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HomeMy WebLinkAboutMiscellaneous - 404 SALEM STREET 4/30/2018 (2) 404 SALEM STREET 210/037.6-0050-0000.0 i ''locations No. Datey Q MORTh TOWN OF NORTH ANDOVER �-� - Certificate of Occupancy $ Building/Frame Permit Fee $ 'ss�cMusEt Foundation Permit, Fe $ Other Permite�Je $ JS, c)_ c) Sewer Connection Fee $ --.--------- Water Connection Fee $ p TOTAL Building"Inspector 7 3 6 7, Div. Public Works PERMIT NO. C2 /� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE ZONE I SUB DIV. LOT NO. F OCATION / pURPOSE OF BUILDING 01 ezl� NER'S NAME Q� NO. OF STORIES E7`G•• SIZE O OWNER'S ADDRESS /V V. /P BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD UILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES _98T. BLDG. COSTT/a4" PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. ' PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING .4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND�APPROVED BY BUILDING INSPECTOR DAT FILEja �V 7 BOARD OF HEALTH SI ATU OF OWNER R THORIZED AG - FEE • o U OWNER TEL.# 6 l'��77 / PLANNING BOARD PERMIT GRANTED CONTR.TEL.# Ig CONTR.LIC.# BOARD OF SELECTMEN BUILDING INBPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 11 STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF`BUILDINGS. WITH- PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 I= CONCRETE BLK. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'T AREA _ 1/1 1/1 3/, FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS - CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW 0 _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE —{I_ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME CONC. OR CINDER BLK. 1 STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR II POOR , ADEQUATE l NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING , TAR & GRAVEL STALL SHOWER 4 "- ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR --- ---- '1 WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING R FORM U - IAT RELAX FORM y 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 dO U 41 LOCATION: Assessor' s Map Number Parcel Subdivision Lot(s) Street St. Number �— ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Arnroved Conser�azion Ad:�inis `rater Date Rejected Cc=ent_s Date Approved Town Planner Date Rejected Comments Date Approved Fo d Inspector- ealth Date Rejected Date Approved Se�zic inspecz�r-ciealth Date Rejected CoI?L:.en z- } Pu:.l is Wcrta - sewer/water connections _ - driveway permit Fire Decartment- Received by Building Inspector Daze l..t 1i��1�Cr��•Ua rj+,+i.`f J._'^.;>1 iu x_t:x A.e, at'1.1 a.r3u -..s. Xtli- til':r1�6Ltr,�"•7'l�. Lr��;� �,.'- 4 ki �y ;:. • `;l �aiy` t. t �Y ?C"4 '�t1•!" '�'� V ,t 73 �Y d t t i a .. t :1 7� \..: �� IT"1 �; �.X11 t\���;\ \ '•il. i y .. � 1 "M - .. 1';ti .,�,�;�' ;1.• :>:.T',�j '7�51 to a`h7 Ae� .._..._._-�._ _._. MORTGAGE INSPECTION PLOT PLAN NORTHERN ASSOCIATES, INC. 65 SALEM STREET, LAWRENCE, MA 01843 •Tel. 508-975-7117 / � MORTGAGOR JOHN ✓. 6 DOLORES C. HA YES DEED REF. 1'S15 208PLAN REF. 4818 LOCA TION.• 404 SALEM STREET SCALE.- 1- 60' CITY, STATE, N. ANDOVER. MA JOB #; 90/ 1335 DA TE:• APR/2/90 6 Lor 16 A LOT 15 A 0 0 b POOL Q 0 ti N _ 36' �Sh�E7 2 STORY MOOD 1 1 a 1 150.00 SrgEEr SALEM �,����y(,��``�� � ._' __.._. - - --=� ..se..re,..��:a•��.�Qom- �. a. �.1 .� i a�n 'Al'�y�- '.R�i..�-'(a'�:d1'iMy� a:�41��`�.W..... iww""44 'fi^� "�^'a ��� i • ZYy„���!,► ryA i ti r, ' (UM15 OF Mb” i 19,_3„ i S, 14,_3u I At ftVO: J015 y rf 16" X. p R7fs R I 1-4 COUP P05f MOrO%9 5rA1tz � OPEMN(5 5/.4 6 P. . c3 I t I I r � I I PPUP05�P COCK PLAN 10 -3 170131,E iO ON i �fx'C OF M05MU HOUSE 11'PICAI.PAIL C,Ot�15t. I 2X6 T(Y PI,A1F 04 V05f 2X2 BALD 15itP5 ; / 2M 51YPOpf5�� n n r I �� �✓"EtE��h!NEf� I j PLIV-y C 3) 2X8 �. ? JG C01�lSt. i 811cr1w.P05T _ I PPOP05E1?5fm CAStr t7t?AWN:' FOP: JOHN J. & 1701.01-5 C.HMW5 ! WE: A,l FpCC5�P PACK PLAN �5&EM 5 �1� �2 �,�� 5c": I/.4"-1'-c" NOM SIJ mvcvm MA. J G. NORTH own of No. 2 4 B 0 ;tr "��,�..;: Date....:52.^ ...........2 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .........7(.............................................................................. has permission to perform .........1-4..k.w...... ....... F wiring in the buildin of..........4,6. V4 ry L/�Wl- .. ........................... 1-40 q "9-e 577 at......................... ............................................. North Andover,Mass. '00 Oro Lic. ........ .. .... ..... ........ ........... ... CTRICAL INSPECTOR Check # 10682 t - Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 1 G�69� - BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 2_- 2 g l Z_ City or Town of: NORTH ANDOVER To the Inspector of Wires.- By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) *�H 4) Owner or Tenant Vi 9'm Ir- Lt v Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building rWAIVte Utility Authorization No. d Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: n ,4ll Completion o the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El 'No'oEmergency ,gliting rnd. Lyrnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained i Totals: """"""""""""'"""................ Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent Heaters KW Data Wiring: Signs Ballasts No,of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as regztired by the Inspector of Wires. Estimated Value of Electrical Work: r`[ (When required by municipal policy.) Work to Start: 2- 2-3- 12 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 p"completed operation"coverage or its substantial equivalent. The p undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 14 BOND ❑ OTHER ❑ (Specify:) I certify,under the ains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: % u}r•eW a t�/,t ES -I~n LIC.NO.: 4 ISS 17 Licensee: ��e�c�,-� 1 z�(1co Signature LIC.NO.: Q I S J2-9 (If applicable,`enter"ex•!npt"in t e lice se nzr $er line. Bus.Tel.No., ( 3- Address: `� I e r s e I ill Arte,,, dU v c�7 S Alt.Tel.No.: fav s- 2-23- 79e-t *Per M.G.L c. 147,s.57=61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.$ • JELECTRXCAL PERmT M). WSPECUON REP�R�T. E . LEC'�MC,AL I NSPECTOl� _ , s 1.ROUGA.ZN_8P�CTIO_N_ Passed Inspectors'=[ I Failed-[ I fie-inspection requzxecT($50.00) -X I commwemts: (Ing ectors'Signature-•no?initials) Date Passed-, Failed—[ ] _ Roo-inspection required($50.00)-•[ � Inspectors'comments: 2��'�� i (R s&ctors'Signature-no initials) date 3.UNDER GROUND INSPECTION: Passed—[ I Failed—[ I Re-inspection.required($50.00)-[ I Inspectors'mu m.ents: (Inspectors'Signature-•no initials) Date �.'.INSPECTION—BERME: _ DATE C.LIuD NA +ON'AIJ G: � ; NA1F�1 +:• [ Passed—[ I Failed--[ ) Iae-inspection required($50.00)-[ I Inspeetbrs'eommenfs: (Inspectors'Slgaature-ito Initials) Date 5•It SPECTION•-OTBER:' Passed—[ I )+'ailed--[ I_ "Re-inspection repired($50.00)•-[ I Inspectors'coanments: (Iuspectoxs'Signature••7ao fiFdals) Date D 0 O TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA.TO BE INSPECTED IS NOT .A.CCIESSEBLE AND A.RE WSPECTION OF§50.00 IS TO BE CMRGED. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeAW Name(Business/Organization/Individual): Aik^L C 1.u+5-(e_a-1 &CnJ�Ze-S Address: c� L\ c City/State/Zip: Soft,,,__ IU kA S Phone#: 3- c(!& 2- 14 Are yodan employer?Check the appropriate box: Type of project(required): 1.9 I am a employer with 3 4. ❑ I am a general contractor and I 6. ❑New construction ' employees(full and/or part-time).* have hired the sub-contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet. EJ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in an capacity. workers' comp.insurance. . g Y p tY• 9. ❑Wilding addition [No workers'comp.insurance 5. ❑ We are a corporation and its l0. Electrical repairs or additions required.] officers have exercised their 3.❑ I-am a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.El Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ A Insurance Company Name:. $Q56or_.ADZ r-,P Ce w Policy#or Self-ins.Lic.#: 1J Le—S� QU14,ccr C)_� 0 ( 2c�r�� Expiration Date: 3" Job Site Address: tic)H. S A I tiv- J� City/State/Zip , �� YAC- �;1 'C,4 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 hereby cer ' under the pains andpenalties ofpet. nrjury that the information provided above is true and correct Sign--- P".lk, Date: 2 -2 2_ Phone#: � Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not producedacceptable evidence of compliance with the insurance coverage required." + Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom i of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or-permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston}MA 02111 Tel. #617-727-4900 ext 406 or 1-$77-MASSAFE_ Revised 5-26-01 Fax#617-727-7749 www.mass.gov/dia Date. . ... ... .. HORTM 3j TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION 5 SA US i This certifies that . . .A . . -��� . . . . . . . . . . . . . . . . . . . . . i has permission for gas installation . . . /. . in the buildings of . . . 4,z 414 el/7a l. k . . . . . . . . . . . . . . . . . . at . . . `' . . .t. . . . . . . . . . . . . . . . .. North/And}over, ass. Fee., :ou Lic. No..1-' , /, /44 GAS INSPECTOR Check# /.09 8092 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:AoH-k A,%keye.t-' ,MA. Date: Permit# Building Location:"707 &14m* Sim&�-- Owners Name: lowAii mi r Isy wN toJ Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New: ❑ Alteration:(� Renovation:❑ Replacement:❑ Plans Submitted: Yes E] No FIXTURES fe - LU w co v H mtW>u W w 0 H ce> Ovco i- O z 0 � 2 ItO Luz OW W W 02 0: QW X3 w O W wWWWOyO W 0xLL I- Fw- a. cl)W -j o W W a 2 a � MM w o z o > z Lu > > O o z z a I- w w 0 O D u- t7 C7 x x O CL F- > > > S' O SUB BSMT. BASEMENT 1 FLOOR 2NO FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 81H FLOOR Installing Company Name:—&kq Acre Pig 3", #4rQ Check One Only Certificate# ❑Corporation Address: •d. (3p1C 391 City/Town: to-. M State: _ � ❑Partnership Business Tel:9' er se Fax: [)(Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner El Agent ❑ By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By l ❑Plumber Title c3�o i Z ❑Gas Fitter Master PlumbSignature of Licensed erlGas Fitter City/Town []journeyman License Number: APPROVED OFFICE USE ONLY ❑LP Installer i The Commonwealth of Massachusetts Department of IndustrW Accidents Office ofInvestigations 600 Washington Street Boston, AM 02111 wwryv.massgov/iia Applicant Information Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ' Please Print Legibly Name(Business/Organizafion/Individual): - Address: – -- — City/State/Zip: S'a N N 61001 Phone#:—'J 1 Are you an employer?Check the appropriate box: [2. ❑ I am a em to er with 4. Type of project(required):' P Y ❑ I am a general contractor and Iemployees(full and/or part-time).*' have hired the sub-contractors 6 ❑New construction X I am a sole proprietor or partner- listed on the attached sheet ❑Remodeling ship and have no employees These sub=contractors have 8. Demolition working for me in any capacity. workers' comp.insurance. [No workers'comp.insurance 5. ❑ We are a corporation and its 9• ❑Building addition required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp, c. 152,§I(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] I3.( OtherfiAS C2&A_� *Any applicant that checks box#1 must also fill out the section below sho,v inn Weir wo :c;;'erg,-•s2�on poLcy information T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new tiff davit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: • Job Site Address: City/State/Zip: 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 ofMGL 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 t Investigations of the DIA for insurance coverage verification. Y o the Office of Ido hereby cerdix under the pains andpenalties ofperimy that the information provided above is true and correct. Signature: Date.: Phone#: g 9,18-se 1 st � t [[66.Other al use only. Do not write in this area, to be completed by city or town official r Town: Permit/License# g Authority(circle one): rd of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector ct Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than-three apartments and who resides"therein,or the occupant of the dwelling house_of-another_who employs"persons to.do_maintenance,:construction or-repair-work-on such-dwelling-house--- _ --- --— - or on the grounds or building appurtenant thereto shall not because of such employment�be deemed to be employer." MGL chapter 152;§25C(6):also states-thitt`_`every state or local licensing`agency sfiall Awithhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-'contractors)name(s),address(es) and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with.no employees other than the members or partners,.are not required to carry workers' compensation insurance. If an LLC or LLP does have employees;a�policy i&required. Be�advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date-the affidavit. The affidavit should bey rofiarncd to the city or tovirn that the aupliCauon for the pernmi or License is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.. Please be sure to fill in the permittlicense number which will be-used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations wouldlike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 0Mee of Investigations 600 Washington Street Boston,MA.02111 Tel. #617-727-4900 ext 406 or 1-8.77-MASSA-FE Revised 5-26-05 fax#617-72.7-7749 ,www.mass..govfdia Location --/05(7 SA/,,-w S- f4- No. A / Date 'A' ¢`v ,a MORTN TOWN OF NORTH ANDOVER � A • "s +G& a Certificate of Occupancy $ ,SswCHUstt� Building/Frame Permit Fee $ —� Foundation Permit Fee $ Other Permit Fee:: $ TOTAL $ 176 Check # --- 1 8i 93 Building Inspector A TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: _ M SIGNATURE: ` GAVOI*�, M Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Y12 q SALEM Er Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Mirid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided R aired Provided . 1.7 Water Supply M.G.L.C.40.; 34)f I.S. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private p �� Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Print) Address for Service: I Signature Telephone e 2.2 Owner of Record: Name Print Address for Service: O Signature Telephone 'SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address mn 1 Signature Telephone Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ DAVID I Company Name /,3 tj / Q ' Registration-Number ? O S �=/V 9)7 SU-C -F Zxz Address 3� Expiration Date Z t �CJ A Si nature Tele hone Q 4 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 DesciA tion of Proposed Work(check_all applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations( Addition ❑ Accessory Bldg. Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE q ,y Corapleted by permit applicant 1. Building / g O O (a) Building Permit Fee to Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT S y I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 124 V S rk t C,vV E as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief DAVID s Print N&--e c Si nahue of Owner/Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1sr 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIIv1ENSIONS OF GIRDERS IIEIGITT OF FOUNDATION THICKNESS SIZE OF FOOTING X t MATERIAL OF CHIIvMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department artment Tel= 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of,Building Permit Number is that the debris resulting from this work shall be tx. disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: s . b M (Location of Faci ity Signature of.Permit ,Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector �V. 9&Commonwea£th ofWassachusetts Department ofIndustriafAccidents Office of Investigations w 600 Washington Street (Boston, WA 02111 Workers'Compensation Insurance Affidavit APPLICANT INFORMAnTIONL�n^ 11 nnE / Please PRINT Leg:b ; Name: VL D6"L.G LE II AV TO V SX Location: .--46Q &/T1—F—/"( S"/—1 City:--N 6) e 12.d i J=& Telephone#: 92e—(a9-;2,,— I 2e—(agot— 3��g I am a homeowner performing all work myself. I am sole proprietor and have no one working in my capacity ❑I am an employer providing workers'compensation for my employees working on this job Company Name: DAy1D CASTR-JUAM RO0 `1/ ) ti Address: ( !I�6 DLJ. u b Al S� S�+KTG� A,2-top Q City: /V ) /'S'N b O U6K Telephone#: q 10 `r - 3 4.`o Insurance Company: Policy#: V W c 4,66 9�S 0 0 /a a 0 4 I am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following workers' compensation policies: Company Name: Address: City: Telephone#: Insurance Company: Policy#: Company Name: Address: City: Telephone#: Insurance Company: Policy#: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B 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 DLA for coverage verification. I do hereby certify under q e pains and enalties ofperjury that the information above is true and correct II1 l Signature: Date: , Print Name: y S D Q.4 S r9 k* U0 AJ Phone# i 1 $ t� (I.3' 3q .2.0 Official Use ONLY-Do not write in this area ❑Building Department City or Town: Permit/License#: o Licensing Board ❑Selectmen's Office o Health Department ❑Check if Immediate response is required 0 Other INFORMATION &INSTRUCTIONS Massachusetts General Laws chapter 152 section.25 requires all employers to provide workers' compensation for their employees. As quoted from the "law"an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or Iocal,licensing agency shallwithhold the issuance or renewal of a license or permit to operate a business or to construcibuildings in the commonwealth for any applicant who has not produced.acceptable evidence_of compliance with the insurance coverage required. Additionally, neither the.,comonwealth nor any of its political subdivisions shall enter into any contract for the performance of public' 'Work until acceptable evidence of compliance.with the insurance requirements„of this chapter have been presented to the contracting authority. Applicants _ Please fill in the workers' compensation affidavit completely, by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for.confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should.be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the "law” or if you are required to obtain a workers' .compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to.contact you regarding the applicant. -Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Fax# (617) 727-7749 Telephone 4 (617) 727-4900 - ext. 406, 409, or 375 FORTH ToVM of . 4Andover 0 471ow Qg) 11 _ — 7 v C, dover, Mass., Q - LAKE /� COCHICMEW.C. V 7,p ORATED 1 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT IA.. A 0/#*1 I^ / �v� �� � s BUILDING INSPECTOR i. I� ................... ...................................... .. ....................... ............. Foundation has permission to erect.... 1 4 14 s............................... buildings on........ PY......�...... t �........................'........... Rough to be occupied as....................Z r h r O a w moi, /. I ......................................................... Chimney provided that the person accepting this permit shall in every respect conform to terms of the application on file in Final this office, and to the provisions of the Codes andB -Laws slat' to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 7 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION Sj TS Rough 4100 .............................................. Service ..... ........ ........... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR RouDisplay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. r I i' N°RTN TOWN OF NORTH ANDOVER °°� a s PERMIT FOR PLUMBING 1SSAC14us� .� C This certifies that has permission to perform plumbing,in,the'buildings�of!. �!.�'` . . . ... /. . . . . . . . . . . . . (�. . . . . . . . . . . . . . . . North Andover, Mass. r'rz 'I Fee.--/�•. . . . . . i Lc. No.�/-�. . .K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # X5911 stC m � C) �n - rurorqrr� r3 r� �+ 0 1 j WATER CLOSETS KITCHEN SINKS LAVATORIES 2 BATHTUB O V SHOWER STALLS 3 ' DISHWASHERS6N_4_� Ic 3 - DIS ° POSERS Z LAUNDRY TRAYS ; _ r- WASH. MACH.CONN. -- HOT WATER TANKS- � TANKLESS jv u ? c $ SLOP SINKS FLOOR DRAINS I F OAS TRAPS o URINALS N +� DRINKING FOUNTAIN Z AREA DRAIN '� I o - Ic WATER PIPING CI � ROOF DRAINS N O O fl BACKFLOW� W PREV.E � t7 . � OTHER FIXTURES. I O BOILER MAT * '9 GREASE TRAP C SCULLERY SINK 3 g SHOWER VALVE Z Z n BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES . FEE PROGRESS INSPECTIONS NO. APPLICATION FOR PERMIT TO Ifo PLUMBING UNDERGROUND ROUGH COMPLETE ROUGH FINAL INSPECTION PERMIT GRANTED DATE PLUMBING INSPECTOR Date.. . . .�. .� .. . . NORTH - o� TOWN OF NORTH ANDOVER i - PERMIT FOR GAS INSTALLATION •'`qci C HUSEt This certifies that � . . . .� . . . . . . . . . . . . has permission for gas installation .: . . . . in the buildings of, � ff. . . . . . . . . . . . . . . at ..�j `.. .... . . . . . . , North Andover, Mass. Fee/5 ... . Lic. No../VI— . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check.4 -4647 Y. MASSACHUSETTS.-UNIFORM APPLICATION FOF� TO DO GASFITTiNG (Print or Type).. 1/�// 1� l` . Mass. Date +ter Permit "7 `� C , Buiidicp 1 r y G;!l`�� J- owner's N. t�1 f/ / f TYPe �of New ❑ Renovation.-❑ Rem Plans Submitted: Yea© . No p a a W a.. yr W C: a- 0 oa ta Z: a: d J a W C C a p ry ` it Z :I.: a C W Z V W a W < �. O Z. Y t W = }. W <. a � a o: o z o s t .W C. W a Z. < C < <- O O- W C Z O O Z W O ;. O O J v. e: Y: O s F O SUB—BSMT. BASEMENT' 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR. STH FLOOR dTHFLOOR TTH FLOOR aTMFLOOR.. Installing Company Name- AMaaleT, `s pt )cv.� 'nc . Check-one:: Certifiatel. ' Address__ 544 Qe gAt ❑ Corporation. L 04 AX rn A . n a l S I ❑ Partnership Business Telephone - rh i- --j f.9 - ?S5�(c Firm/Co. Name of Ucensed Plumber or Gas Fitter.. S evgyi Q . i INSURANCE-COVERAGE:. I have aYcurrenZ,liabilitY�kWM a❑oe•poiicy Or ft stun equivalent1Whkh7meet2-the requirements.ot.MGL-Ch:142- No If you hm:chheeekedaffl&spmo*ndlcs;ia&wtWeAmverage:by dig the appaepdaWe box, A liability insurance_policy)( Othec:type ocindimnity.❑.. Bond ❑ OWNER'S INSURANCE WAIVER:'1 am'aware that the JkWaee does ix t have:-_the ktsurance-coverage required..by. Chapter. 142 of the:Mass.Generd,!.Awa, andMvd-my signature-on-Ufts pem ki appikation waives this requirement Check one: Owner❑ Agent.❑ Signature of.Owner oryOwrrer s Agent-,, I hereby certify that an of the details and information t have submitted(or entered)in.above application anstrue.and accurate.to.the best of my knowledge and that all pluming work and installations performed under the permit issued for this ica: n will be in compliance with all pertinent provisions of the Massachusetts State Cas Code and Chapter 142 of theGeneral E3y Tiof txense: Law Plumber nature uin or itt .Title Gasfitter Master License Number 31 QCD, City/Town Journeyman j BELOW FOR OFFICE U`SE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION w FEE f.. NO. _ a APPLICATION FOR PERMIT TO DO OASFITTING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER Op OASFItTER LIC. NO. ; PEMMIT GIIAlitED DATE 20 �—� — —— OASINSPQCT q Location No. Date Date a S A i TOWN OF NORTH ANDOVER S' Certificate of Occupancy $ 1 s Building/Frame Permit Fee $ - ,SSACMUSEt oun ation Permit Fee $ r Permit Fee $ — `° Sewer Connection Fee $ Water Connection Fee $ 9 TOTAL $ Building Inspector r n 8311 Div. Public Works PERMIT,NO. �J v' APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 440. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE I SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS4r BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' POSTS DISTANCE FROM LOT LINES-SIDES . REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST FIER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUSTBE FIL D ANp APPROVED BY BUILDING INSPECTOR DATE FILED BUILDING INSPRCTOR r P�G TURE OF OWNER UTHORIZEDIGENT F E E ✓" OWNER TEL.# PERMIT GRANTED CONTR.TEL.# 1� 19 T CONTR.LIC.# H.I.C.# 42 3 ` / c BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 1, STORIES - 'THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH - CONCRETE _ B 1 2 13 CONCRETE BL K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ '/. 1/2 3/1 FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDVJ'D _ ASBESTOS SIDING _ COMMGN VERT. SIDING ASPH.TILE —{I_ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13BATH 13 FIXE GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES 1 y^ TILE FLOOR - TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR , WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st -1-3rd I NO HEATING s ,c NORTH F Town . of o brt dower, Mass., COCHICHEWICK ��` 7 �ADRATED H BOARD OF HEALTH Food/Kitchen Scl)tic Systern BUILDING. INSPECTOR PER THIS CERTIFIES THAT....... . . ... ..........T .............. ... .............. ........................ ... ........................... ... ...........: Foundation has permission ta-arae!'...... b ildings Von ........... . �.... ... ...... ...4. .... ... �......... Rough tobe occupied as........ .. ... ... ... . .... ..... . ........`'�` ....� ... ........................................... Chimney provided that the person accepting this perm' hall in every respect conform o terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 1tough Final PERMIT EXPIRES IN 6 MONTHS - UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough Service BUILDING IN ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT :5.7 e—SORT14 f (508)682.6483 Town o ANDOVER ORM U - LOT DIVISION OF RT7TFASi� FQ� PLANNING 6,COMMUNITY DEVELOPMENT WALTER CAHILL orm is used to verify that all necessary m Boards and Departments having jurisdiction ASST BUILDING INSPECTOR Lrhis does not relieve the applicant and/or Building Office • 120 Main Street • North Andover,MA • 01845 ince with any applicable local or state law, ments. ****************Applicant fills out this section***************** APPLICANTt, �4 Phone 9 LOCATION: Assessor' s Map Number Parcel Subdivision Lots) Street _ St. Nu-iter - ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Aooroved cons er•a--ion Ad::inistrator Data Rejected Cc eras Date Approved Town Planner Date Rejected COI11;len--s Date Approved Fo d _r.spe/►ct`or- ealth Date Re-i ected —7 /L Date Approved Jr l¢ Seot_c Irsoec .or-health Data Rem ected J Co--en�s Pu-'-1-4c: WcrL:s - sewer/water connections - driveway permit Fire Demartment- Received by Building Inspector Date '. `•,. ... tit 3o�CaC layt�h�i).�0 \f.�v't'}��j1.1a'itl�1 ti<\1i7 r `.:'1 -t^i '...,: �+.i: . .._.......... MORTGAGE INSPECTION PLOT PLAN NORTHERN ASSOCIATES, INC. 65 SALEM STREET, LAWRENCE, MA 01843 •Tel. 508-975-7117 MORTGAGOi JOHN J. 6 DOLORES C. HAYES DEED REF. 15-151208 LOCATION.• 404 SALEM STREET PLAN AEF. 49-18 :I TY, STATE' N. ANDOVER. MA SCALE., 1 60 DA 7E.' APR/2/90 16/08 /: 90/ 5335 6 2a9. LOT 15 A LOT 15 A I O O b POOL Q 0 ti N 2 STORY ShE7 MOOD 1 a 150.00' STAEET SAL.Et4 (LIMITS QE E)5"1101.0 19,_3„ l ZQ ft,% 1015 16" 9.C. I o p �. I , I I E'l,�.T L C�)2XB 7 � Ali WIW� P05T 1--4' P?OPO%p 5TAItz o OPER 5/4 6F. - 00 I7 . I I � I � ' I i pp0P05�P COCK PLAN 10'-3" VOLME 20 ON AIL Ep12: OF EM IN6 NOUS TYPICAL RAii.CON5T. 2X6 TOP PI,A1'; i 04 P05T I 2X2 BALUS>t� ' / 2M 5UPFOrf5 j n r n r 51511% E 10 BUL. AF(3) M �., ?,�JG CONST. 8"Cr,4,C,P05T -, i I'RO'05W 5fff CASE PPOP05�P MCK PLAN . mm: Fo1r 404 WM�5�s C.w�YEs pa�E: :v���-I'-O° �GJ 14"AkVOVEP,MA ; � 12, 199-4