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HomeMy WebLinkAboutMiscellaneous - 39 WOODLEA ROAD 4/30/2018Z. l 10027 Date .7/// � ���'c1,Yrb�s•s,,' TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that 11,,,... ............. . has permission to perform ..- ............. plumbing in the buildings of. g .. lti ..................... at ..'...�h1�...4V........ North Andover, Mass. Fee..3b?O .. Lic. No..1. -�!�-7/ .. A7 � ................ ... • Check`# v i PLUMBING INSPECTOR --- ..._... y MAS'S'AC.HUSETTS' UNIF.ORM�APRLICATION`FOR}A' PERMIT TO PERFORM'PL"UMBING WORK -1(y) I IMA DATE! ---- PERMIT# /1 1�r CITY !_ �'!..... l _....... _.— _ ............. ._ '✓i�OWNER'S NAME! Gn�JO3SITE ADDRESS -_1t G✓Cr� ,' '�- OWNER ADDRESS L_ - - `- TELL �I�.-1_'?.......�FAXI..._............_..._........_..__._.......•_ _.- - -COMMERCIAL TYPE OR OCCUPANCY TYPE i__.-; EDUCATIONAL ( RESIDENTIAL C PRINT __. ,_--' i REPf_ACEMENT: PLANS SUDMITITD: Yf.S ; j NO CLEARLY NEW: ,: RENOVATION: (_- - -- — — -- — - -- — -------- FIXTURES Z FLOOR- --- -- --------.. _— CROSS CONNECTION DEVICE -- -- '!f .---- 13SM 1 ! rt I _ ._J............. 'IL DLI]ICAI`_D SPECIAL WA°STE.SYSTEM I� —. —_— -- SYSTEM �.----Il--- 1 I]EDICATED GAS/OIL/SAND DEDICATED GREASE SYSTEM - DIFDICAI IFI] GRAYWATER SYSTEM _ II--- =, jr _ju�it DEDICATED RECYCLE SYSTEM _ _ — - -- -- -- I)ISHWASI II R -T • - j I _ �- ; I ti C'I ; DRINKING FOUNTAIN _f • .___ � �. _' .�`I ,t�. - I�I 1=00D DISPOSER 1i DhAIN I I OOR I AhLA INT I RCEPTOR (INTERIOR) �� � al - — - ---------------- KI I CI IEN SINK LAVATORY TORY I- 1 d -_ ROOF DRAIN_� — ------.— - — __..- --- —t l J r i 11 r ill I at 1 11 SHOWER STALL ���---.- ---- -----� � i If RVI C1= I MOP SINK lUllf I �... i_.. _ r ' I - � i r t U13INAI_ WASHING MACHINE CONNECI)ON ---- --- --- _— �Al ER HIFATEh TTY t'ES —� .��_,. �1 1 r, t ,... a V -:= I WARyPIPING I f f. _--_-- rr )THL-I 7 y r 1_..e, �j —_ Lv. ._ . 1�I I INSURANCECOVERAGE. I halve a current liabilit insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES � ^j NO _ 11 Y( -)(,j CI-IFCKI"IfYLS, I'LEASF INDICATE 1111_ IYP1. OF COVERAGE 13Y CI IECKING 1,I IE APPROPRIA'TL= 130X 131=1.OW I I_IABILP Y IW URANCI= POLICY f I OTI'IIFR TYPE OF INDEMNITY ( BOND I.... _, OWNER'S INSURANCE WAIVER: I am aware that the licensee does not,have the Insurance coverage requiredby Chapter'14'1_ of the.. Massachusetts General Laws, and that my signature on this permit application waives this requirement. CI-IECI( ONE ONLY: OWNEI,. AGENT , i I _ SIGNATURE OF OWNER OR AGENT _ _------- -1— ----- I holib11 Y cc.rUiytluit ,al6of the Details and information I have, submitted or entered regarding this al'tplicaUoii rrc true aiaccurate to he St of my luu�wlr c -itis: and that all plr.umhing work and it performed i.uxler the permit issued for this application will be in c.ompliarc2 all P .rf i.r t provision nl Ill(-.,\\ M :r.;s,achr.isetts State Plumbing Code and Chapter 'Ih of the General Laws. �\ ----_.._._...___._ _--- , SIGNATURE PLUMBER'S NAME .Michael Porter (LICENSE �i I„13671 -...v__; MPI � ; IP CORPORA _',�<f 3 16 �PARTNERSHII I___,Iab L__.'�#i____._..._..............___._.! I LLC Go ., +ADDRESS 134 Gold St I COMPANY NAME J4 HRS INC-_-_ ------ r^_y .:_...�_..,-.......- .._..._ ? --_ __-___.—_.___..., _ ----1 ZIP 01G08 i TEL X08-798-9955 I I CITY Worcester I STATE I MA —__— FAX I .'�03I1 i -9!i56 l CELL 41 3-668 6544 EMAIL dlspatch�mrplmb.com-_.___..._.._..._-..__:_._.__....._..._......-.__.___._.___._.____-_......__..._... _... . �7 The Commonwealth of'Massacfr.usetis Department of -Industrial Accidents Of of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.tnass.gov1dia Workers, Compensation Insurance Affidavit: Bullde>rs/Contractors/Elect>ricians/Plumb.e l•s Applicant Information Please :Print Le; ibjy Name (Business/Organization/Individual): 24 HRS INC Address: 134 Gold St City/State/Zip:Worcester MA 01608 Phone #:508-798-9955 Are you an employer? Check the appropriate box: ❑✓ I am a employer with 50 4. ❑ I am a general contractor and i employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and.have workers' comp. insurance.t 5. ® We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance. required.] Type of project (required): 6. ❑ New construction 7. ❑ .Remodeling 8. ❑ Demolition 9. El -Building addition 10.❑ Electrical repairs or additions I I.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.n -Other `Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then Hire outside contractors muss submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. lythe sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance forPmy employees. Below is the polis y and job site In. f ormation. Insurance Company Name: Liberty Mutual Insurance Company Policy # or Self -ins. Lic. # .lob Site Address WC531 S387893012 ALL JOBS Expiration Date: 10/12/2013 City/State/Zip: ALL Attach a copy of 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 herebv certify una/g"h�ltiosdan p nalties of perjury that the information provided above is true and correct. ®fficial use only. Ido not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: In ormat�onf-,and,.I.nstruction,s ,r o Massachusetts General Laws chapter 152 requireslall,employers,to provide workers' compensation for their" employees: Pursuant to this statute, an employee is defineda`,",...every; personin the service of another under any co'ntra`ct=of l=ire,= Y, express or implied, oral or written." An errip`loy�%r is'"defned'`as''an iiidividLial`',`parti ership ta'ssociationi corpoi'ation or`otl er'"le galteritity.,;Or any'two';or,more of the'fo'regoing engaged'in,a joint enterprise, and including the leg al representatives of a deceased employer, orahe receiver or trustee of an individual, partnership, association or other legal entity, employing employees. MHowever the owner of a dwelling house having not more than three apartments and who residesltherein,•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"lie an employer:".. " MGL chapter -1-52, §25C(6) also stateslthat,"every;state or. local, licensing agency; shall withhold theli'ssuance_or renewal of,a:license lor,,per.mit to operate a business or to construct;�buildings:in�the�coinmonwealth,for+,any applicant who has not'producedacceptable evidence of compliaoceWith the insurance'coverage required," Additionally, MGL.chapter 152, §25C(7) states'"Neitlier thLc'ommonwealth nor any of+its,polrticat,,s�ibdivisions shall enter into any contradd.for'tl e perforrnhnce of public�work,until'accepta.ble evidence -of compliance -w,ith,the insurance. requirements of,this.cliapter'liave,been presented to,the,contractinggautliority." Applicants Please fill out the workers, compensation affidavit completely by,checking the boxes that applytoyour situation and, if necessary, supply sub contractors) naine(s); address(es):and;phone,number(s) along with tli.eir cei f►ficate(s)•of insurance. LimitediLiability Gompadies (LLC).„or Limited Liability'Partnerships (LLP) witl no ei i°ployees otlier than the members or partners, are not required to carry workers: compensation,insurance. if an LLC or LLP does li'ave , employees, a policy is required. Be advised that.this affidavit;inay,be,submitted to the Department of Industrial Accidents for confirn atioff'Of risUdrice coverage.” Also be suretto`siguland, date the affidavit. The ^affidavit should be returned,to,the city orttown-that,the application,for the ,perinit or license is being requested not the Department of. Industrial Accidents:, Should you•have,any'questionwegarding the law•orr,•ifyou are, MCI L fired to obtain vworkers'• compensation policy, please call the Departinent,at,the`iiumber-listed°below: ',Self=i�nsured�companies should, enter. their self:insurance,licen.se number on the,appropri'ate;,line:', City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department'has'peovided a space at�tl e'botto "t , a :" ' ,,, f , ,. of the affidavit for you to fill out in;thel,event the Office of Investigations has,to'}contact you,regarding_.the applicant. , Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit_multiple peri-nit/license applications in any given year, need only submit one affdavit'ihdicati,ng current policy,information,(if necessary).and Under"Job ,Site ,Address" ,the -applicant should write "all locations in (city or town).:' A-copy,gfth affidavit that has been offi'ciallyi stamped or marked.by the 3c 1ty or town may be�provided to the F, •r,�, d'a,m ) applicant asproofthat+a valid affidavit,is�on file'for future permits or licenses. A new affidavitmust be filled out each t. f •! i/ i .. � �r .a / f 1 /e, �_r� �i: r f - i t .... .i'•'+`d { P year. Where,a,,hopie,owner'or citizen is`obtaining a license or per�nit'not related to a'kjny business or_coinmercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT requireduto complete this affidavit. The Off ce,of Investi,gations,woulddlike.to�,thank you in advance for your cooperation and should you have.- ny,q iestions, please'do'not,hesitate'to give us 'a call:, The Departmen=t'"s address; telephone and"fax number: The Commonwealth of Massachusetts. D.eparCment of Industrial Accidents Off ce of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 . fe y•. aM. ,,,'r t... ` e' e .,, 17 . r a,'r y ac: re: �;,. Tel: ?#' 617-727-4900'ext 406 or, 1-877=MASSAFE Eax # 617-727-7749 Revised -7-2010 '' k �Wwwwanassigov la .. .. A L C3c SM CLAIMS DEPT. January 15, 2013 Commerce InsurancesM The Commerce Insurance CempanysM Citation Insurance CempanySM Members of The Commerce Group, Inc.'" 11 Gore Road, Webster, Massachusetts 01570 (508) 949-1500 www.Commerceinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL NORTH ANDOVER MA 01845 Board of Health or Board of Selectmen Town/City Hall RE: Our Insured: ANAND NARAYANASWAMY /_VIJAYA IYER Property Address: 39 WOODLEA-RD Policy#: BDGGDV Date of Loss: 01/11/2013 File#: CPYX42-XTXY21 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. GEORGE MILIOS Telephone: (508)949-1500 Ext: 15552 Claim Representative I, Property Toll Free: 1-800-221-1605, Ext: 15552 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. January 15, 2013 Co11 mere Ccmpanies .... COME GROW WTH us CIC 254 (Rev. 4/95) MAIL M88 No 2125 Date.. ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that1)..Dl ......................................................................... ....... ........... has permission to perform . '0 - , .............. wiring in the building of ... ...................................................... at .............................................. s� ......... North Andover, Mass. ' 91, ( , Fee............... Lic. No. :T ..... ...... .................... ELEcrRICAL INSPECMR 14, 14 /,, P12a WHITE: Applicant CANARY: Building Dept. PINK: Treasurer • Office Use Onl�� 19 �f�e C�ogimonwettlt� of Mas's *1111 dto Permit No. 11cllarttalnt of Vublic Btlfeta Occupancy ,& Fee Checked 3 /90 (leave blank) BOARD OF F1Rt: 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 CM2:00 (PLEASE PRINT IN INK OR E ALL NFORMATION) Date R 4 UG City or Town of _ 1 0� a) To the Inspect r of Wires: The uderslgned applies for a permit to perform the electrical work ascribed below. Location (Street 3 Number) G g -n , 2 ✓ d/ l(/ 'iL Owner or Tenant Owner's Address No. of Self Contained No. of DishwashersSpacefArea Is this permit In conjunction with al building permit: Yes ❑ No ® (Check Appropriate Boz) Purpose of Building Utlfity Authorization No. Existing Service __ Amps —.-J—its Overhead ❑ ' Undgmd ❑ No. of Meters New Amps / Vblu Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity No. of No. of Ballasts Location and -Nature of Proposed Electrical Work No. of Water Heaters KW Sign No. of Lighting'Outlets No. of Hot Tubs No. of Vansformers Total !s.' No. of Llghttn(t`):Ixtures fiir(mmino pool _.. Above In•... gmd. ❑ gnx❑ .. . Oensrators .:. INA No. Hydro Massage TJbs No. of Motors Tbtai HP No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners - Battery Units - RVo. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones _No. of Detection and trio. of Ranges No. of Air Cond. tones Initiating Devices No. of Disposals Heat Tbtal N0.01pumps Tons Tog KW No. of Sounding Devices No. of Self Contained No. of DishwashersSpacefArea Heafh+g KW OeteetioNSounding Devices Heattrtg Devices KW Local ❑ Min ❑Other No. of Dryers No. of No. of Ballasts vbnao Wiring vin -c L. i No. of Water Heaters KW Sign 1 No. Hydro Massage TJbs No. of Motors Tbtai HP nTNF . INSURANCE COVERAGE Pursuant to the requirements of Massachusetts general Laws 1 have a current Uablilty Insurance Policy including Completed Operations Coverage or Its substantial equfvalenL YES G NO O 1 have submitted valid proof of acme to the OHlce. YES O NO O It you have checked YES. please Indicate the type of coverage by checking the appropriate boat. INSURANCE O BOND. O OTHER// //O (Please Spedfy) (Exp at 0n ate) Estimated Value of cmc f Work i ` e' zl � �% Work to Start Jam— Inspection Date Requested: Rough Final Pe Signed under th nanles of perjury: UC. NO. r! UcenFIRM NAME LIC. NO.. 1231C� Licensee rinnal A A en s Signature Bus. Til. No. (TOS) '741-4008 Address _ 111 Ngroo, Street:., Norwood. 1fA _ Ali. Tei. No. 978-11 OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not haw " Insurance t:overage Of its substantial equivalent as re• qulred by Massachusetts General Laws. and that my signs lure on this permit spplicauon walves this requirement. Owner Ag!nt (Please chock one) ... TelephoPERMIT FEES. G to (Signslws of owner at Agent) ••4SA4 .!N2 1942 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ......... ................... has permission to perform /................... .................................... wiring in the building of ... . ....... .... ......................... ,at ...................................... .............................. . North Andover, Mass. Lic. No.,��:/-r' Fee- .... ............. a ....... I ..................... XELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TM COMMOWEALTHOFAUMCRU.SEM Office Use.gnly..Y DEA4RT�1VlOFPUI3l1CSr4FE7Y F7 y� BOARD 0FF7REPR8VL' M0NREGUL4770AN527GW 12-00 Permit No. / -- — — Occupancy & Fees Checked ,yr�`� APPLICA TIONFOR P RAIET TO PERFORMELE(=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work Location (Street & Number��f��,� Owner or Tenant A<17 /,,'��1 Ol%%e -5 Owner's Address ;FY o/ I'Y'e To the Inspector of Wires: below. PARCEL /_-,/-- '20e—,— Is this permit in conjunction witha bold g pemruV Yes �No (Check Appropriate Box) Purpose of Building des/ Utility Authorization No. Existing Service 61A�7 Amps/,;V/;��lyolts Overhead Underground No. of Meters / New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work //S 7T,71Je— No.;pf Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 1:1and No.`uf Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners 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 Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local � Municipal Other No. of Dryers Heating Devices KW ' 4 : Connections No. of Water Heaters KW No. of No. of Sians Bailasis No. hydro Massage Tubs No..Otmotors Total HP lr» P�st>srrttotheregttaana�solNlass�a.�lLse�alaalL3ws �'� a Iha�eaa>IIartLiab>hlylrnlaatrePc�cymchr)mgCarrQ]ele Ca�agzaitssale'ilart YES NO Ibaw%± r dedvabdpmdofs&=1odmCff e YES Fn No F7 Ifyouhawd� do YES, pleaseit�drej eof=uao bydrda g*& II�1S'[JRANCE BOND F 01HERR Pkasr Spa*) E�SadonDale Estnn VakrdElecta Wak $ Waktostart /© �9 9 Incl ect ,DateRmpestd �!Rotgh / Final Sig rdunjuTrPerlamofpajuny /Q e d-1 /2// Soy �% /til % C LioaseNo Licensee � tom �✓ Sigrla�e I.ioa�seNo 1 l %% &=rssTelNO. Ad ,- is// CJ / e l %/ l d''e ,� /�� //� ��.� AIL TL Ni, OWNER'SINSURANC.`EWAIVER, IamawaretbattbeLimisedoes rmthaw theinstuar>cce ort, sutl aleq valatasregttitedbyNi�GmmlLaws atzlthatmysignhuecnthisPMBIappli _VVMNUthisieqaTa3rt (Please check one) Owner = Agent ® •�7 c� � Telephone No. PERMIT FEE $ r--/ • � tgnawre of Owner or Agent Y(� Ae ��ocation. x o '' Date , CP NORTH TOWN OF NORTH-, ANDOVER Certificate of Occupancy, $� Building/Frame Permit Feecc ".° tFoundation Permit FeeHU >. O bBr'Permit Fee $ /' jet:::�A Sewer Connection Fee $ %,90 o L Water Connection Fee $ co TOTAL $' c 8 B di �sc:tor Q4fc"i19 tJ$:47 fa. :2 .9.20.4 o Div. f�u¢ic works 4. ,Location. fC>No. Co Date /Y7 J �. to �ORT� TOWN OF NORTH ANDOVER$ a Certificate of Occupancy $` n' Building/Frame Permit Fee $ Foundation Permit Fee $ t m s�cwUs j� � Oib,er-Permit Fee $ a Sewer Connection Fee $ Water Connection Fee $ Al TOTAL $ Building Inspector 04127 9 7 1:404.04 PAID "'"� ,a t�fr ✓ ', 'J� 'r `. Div. Pub is Works W a � Iz °-- o U F Y m° f oc4a� 0 mIL 1 W x h Y a u w v 0 11 F x Z W z 0 W IL0 Z < W J N a Z z no $ k a Ai p (� r- ► z r4 ei w`_ v I iz 0 0 0 w Z �. 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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: !(1/�P t7�� C,� Co 6 Phone LOCATION: Assessor's Map Number �8/� -/07 Parcel Subdivision ���e �1) Lots) Street St. Number ************************Official RECO ND TONS F AGENTS: Conservation A +mi istrator Comments Town Planner Comments Food Inspector -Health �e�c Inspector -Health Comments Use Only************************ Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected %29157 Date Approved -7 Date Rejected Public Workssewer/water onnections 7W - driveway permit97 Fire Department e_e- . P. t,1 �1.. S Received by Building Vnspector Date ro I� IIQ, I p��O pOpg 5 . -4 11 cl 1 G(- U Q �� ?t i II <tl C) 00, ti� 11 t;+ �oJ _9'0Wo Otiwn o 0) .\ �71 ;820 o Ilin rn 30.435 o0 j. CiD It 00 �6 SC I��� - •`� \\�66 t 121.6— 7' S 85 9l p - 7 , _ , �S 7QS'5_.4 _ gOyZ.bLs ,O �t'6 � �Op, ' S �\� 1 -y r__ , M Z CD i pfd, fy II N / n lotnl O Z5 0�. a ' d'c'�. U) ootPwN -� rn bo y.cr� �- 9 Ko o s: °'II +i II ,poi 0 32 5-' 9 o o ; : ; [b c 0 CD. (-)n C� ,� N88 07 37. \ 6 ril r' i a j.i}'cJ;'�� to W_ T- u u co o ti N cN H O :� fn 73.92' S� 4'S7_W �, 0 iot/g ° > ov.� '� C-ji _ S 79'15'02"mac—.-.i' �' it o �, o.t, c_, s� PID i b tD to N� 1✓1 �� / O;.,; -_ - — --- --' Ln j3cnDON �� r o �rn I_- 12�.$6' 5 81'18'46„-W 0 72.74' o9tnll Dtn`1�=}'l� v ti i n 7.��1 78.04 57�M1 '8 05"26' �6p n' C S r. rn 47.4E #�"�. > o 11 !;� Q ! o- I" iD nor' 01 b ' w I 0ala o y � O v At Lp cn Ntv 6?> U3,„ .b O Q N>g o rn 1 @ 1 n 26 ^4, . , LJ 3 100 5 r, t' $' '♦1 i 8.8j ? ` ' t � \ � �4 { i ��' � • N Ib { i ift 111 � 1 �`i ♦� � Z 1 .� 'Yf �f 2'`' i' 1. 'x-711 i.+ U Z ` e C ih . V �No rnti� ; r o fo moo°' j- ry o t DV) ;s .i Ui � 'i � 47 �1 O i a Wto ^, ( t{ iS� D• Q01 Aj �.�4 ! r F i �r •'1 o� y'A 6. ch I t 11 11 �' '.a !'i=} M:•7f6 i •� // r 'r..r#'� y 'k..a` ,rig r• � r c., pb ay + } y. OU'LV 1` dy�y, Ate 1 6 a t5� S"{7 it 74 S!, O i Cr U, N.� r ilf;`. v a`r• C^ a y �'� .S 1CP N !` E ♦ 1 , c I O ! �1S y 'i'#y2 "i 1� k4} s 11 W,ly� N LO r'l / [a{ Nor! b6PhAiEO BT OF PUBLIC SAPBTT 1' Licr.dco, nRSTRUCTIOR SUPERVISOR t Hinh�� Bzpires einhdat? t �S 067.3)3 11!1111991 01111!1943 JAHE9 1 HCL&hR I. ' 2B CWROB AV& SUITE 15 i owk, 99 03063 RRSTRICt10NSa0 .. .II PO `Roll^ I lA - liasonzy nnl� � 16 1. & 7 Fatly Homes r \. i Growth Management Bylaw Exemption* Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) Cv,i �.� Map and Parcel: Pu ose of Application (check below) Pho a Number f Ap licant: - ql�Single Family Two Family I the 4nPersigned'applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or an to this from the requirements of obtaining other permits required prior to the issuance of the Building ding Permitpermit Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is[ issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. /The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c,are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. adjThis application represents a tract of land existing and not held by a Developer in common ownership with an acent parcel on the effective date of this Section 8.7 shal parcel. l receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the c4�eic }ng off of an above item which does not comply, whether done to my knowle ot, is grounds fqt r�,ft5sal by the Building Department to issue a Building Permit. /�/ ;gror A thoriz Agent i e Atta ed Building Permit Date be attac ed t the Bu' di g Permit on pplication for such permit. CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 77 Date Lolaclz?(`' THIS CERTIFIES THAT . THE BUILDING LOCATED ON���� MAY BE OCCUPIED AS -S�/,(iq�ce �� ��� 07 Sr�a N ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. ,. I&ORT" , CERTIFICATE ISSUED TO p ADDRESS "7 Z/1-� JACMUSEBuilding. Inspector I -zi- rs: , { 4 h CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 77 Date Lolaclz?(`' THIS CERTIFIES THAT . THE BUILDING LOCATED ON���� MAY BE OCCUPIED AS -S�/,(iq�ce �� ��� 07 Sr�a N ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. ,. I&ORT" , CERTIFICATE ISSUED TO p ADDRESS "7 Z/1-� JACMUSEBuilding. Inspector I -zi- { 4 h O z Cd 8 0 F. 0 co O Z N �. n OT F- co E-4 z %-- W4 - U � w Z �� U t� A �, O w d ¢�vQ�Z;Z. CD cm V3 u y '� U /) `u yC w° cn c V w° U x a �I a r� w v - W � w z v u v [ Y~ co O � co W cit cn 8 0 F. 0 co O co L O 0 co Z d O D y C I CD cm V3 Q 'O COO •� W W i O CD co O � co DO OO a- cmQ h O O a=••• C O O Q J •fl •a. O co C co Q V CL y O C •C C _� fl. CA. J s 0 U) U) crW W Ir U) r .J ` C t'1 t o it. BOO K n O �9SSAGHU'S���y APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY: DATE REQUESTED FILED/READY FOR INSPECTION lelyI CLOSING DATE ON PROPERTY: ! ©d FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK'AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNED ROUTING ,(#V,% t1b f CONSERVATION PLANNING DPW - WATER METER NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO TTAL OF TH,E O CUPANC INSPECTION REQUEST 1 DPW Signature File: OC form revised 618198 r d fk. E a U) O i C41 C cm 0 CD C m O cm C �C O Z O 5 0 U C/) f� I O O •A L O � CIS Z CL O � C y Q0 U t� • FU m m CL. C W O O co C 03 : rr �+' ca O cc O� 0 Ea ca c m � ci ca c Z o o. c y COD • A _ t � C � O . m C CQ x y A o :ora o 0 y � 3 � o C C � S O uX v is id p CL=O v 00, G C p C � CIO w cn w w �U w w w" c9i w rx w w U) cn E a U) O i C41 C cm 0 CD C m O cm C �C O Z O 5 0 U C/) f� I O O •A L O � CIS Z CL O � C y Q0 O CS MI rCD m m CL. C =ca O O co C 03 : rr �+' ca O cc O� 0 Ea ca c m � ci ca c Z o o. c y COD • O o � C � O . m C hd o C y A o :ora o 0 y � 3 � o C C � S m is E a U) O i C41 C cm 0 CD C m O cm C �C O Z O 5 0 U C/) f� I O '= C ' y A r L O � � y Z CL O � o O cm CO O OILO MI rCD m m o'L =ca eo � H o 03 : rr �+' ca O� C Cc f. :I: ca c cyQ ci ca c Z c O coaC �y O COD • A � Z � C � O hd o C o :ora LU.40O C r C � ac 'E CL=O v 00, CL CIO a to o- .0EL'_ s a4m E a U) O i C41 C cm 0 CD C m O cm C �C O Z O 5 0 U C/) f� I O '. CD L O � v CD Z CL O � y C O cm CO O MI rCD m m CD =ca eo � 03 Q ca O� C Cc f. ca c CD ci ca c c COD O 1y�2 3724 DatA TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that,//—/—.. .... .. ............. has permission to perform ...... .............. plumbing in the buildings of . �. ...... ............ 412.,( at . '.JAI._'............. North Andover, Mass. Fee:P Lic. Noll ... .............................. PLUMBING INSPECTOR 06/15/98 11:51 279-00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer i MASSACHUSETTS UNIFORM APPLICATION FOR VERMIT TO DO PLUMBING Type or print) /S' e NORTH ANDOVER, MASSACHUSETTSJ� 1.00 Date wilding Locations 0 (. l - Permit # Amount Owner's Name �'D BSG 6J. CJ U&C0P1W-r'1/ % New Renovation E] Replacement FIXTURES Plans Submitted n (Print or type) Check one: Certificate Installing Company Name W Nt.4�A 4 ^K T� zL� Corp. Address UTOPIA -/W- /Partner. 8 ( Lu-- V e'c' „w b& , Business Telephone Q Q - t $-06,0,3 Firm/Co. P 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: rsigned, have been mdde aware that the licensee of this application does not have any one of the above three insuran Signature�� Owner Agent Ijx�re tha 1 of the details and information I have submitted (or entered) in above application are true and accurate to the f my edge and that all plumbing work and installations performed ermit Issued for this application will be in compl' ce with all pertinent provisions of the Massachusetts State PI ing Code d Chapter 142 of he General Laws. By igna re OT Licensea Type of Plum - g nse Title / �s City/Town Liceen mer Master ET�Journeyman ❑ APPROVED (OFFICE USE ONLY 2881 Date .... i A� TOWN OF NORTH ANDOVER I PERMIT FOR GAS INSTALLATION R This certifies that ..... ::: ' : f • • • • • • • • • • LO has permission for gas installation , ... .. • . • • • ' in the buildings of .. 111-e .t°':--6':--c^: 6. "jt'Z w�'�: ... `• • �� �J �� at .. :'?":=: �':`-�'• •'� :`:f • • • • • • • , North Andover, Mass. Fee . 7'S.. " . Lic. Nof�,?1 .. .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer RASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTIN or print) I'MvicIH ANDOVER, MASSACHUSETTS Date 19 Building Locations 34) woo t:� G t.To- 14, Permit # Amount $ , Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) P Check one: Certificate Installing Company Name I } V-^ `A m,) PLAt t&�t4 ❑ Corp. Address 0-1 091dN AD - FLI-15artner. "a iMM� Business Tele' none Ci?00--'2- if9--0003 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter S,6 /►-1(3J C Opti✓/" INSURANCE COVERAGE Check one I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the 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 ❑ I hereby certify that all of the details and information I have submitted (or entere above application are Lrue anu accu,a« LU «lam best of my knowledge and that all plumbing work and installations perf ed under ermit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State s Code and apter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature o Ic �icense lumber Or Gas Fitter ❑ Plumb 6HP s ' er m er ster ❑ Journeyman m O Z j C Z W GZ C7 W W L Cn Cn 7 F Z e- Z w F W Ci C > T C 7 .�, W > W C a Z 'C C C C W '� O W P > ^ O SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6T H. F L O O R 7T 11. FLOOR RT 11. F1,00 R (Print or type) P Check one: Certificate Installing Company Name I } V-^ `A m,) PLAt t&�t4 ❑ Corp. Address 0-1 091dN AD - FLI-15artner. "a iMM� Business Tele' none Ci?00--'2- if9--0003 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter S,6 /►-1(3J C Opti✓/" INSURANCE COVERAGE Check one I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the 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 ❑ I hereby certify that all of the details and information I have submitted (or entere above application are Lrue anu accu,a« LU «lam best of my knowledge and that all plumbing work and installations perf ed under ermit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State s Code and apter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature o Ic �icense lumber Or Gas Fitter ❑ Plumb 6HP s ' er m er ster ❑ Journeyman