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HomeMy WebLinkAboutMiscellaneous - 45 HOLLOW TREE LANE 4/30/2018 (2) 1 45 HOLLOW TREE LANE 210/104.A-001&0000.0 9765. Date......//-7:zz-z TOWN OF NORTH ANDOVER PERMIT FOR WIRING AT.D CHUS This certifies that ........... ................................ has permission to perform ........ ................................................ wiring in the building of....... ................................................... at.Y5........................................................................ Iorth Andover,Mass. jFee.3���.. Lic.No3D..74.4F ...........iLiCTRICAL I?SPE Check 1 Com/Y'I®P]Id/ealth of Massachusetts Official Use Only Department of Fire Services Permit No. `7�' �'- Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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 (PLEA SE PRINT IN INK OR TYPE ALL INFD TION) Date: City or Town of: To the Inspector of Wires: By this application the undersi ed gives not' e of his or her intention to perform the electrical work described below. Location(Street&Number) ��G Z5. Li✓ Owner or Tenant 3;R j AAd F00—tl t Y Telephone No. Owner's Address S rW'"h-_ Is this permit in conjunction with a building permit? Yes No ❑ BLDG PERMIT# Purpose of Building 07 LI 44 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: Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No,of Ceil.-Susp.(Paddle)FansNo.of Total. Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ Ao.of Emergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Tota No. of Ranges No.of Air Cond. onsl No.of Alerting Devices No. of Waste Disposers Heat Pump Number .Tons. KW No.of Self-Contained Totals: •" Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security of Devimees or Equivalent No. of Water No.of No.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: t No.of Devices or E uivalent OTHER: Attach additional detail ifdesired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start://-//-/a 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"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE E, BOND ❑ OTHER ❑ (Specify:) I cert,under the pains andpenalties o perjury,that the information on this application is trace and complete- FIRM NAME: lV i-i �) t,1N7t; 6 0'0 LIC.NO.: 3q/ •7b& Licensee: SA vq Signature LTC.NO.: (If applicable, enter "exempt"in the license number line.) G c '? Bus.Tel.No.: Address: 7 S c ,l3 S i1r-lc AJis r d,141+rw nl14 6?3 Alt.Tel.No.: 35 *Per M.G.L. c.147,s.57-61,security work requires Department of Public Safety"S"Licen 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. $ ELECTRICAL PERMIT NO. q7L> INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL _ 1 GJIASPECTION: Passed—M Failed—[ ] Re-inspection required($50.00)- [ ] Inspectors' comments: (Inspectors'Signature-no initials) Date T`' L { 2.FINAL INSPECTION: Passed— Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors' Signature-no initials) Date 3.UNDER GROUND INSPECTION: Passed—( ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: a (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)- [ ] Inspectors' comments: f r (Inspectors'Signature-no initials) Date t 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: .(Inspectors'Signature-no initials) Date i DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. + . The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA. 02111 www.mass.gov1dia ,Workers' Compensation Insurance Affidavit: Builders/Contractors/)Electricians/Plumbers Applicant Information Please Print Legibl NaMe(Business/Organization/Individual): %rJ :1. 7P►17V /VAS C Address: :I S W 0749 5 l6*1 &A;r— City/State/Zip: F0L i-I A dh 1\1H o36_26, Phone#: Vg 31) Z_G,y 3 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.X I am a sole proprietor or partner- listed on the attached sheet.s �• Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working forme in any capacityworkers'coin. p•insurance. 9. Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we haveno 12.0 Roof repairs i insurance required.]t employees.[No workers' comp.insurance required.] 13.❑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. tContractors 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 employes that isproviding workers'compensation insuranceformy employees Below is thepolycy andjob site information. Insurance Company Name: Policy#or SeIf-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: s 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 certyf under t pays andpenaldes ofperjury that the information provided above is true and correct. Simafore: / Date: �!J Phone#• q 7919 0! 2 &o 3 [Other only. Do not write in this area,to be completed by city or town offciaL To' n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town CIerk 4.EIectricaI Inspector 5.Plumbing Inspector son: Phone#: Dane.. .(ices......... �aORTM TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 4CHu5E� 01 This certifies that ...... ... . I� s 4 �Q has permission to perform ..........�-.:............. ......4�;.;+....... ...:h1..........!!`n... wiring in the building of... ►�1 at......4fa.w........t........e.....L.��..,North Andover,Mass. Fe ........ Lic.No. .....l.....�f3 .... �.Q.Pi�.....&........... ELECTRICAL INSPECTOR Check # '10805 ( J Commonwealth of Massachusetts Official Use Only ��� Department of Fire Services Permit No. / -5 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leaveblank 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 ININK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or Dher intention to perform the electrical work described below. Location(Street&Number) /�j)GGt1t�J'f 2G� "A-65r- Owner A 65r- Owner or Tenant —Sr-[Z i N S-Pr--y r--/ Telephone No. Owner's Address Sok-h-t Is this permit in conjunction with a building permit? Yes F\J No ❑ (Check Appropriate Box) \` Purpose of Building / -wCLr Utility Authorization No. - Existing Service ZD O Amps 12-6/Z YD Volts Overhead 5(7] 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: �},� Completion of the following table may be waived by the Inspector of Wires. of No.of Recessed Luminaires No.of Ceil: TransSusp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No. of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ❑ No.—Of Units Emergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices � No.of Dishwashers Space/Area Heating KW Local❑ MunicipalConnection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* Y 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: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE R BOND ❑ OTHER ❑ (Specify:) I certify,under the pai and penalties o erjury,that the information on tltisl app ication is true and complete. FIRM NAME: . ptT LIC.NO.: la Licensee: NM 15— Signature LIC.NO.: (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: Addres s: 2 Sl.�r�-a3 S" � A�/tT F97 /-//kris/&A a 7 Alt.Tel.No.: *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 PERMIT FEE: $ Signature Telephone No. t � l'1R�1�-+.�A'.-x.�.+.CJ4Q•f 1LL�19��tL�ll�" r • � f x.�017G 7SP C�XON, YiMpectore cop]Inealts: � Q (Iuspeetorig"ftVatuz'e-�o kuluals) Pate 2.YNAL Vasse -[' ailed--r ) ens ectio�der uzxe ($ O.OD}-[ �n�ectox-s'comments; ftspectors'ftnature-)toiumais) ±,; date Passed--� ) +ai�ed--j ?�Ze-ttspeetto�xecu9xet�(�s4.QD)�[ ] Thspectoxs'comments; (lnsPectoxs'aignatuxe�noinifials) Pate ' WVE,CAI MM0WR A U ONM C-1II j I. assed.--[ } �+'ailed--j ) �e-�.nspecttonxequixed(�50AD)�( � ' tspecta7rs'eo�t.extfs; (Cats ectoxs'piga tuxe-io$nitials) Date WSPA ' 'XON romp's" ,sed- ( ailer•, Xte xnspectiottxeguixet�($50.00)-[ } - p ectoxs'cosi melts: . '(41s ectoxs,91gnatuxe-no iii Fdals) Pate aOR TAAGj5A=T033E FMLED PLUTAND)GE7EXON)SIT`EIFM.APXA TO3E STECTU DXS NOT ,.r ry The Commonwealth ofMassachusetts , - Department oflndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.masssgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Amilicant Information Please Print Legib Name(Business/Organi-zationftdividual): Address: A VE- - City/State/Zip: f&M6� / 11± o 3d 7& Phone m 2-Coo 3 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(fall and/orpart-time) have hired the sub-contractors 2.A1 lam a sole proprietor or partner- listed on the attached sheet.x 7. Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑I am a homeowner doing all work right of exemption per MGL 11.❑Plumbingg repairs or additions myself.[No workers'comp, c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they ere doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. X am an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information. Insurance Company Name% Policy#or S elf-ins.Lic.#: 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 requiredunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a .fine up to$1,500.00 and/or one-year imprisonment,as wellas civilpenalties 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. X do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. - Signature: Date: 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.CitylTown Clerk 4.Electrical Inspector 5.PIumbing Inspector 6,Other - - - Contact Person: Phone#: y ! 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 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 ofpublic 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 numbers)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. Iran LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 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(ifnecessary)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 maybe provided to the M applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or]porm t not related to any business or commercial venture f (i.e.a dog license or permit to bum leaves etc)said person is NOT required to complete this affidavit. r 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 Commoawealth of Ma..ssarhusotts Dop-a ont ofladusWal.A.ccxdoats Office o luxestigatiou 600 Waftg oa Street Boston,MA.021 X X TQL#617727-4900 Qxt 406-or 1-877:M.A.SSAFE Revised 5-26-05 Bay,0 617;,727-7749 www.Mass,gevfdja. Location No. Date 10-/9 �oRTM TOWN OF NORTH ANDOVER 10. 9 41 ' Certificate of Occupancy $ Building/Frame Permit Fee $ S� JACHUSE Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ c S Check # 1 5 1 0 2 ✓ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �DBUILDING PERMIT NLJAhBER: a� � DATE IS SIGNATURE: G Buildin Commissioner/I ct r of Buildin Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions:.- ..Zoning District .'... .Proposed.Use Lot Areas Fronts a .R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided L5. Flood Zone Information: 1.8 Sew . 8 '"osal S term 1.7 Water SupplyM.GL.C.40. 54) Dup Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner,of Record - \ �1�'l l � �' ✓� �5` 11oCeJ r'� L vim. 0 ame(Print) Address for Service Signature Telephone 2.2 Owner of Record: �I Name Print Address for Service: Signature Telephone - I9 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licesed Constru,lion Supe i o t` License Number Address a Expiration Date : Signature. Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name P Y Registration Number Address Expiration Date Signature Telephone i ' SECTION 4-WORKERS COMPENSATION(NLG.Il. 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.......0 : No ......Q v. SECTION 5, Descri_&h 6f Prb 6sed Work check ail a liable.- New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed.Work: i SECTION 6-ESTIMATED CONSTRUCTION•COSTS ' Item Estimated Cost(Dollar)to be WIN @� Completed b rnut a licant � _� x No x x.., �. I. Building (a) Building Permit Fee 8 O_ ®/ Ivltilti lien` D�` 2 Electrical _ - -(b) Estimated Total Cost of / Construction ! r 3 . Plumbing-, Building Permit fee(a)X(b) 4 Mechanical AC 5 Fire Protection _ 6 Total 1+2+3+4+5 p o-O "i" Check Nuiiiber SECTION 7a OWNER AUTHOR TION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property f . Hereby authorize `` //, C. to act on My behalf in A matters rel ti to work a tho " c by this b4ilding permit application. r/ AO Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 ` ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DINENSIONS 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 FORM U.- LOT RELEASE FORM !� INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from f Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** // APPLICANT—_16�// PHONE ZT 8g—&/S S { LOCATION: Assessor's Map Number PARCEL IV SUBDIVISION LOT(S) STREET_ �lD Gt/ e — ST. NUMBERS *****************************************OFFICIAL USE ONLY*********************************** RECOMM DATIONS Ok TOWN AGENTS: 41",—/ kLx4q PLC ONSERVATION ADMINISTRATOR DATE APPROVED 10 I-7 D DATE REJECTED COMMENTSI a.U n - V- of ',n d-) S e, 'An n E r� r>_ I �, �,�- x�c � . -('4-I1.N GAJ C orv�vs-t- TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS F99D INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED hriyg COMMENTS qP I"' Q. a PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 Jm i __ J � I � I V w I + I i i' I + i i �QI i + i s North Andover Building Department I 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 disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location offFa�c_ility) N�1 Signature of Pe it Applicant `6 /S ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I� .Oct-10-01 07:20P 5 P_01 n cuo � I MUtN1�nn.r nut IHR ntMgq 1tNWNM1 TITS"M AM NOt 1 OCA11O WMR4 A%M MArMD We A!CKLKA14 ON 1M triA1 C/ p aoA".ff NO. Ltra.9� Ootoe ryoRTH W*.vrwt% •lj= • 3�1 a OW r el N• i C lit. fir` n. " u rn • to n• FOX o ' vQ h a SUMOST Rolle CR LISLC, MA6s. (dGAT10N:NRMZy Csr $eRLE: I"� 6o Oft7m.E4.�Sa '-I.aa3„ on this p[onlsleeo}ad nrr�fhayrovrtdps S$hownpt /Tow�i�ot-:(nNl¢tonlrx� L N if'RgRNC IQWSQft 1 RR Vn1�9 Lcp b _on0Pign b !"•w�• N.w Ta�Qd, S_ _`l.LCP-a y �'ra¢n;a¢$Tn S1eNRo1� �¢`g1S�ry o�`DQads. r'fy___.�.� Q''1&�•°LJ� .. ookNa!�s� '�r'2Pa allo, g t 7M•Mef�nM 1 ��r� • �,11N0� N h�ewri on t IIn orld$fraall)„n b la e•lij r a• «�rfwh �+s^mnrcA' dPZ t}um(n4 own P 4mo^ra mqui-c ly pr M.�d b rt�Mu�lk� d R C GD-2 se•d LOCATION:5 RX TIME 10/10 '01 19:45 Town of North Andover -•�� Building Department 27 Charles Street r North Andover, MA. 01,845 D. Robert Nicetta Building Commissioner (978) 688-9545 :(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print ll DATE1J` JOB LOCATION Number Street Address Map/lot „HOMEOWNER _ � � /. zee/-2 (fJ v fl/�S 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 two 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 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 farm 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.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL NORTH Town of Andover 0 No. 0 L A over, Mass., COCHIC Ort .44 RATED C2 H BOARD OF HEALTH Food/Kitchen PERMI-T T D Septic System BUILDING INSPECTOR ............. ................... ............... THIS CERTIFIES THAT....AN —7-3�14A>.......r_�............. Foundation 7P r-v-- AA.)v-- ..... .. .... . ....... ................... has permission to erect..../.. buildings on ...... .......!0!��.......................................... Rough to be occupied as.....1L. / ZXCZ.6........ .......0 PS. O.......DZCX..........T.... r. P1.A C e 1�1#..M....../..—.................... 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 ws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. qlej 5 Xc-2S 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 C.....� .......`....`.'.....�............. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE Location dA&6te2 1 No. 5 Date f3 N�RTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ - � b�ATao I'`• �SSACHUSFo ndda�ttiion Permit Fee $ ermit Fee $ /`7 Sewer Connection Fee $ Water Connection Fee $ TOTAL 11/24/9311.4 BIa .ti(i9lr�sp�Dctor <� 6745 Div. Public Works Ontury — WP MLS© Carriage House 10 High Street Andover,Massachusetts 01810 Res.(508)474-0560,Voice Mail(508)937-4385 Out of State Toll Free(800)346-2121 , Bus.(508)475-1243,Fax(508)475-1741 GGmp Phil Porter &GG. CGG9 REALTOR®-Notary Public ' "Consider it Done" Each Office Is Independently Owned And Operated PERMIT NO, �s APPLICATIOPI FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. Pac>; i %.1:MAP 4-40. LOT NO. 12 ORD OF OWNERSHIP ;DATE BOOK ;PAGE — ZO —) SUB DIV. LOT NO. CATION u O G o W ,eEe G^..,i e-- PURP05 E X II S T r/V V- k&d D OW ER'S NAME �N 1 /1 L/.�.... /�, NO. OF STORIES SIZE OWNER'S ADDRESS -//L,` •1 j2 D SCJ%) /v BASEMENT OR SLAB ARCHITECT'S NAME !7/L a C� 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 BUIkDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND ` Wil_)_BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER - BO+D 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 EBT. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES..MUST CONFORM TO STATE FIRE REGULATIONS PLA MUST FILED AND APP/ROV BY BUILDING INSPECTOR DATE LED BOARD OF HEALTH IGNiATU F ORI ED AGENT • FEE PLANNING BOARD PERMIT GANTED MY 19 i BOARD OF SELECTMEN JJ� �Lsc Com,. BUILDING INSPECTOR WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILY I I 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 I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE a 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 -BASEMENT I - • AREA FULL FIN. B M'TAREA v, 1/1 1/ FIN. ATTIC AREA _ NO BM'T - FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WAILS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH __� - - ASPHALT SIDING HARD\V'D ASBESTOS SIDING. COMMON 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.1 POOR _ ADEQUATE NONE 5 OOF 10 PLUMBING GABLE ' HIP BATH (3 FIX.( GAMBRELIVED "MANSARD TOILET RM. (2 FIX.( ` FLAT 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. &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 13rd NO HEATING I 1 -,WOOD STOVE INSTALLAHON CHECKLIST Oka Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove / A. New Used 1/ B. Type/radiant Circulating C. Manufacturer Lab. No. Name/Model No. Collar size Dimensions/Height Length Width Chimney A. New Existing B. Size(flue area) C. Other appliances attached to flue(Number and flue size) . 0. 'Prefab(Manufacturer—name and type) E. Masonry/Lined Flue liner ryos b manuracmrerl Unlined F. Height(refer to diagrams) cap I 10.,F-? Ic" O10' I 121 h11N. VER ;2WK Z 111 k,11! 1• 3`MIµ 107, Ig"MIN. (FUEL,A_c-4-1 n HEARTH CHIMNEY HEIGHT Hearth(non-combustible) re r`�It C A. Materials B. Sub-floor construction C. Minimum dimensions(refer to diagram) Clearances and Wall Protectlon(.see s;ov in­glllatign plearances chart) A. Type of wall protection provided B. Clearances(refer to diagrams) I r FIREPLACE CORNIER WALL/CENTER 13