus. Tel No. 1 57� Address %vU fi6 ?c�< t^e TFC cC x6.t/ate Alt Tel. No. OWNER'S INSURANCE WAIVER: Ii aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $_� (Signature of Owner or Agent) Total No. of LightSnq Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimminq Pool gmd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Bumers FIRE ALARMS No. of Zone No. of Detection and Tolal No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Oiposal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Soace/Area Hearing KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Baiiases Winn No. Hydm Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) �C�o o c� _ u G� (Expiration Date) Estimated Value of EI tri I W tk5 T Work to Start Inspection Date Resquested Rough Final Signed underthe naltles of perjury: FIRM NAME - LIC. NO. NO. 11-2 1' � I /t ,,( / Bus. Tel No. 1 57� Address %vU fi6 ?c�< t^e TFC cC x6.t/ate Alt Tel. No. OWNER'S INSURANCE WAIVER: Ii aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $_� (Signature of Owner or Agent) No.Date 3 //0 � NORTH TOWN OF NORTH ANDOVER go Certificate of Occupancy $ Building/Frame Permit Fee $ • 01" < .�. • A S�1CMus - Foundation Permit Fee $ 4 �} C� Other Permit Fee $ >L Sewer Connection Fee $ m Water Connection Fee $ F TOTAL $ r 2,CL70 Building Inspector co .. M Div. Public Works V a 00 o- 9 l �0 o� � V 195 0� N W 8 W m ow W h h A = i 0 0 u g u i a <a�999L n o� o0 t z A j F F W W F- W d a z IA z 0 F u N z e � l �r V N n o� o0 LU w 3 0 0 O V f + 1 r • HOME IMPROVEMENT CONTRACTOR Registration 108176 TYpe -• PRIVATE CORPORATION ExpiTation _ 00/13/98 4 RANUCCI CONSTRUCTION, INC. Joseph A. Ranucci I I &' tlfiTneT Road ADNUNISTRATOR MaynaTd MA 01754 "- "*✓�te Gnnzrxorzu�rrl(� n`� ljraluc�utr/l 1 j r"t R F DEPARTMENT OF PUBLIC SAFETY CONSTR0GTl01 SUPERVISOR LICENSE r _ Naaberi Expires. Birtbdete: r i CS 117999 /113111999 8113111946 Restricted To: CO JOSEPH A R:4N0001 4 TURNER RD ' d.Goa.,,w �5 Qifttd MAYNARD, MA 11754 t R f + 1 r • HOME IMPROVEMENT CONTRACTOR Registration 108176 TYpe -• PRIVATE CORPORATION ExpiTation _ 00/13/98 4 RANUCCI CONSTRUCTION, INC. Joseph A. Ranucci I I &' tlfiTneT Road ADNUNISTRATOR MaynaTd MA 01754 lips . I' giriT, . JCi vices iJ;;)UCS WJU-61114 rLL. �C_? il_1 • 1 D 141, . :t_ r . _i rhe Common wealth of UaSWMUSetts ` Department of Industrial Accidents' - ol�resorr�vssu�►�uoas 600 Washington Sired Bostall, Mass, 01111 Workers' Compensation Insurance Affidavit IACetinn• O n r .. O �wN7 u, $nes statement may be forwarded to the Office, 0r I(IvcB,Iga-- -- Uf the, DIA for &,%!rage %cri013 nU'M a day against me.. I understand that a 1 do hereby !jy ander p/alntand enalfles c jpetj"O hat the irtjorMarin„ provided above is true and rorrea .SlpJt&CUIE -+ !/ // 2,A .-Pate Print Print name ,!Acta! use only do 1101 write in this arca to he completed by city or town omelal dty or town.,^, •--- ...._ ..--- permiuH&ense q _ ,.�AAuliding Departnotcnt ❑ check If Immediate response is rtyulred OLieensing $oard pScleetmen's Opice contact person. phone k; ClItAlth Department �..�_.... ,, —... Others_ (miwd IM PIA! vrVri U - LU I KELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/per" from Boards and n-,)artments having jurisdiction have been obtained. This does not. ve the applicant and/or landowner from compliance with any applicable or elie requirements, "***"*"*�*****APPLICANT FILLS OUT THIS SECTION J APPLICANT D6 s L /�I . ✓LOCATION: . Assessors Map Number PHONE ?b � J SUBDIVISION PARCEL L / VJ 2� OT (S) v STREET ,a, P�5j fo ST. NUMBER 3 06 USE ONLY KCGVMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED _ IS 7 DATE RE ECTED— CnMMENTS r7yyl TOWN PLANNER DATE APPROVED C - DATE REJECTED FOOD INSPECTOR -HEALTH "%I c ArrKUVED -- DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS /PUBLIC WORKS - SEWER/WATER CONNECTIONS �j DRIVEWAY PERMIT �,� 3 FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE i t .t Registry of Deeds Northern District of Essex County Lawrence, MA 01840 09/17/97 DOUGLAS ELY �3 (� 5 # 49 Rec:time 1142 Type FLAN 1.00 Inst 23822 Copies 2.25 Total 27.25 # 50 Payment Cash 27.25 THANK YOU! Thomas J. Burke Register of Deeds t Y 'a. t 'a. 0 0 PjjW 4�� 1 � 10 _-) o ;c TOWN OF NORTH ANDOVER �•' MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION REpI;F-, JOYCE BRANAAW TOWN CLERK NORTH ANOOYER JUL 21 la 32 AM T Property: 386 Great Pond Road Douglas Ely & Judith Zazula Date: July 21, 1997 386 Great Pond Road Petition: 011-97 North Andover MA 01845 Hearing Date: 6/10/97 - The Board of Appeals held a regular meeting on Tuesday evening, June 10,1997 and July 8, 1997 upon the petition of Douglas Ely & Judith Zazula requesting a variance under Section 4.136 Paragraph 3c (iii) (3) of the Zoning By -Law. The request is for relief from gross floor area increase limitation of 4.136 Paragraph 3c (iii) (3) in the Watershed Protection district for the purpose of expansion to an existing structure.. The following members were present and voting. William Sullivan, Walter Soule, Robert Ford, Scott Karpinski & Ellen McIntyre. The hearing was advertised in the North Andover Citizen on May 21, 1997 and May 28, 1997 all abutters were notified by regular mail. Upon a motion by Robert Ford seconded by Walter Soule to Grant the petition to allow expansion .of existing structure greater than 25 percent, expansion of living space will be 40 percent and the rest is the garage and basement area in R-1 Zoning District: The request was for relief from gross floor area increase limitation in the Watershed Protection district for the purpose of expansion to an existing structure. Decision made with the condition that the tie into the sewer system be done prior to any building or expansion. Voting members were: William Sullivan, Walter Soule,, Robert Ford, Scott Karpinski, and Ellen McIntyre. 0 M The petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the granting of this -variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning By law., Note: The granting of the Variance and/or Special Permit as requegted by the applicant does not necessarily ensure the granting of a Building permit as the applicant must abide by all applicable local, state and federal building codes and regulations, prior to the issuance of a building permit as required by the Building Commissioner. BOARD OF APPEALS, William Sullivan, Chairman t Y IV, ;c o o v O y VO V O, C cc :=o Ea a� r C W CI ( v D M V I, `r m . o o. EE i o n�t; C Q H E p C Q C a y A C c'vyva : E m av m ' H O :tt o CM Q C O Q ' dCt 4 o pt m V H Z O O O Of Q � y O C •O C36 C2 N Uj CIO r W 0 ac 'E ca �h o C.3 o g y O. O O :0 �-em= Cl cco.S m 5 T 9 O v ICD cm O•— Na � 'fl ai■— N! O O •i m m CD 0 co CD cc cm cc 0 CL O L M, O!Q ca cc ■w � 'v 0D i. CD CL G.� CO) cc C. C • C cc E 0 G a a u N ` 9 C U w �h a ;c o o v O y VO V O, C cc :=o Ea a� r C W CI ( v D M V I, `r m . o o. EE i o n�t; C Q H E p C Q C a y A C c'vyva : E m av m ' H O :tt o CM Q C O Q ' dCt 4 o pt m V H Z O O O Of Q � y O C •O C36 C2 N Uj CIO r W 0 ac 'E ca �h o C.3 o g y O. O O :0 �-em= Cl cco.S m 5 T 9 O v ICD cm O•— Na � 'fl ai■— N! O O •i m m CD 0 co CD cc cm cc 0 CL O L M, O!Q ca cc ■w � 'v 0D i. CD CL G.� CO) cc C. C • C cc E 0 N° 6 U' 7 Date.��.�G ..,�,... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 'ISSA`Jf (` This certifies that ...... .a::� . ........................................ 5 has permission to wiring in the building of ...............:....a ....`................................ at ...�.'�.!«..... ...... , North Andover, Mass.°; — e7_61 Fee ..................... Lic. Noes ' ................. .............................................. r- ELEC RICALINSPECTOR .r WHITE: Applicant CANARY: Building Dept. PINK: Treasurer AM_ Erpti-twit cf Ilublic $afrtq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 onloa Un P0ermit No. d o«upa a rya clacked W90 paaw blank) APPLICATION performed IPERMITwtTO PERFORM ELECTRICAL WORK MassachusettsAll work to be Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date _I 7 %* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to Location (Street & Number) Owner or Tenant rform the electrical work��descr' ed below. rI.,-- J J Pit, , , Owner's Address V Is this permit in conjunction with a building permit: Yes No [ (Check Appropriate Box) Purpose of Building i l" Utility Authorization No. Existing Service Iv` b Amps 12/ 2c(a Volts Overhead Le"I" Undgrnd Q No. of Meters _C___ • New Service Amps _J Volts Overnead _ Unagrna C No. of Meters Number of Feeders and Ampacity 3 Location and Nature of Proposed Electrical Work T`1 No. of Lignhng OutletsI No. of Hot acs No. No. of Transformers Total KVA No. of Lighting Fixtures i Swimming P^oi Abcve.— in- f— grno. _ grno. I Generators KVA No. of Receotacis Outlets No. of Oil corners No. of Emergency LightingBattery Units No. of Switch Outlets I No. of Gas=_rrers FIRE ALARMS No. of Zones No. of Ranges No. Cf Air C-r.c. oiai No. of Detection and !cns Initiating Devices No. of Disposals I No.of Heat 70..ai .otai Purr.cs :ons P(W No. of Sounding Devices No. of Sed Contained No. of Dishwashers I SoacerArea Heating K%v OetectionrSounotng Devices No. of Dryers I Heating Cevices KW Local ; Municioal r—Other Connection No. of .VO Jt Low Voltage i No. Of Water Heaters KW I Signs °a lass Wiring No. Hyaro Massage Tubs I No. of Molcrs -oiai HP OTHER: INSURANCE COVERAGE. Pursuant :o the reouvemenis JI Massacnusers ;eneral Laws 1 have a current Liability Insurance Policy including C;,mb:etec Ccerations Coverage or its substantial equivalent. YES = NO — 1 have suomitteo valid proof of same to the Office. YES = v0 = It you have checked YES. p(eaae indicate the type of Coverage Oy, checking the approonate box. "_ INSURANCE = BOND = OTHER = (Please Scec:��) I=flV(C Estimated Value of E!ectncal Work S /2191)- cn� (Exouation Ostsi Work to Start �' % L %% Insoecaon pate �acues:ec: o gn Final Signed under th Pena ties of pe / FIRM NAME LIC. NO. ZS- Vy Licensee Si azure "��� �' UC. No. �a U"S,D ,-t 'Ciw(\S�u,,,, 9ua. Tel. No. Address Alt. .el. No. I OWNER'S INSURANCE WAIVER: I am aware that the t-: see toes not have the insurance coverage or its substantial equivalent as rw duireo by Massachusetts General Laws. and that my signature on ^'s cermit aoplicauon waives this redutrement. Owner Agent (Please Check over :sieonone No. PERMIT FEES (Signature of Owns or Agsntl Town Of North Andover Building Department 508-688-9545 Plan Review 146 Main St. Town Hall Annex Daglas & Jodi Ely APPLICANT: l �t � MMA' 01845 DATE:March 27, 1997 Zoning District : ' Use Code: Title of Plans and Documents: Addition to Existing Dwelling Request: Reviewo oning Please be advised that after review of your building permit and or zoning review has been DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Open Space Insufficient Lot Frontage Sign requires permits prior to Building Permit Form U not complete by other departments Not in conformance with Growth By -Law R I Use requires permits prior to Building Permit IX Other I Other Prohibited Uses Remedy for the above is checked below. Dimensional Sign Variance Special Permit for Watershed Review Special Permit for Site Plan Review S ecial Permit for sign Complete Form U sign -offs Copy of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Variance for Sin Other Plan RevleW The plans and documentation submitted have the following inadequacies: �ay10 J8410 uluueld uolsslwuao0 0110lslH sliom ollgnd )0 luaua>Je as u01jeAJasu00 pleog uluoZ aollod rllleaH all -A m I. n 1 n\ 1 Plan Review Narrative The following narrative is provided to further explain the reasons for denial for.ithe building permit and or request for plan review for the property indicated on the reverse side: ' following Boards and Commissions must issue Permits prior to The submittiniz an applciation for a Buildin Permit: 1- Narth Andover Chnspryation commission-, 2. North Andover Watershed Protection Commission 3. North Andover Zo i g Board of -Appeals - 4. North Andover Planning Board - Special Permit. 4.136 WATERSHED PROTECTION DISTRICT Prohibited Uses: 4.136 c 4.136 d (,ii) ii 3 (8) ] percent e computation of the building footprint shows the expansion f the existin structure to be well over the 25 allowed in he ex ansion is prohibited in the Waterahesl�F Qtection District. Please have your Engineer/Architect verify the Gross floor Area of the proposed expansion vs. the existing structure. E closed onvenience and review. • J are not organic or slow-release nitrogen. iv. Building Requirements: All construction in the Watershed Protection District shall comply with best management practices for erosion, siltation, and stormwater control in order to preserve the purity of the ground water and the lake; to maintain the ground water table; and to maintain the filtration and purification functions of the land. C. Non -Disturbance Buffer Zone There shall exist a Non -Disturbance Buffer Zone within the Watershed Protection District which shall consist of all land areas located between one hundred fifty (150) feet and two hundred fifty (250) feet horizontally from the annual mean high water mark of Lake Cochichewick, and between seventy five (75) feet and one hundred fifty (150) feet horizontally from the edge of all wetland resource areas (as defined in M.G.L. Chapter 131, Section 40, and the Town Wetland Bylaw) located within the Watershed. i. Allowed Uses: All of the Allowed Uses listed in Section 3(a)(i) of this Watershed Protection District Bylaw are allowed in the Non -Disturbance Zone except as noted below. ii. Uses Allowed by Special Permit: The following uses shall be allowed within the Non -Disturbance Buffer Zone only by Special Permit issued pursuant to Section 4 of this Watershed Protection District Bylaw: (1) Any activities which cause a change in topography or grade. (2) Vegetation removal or cutting, other than in connection with agricultural uses or maintenance of a landscape area. (3) Construction of a new permanent structure only after a variance has been granted by the Zoning Board of Appeals. (4) Replacement of any permanent structure. (5) Any surface or sub -surface discharge, including but not limited to, stormwater runoff; drainage of any roadway that is 50 d any private association; outlets of all drainage swales; outlets of all detention ponds. (6) Construction of any accessory structure or expansion of any existing structure by less than twenty five (25) percent of the gross floor area of the existing structure. (1994/1STM) iii. Prohibited Uses: The following uses are specifically prohibited within the Non -Disturbance Buffer Zone: (1) All of the Prohibited Uses listed in Section 3(a)(iii) of this Watershed Protection District Bylaw are prohibited in the Non - Discharge Zone. (2) Construction of any septic system. (3) Construction of any new permanent structure, or expansion of an existing structure by twenty-five (25) percent or more of the gross floor area of the existing structure. (4) The use, or method of application of, any lawn care or garden product (fertilizer, pesticide, herbicide) that may contribute to the degradation of the public water supply. (5) The use of lawn care or garden products that are not organic or slow-release nitrogen. iv. Building Requirements: All construction in the Watershed Protection District shall comply with best management practices for erosion, siltation, and stormwater control in order to preserve the purity of the ground water and the lake; to maintain the ground water table; and to maintain the filtration and purification functions of the land. d. Conservation Zone There shall exist a Conservation Zone within the Watershed Protection District which shall consist of all land areas located within one hundred fifty (150) feet horizontally from the annual mean high water mark of Lake Cochichewick, and within seventy five (75) feet horizontally from the edge of all wetland resource areas 51 i (as defined in M.G.L. Chapter 131, Section 40, and the Town Wetland Bylaw) located within the Watershed. i. Allowed Uses: The following uses shall be allowed in the Conservation Zone of the Watershed Protection District except as noted below: (1) All uses associated with municipal water supply/ treatment and public sewer provided by the Town of North Andover. (2) The Division of Public Works may conduct routine maintenance of any existing use of property, including the maintenance and improvements of existing roadways and drainage systems. (3) Maintenance of fire access lanes by the Fire Department. ii. Uses Allowed by Special Permit: No Special Permits will be granted in the Conservation Zone. iii. Prohibited Uses: The following uses are specifically prohibited within the Conservation Zone: (1) All of the Prohibited Uses listed in Section 3(a)(iii) of this Watershed Protection District Bylaw are prohibited in the Non - Discharge Zone. (2) Any activities which cause a change in topography or grade; (3) Vegetation removal or cutting, other than in connection with existing agricultural uses or maintenance of an existing landscape area; (4) Construction or placement of any new permanent structures; . (5) Any surface or subsurface drainage, including, but not limited to, stormwater runoff; (6) Animal feedlots or the storage of manure; (7) Construction of any septic system. (8) Construction of any accessory structure or expansion of an existing structure by twenty - 52 4. expansion of an existing structure by twenty- five (25) percent or more of the gross floor area of the existing structure. (9) The use, or method of application of, any lawn care or garden product (fertilizer, pesticide, herbicide) that may contribute to the degradation of the public water supply. (10) The use of lawn care or garden products that are not organic or slow-release nitrogen. The above prohibitions shall not apply to any activities undertaken by the Division of Public Works within its authority or to work completed in conjunction with the construction of the municipal sewer system. (1994/1STM) Special Permit Recruirements a. Nine (9) copies of an application for a Special Permit under this Section shall be filed with the SPCA. Special Permits shall be granted if the SPGA determines that the intent of the Bylaw, as well as its specific criteria, are met. In making such determination the SPGA shall give consideration to simplicity, reliability, and feasibility of the control measures proposed and the degree of threat to water quality which would result if the control measures failed. b. Upon receipt of a Special Permit Application, the SPGA shall transmit one (1) copy of each to the Division of Public Works, Fire Chief, Title III Committee, Division of Planning and Community Development, Conservation Commission, the Board of Health, and the Watershed Council for their written recommendations. Failure to respond in writing within thirty (30) days shall indicate approval or no desire to comment by said agency. C. An application for a Special Permit under this Section shall include the following information: i. Application Form for a Special Permit from the Planning Board. ii. Map on a scale of one (1) inch equals forty (40) feet prepared by a Registered Professional Engineer or Surveyor showing: (1) the annual mean high water mark of Lake Cochichewick (if annual mean high water mark 53 Date.-/-;.... e ............ NORTH tb)yN OF NORTH ANDOVER 2 Ory 41 QED d,ti OO� /I�yJJJJ/^/;PXRMIt''� / ,q� GAS INSTALLATION 110," Esc, �y 9SSACENUSEt t��i/ � q010- This certifies that.. .. > has permission for gas installation ../. '.... " r............. in the buildings of ..: �c c : ` �r ................................ at .%C .'` !'..'. a : !.'� :.:! . .............. North Andover, Mass. Fee..'.? ..... Lic. No.0%::!? . ?... ......................... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINC� / (Print or Type) / / `�� C o ��+(f , Mass. Date 19 Permit #1. % 2 Building Location 3XC =Owner's Name Type ofOccu anc P Y RF_� `IDEM-flAi - 1 -- New Renovation❑ Replacement ❑ Plans Subs' ed: Yes❑ No installing Company Name BAY 5TA-rF CAS CD (PRoPaNF) Check one: Certificate Address 55 H A R5T0 I 0 Corporation E 4 C� _ I LA lel R EQ " HA r,1841 ❑ Partnership Business Telephone - _ S _ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter, dN't'ry"ey INSURANCE COVERAGE: 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 coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of Indemnity ❑ Bond ❑ !`r I: 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 ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene ws. BY T e of Ucense: ✓�Lsar�'�1 _.. . Plumber Signature of cense lumber or Gas Fitter Title Gasfitter Master Ucense Number City/Town . Journeyman APPROVED O IC L r 'MENEM ON MEN MKIMEMI ■MMMME■11111111vu��N�■MEMOson installing Company Name BAY 5TA-rF CAS CD (PRoPaNF) Check one: Certificate Address 55 H A R5T0 I 0 Corporation E 4 C� _ I LA lel R EQ " HA r,1841 ❑ Partnership Business Telephone - _ S _ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter, dN't'ry"ey INSURANCE COVERAGE: 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 coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of Indemnity ❑ Bond ❑ !`r I: 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 ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene ws. BY T e of Ucense: ✓�Lsar�'�1 _.. . Plumber Signature of cense lumber or Gas Fitter Title Gasfitter Master Ucense Number City/Town . Journeyman APPROVED O IC L 2 0 f - U W a 2 t N v y J .-.. ¢ a 4 } � t ' v a i E LL i o TW.' H W- cc o 10 cc o :w a t' a a a ' ur L i» w .z ¢ W .r = r i 0 ' fL ' N Z .1 a Z_ LL v z c J n LL 0 w IL 1- 44 w z 1 . N a v O C: w C3 J C. 0 Date.... .. w 1?p TOWN OF NORTH ANDOVER 0 Oy tt�eo FOR GAS INSTALLATION 49 L9 SACHUS /VO 1999 This certifies that .... has permission for gas installation ......... . in the buildings of ... 6t4 .............. at NorAndover, Mass. Fee. <f:,:-). 7---r-Lic. No../(i. 1-3. .......................... ( I t( ..", / -� > �(r -, GAS INSPECTOR WHITE: Applicant -Z4�-.- Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINGh . (Print or Type) ko, 41vyeyelz Mass. Date 19 City, Town Permit # 6?iH Ci/33(w` Building ) Owner's / AT: Location 3r6 elygewl f D !K�✓ Name �O(%CyLAS �id�Ly G Type of Occupancy: S%NJL�c New ❑ Renovation P3 Replacement ❑ Plans Submitted Yes ❑ No F] (Print or Type) /v Check One: Certificate Installing Company Name e6myte Will�o/LP. ® Corp. I Address 1?7 RDU(1-j 1VA1 �c�, ❑ partnership al)/y40 {{qm Al-AlI ❑ Firm/Company Business Telephone o? -?'f -(� 6/S Name of Licensed Plumber or Gasfitter A / er- 0 C :4 iRl?,61-1 7-/ ( -::s 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: G erz Y Plumber Gasfitter Signature of Licensed Master Plumber or Gasfitter Journeyman 100 -,3 License Number MEN ■■■■■■■■■■■■■■�■■■■■■■■■■■ (Print or Type) /v Check One: Certificate Installing Company Name e6myte Will�o/LP. ® Corp. I Address 1?7 RDU(1-j 1VA1 �c�, ❑ partnership al)/y40 {{qm Al-AlI ❑ Firm/Company Business Telephone o? -?'f -(� 6/S Name of Licensed Plumber or Gasfitter A / er- 0 C :4 iRl?,61-1 7-/ ( -::s 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: G erz Y Plumber Gasfitter Signature of Licensed Master Plumber or Gasfitter Journeyman 100 -,3 License Number 0 v m S z V. 3 In to O z O In m m 'j z D z N �v m A -i O Z ►= 3742 IjORTPI 1 O T SS�CHUS� Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ................ has permission to perform . /�.J -5�!!.,/f e, ......................... plumbing in the buildings of .. j%('. ........ at. -�� .. 'z 12& ......, North Andover, Mass. Fee . 7�. -. Lic. NO -1) C? .......... I ................... PLUMBING INSPECTOR 45/14/98 48;44 70.00 RAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �o MASSACHUSETTS UNIFORM APPLICATION FOR PEIT TO DO PLUMBING Cype or print) NORTH ANDOVER, MASSACH�ETTS f duilding Locations Q�vo Y e W T I d Owner's Name New In Renovation F-1 Replacement Plans Submitted n FIXTURES Date C, 1 bs- Pen-nit # 7 O 2_ Amount (Print or type) Installing Company Name !l Address f -'e J14, S � :e 0"A o Check one: n Corp. " Partner. Business Telephone J310 T(- 3,7 go S Q © Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above Certificate t rance Sighaturg, Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass setts State PI bang Codeand Chapter 142 of the General Laws. 7 �,�� BY Signa ui re of -L uens�� um er Type of Plumbing License Title /5, G �4� City/Town ►cens um er Master Journeyman APPROVED (OFFICE USE ONLY • .-1` I -------------------------I (Print or type) Installing Company Name !l Address f -'e J14, S � :e 0"A o Check one: n Corp. " Partner. Business Telephone J310 T(- 3,7 go S Q © Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above Certificate t rance Sighaturg, Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass setts State PI bang Codeand Chapter 142 of the General Laws. 7 �,�� BY Signa ui re of -L uens�� um er Type of Plumbing License Title /5, G �4� City/Town ►cens um er Master Journeyman APPROVED (OFFICE USE ONLY MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMrBING Cype or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New Renovation Replacement El Plans Submitted ri FIXTURES Date — Perm it Amount (Print or type) Check one: Installing Company Name Corp. Address Partner Business Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy n Other type of indemnity a Bond ❑ Certificate 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 Owner 11 Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Signature ot Licenseaum er Type of Plumbing License Title City/Town LlcenSe Number Master ❑ Journeyman ❑ APPROVED (OFFICE USE ONLY