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HomeMy WebLinkAboutMiscellaneous - 41 BRUIN HILL ROAD 4/30/2018 (2) / 41 BRUIN HILL ROAD 210/104.A-0032-0000.0 i k Date......... ...ly................. ��b NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING / s c ,`•w # s o s SSACMUS� This certifies that .. .......................... ........... GC.J............................ `,has permission to perform 14 /� /. ,_.f.Q�:..�.'./..�. ..,....:...................... wiring in the building of ' /.-t.. .....lu !,•C............................. atf. '.: .................. .North Andover,Mass. F".(0.. Lic.Nol.�I.IW........................................................... ELECTRICAL INSPECTOR Check # 5266 I Commonwealth of Massachusetts Official Use ot,l i/ fL� Vtt Permit No. i t , Department of Fire Services J ` Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]1/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Matsaehnsetts Electrical Code(MEC),5')7 CMR 1"00 (PLEASE PRINT IN INK OR TYPE ALL INFORII%IATIO j Date: �ilg 661 I City or Town of: � az.(_1 _ To theIts peC of r of Wires: By this application the undersigned gives notice of his or hq&intention to perform the electrical work described below. - Location (Street& Number) `N,/ Owner or Tenant gpjuprv� i 1 1N S Otry "telephone No.Q_7 ,X /4, Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of'Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �� a Complelion o%Ilse fol/otvhi /able men,be waived br the his recior ol'INire.c. No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA AboveIn- o.o t Emergency /g /ng y No. of Lighting Fixtures Swimming Pool ,rnd. ❑ grnd. ❑ Batter Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No. No. of Switches No.of Gas Burners of Detection andInitiatin= Devices No.of Ranges No.of Air Cond. Total No. of Alerting r Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertin r Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection Heating Appliances Security Systems: No.of Dryers pP }`�'� No.of Devices or Equivalent No. of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Y AItach additional detail ff desired,or as required br the Inspector uJ'i6'irr.r. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that Such covere is in force,and has exhibited proof of samOffice. e to the permit issuing oce. ANCE CHECK ONE: INSURBOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: 60►Q� (When required by municipal policy.) Work to Start: F�1Jy6� Inspections to be requested in accordance with MEC Rule 10,and upon completion. /cel4ify, under the wins and pen(!/ties of�ur)r, that th in,0l'J/r(/tl(Ilt IIR this LfJ)phC[!t!O!1 1S trite and C(Illrp/C'tL'. FIRM NAME: Orb #.4 C-1.A1 LIC. NO.: Licensee:_ ,yti Signature LIC. NO.:��� (1/crppliccrhl rlgr "e rp/"in//je li rrsc ntnn( 'li e.) Bus."Tel. No.: G L1 Address: . �X [� � J*���'�^'N ^14 6- 0-29 Alt. Tel.No.: 7'F 11c S 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. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ PQ,0 6 NORTH Town of � _ 6 ndover p ✓+. ti 0 o h ver, Mass, S 0 17 COCMIC MlwKM y1' �,O A�R�{TED PPp��S S U BOARD OF HEALTH Food/Kitchen PERMIT T LID Septic System THIS CERTIFIES THAT ......044Y.ct �'� .. BUILDING INSPECTOR .................................... ................................... .................. ' v�� has permission to erect .......................... buildings on ....... ........................ ............�. ..�!. .....ab Foundation Rough tobe occupied as ............. .�. t.. ................MI.0.0.0C. ............................ chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR... UNLESS CONSTRUCTION ARTSRough Service ............... .. .. .... .... ....................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display 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. ��� • r Smoke Det. w V v 4P 0 :4 fJ(pDMZ The Commonwealth ofMassachu Department ofIndustrial Accide 1 Congress Street,Suite 100 Boston,MA 02114-2017 ' www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contra, TO BE FILED WITH THE PERMTrMG AUT Applicant Information Name(Business/organization/Individual): Cq54-P r,^ 2ft:0--%e 6c) Address: 13 t W g t e,f S f. City/State/Zip: 4. 0 1`i 33 Phone#: 4 re you an employer?Check the appropriate box: Type of project(required): Li lt.(�I am aemployer with f*�s employees(full and/orpart-time).• 'i. New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity. o workers'comp.insurance required.] D P tY iN P 3.[—]l ama homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition Q4.El am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers',comp.insurance. 14. 6. We area corporation and its officers have exercised their right of exemption per MGL c. [Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] _� �' — S c l 1 C♦ . h C�.n,4 -t..i t 'Arty 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: f-1 t$i - G e ►:n g (}r.,.�y:C G J ,�.S u v G"CP Policy#or Self-ins.Lic.#: C W G C*6 00 C>0 g 0(o 1& Expiration Date: 3/ 5/ 17 Job Site Address:_ I J1-4 1 c) , City/State/Zip:()0 r_t-L-- t9A d UU f✓ fh Attach a cony of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify undLerJhevains and penalties of a 'ury that the information provided above is true and coirect. Signature: Date: 3 1!*// Pho 1�'- 5v d Official use only. Do not write in this area,to be completed by city or town o ficial I 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 1 Contact Person: Phone#• i a� The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 ' www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. . TO BE FILED WITH THE PERMT17MG AUTHORITY. Applicant Information Please Print Lezibly Name(Business/Organization/Individual): Address: 13 i U—>g�e . City/State/Zip: o l J 33 Phone#: C )T- -75c-- 6-To o re you an employer?Check the appropriate box: Type of project(required): �(. I am a employer with -T--) employees(full and/or part-time).• 2. 7. Q New construction am a sole proprietor or partnership and have no employees working-for mein'❑I li any capacity.[No workers'comp.insurance required.] S. E]Remodeling 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.Q I am a geheral contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'.comp.insurance. 6.❑we area corporation and its officers have exercised their right of exemption per MGL c. 14._dOther G O S V7_}1;n 5 152,§1(4),and we have no employees.[No workers'comp.insurance required.] (),^ -t..a( cis QIy PP �J+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. t'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. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: t 1 1 - - rr.-er'C C1 _i.V-,5 u v C.e%t Policy#or Self-ins.Lic.#: C W G C i�O t s o O g�n(tl l�, Expiration Date: 3/i5/ 17 Job Site Address:_ C), City/State/Zip:()0 r 1`�, t9A d CCW e✓ Ch Attach a cony of the workers'compensation policy declaration page(showing the policy number and expiration date). a 1 Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyand airs and penalties of a 'ury that the information provided above is true and coirect. Sip-nature: Date: 3 /11,/16 Pho Official use only. Do not write in this area,to be completed by city or town o f ciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board:of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other' Contact Person: Phone#: i i Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS ® o -44 BOARR OF . : , PLUMBERS AND GASFITTER; ;: ISSUES THE FOLLOWING=IrICEIVSE ,LICENttp A$°A JOURNEYMEN PLUMBER BENEDICT J BRE ITUNG'' 1j 52'SUTLER ST IN j SALEM,Nti 03079 3924 I 30283 05/0112018 45588 t act CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDI 3/14/201616 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Maryann Plass NAME: G S A INSURANCE, INC ExtlPHONE • (603)742-2644 aCNo:(603)742-2406 34 Dover Point Road EAIL ADMDRESS: INSURERS)AFFORDING COVERAGE NAIC N Dover NH 03820 INSURERA:HDI-GERLING A'ERICA INS INSURED INSURER B: Eastern Propane Gas Inc. INSURERC: P.O. BOX 1800 INSURER D: I 28 Industrial Way INSURER E: Rochester NH 03866-1800 INSURER F: COVERAGES CERTIFICATE NUMBER.C1,1631402210 REVISION NUMBER: THIS'IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDL SUBRi POLICY EFF POLICY EXP I LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDOIYYYY X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE S 2,000,000 DAGEA I CLAIMS-MADE FJ OCCUR I PREM SESOEa oau ence S 250,000 X EGGCD000080616 3/15/2016 3/15/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 M'OTH'ER L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY❑PRO ❑JECT LOC PRODUCTS-COMPIOPAGG S 2,000,000 : Is AUTOMOBILE LIABILITY I COMEaadnt BINED SINGLE LIMIT I $ 2,000,000 ccie A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED EAGCD000081616 3/15/2016 3/15/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS X NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident I �$ UMBRELLA LIAB OCCUR ( I EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I RETENTION$ I$ WORKERS COMPENSATIONI I I X PER 0TH- AND EMPLOYERS'LIABILITY I STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE YIN N OFFICERIMEMBER EXCLUDED? N 1 A E.L.EACH ACCIDENT A (Mandatoryin NH) I $ 1 000000 EWCD G000080516 3/15/2016 3/15/2017 E.L.DISEASE-EA EMPLOYE $ 1 000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 i DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Includes additional insured status when required by written contract. CERTIFICATE HOLDER CANCELLATION cs@eastern.com, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Any City/Town in Massachusetts THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MA ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Maryann Plass/MP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011) Location 4/ /3/2 y;k) No. 67 Date G G7 NORTh TOWN OF NORTH ANDOVER 0` Certificate of Occupancy $ $ p P Y •i Building/Frame Permit Fee $ /S �sS.4cMFoundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building In or 7410 Div. Public Works PES.AfIT NO. cou/ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 440. LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE I SUB DIV. LOT NO. F- I i LOCATION C, i L URPOSE OF BUILDING A-U '/1 ,4 t6 1 _ sl— LA'YV-NER'S NAME Uesvg, NO. OF STORIES SIZE �% WNER'S ADDRESS d ��U! BASEMENT OR SLAB srr �rr�� s/Or-"Jl l ARCHITECT'S NAME �1 SIZE OF FLOOR TIMBERS IST . 2ND `7 3,R`D// UILDER'S NAME ����p � 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 T. BLDG. COST PAGE 1 FILL OUT SECTIONS t - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS I - 12 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 �^ 7 - DATE FILED % �� ` �� T �1v- � '72/� BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE /6a,— /'�� PLANNING BOARD �O PERMIT GRANTED �'�UVVNER TEL.# ��"SIS NTR.TEL.# TcmtF 19� LEBNTR.LIC.# " BOARD OF SELECTMEN el,4 71;16 BUILDING INSPECTOR i BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY F2-FFICES 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 3 1 2 13 ' CONCRETE BL K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ -6 RY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M AREA _ 1/1 1/1 V. FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK N 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 GABLEHIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) C� FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING - } TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. d 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 OIL B'M'T 2nd _ ELECTRIC Ist 13rd NO HEATING r I r NVI . 0 of o Norvir , dover, Mass., ..J yN T_199'x-' ORATED P .\, 9s B l BOARD OF HEALTH 0 Food/Kitchen" UIL Septic System PERMIT T D O BUILDING INSPECTOR THISCERTIFIES THAT............... ................................................................................................................................ Foundation has permission to erect......... ....... buildings on ......... ,L�......IF-b.0... Rough g tobe occupied as.............. .......1 . ....4 .. ...... .................................................. Chimney provided that the person accepting this permit shall in every respect conform to the 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. Rough Final r PERMIT EXPIRES IN 6 MONTHS F UNLESS CONSTRUCTIO STARTS ELECTRICAL INSPECTOR Rough .......................... . Service BUILDING INSPECTOR Final Ocaipcan(--y Pemut PeCItth'ed to Occ uj.)y Bid0ing GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y p Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT Town of North Andover BUILDING DEPARTMENT — r Homeowner License Exemption (lease print) DATE J„ ,e_ JOB LOCATION Number l Street Address Section of town "HO'lE0WNER” �_oW 0-�AdvE ('IS [ 6/5s" 975 -9404 Name Home Phone Work Phone PRESEiT i`IAILING ADDRESS4 D�ui� 01084.5 City/Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellinzs of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license , provided that the owner acts as supervisor . (State Building Code , Section 109 . 1 . 1 ) DE:IVITiON OF HOMEOWNER: Person( s ) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be , a one to six family dwell- ing , attached or detached structures accessory to such use and/or farm structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work. performed under the building permit . (Section 109 . 1 . 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and regulations . The undersigned "homeowner" certifies that he/she understands the To,.an of :North Andover Building Department minimum inspection procedures and recuirements and that he/she will comply with said procedures and reout_ ements -, 7. u`.. .. ..... J :;A_URL AP? .C` L OF BGILOFFICIAL e � T;,ree �cTil d.aellings 85 . 000 cubic feet , or larger , will be State BuilQing Code Section 167 . 0 , Cons-UC ��OR c3n :rol . 0 FORM U - IAT PRTFASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** �PLICANT: Qou u- �OyF Phone GB( - (I S5 LOCATION: Assessor' s Map Number Parcel Subdivision Lot(s) 1__�Street 4A� DCUir\ �� �� �. St. Number 4/ ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Annroved Conservation Administrator Date Re-JJected CoHl.^.ients Date Approvers Town Planner Date Rejected Co < «ents Data Approved Food Inst_ ec_or- ealth Date Rejected Date Approved �� 9 Sept;c InDate Rejected Co=ent_= Put _c Wcr.:s - sewer/water connections _ - dr'_veway permit Fire Denart-ient Received by Building Inspector Date 22-141 50 SHEETS f / 22-142 100 SHEETS ^MPA. 22-144 200 SHEETS `Do6bl-r- 4iuL A> e P.T. 2-a 7co i r k-- 6,e c o n r e cl�--W ec:s� �g souse � , kelt.✓ ttoLi �� �c� rori I 6'r (r>. 1p-"u�4 f S �� OC • 1YtQ b< • �r 1 � I bei 16' I� / 1 1 22-141 50 SHEETS 22-142 100 SHEETS \ 22-144 200 SHEETS , d'C' MCR K i i k G alv. 4v-4 Po,-4s SAV �vvr- TI-I 1 1 22-141 50 SHEETS J 22-142 100 SHEETS / OAo 22-144 200 SHEETS c Y. 11 1 ff rr � r C G'rGs ATG�oC>�� 1� / T 1 l 1r 1 22-141 50 SHEETS 22-142 100 SHEETS HMPAO 22-144 200 SHEETS CIC4001a tv,3 PC t f'Y� I , 1Q b o l�ed 4o I � , �i r � � � ME RMP.Ci ENS =ER.:E': N �t/o rES - -OAT-�rp /l7.oy 8, /49 � E.v6i�►/E�ic�iv6 t S�.e✓�y �os..r��r.Q,v rr� /.vC. i `�' Fo� �,�°d.oEe ry L/•✓E .errrcE!'E'rvl�- ; 7-0 E gScc-/J��ic, r �0 r 93, 704 s r2� D � I 1 _ 7S � W �4 4'�oE.v.E.P.CO l r�G P•��,� ��'r, � EASEine�/•r'`1n1 �� ��` � �Q � ♦'� FE 2yF r, V M C ha. RUj i6q 2,6.F.- N .E2� L'F33Syl ',• Q 57, R p F "r hlefCeY 7-0 7We rir��irvsareorc rdvo / o r R4+.4'N 7b Tr4'E ff,4 Alt' rrV47" T.VE o.✓E,c41,w /s eae,4TEO Ort/ rryE 407-,IS s sem..-.v.4,Vo r, r/rods ccwFar� /ice rrir� raE' rowN of�.nN�x�vE,� zory/,v6 .cEsv�,�rnvs / crttoirc� sEre.�ars IoM reEe-rs f mor uvEs NORTH ANOOV6R MRSS, .0,1-1'4-1/,Y6 /.f.t/OT L nGI TCO /.V Tri' t H.IZ�t'O A t'Era, O!eiq oeA1 Fo.P SrYawN DiS/ F� O .Y, P�NCL 'R25UOq�+ /S 83 RONRLJ�. MO//�R ?En/-NOPE JTEP.SrE •. � .S 7� /00` mprY 99 DoT FOA- eoavoty �x'r�rt�ia.� rvor+�<iv.�o/%►f- �E.P�/�ivGt' E.V4.at�(EE.�.W6 SE•�YicEs - ,.rr�ov rr�,rE.y f,�,f, Et-rJr�.vG .tEcacos. GG �A•P,W .ST.e'EET M-zs(op .I/t/00�'E�C, ,ifrISS.4C.fi -rd TTS O/d/O s ' % 22-141 50 SHEETS 22-142 100 SHEETS AMPAD 22-144 200 SHEETS 1 -------------------------- x u� i a + � N �