HomeMy WebLinkAboutMiscellaneous - 43 PHILLIPS COURT 4/30/2018 '_ ' 4�L3 Ph.111105
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Date...t..............................
t HpR7p
t, o TOWN OF NORTH ANDOVER
o ,. ,• ,
e.,�
3: ... '• of
PERMIT FOR WIRING
'ss�cHUS
This certifies that -'t-
.............. ................................................................ ......... .j
has permission to perform Vit. ci
................................................... ............ d.
........
wiring in the building of.:.....�'�3.........
!>..L........ f
....... ,North Andover dss.
o' s
+ Fee..... ,?..�....... Lic.No;???.O> ............�... ....
ELECTRICAL INSPECTOR
Check #
a
Commonwealth of Massachusetts official use only
Department of Fire Services Permit No. 44 Z
BOARD OF FIRE PREVENTION REGULATIONS [ROccupancy and Fee Checked
' ev. 9/051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PL EASE PRINT IN INK OR TYPE ALL INFORMATION) 'Date:
City or Town of: �� ��__ 4� � -� �� "
By this application the undersigned give�ce��)1 �her intention to perform the Inspector of Wires:j pe rm the electrical work described below.
Location (Street&Number)_4/
?� /llI
oaS
Owner or Tenant
Owner's Address Telephone No.
Is this permit in conjunction with a building permit? yes j No
Purpose of Building_��P�r P ❑ (Check Appropriate Boy)
— Utility Authorization No.
Existing Service� _ AmpsQ /a((d No,of Meters Volts Overhead dgrd
Un ❑
New Service Amps / Volts Overhead
❑ Undgrd❑ No. of Meters
Number of Feeders and Ampacity
Locatio and Nature of Proposed Electrical Wor / 1 G r
0711 o�L n Parr
rl n
nuie 7 S � �e� t/1 � rS r�1 .
Com lelion of the following table may be waived by the Inspector of Wires.
LNo.of
Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans 1,40.01 ota
Transformers KVA
Luminaire Outlets No. of Hot Tubs
Generators KVA
Luminaires Swimming Pool bove [] )[n- ❑ o.o mergency rg ung
nd. rnd• Butte Units
No.of Receptacle Outlets � No.of Oil Burners
FIRE ALARMS No.of Zones
No. of Switches No.of Gas Burners 4 0.0 etec ton an
No. of RangesInitiatin Devices
No.of Air Cond. °�
Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons o.o f-Contained
Totals: ............_......_.... ........._.................._.
Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑
Connection unretpal
E] other
No.of Dryers Heating Appliances KW Security Systems:*
No.of ater0 0 . No.of Devices or Equivalent
KW
Heaters °.o Data Wiring:
Signs Ballasts No.of Dvices or E uivalent
No. Hydromassage Bathtubs No.of Motorselecommunicahons firing:
OTHER:
Total HP No.of Devices or Equ valent
IrZ 4— Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work. g' _ (man required by municipal policy.)
Work to Start: G a- Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no
the licensee provides proof of liability insurance includingpermit for the performance of electrical work may issue unless
"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the pennit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and pen o
f perjury,that the info on on this application is true and complete,
FIRM NAME: a r
Licensee: LIC.NO.:__,
Q.1''' Signature
(If applicable enter" "in the license number line.)nn _ LIC.NO.:
Address:
*Security Bus.Teo No.: -/)(,o
?6
vstem Contractor Li nse requtred for ttus work,tf applicable,enter oe�license number hTereel.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)El owner 0 owner's agent
Owner/Agent
Signature Telephone No.
p PERMIT FEE: $
tic
i
s
I
I
I�
Date..
F / AORTk
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
no•r•'4h
�9SSAC HUS-
This certifies that . . 1 --l4w e,:-. .ti. . . /3.!G 4! . . . . . . .
as permission for gas installation . . //—/y . . . . . . . . . . . . . . . . . . . .
in the buildings of . . .//C,.cam: . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .. North Andover, Mass.
Fee. ..) S '. . . Lic. No..ical.kt.
AS INSPECTOR t
Check# 1,11-3 L
5346
U �
30 ,
O�
MAS,SACHUSEM UNNDRM N FORPIIt W TODD GAS ffn1% r
Date
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
�f
Building Locations 3 �(/' s - Permit#
Amount$
Owner's Name {�/
New Renovation Replacement Plans Submitted ❑
U 1 a
c a z c
a
GL01
z z a o °o. w
U a �' a w H o
SUB -BASEM ENT
BASEMENT
1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
STH . FLOOR
6TH . FLOOR
7TH . FLOOR
STH . FLOOR
(Print or type) Che k one: Certificate Installing Company
o ��
Name !$y11I�A.) � P�CU'lD
rp
Address uu tJ u ❑ Partner.
lbe
Business a ep one 6F 7Q ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or' ' ubstantial equivalent. Yes ❑ No Q
If you have checked Les,please indic a type coverage by checking the appropriate box. 13Liability insurance policy Other type of indemnity 13Bond
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 ❑
+'o I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Stat as Co C_hOoer 142 of the General Laws.
i
Si re of Licensed Plumber Or G ►tte
Tit lumber
Title
City/Town Ga tter [censeNumber ,
aster /V
APPROVED(OFFICE USE ONLY) ❑ Journeyman 6
i
Date. Z5:� .2-
NORTH
TOWN OF NORTH ANDOVER
r �1 O A
' PERMIT FOR'GAS INSTALLATION
9SSACNUSE�
This certifies that .... . . . . . . . . . .
has permission for gas installation . . . . !?. . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . .,/ �.1��j.�. . .�a . . . . . , North Andover, Mass.
Fee; a,.-. . . Lic. No..�%�-��. . . -.
AS INSPECTOR
Check# 26/ (,
4173
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Pent or Type)
:t
„ t , M Date 11 .2c�z Permit #
4 h Building Location 7/ Owners Name
—4, /1,?Aww'- Type of Occupanry
New ❑ Renovation ❑ Replacement 2 Plans Submitted: Yes❑ No p
y
y ¢
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W W y ¢ O V m t Z SA
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= O W Q C o C r FW-
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SUB—BSMT.
BASEMENT
!ST FLOOR
2ND FLOOR
3RD FLOOR
a
4TH FLOOR
} STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name :f r jAt;--g T A . `Ain mA Tit)r Q Check one: Certificate
Address 30
h 4- ❑ Corporation
nIETHuerj r11 A . U (k q 4 p Partnership
Business Telephone_ /d 2 —(7 (7- 1 9--firm/Co.
Name of Licensed Plumber or Gas Fitter t),8 E T A5 A M rPl r9 Tr4 r
INSURANCE COVERAGE:
I have a current I biltty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142..
Yes No O
If you have checked yes, please indicate the type coverage by checking the appropriate box
A liability insurance policy 0 Other type of indemnity❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 OwnerO Agent [I
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the pern)K10wed for this application ' be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne taws.
By T of License:
True Plumber n ure of Licensedu or fitter
tter
er License Number (73 3-
City/Town Journeyman
O C ORM
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE ,
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
i
NAME a.TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
/ r i
LIG NO.
j
PERMIT GRANTED
DATE
OAS INSPECTOR
Date. �. . .�. .G.
N2 4842
TOWN OF NORTH ANDOVER
1� P0
PERMIT FOR PLUMBING
1' •
'SSACHUS�
This certifies that . . . . . .. .. . . . . :. .:�. .
has permission to perform . . .�. .' . . . . . . . . . . . .
plumbing in the buildings of . . . /-A . . . . . . . . . . . . . . . .
at. . . . . ., North Andover, Mass.
P'
Fee. .`/c. . �. .Lic. No....'.'. . . . . . . . .. . . . . . . . . .
PLUMBING INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
.Print or T�y1pe)
-_--_ y
G --- 7
~\ ,n ---- ' 4VCfrr , Mass. Date _ -_ G 19_.�--Permits �� Z ''•.�� ��`,
=411
�✓ //' _✓1 Owner's Name
el?
Building Location — —� / l� -
SM
N� Type of Occupancy
�:�
New Renovationi-=] Replacement _.: Plans Submitfe Yes ❑ No
FEATURES
z z
U
Z Y ) Cl)U) 0 Z
Z
o ? w - U m U) Q U) Z a Z n � s
J cn W Cl) U) rL S ¢ W U) Y (r 0 ¢ ¢ 3. X
E-
C) m m cn } F- rn z o ¢ ui m a m. O E-
Z m W m ¢ w Z lJi m
Cc W O w ¢ (n Cn Cc J o
W = Q S � 3 O _ Y d Q t- ¢ Y ¢ w :LL Y W
Z n. cn F rn Z Z w O v =
Y J m (n a J > �'I-- rn LLL (D Q ¢ > 'cc m O
e
SUB-BSMT. "I `
BASEMENT e t•
i 1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
ST,H FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name � �/771J iC�/�^�/I e— Check one: Certificate
Address )(Corporation 74
Partnership
Business Telephone - Firm/Co.
P _
Name of Licensed Plumber
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes No
If you have checked yes. please indicate the type of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity _i Bond i.
OWNERS 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:
Owner "_ Agent
Si nature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to
the best of my knowledge and that all plumbing work and installatio erforme oder the permit issued for this application will
be in compliance with all pertinent provisions of the Maksach et Sta Plu ing Code and Chapter 142 of the General Laws.
By _ ;..-
----- ------.._ Signa re ot Liceirindum -- - -- - ------
Title __ Type of License: Master Journeyman
License Number_-_
- - ��-fit- -- --_ -. _
FEE
N O
i
APPLICATION FOR. PERMIT TO DO PLUMBING
OWNER: .
.. a NAME & ;TYPE 0 ':BUILDING
1
LOCATION OF BUILDING:
PLUMBER, OR GASFITTER:
r LICENSE NO:
PERMIT GRANTED
DATE:
PLUMBING INSPECTOR s'
I
N° 3 5 U Date... �f. ..F..��. .............
t �aOFtTM A
� TOWN OF NORTH ANDOVER
� p
PERMIT FOR WIRING
,SSAC14US
1
This certifies that .... �.'. ..��/ ��`'.' .. �/
................... ................................................
has permission to perform ....... .......!..`:-1.............................................
r� T-
v�nnng m the building of... .............:. ...��.��� ` ..............................
.. J ,North Andover,Mass.
FA.....�. V Lic.No.......`....
" v
� 7 ELECTRICAL INSPECTOR
Check # C) 7 f
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
THEC0W01VWE4LTH0FM,4MCff I SEM Office Use only
DEPARTAL&VTOFPUBLICS MY Permit No.
BOARD OFFIREPREYE MONRWUTATIOI N527CMR 120
Occupancy&Fees Checked
U11
PPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 3
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �„„�_
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number) q 3 Pk, fij xos �O o UST11m ()/l
Owner or Tenant 0
Owner's Address
Is this permit in conjunction with a building permit: Y No, (Check Appropriate Box)
Purpose of Building A ,'r.C /tA I � Utility Authorization No.
Existing Service �„�-O AmpsGo /aNAG Volts Overhead L;;�J Underground No.of Meters
New Service .n— Ampsl y / �-o Volts Overhead Underground No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total
KVA
No.of Lighting Fixtures Swimming Pool Above Below Generators KVA
ground zround
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
1 I
No.of Switch Outlets
No.of Gas Burners
No.of f anges No.of Air Cond. Total FIRE ALARMS No.of Zones
Tons
No.of Disposals No.of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices KW Local a Municipal Other
Connections
No.of Water Heaters KW No.of No.of
Signs Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
OTHER
Irstrd=Co�Pt1Suarit1Dthere XeftlallsdMwxhm0sGataalLaws
Ihawaav mtLnbiltyh>st m=PohcymdudmgC #At CamaWcrits tdegiv,&t YES NO
Iha%eabnodvdhdpcoofofsmnetDthe0ffim YES rJ NO IfjcutmedvckedYES,pleaseedic*tttetypeo£wmaWbydxckrgthe
apprq. box
INSURANCE M BOND O I R (PtemSpe y)
E*afim Dole
Fsliml ad Value ical Weds$
WorktoSlart IrspedmD*Rgxswd Rough FmW
Signed uncle M P Woes ofpajtey.
FIRMNAME Lioa�seNa
Q�
Li.. �2r. GV�-Q,�� Slgr>atine LicmNo
BtscrssTdNa
Address .. AIL Tel Na
OWNER'SINSURANCEWAIVER;IamawalethattheLimwdmn e$reirstraneoaa�aor9ssubsl�>lial malm�asregtmadbyM Ga>aalLaws
and�atmysgttaernthispertwpfiolwai�s111isrmt
(Pleases _ on ) ner Agent
r ' Q Telephone No. PERMIT FEE v
TOWN OF NORM!I A NIDCJ,V,
BOARD OF HEALTH
r
ON
f ABA TEAVENT CONTROL SERI/®CES ®�lC. � 17 10
ASBESTOS REMOVAL & MAINTENANCE
w
v
DECEMBER 14, 1998
N.ANDOVER HEALTH DEPARTMENT
146 MAIN STREET
N.ANDOVER,MA 01845
DEAR SIR/MADAM
ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE
FOR AN ASBESTOS ABATEMENT PROJECT.
THE JOB WILL TAKE PLACE ON JANUARY 15 , 1999
LOCATION: 43 PHILLIPS COURT
ANY QUESTION CONCERNING THIS MATTER SHOULD BE DIRECTED TO MY
ATTENTION.
SIINNCERRLLY,
FRANK BALOGH
PRESIDENT
2 INDUSTRIAL WAY SAL - _
EM, NH 03079 NH (603) 898 9472 MA(888) 870 9292 FAX(603) 898-1846
L'o/flN1� �P/lh8�l�/�ss8'ChlJS8lls �s `�� :'in
"M +.
ert�►slYat!/ICat/o�►f,�rm--�Ylr�lD1 71
13
L. Facility location:
BONNIE DESMOND 43 PHILLIPS COURT
wnA�Cn�� N.ANDOVER,MA 01845 978-794-1941
1.AN NOWra of On CAty/ToM►► Zip Code TMgohw�e
form nwd be BASEMENT
coepktad In order to ._—..._..—_..... _...._.-_. —
compp Vft the Wl►a.M Me warkso/out/on;'9udding name, 0, wring,floor,roam
DeM unwd of
eiw1lowneow 2. Is the facility occupied? , Yes [I No
Prsteeflen
notlftca0oft
nerauMements of 310 3. Asbestos Contractor:
CMR 7.1 S(M mm"
dlaya pfrta►no6rki0ron
isnquYadafany ABATEMENT CONTROL SERVICES, TNC. 2 INDUSTRIAL WAY
aeatenrranfp+alwt! — -
and do D"Offamrt Narl>e Aadien
oftaaww0d SALEM, NH 03079 603--898-9472
IMmdwiee -
nofMkatWn G4i'yor~n zipcvde
� w of
f.12(EandAyY� AC00036'l WRITTEN
paw raaw-awn At DU Lkeim/ Con"et 7)'pe(Wintten or Verga/)
a0i1omwt~ 4. Oft-Site Project Supervisor/Foreman:
greater Dun aver
Mow or tquanr heU.
2.9uwM&4lnalAS31505
Foran To: NAM DU Cerbf9ubon I—
t'wnrswownre�llle of
S. Project Monitor:
'i AMeoflw heron .
111'0.s.1ioa7407 NORTHEAST ENVIRONMENTAL AA00153.
INs Form be Nam e _ ... .__...__.... .. _._._____... _...— DaCeta abbn a
U"d
notilly
an
U.S.EmkorwnenW
►►ooectkn Agwy 6. Asbestos Analytical lab:
Regbn 1 of aebeatot
Wmw'f on SAME
operedona subject to
f1E94APS(40 Cfit Name DLI Cerbf idw A
SuOpaR M).
7. Project start datel-15-9%nd date 1-15-9 gpecific work hours(Mon.-Fri.)'74(Sat.-Sun.)
Fa curiumu.e o�v-
8. What type of project is th1s7 a.r.r Aww **(..pori
rruarkatrm i
9. Describe the asbestos abatemenCprocedures to be uses- olaK wv.
ilataew desk d4toaeaf oQ/)' Offier(e.7dunJ y"`
RGMW
10. Is the Job being conducted ', indoors ❑ outdoors?
ftwA Apl>rOKfOtl.r00
_— 11. Total amount of eachW of Asbestus Containing Materials(A.CM)to he handled on pipes or ducts(linear R.)1� w other
°iCi4f°"e surfaces(square ft.) to be removed, enclosed or encapsulated:
;near I Sgrafa feet
BW er bwcMsg dug rinA swfkv cw&W _ 30 nermil ,aid gar pia inr.•at4:0
CO tWi,at/nV arrw papa pee/nw4ao, �.r,� lwranny cement _ --•--
siW4'-w 4 roaft _ TrWW*f&k r cnaonys
Ck t rwren fallev —— _ Trans+re&W.-J,wail&Wrd
12. Describe the decuntarnination system(s)to be used:
._. .... —_._._FULL .CO.N'�.�LN�F11t'�. .. . ....—__— .._ __.__.._—..... __._..--•------.. .
13. Describe the containerization/disposal methods to comply with 310 CMR 7.1 S and 453 CMR 6.14(2)(8):
'ALL CONTAINER IZATION/DI.SPOSAL. WILL-.COMPLY. WITH_-.---__.__,___..-_- ._
310. clnr 7_5 and 453 cmr.-6 . 14_....(_2 ). -(g) .
14. For Emergency Asbestos.Abatement Operations,the DEP and DU officials who evaluated the emergency:
N&M of 9V CONCANI n*
' da dlAutl�ontrabbn ._. . water.rr
Mane a/ALl p1kAa! n*
Dw*of4&WWtrabbn Walter 0
f�//lQf�su�pdso
1. Current or prior use of facility:
HOME
2. Is the facility owner-ocapied residential with 4 units or less? X. Yes'C]No - - • - .
3. Facility Owner:
BONNIE DESMOND 43 PHILLIPS COURT
Name AW^w
N.ANDOVER,MA 01.845 978-794-1941
pq,/rm zip Code Tektaha�e
4. Facility's Owner's On-Site Manager.
NA
Name Address
CAY/ra zip code Tq ►one
S. General Contractor:
NA
Name AdWea
ow/Tom zip code Tekp av
Caftews Wvaters Coop !)alar _. Aviky d' f P'�
6. What i the size of the_facility?2 '_0 4 R) ( floors) r,-.r
1. Transporter of asbestosroontaining waste material from site to temporary storage site(if necessary)to final disposal sit?
ABATEMENT CONTROL SERVICES, INC. 2 INDUSTRIAL WAY
Name Mdrea
SALEM, NH 03079 603-898-9472
0WITown zip cede Th*ft e
2. Transporter of asbestos-containing waste materials from removal/temporary storage site to final disposal site:
SAME
Name Ad&eu
ah'/Ta+�► zip code Tdgoihav>c
Ito Transfer3. Refuse transfer station and owner(if applicable):
Stations must
Comply writ the Address
Slid Waste
OW067 reguia• _ T�pna►e
Carrs 310 CMR rAy/Town
18.00
4. Rnal Disposal Site:
,TURNKEY LANDFILL WASTE MGMT OF NH
1"awn Name Owws Name
90 ROCHESTER NECK RD
Addrw
ROCHESTER, NH 03067 6Q3-332-2386
Jp code Ttfe�+ftar�e
0 l:0%dJliCi�00
' The undersigned hereby states,under the penalties of penury,that he/she has read the Commonwealth of Massachusetts Regulations
for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15, and that the information contained in
this notification is true and correct to the best of his/her knowledge and bellef.
• FRANK BALOGH
— /Mime Audartred _ D"
ABATEMENT CONTROL SERVICES, INC. 603-898-94.72
sow Cunbactcr President
must sign thisWRMrffFd p T
�`- .:,;.:. •
fbr"for D11 2 INDUSTRIAL WAY SALEM, NH 03079
noGlScadan _ lap.coot
dij
purer Address /7 ow» --
Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less) Yes U No
729.618
Stickers(from front of form):
Location
No. C:: ") Date
MORT1y TOWN OF NORTH ANDOVER
?O�f�•o � '11ih0
~ s
i Certificate of Occupancy $
,S1ACMU SE� Building/Frame Permit Fee $ C>2
Foundation Permit Fee $
Other Permit Fee $ _
TOTAL $ C> r 1--
c �o
Check #
l
14819
j Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
(fpz y s 4
, a:: --.,4 "{f .,„.;... ., 'Z, „"en�ecl�6�f^ zv.• 4.•_? s ti:. :sr:;'w
BUILDING PERN 41T NUNvIBER: P72DATE ISSUED:
SIGNATURE: -.0010 VIt 00AW `
Building Commissioner/I for of Buildings Date
SECTION I-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
q3 TA, t t gas CA
�(�) 31 (
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage Cf L)
1.6 BUILDING SETBACKS ft
Front Yard '' ' f Side Yard Rear Yard
Required Provide Required Provided ReqWred Provided
1.5. Flood Zone Information: Sewerage Disposal on: 1.8 Sew e l
1.7 Water Snpply M.G.L.C.40. If
54) System:
Public ❑ Private. ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M
2.1 Owner of Record
-3
Name( ) Address for Service
Signature -Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
License Number
10
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
I
i
SECTION 4-WORKERS COMPENSATION(RG.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 rmit.
Signed affidavit Attached Yes.......❑ No.......❑
SECTION 5 Description of Proposed Work check ail applicable)
New Construction ❑ ,,, Existing Building Repair(s) ❑ Alterations(s) Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be ' QFFI '' LISEOI!TI:Y E
Com leted by permit applicant
1. Building (a) Building Permit Fee
,-Q-Q Multiplier t s
2 Electrical (b) Estimated Total Cost of A ,
�Q. Construction
3 Plumbing p p O Building Permit fee(a)X (b)
4 Mechanical HVAC .
5 Fire Protection
5 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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
I, i ,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
Print Name
Si i ature O r A en' Date
NO. OF STORIES SIZE
BASEMENT OR SLAB P
SIZE OF FLOOR TFVMERS 1 2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Nux7h
Town of North Andover o�ot
Building Department
27 Charles Street
North Andover, MA. 01845
D. Robert Nicetta SSAC
SE�1
Building Commissioner
(978) 688-9545
..: 978 688-9542 Fax
HOMEOWNER LICENSE EXEMPTION
Please print
DATE `
JOB LOCATION /2 r.//,0!zS q 3 q
Number Street Address Map/lot V
"HOMEOWNER
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
------------
P
City Town State Zip Code
The current exemption for"homeowners"'was extended to include owner-occupied dwellings
of two units or less and to
allow such
homeowners to engage an indmdual for hire who does.
not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1)"
DEFINITION OF HOMEWOWNER:
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one or two family dwelling, attached or detached structures ac-
cessory to such use and/or fart structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner.
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned"homeowner"certifies that he/she understands the Town of No.An over
Building Department minimum inspection procedures and requirements and that he/ he will
comply with said procedures and requirements. %
� r
HOMEOWNER'S SIGNATURE k
APPROVAL OF BUILDING OFFICIAL
� �OF�T►y
Town ® _- 4 over
No. Z o7
~
y ��/10 �
i LA o dower, Mass.,
COCMICMEWICK
AoRATED V'Pa,` 5
S H BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
THIS CERTIFIES THAT......... ..�....�l.......................:�.�.w!�,II......... .......................................... ............. BUILDING INSPECTOR
Foundation
has permission to erect.....�a.... . buildings on.... •
.�
' ..... ......... ................. Rough
to be occupied as...............40............. ..�� �................ I.S .�........ 1►d s................. Chimney
provided that the person accepting this permit shall in everyrespect 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 Constructi n of
Buildings in the Town of North Andover. A*) 9;, A 30) PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
Rough
............. ...... ............ Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Fnagh
No Lathing or Dry (Nall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
' SEE REVERSE SIDE Smoke Det.
s Location `
Date (� t
F
0f,4
.0 RT" ,N TOWN OF NORTH ANDOVER
Y Certificate of O�c�cu�pa►�� $
Building/FramNerm�it`F�e $
�S I Foundation Permit Fee $
{ SACMUSE
Other Permit Fee
Sewer Connection Fee $
Water Connection'Fee $
} TOTAL $f
x.
s� wilding Inspector
l- R f 7 G.2 Div. Public Works.
PERMIT No. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
MAP KdO. LOT NO. 2 RECORD OF OWNERSHIP iDATE (BOOK PAGE —
ZONE / I SUB DIV. LOT NO.
ZOCATION PURPOSE OF BUILDING
_to
OWNER'S
OWNER'S NAME' fj��✓' ��is%F✓( aY rc/ Y�(•r"/` NO. OF STORIES , K- SIZE _
OWNER'S ADDRESS P"- ���/ S Gf� 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
Ir 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 i �/"`lf IS BUILDING CONNECTED TO TOWN SEWER t i
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
,�'{ m�� 3 PROPERTY INFORMATION
/c' S/j`"��7` L
LAND COST
SEE BOTH SIDES EST. BLDG. COST
Z-000, EST. BLDG. COST PER SQ. FT.
I -PAGE 1 FILL OUT SECTIONS 1 - 3 �
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
d ✓
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING �l�'�� ���
4 APPROVED BY
- ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING IAISPECTOR cev � �7 ®� G� e
DATE D AGO
UILD INSPECTOR
SIG RE OFT�4E�R AUTHORIIZE AGE
i
FEE OWNER TEL.#
e PERMIT GRANTED 11 1 CONTR.TEL.# v'-
N ` 19g4
CONTR.LIC.1/ r,�
]A
1 H.I.C.<r M/ Yiv `,'
f
BUILDING RECORD
BUILD CO D
1 OCCUPANCY 12
SINGLE FAMILY 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 d 1 2 (3
CONCRETE BL K. PINE
BRICK OR STONE HARDWD
PIERS PLASTER _
_ DRY WALL
UNFIN.
3 BASEMENT 11
AREA FULL FIN. B M AREA _
1/1 '/2 �/� FIN. ATTIC AREA _
NO B M 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 D _
ASBESTOS SIDING _ COMMCN _
VERT. SIDING ASPH.TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. 8 FLOOR _
BRICK ON FRAME
CONC. OR CINDER ELK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I- I POOR
ADEOUATE NONE
5 ROOF 10 PLUMBING
GABLE ' I HIP BATH (3 FIX.)
GAMBRELMANSARD TOILET RM. (2 FIX.)
FL _
AT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY _
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR 8 GRAVEL STALL SHOWER
ROLL ROOFING MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE
t
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. 8 COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS _ AIR CONDITIONING
RADIANT H'T'G F
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
lsr 13rd I NO HEATING
l
A\C t 1.1
��
Town o �� mrd ! t over
North ,Andover, Mass., ` toyL-'l 19 94
tAKF 1.
/� cOt.rucr�Ewi(n �
L %SAO!?ATED nF>FX\C-)
BOARD OF HEALTH
Food/Kitchen
PERMIT T UILD Septic System
f
BUILDING INSPECTOR
THIS CERTIFIES THATA�l ��.4rV1o 'a
.................... ................ ........................................ ......................................;.............................. Foundation
y
has permission to ................ buildings on44S.......4i.wm...4 wa. ........................................ Rough
Y„V1�+.? .-. �.F�1 ... �1P� 1.1+141 . .". � ..... ... himney
to be occupied as-$ft !1�... 1,.
provided that the person accepting this permit shall in every respect conform to the terms of the application oh 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
AIL PERMIT EXP6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CO STR.t 1 N LSI:' T Rough
0
...... .... .. ............... Service
Pt BUILDING ECTOR
y Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
� Display in a Conspicuous Place on the Premises — Do Not Remove Rough
,5 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.
ti Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
i
Town of North Andover
I
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE
JOB LOCATION
Number Street Address Section of town
:'HOMEOWNER"
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
City Town State Zip code
The current exemption for "homeowners" was extended to include owner
-occupied dwellings of six units or less and to allow such homeowners to
engage an individual for hire who does not possess a license, provided
that the owner acts as supervisor. (State Building Code, Section 109 . 1 . 1)
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
reside , on which there is , or is intended to be , a one to six family dwell-
ing , attached or detached structures accessory to such use and/or farm
structures . A person .who constructs more than one home in a two-year
period shall not be considered a homeowner . Such "homeowner" shall submit
to the Building Official , on a form acceptable to the Bulding Official ,
that he/she shall be responsible for all such work performed under the
building permit . (Section 109. 1,. 1)
The undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other applicable codes , by-laws , rules and
regulations .
The undersigned "homeowner" certifies that he/she understands the Town of
North Andover Building Department minimum inspection procedures and
requirements and that he/shY will comply with said p cedures and
requirements . t
0
r
HOMEOWNER' S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note : Three family dwellings 35 ,000 cubic feet , or larger, will be
required to comply with State Building Code Section 127 .0, Construction
Control .
I