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HomeMy WebLinkAboutMiscellaneous - 450 STEVENS STREET 4/30/2018 450 STEVENS STREET 210/096.0-0006-0000.0 1 Location No. Date I Qj1 to 10 0NOItTIy TOWN OF NORTH ANDOVER ►0. .•,hOOj° � + i Certificate of Occupancy $ Building/Frame Permit Fee $ S�GMU°+ Foundation Permit Fee $ d Other Permit Fee $ TOTAL $ l ! Check # 41T45Z) 17906 � - - `� Building Inspector s TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAJIL RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. 7 DATE ISSUED: v /a L/ SIGNATURE: Building Cominissloner/ln for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: nn ffnn Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Lot Area Fronta a(ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided SM.G.L.C.40. 34) 1.5. Flood Zone Information: Sewerage Disposal System: 1.7 Water Z° Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ Public J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(P ' t). Address for Service: ckk M, VC Signatur Telephone 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone QQ SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: �— l� �V�k t , + License Number ic Expiration Date �.. Si nature Telephone r' 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name M Registration Number r Address — z Expiration Date G) Signature Telephone (ceCUtiS'� r� cT ' • FORM - U - LOT RELEASE FORM �aj Ott INSTRUCTIONS: This form is used to verify that an-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or hmdowner from compliance with any applicable requirements. �l.■.w■■lwww■w!lrwwrlr!!!w!rlwwrrww!!wlwwwwrrwrww�■■wwwwwwwwwwwww soma mammas ago APPLICANT �� �l er PHONE 6 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER l 5�� `S/'5uF STREET �lJs cSu / STREET NUMBER -1 S �rwrwwwlrl■!w!■wlwwwlr�wawlwwwwwwwwwsrwwww■rwrwrrwwrwrw.wrrrwwwwwwwww■ww■www■ OFFICIAL USE ONLY �wwrw■wwwrl.wwwwwwwwwwwrwwrwrwww.■awaww.rwrwwwwr•wwwwrwww■.rwwwwwrwrrwawwlwwwwwa TIONS OF OWN AGENTS now wl. w ■waFw■ w ! ■wwlurlww�lwrrrwwurwrrwlwwrrrwwwswwwwwwwwwww■ DATE APPROVED CCNSERVA7T0T4ADNTIIJISTRATO DATE REJECTED COMMENTS 40 UJOKKIS 1& b fh r� TOWa* aN DATE APPROVED DATE REJECTED COMNIEAIT'S DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED S e _@,� DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTS) COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS 6LpgApY DRIVEWAYPERMIT FIRE DEPARTMENT 2, DATE APPROVED—�-. 9-p FIR DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR -'TE V North Andover Building Department 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: 4YI�,114. on of F cility ig otdre 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 i BOARD OF BUILDING REGULATIONS ` 6cense: CONSTRUCTION SUPERVISOR Number: CS 083299 ' •' �BIrthdate: 03111/1966 I Expires:03/1112006 Tr.no: 83299 JRestricted: 00 i JOSEPH C SALAMONE 19 VALE RD (� WAKEFIELD, MA 01890 Administrator i C The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name —S4 - ® Please Print Name: Q" Y�c9r,'yaX t� Location: City /U _ A-y, ddo&-. i`�l� Phone # 7:3 5--0 t, I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity QI am an employer providing workers'compensation for my employees working on this job. Com an name: Address Ck.. Phone# Insurance.Co. Policv# Comoanv name: 7o P— Address Phone# insurance Co. _P011GY91 Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisormmt_as viten.as_cMi.penaitiesjnlieI=da_SIOP WORK_ORDER.aid_a.fine of.($100.00)-a day.agalnat.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. !do hereby rtify r the pains and pen s of perjury that the information provided above is true and correct. Signature r --Date_Z2_ Print name one Phone# '3 S _4 76 Official use only do not write in this area to be completed by city or town official' City or Town Perm!UUcensing [:]Check if immediate response IS required Building Dept ❑ Licensing Board Contact person: Phone#. ED Selectman's Office ❑ Health Department ❑ Other AAC-TM CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 02/04/2004 PRODUCER (781)438-5000 FAX (781)438-5028 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION .New England Heritage Insurance Agency Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR DBA Robert F O'Neil Insurance ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 335 Main Street Stoneham, MA 02180 INSURERS AFFORDING COVERAGE NAIC# INSURED Top-Notch Construction INSURERA: NATIONAL GRANGE MUTUAL INSURAN 14788 17 Li l ah Circle INSURER B: Wakefield, MA 01880 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L EF POLICY EXPIRATION LTR NSRE TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DDIYY LIMITS GENERAL LIABILITY PENDING 01/30/2004 01/30/2005 EACH OCCURRENCE $ 1'000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTE15-PREMISES Ea occurence $ 50,000 CLAIMS MADE FRI OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ EAUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS arpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Bonded Building Home Warrant Association Tara Schafer DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 2201 Corporate Blvd N. W. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Suite 100 ANY KIND UPON THE INSURER TS AGENTS OR REPRESENTATIVES. Boca Raton, FL 33431 T ORIZED EPRESENTATIVE ACORD 25(2001/08) FAX: (561)994-8428 ©ACORD CORPORATION 1988 Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code RES cheekSoftware Version 3.5 Release I a Data filename:E:`,.Local Projects`3680.rck TITLE:Epoch House 3680-04,Top Notch/Doherty CITY:North Andover STATE:Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) DATE: 10/07/04 APPROVAL. LIM17-D TO DATE OF PLANS: 10/7/04 FACTORY BUILT PORTION PROJECT INFORMATION: 2 4 200 28'x 44'Colonial Residence OCTL t U "N011111111 111,11't COMPANY INFORMATION: ���` �SN�r ftgcy'o��' Building module manufacturer:Epoch Homes,Pembroke,NH a 1 R7 GJ, General Contractor:Top Notch Construction,Wakefield,MA 1 �Ti:I�0-z'RG NOTES: - I�p.41113 Building modules will be fabricated and erected by Epoch Homes. All , ,� A, other on site completion, including all insulation below first floor V c deck,will be done by Top Notch Construction. COMPLIANCE:Passes Maximum UA=388 Your Home UA=374 3.6%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiline or Scissor Truss 1232 30.0 0.0 43 2nd Floor Walls:Wood Frame, 16"o.c. 1152 19.0 0.0 59 Pella DH:Wood Frame:Double Pane with Low-E 163 0.340 55 1 st Floor Walls:Wood Frame, 16"o.c. 1296 19.0 0.0 65 Pella DH:Wood Frame:Double Pane with Low-E 115 0.340 19 APPROVED SF I: Solid 22 0.140 PFS CORP SF4: Glass 18 0.290 7281 Slider:Glass 40 0.340 13 OCT 18 70014 SFS5: Glass 12 0.380 APPROVAL Floor 1: All-Wood Joist/Truss:Over Unconditioned Space 1217 11.0 0.0 8 ACTORY LIMITED (PORTION COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in RES checkVersion 3.5 Release 1 a (formerly NI ECchecl and to comply with the mandatory requirements listed in the RES checklnspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Builder,Designer Date 1 71 q- APPROVAL LIMITED TO FACTORY BUILT PORTION OCT .2 # ```�.�itnn ur►►►��i 0 MA JRT �yGJ,ms's A. u T ENB wRG tJo. 411 it v fSSlO?VR1 APPROVED PFS CORP OCT 18 ?004 APPROVAL LIMITED TO FACTORY BUILT PORTION RE& ieck Inspection Checidist Massachusetts Energy Code RES checkSo$ware Version 3.5 Release 1 a DATE: 10/07/04 TITLE:Epoch House 3680-04,Top Notch/Doherty Bldg. I Dept. Use I Ceilings: [ ) I 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: [ ] I 1. 2nd Floor Walls:Wood Frame, 16"o.c.,R-19.0 cavity insulation Comments: [ ] I 2. 1st Floor Walls: Wood Frame, 16"o.c.,R-19.0 cavity insulation Comments: i I Windows: APPROVAL LIMITED TO [ J I 1. Pella DH: Wood Frame:Double Pane with Low-E,U-factor:0.340 FACTORY BUILT PORTION I For windows without labeled U-factors,describe features: OCT y I #Panes Frame Type Thermal Break? [ ]Yes[ )No OC 1T 2 4 200 Comments: [ ] I 2. Pella DH: Wood Frame:Double Pane with Low-E,U-factor: 0.340 `% y ���ii" !"'���/ For windows without labeled U-factors,describe features: ��o` ��t10 MA49� ,,, #Panes Frame Type Thermal Break? [ ]Yes[ ]No BT Gs�: o Comments: A. —jFNBERG � s Doors: c, No. 1131 [ J i I. SFI: Solid,U-factor:0.140 Comments: F [ ] I 2. SF4:Glass,U-factor:0.290 Comments: [ ] I 3. 7281 Slider: Glass,U-factor:0.340 Comments: [ ] I 4. SFS5:Glass,U-factor: 0.380 Comments: I Floors: [ ] I 1. Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-11.0 cavity insulation Comments: Air Leakage: [ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] I When installed in the building envelope,recessed lighting fixtures I shall meet one of the following requirements: I. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture I and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 L./s)air movement from the the conditioned space to the ceiling cavity. The lighting fzxt e APPROVED I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. PFS CORP I I vapor Retarder: OCT 18 1004 APPROVAL LIMITED TO FACTORY BUILT PORTION [ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: [ ) I Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ) I Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. I Duct Insulation: [ ) I Ducts shall be insulated per Table 74.4.7.1. Duct Construction: [ ) I All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ) I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. i Heating and Cooling Equipment Sizing: [ ] I Rated output capacity of the beating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. I Circulating Hot Water Systems: [ I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] ! All heated swimming pools must have an on/offheater switch and require a cover unless over 20°o of the heating energy is from non-depletable sources. Pool pumps require a time clock. I Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 °F or chilled fluids below 55 OF must be insulated to the levels in Table 2. APPROVAL LIMITED TO FACTORY BUILT PORTION OCT 21120 4 MA�S9'' o z1PIT cyG� T,-- EE R G NO.41131 y `� A B� v J APPROVED PFS CORP OCT Y 8 ?004 APPROVAL LIMITED TO FACTORY BUILT PORTION Table 1: minimum Insulation Thickness for Circulating Hot 13'ater Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to 1" Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Alinimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2"Runouts I"and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) APPROVAL LIMITED TO FACTORY BUILT PORTION OCT 2 11 2004 1OF' A,,�9 ''�, 1 _ AiG SS14FaR APPROVED PFS CORP OCT 1 R 2nn4 APPROVAL LRAITED TO FACTORY BUILT PORTION' CIRCUIT DIRECTORY #3680-04 BR—I BEDROOM I OUTLETS JARC KN—I REFRIGERATOR OUTLET 15A AND F/L 20A BR-2 BEDROOM 2 OUTLETS IARC KN-2 KITCHEN COUNTER GFI 15A BATH 2 LTS., HALL OTLT. 20A OUTLETS BR-3 BEDROOM 3 OUTLETS IARC KN-3 KITCHEN COUNTER GFI 15A AND F/L 20A OUTLETS BR-4 BEDROOM 4 OUTLETS IARC KN-4 KITCHEN COUNTER GFI 15A AND F/L, BATH 2 LIGHTING 20A OUTLETS FR—I FAMILY ROOM OUTLETS DR-1 DINING AREA OUTLETS 15A AND F.P. LIGHTS 20A SA-1 SITTING AREA OUTLETS DW—I DISHWASHER OUTLET 15A AND F/L 20A LR—I LIVING ROOM OUTLETS DP—I SINK DISPOSAL 15A AND FAN 15A LC—I SMOKES, HALL LIGHTS IARC RA-1 RANGE OUTLET 15A AND FRONT EXT. LIG1 TS 15A AND RANGE FAN LC-2 BATH I, W.I.C. f MW-1 MICROWAVE OUTLET 15A STAIR LIGHTING 20A LC-3 FAMILY ROOM LIGHTS BA-1 BATH I OUTLETS 15A AND FAN/LIGHT 20A LC-4 LAUNDRY, 1/2 BATH, � NAL BA-2 BATH 2 OUTLET 15A LIGHTS. HALL OUTLETS 20A LC-5 KITCHEN LIGHTS t BA-3 1/2 BATH OUTLET 15A HALL OUTLETS 20A LC-6 KITCHEN $ DINING LIGHTS BA-4 BATH 4 OUTLETS 15A 20A LC-7 LIVING ROOM, SINK, REAR WA-1 WASHER OUTLET 15A EXT., $ UNDER CAB LTS. 20A LC-5 ATTIC LIGHTS JARC 15A HL—I HEATILATOR APPROVAL LIMITED TO 15A FACTORY BUILT PORTION EX-1 EXTERIOR OUTLETS GFI OCT 2 4fl,004 15A till DY-1 DRYER 4f Aq'', 15Ad`�%u T c'yGJ, . � . �s YRIG APPROVED FS CORP OCT 18 7n04 APPROVAL LIMITED TO FACTORY BUILT PORTION! _ j�'� 3 :� .��e �oorv»zaieurea�i o�✓�aaaac`ivaella I ' BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR {'s Number: CS 083299 Birthdate: 03/11/1966 t F Expires:03111/2006 Tr.no: 83299 Restricted: 00 1. JOSEPH C SALAMONE;. i ' 18 VALE RD WAKEFIELD, MA 01880.` Administrator t w 64 e') t + r p,l ., r 971 "X0 Meawl- A�ZZW4, Mitt RomnOJ 097, �'p Governor // Cl Joseph S.Lalli Kerry Healey CJ fL0lTPi Keno) Commissioner Lieutenant Governor �—� / Thomas Gatrunis Edward A.Flynn Chairman Secretary Thomas L.Rogers Administrator May 1, 2003 Epoch Homes, Inc. Rte. 106— P. O. Boa 235 Pembroke,NH 03275 RE: RECERTIFICATION IN THE MASSACHUSETTS MANUFACTURED BUILDINGS PROGRAM —MC #089 To Whom It Mav Concern.- This oncern:This letter is to confirm your certification in the Massachusetts Manufactured Building's Program as a producer of Manufactured Buildings for the period of May I, 2003 through April 30, 2004. This approval is contingent upon compliance with all previously listed conditions of your approval,and compliance with the provisions of the current Massachusetts State Building Code. Electrical Code and F e / u l Gas Code. Yours truly, STATE BOARD OF BUILDING REGULATIONS AND STANDARDS wle- rYN A 4, Thomas L. Rogers Administrator cc: MA Board of Examiners of Plumbers and Gas litters MA Board of Examiners of('lectricians 71iis correspondence has been issued from the iBoanlctf(B,uldiny c>,yu�ahotu�andStnndards TauntonTDistiict office 1380(Ay.4t.,(P.o. 93o.�871, Taunton,511j1 02780 R Tly own o It, 11 1% Andover No. — ss Ido dover, Mass., /02 T Q - LAKE T COCMICMEWICK V ORATED PP�,`�5 SSA HUSE FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ....Aeke!V............Do .................. has permission to excavate and pour foundation at .... ......... ....................................................... for the purpose of... .. d0 �... ......... ....A ..... O��I/ .r.... �!v ��... '.. � The person accepting this permit must return to the office of the Building Inspector a ce ified plot plan show of building thereon before Foundation will be inspected. VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. ...... ..................................... SEE REVERSE SIDE ... BUILDING INSPECTOR NORTH ovm Of RAndover No. 4etv,1 '3 cl 040 CON L A o dover, Mass., COCMICKEWICK V ORATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System f�I/V .d V/� BUILDING INSPECTOR THISCERTIFIES THAT.....( ........................................................... ....................................................................... ..... Foundation y SD �,c.w�e� has permission to erect......... .......................... buildings on ................................ ............................ .......... occupied .....5...... Rough to be occu as � 1I� � . 1A 041V'�r S 1% FA • iUlM6.himney p ....................................--..... . . . . . .. .. . . . 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 elating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. I G l PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI N T TS ELECTRICAL INSPECTOR C Rough .... ...................... Service . . .. . ... .. ... .. .......... BUILDING INSPECTOR Final Occupancy Permit Required to Omtpy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F Rounal 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. i T t itOF7y w6� swwcHu' � CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 'yam Date ao� -- THIS CERTIFIES THAT THE BUILDING LOCATED ON Of N S MAY BE`OCCUPIED AS CSI /� IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Building Inspector NORTH Town of RAndover T O No. oo dover Mass. /.? /Y y COCMICMEWICK ORATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System V THIS CERTIFIES THAT �v/N O h BUILDING INSPECTOR ..... .. .............................................................. ........................................................................ ..... Foundation d has permission to erect.. ..... buildings on ... Vr'Q5 S Rough to be occupied as... ... &.M.#...a...'.'0, aAT4j...M 0 V..............................................�I�... AIN 11� • imney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final D D this office, and to the provisions of the Codes and By-Laws elating to the Inspection, Alteration and Construction of / �� t' ���A Buildings in the Town of North Andover. efG ` PLUMBING INSPECTOR sd .* fid VIOLATION of the Zoning or Building Regulations Voids this Permit. u 0�1 "2 r PERMIT EXPIRES IN 6 MONTHS 7 ELECTRICAL INSPECTOR , UNLESS CONSTRUCTI N TSC.... . 7�- o . ...... ....... ... .... ........ ................... BUILDING INSPECTOR 1 5Fi Occupancy Permit Required to Occupy Building GAS INSPECTOR- Rough NSPECTORRough Display in a Conspicuous Place on the Premises — Do Not RemoveC� No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner RE DE Street No. r SEE REVERSE SIDE smoke Det. I June 3, 2005 North Andover Building Department Osgood Street North Andover, MA 01845 Attn: Mike Maquire RE: 450 Stevens Street,North Andover, MA Dear Mr. Maquire, In regards to the above-referenced property,we acknowledge the requirement for front stair railing is needed. We will install said railing as soon as possible per your request. you fo y ur time, qElte&Kevin Doherty 978-687-2260 Town of North Andover � NORTH O 1 Building Department 6, 1'O 400 Osgood Street 32 g°;,� "•. 6 pL North Andover Ma 01845 p too ti -A (978) 688-9545 Fax (978) 688-9542 ­. .11 ,y '4ATOD 0' 4 C2 SACHUS� APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS �` b �p CI S*' LOT NUMBER SUBDIVISION DATE REQUEST FILED DATE READY FOR INSPECTION�� 6 TEN (10)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME . FRAME. A -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED T E STRUCTURE DOE OT MEET ALL APPLICABLE CODES. SIGNATU OUIAL USE ONLY ` ROUTING D.P.W.—WATER METER )"0 DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. (kms I . SIGNATURE/DPW AUTHORIZATION 1111✓uUMMUIVW1:A1: H' P'A1A&"C11V3 11N Offi F DEPART111FV'IOFPUBLICSAMY Permit No. J7 BOARDOFFMPREVEN*ONRBgJMHONSM70212:10 j Occupancy&Fees Checked APPLICA77ONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE wrl1i THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 n (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) r'' Dat2. . i o Town of North Andover To the l ispector of Wires: The undersigned applies for a permit to perform th electrica work described below. Location(Street&Number) q 5 (� s t� h( Owner or Tenant v.z Owner's Address Is this permit in conjunction with a building permit: Yes[:D-'Noa (Check Appropriate Box) Purpose of Building' S jNI-1f fi� M'1% LA)t 17 Nt Utility Authorization No. Existing Service Amps��Volts Overhead Underground a No.of Meters New ServiceAmp rs/ a=Volts Overhead Underground No.of Meters Number of Feeders and Ampacity. 14? 2 0 Location and Nature of Proposed Electrical Work /17F1�1 V jC l- 7/_)1k)L' 1.q 1)1 If k,- JA-)b No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above El Below Generators KVA round eround No.of Receptacle Outlets No.of Oil Bumers No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons .:.f Disposals No.of Heat Total Total No.of Detection and Plumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices f Dryers Heating Devices KW Local Municipal Other Connections Water Heaters KW No.of No.of Signs Bailasis ydro Massage Tubs No.of Motors Total HP R• Cowraga.A1=1ttDdctegtmwxr&ofM%sxhuseMG=2WLaws cu=tLiab&ykmm= 0icyutchxk9Canplele CDNMWcrit3&ksiarWePvW t YES NO validpioafofmmiatheOffim YES rT Ifyoubawdocl®dYES,pkmitxic*degWofwraWby It bm BOND p 011­1�R p ) B#mfimD* F_9lim mdVakXdE1earicalW(dc$ qAME � os r�arortD&I�mdFmal �papy. < �_ XU/�° � s LioatseNo. a�� Wit✓!'f^ !9%/C/j�/S Signaaue -` ' ` LiDa>9eNo /Sf 6•:Z Bt>skmTelNo. �ffl-�S4'C- %Ca 1 �� 1/vl A Alt Tel Na 'SINS RANCEWAMI ;IamawateduttheLio=dommthavedleinst==CDW*0rilSa*iarWgt valatasteg byMmduqoltsCxn Wlaws mysg mncnduspetn>itq#Cadonwaivesthistagtmenat check one) Owner Agent a Telephone No. PERMIT FEE$ signature of Owner or Agent r- �_ r� Date. .. ... NORT►, TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING SACH f `�- '........� • This certifies that ...........:: !. ..: ..�..... ........... has permission to perform ...... ...:.......: i ................................................. , wirin/g/in the building,of . ....... ...... .... .... ,North Andover,Mass. / 5. � i/E Vii. / �1��.I � A Fee..::.,............... Lac.No....1....... ...............:. .............................:.:........... ELECTRICAL INSPECTOR!/ y Check # - 5619 JHb(.'ULV1MUlVYYPA:1,H1''MANJ'MCHUNEIIN Office n T DEPARTMMF�U0FIUBUICSgFMY [T�, Permit No. BOAROOFFIREPR ONREG MMONS527CMR12.00 / Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date _ Town of North Andover To the Ipfspector of Wires: The undersigned applies for a permit to perform the electricalwork described below. Location(Street&Number) q 5 U ST Owner or Tenant Owner's Address �S0 STS l�C/�S Is this permit in conjunction with a building permit: Yes[Z]-No (Check Appropriate Box) Purpose of Building S`N hit 7AMIU .t�W t YI7 rJ L'` Utility Authorization No. ?S Existing Service Amps Volts Overhead Underground No.of Meters New Service Amps/ Q�Q Volts Overhead �'Underground No.of Meters Number of Feeders and Ampacity 14T zoo Location and Nature of Proposed Electrical Work _/l1N'lC) SC-,Y VJCC-� No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges 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 Ivlunicipa! r--1 Other � Connections No.ref Water Heaters KW No.of No.of Signs Bailasis No.pydro Massage Tubs No.of Motors Total HP OTHER. hU==CDWrag�.Puta>anttothetecpmar ofMassadusensGena�alLaws IhaveaatnaltLiab>7ityhsivatreR�licyinchrlmgComplege Cowrageaitssubalecguvaia�t YES NO Ihawa rriwdvandptoofofsam,tDdrOffjcf-YES IfycuhmedledodYES,pleamhYbc*thetypeofcomnWby dwkitgthe INSURANCE BOND M OTHER (Plea9e Specy) M ""t""afm D"" Wok Co SdR o�i� d� Estar�d Vahre ofl icincal Wotk$ ons Final SignedundAie ofpew' .. RRMNAME. - Li=wNo. Licerwe 3-L FF Sigrm- ce - LiNo /Sf�6✓Z f �D 1 Bnsul sTelNo. 991" 1 ArNrPcc t 5,>0C� ��/L,7��.4 / �1(, 7 S J/I/l A- Q!�t7 A1<Tel No. OWNER'S INSURANCEWAIVER;Iamawatedmtthe Licamdoes nothave the insiu&=c0W$a9eorAsabtstarmalq valartasragmedbyMasmda>selisGerlaalLam andthatmysgwinmonthispeantapplicationwaivesthisregt mfft (Please check.one) Owner 1:3 Agent Telephone No. PERMIT FEE$ signature of Owner or Agent r " DA TE�, / TIME - AM ` V -"- PM P F PHONE( ) CELL( ) FAX N 00, E � ' y --- � - - O E-MAILADDRESS - -'GED PHONED ❑ BACK El RNED ❑ EE YOU❑ AGAIN ALL ❑ WAS I ❑ URGENT ❑ Date. . . .'3.. t " ,'I. •yTOWN OF NORTH ANDOVER O� ao ,a, 0 - PERMIT FOR PLUMBING 40 i ,SSACMUS� e This certifies that . .tta 1. . . has permission to perform . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . - v.e tl�. .at . . �� . . . . . . . . . . . . . ., North Andover, Mass. t Fee. t?9Q . .Lic. NoJa%D. �— k PLUMBING INSPECTOR �+Check # S 6328 i MASSACHUSETTS UNIFORM PPOCATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS 3 Date Building Location S Owners ame c711 Permit# Amount Type of Occupancy �c s ro New M Renovation Replacement Plans Submitted Yes ❑ No FIXTURES 3 sisal g��vr lEMOCIR 1 M HJOcIR MKOM 41H It" M HJOM sM>J 71HHDM s>Hrv" (Print or type) Check one: Certificate Installing Company Name ;/y t LcJ r-( 119 n/ Ca✓ Corp. Address �7�-- 1N� -/''1 .�' S� ❑ Partner. Business Telephone ❑ Firm/Co. ,Name of Licensed Plumber: &sc jo C In 41r e Insurance Coverage: Indicate the type 6f insurance coverage by checking the appropriate box: Liability insurance policy M Other type of indemnity Bond .f El Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner1-3Agent ❑ 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 iIst1lations performed un r Permit Issued for this application will be in compliance with all pertinent provisions of the Massactate PI mbinge i hapte 42 of the General Laws. By: igna ur i e um / Type of Plumbing License Title City/Town L1CCDSeTNum5er Master Journeyman APPROVED(OFFICE USE ONLY ❑ r Date. . . . .. . .. . . . . .... .. .. 40RTM pF �.ao 1tip o� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,SSACHUSE� This certifies that . . . . `. . R v l . `A- . . . . has permission for gas installation . .HOCM!L4 iz 140 U. we in the buildings of . 'h. `�. . . . . . . . . . . . . . . . . . . . . . at . .L4. . ... n V-C�S S , North Andover, Mass. Fee. . Lic. No.3 n� . . - (o?z itC�o y i�L GAS INSPECTOR Check# �S .s 5020 i MASSACHUSEI'IS UNDDRM APP ATON FOR PERNMO DO GAS FrrnNG (Type or print) Date '1� 3 NORTH ANDOVER,MASSACHUSE T Building Locations Permit# � Amount$ Owner's Name � New Renovation ❑ Replacement ❑ Plans Submitted "J rJ U W z z 0 F < O O 0 W EW C7 W aCW7 Fo w �d 3x z F v� Q G zZ z W y A ° a > 00 H a a F a o SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) �. 01-7,q� j C eck one: Certificate.Installing Company Name \I �l I 66rM C dl Q,4 r Corp. Address i :z © IP L-L--A A�S. �1 '��I/ �✓OJ/�� 4�•� Partner. Business Telephone — > / D Firm/Co. % Name of Licensed Plumber or Gas Fitter T� ((�yQ / r lba c INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes M No 0 If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy r Other type of indemnity 1:3 Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 1:1 Agent 1 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 in allations performed under Permit Issued for thi application will be in compliance with all pertinent provisions of the Massac pus tts State Gas Code a01 apte . of the 'e ral Laws. ignature of Licensed Plumber Or Gas Fitter By. Plumber 3 7 QIP/ Title City/Town MV Gas Fitter License Number t Master APPROVED(OFMCE USE ONLY) Journeyman /75 Locatlen No. Date a ►CRT" TOWN OF NORTH ANDOVER b • OR Certificate of Occupancy $ ��s"••�•Eta Building/Frame Permit Fee $ 4c Mus Foundation Permit Fee $ Other Permit Fee pew $ `7�U TOTAL $ _ ` 3 Check # 17860 t./ Building Inspector t r , TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING OU �, �,��,�•s ;.-:.e nm BUILDING PERMIT NUMBER: DATE ISSUED: C7 SIGNATURE: Building Commissioner/In for of Buildin Date SECTION 1-SITE INFORMATION I ^ 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 44 S O s7L-e yer►5 sy ,, N 6 A/ '7 6, e,r Y M 6 — Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 1 ml I Li 006 / (9-57-. O� Zoning District Proposed tW Lot Area(sf) Frontage(ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided r OL® , s It , 1.7 Water S M.GL.C.40.154) 1.5. Flood Zone Information: Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(Pr' t), Address for Service: r I Signatur Telephone 2.2 Owner of Record: Name Print Address for Service: t z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: _ Not Applicable ❑ A-)6JCJ-1 Cots - 1 Licensed Construction Supervisor: 1-4 t �� _. License Number )m— '( W(k��i Expiration Date ',3 i n tTelephone 3.2 Rrgfkered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date p) Signature Telephone 9�I ` I i SECTION 4-WORKERS COMPENSATION(NLG.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....... SECTION 5 Description of Proposed Work(check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition IV Other ❑ Specify Brief Description of Proposed Work: r r SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be (3T!'.F.1ttm USE ,y Com leted b permit applicak"Ynt 4.g �. :r ... ..,.r . ......._.. 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of /GOD Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical(HVAC) �_. 5 Fire Protection �l 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUELDING PERMIT 1, 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 ,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 an f Prt t Name 16 Si ure of O r/Apient Date ir N OF ST S SIZE BASEMLIRT OR SLAB SIZE OF FLOOR TIMBERS IST2ND3RD 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 Town of North Andover O� t1ORTy q Building Department �? yt'S,to w616�4o 27 Charles Street o North Andover, Massachusetts 01845 4 (978) 688-9545 Fax (978) 688-9542 �` •"" -V 9 c«wrt .wc• ' Building Demolition Affidavit �4SSACHIlS���� i DATE a �L �( OWNERS NAME &ADDRESS J:�ou \/A � 0 PROPERTY LOCATION l S 7r--u C kw S V 1 DESCRIPTION J't(e-(— t)bW v,, SA 4 w� l Dy►� Q� CONTRACTORS NAME &ADDRESS l b D- DEPARTMENT SIGN-OFFS D.P.W./WATER W �ff1EWER l� GASR(L-J��V ELECTRIC TELEPHONE C?. 2 CABLE✓ TAXES �a fgOtf POLICE FIRE EXTERMINATOR 4jDUMPSTER-ON/OFF STREET DIG SAFE NUMBER G ��O BLDG. INSPECTOR DATE REC'D NlYN e.K__ T —i FORM - U - LOT RELEASE FORM C i`' 10 INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained.This does not relieve the applicant and or landowner from compliance with any applicable requirements. tons*aaawaswwaawa.Tawaw......aw•asasaww■■awwww■wawawaawwaaaawwaww a a a a a0aaaa■ APPLICANT �� �'l�r PHONE 2 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER � <S%amu- , u STREET l/ � �-S ) STREET NUMBER l S I a w 0 waa00waaawaaa ..00a0a0■a.a.aa00waa0aaaaawa■a a a a a a a a.a a a w a a a a a 019 a s aaaw 0 OFFICIAL USE ONLY awaaawawwa.•sawwwwaawa■ OWN waa•waawaa.aasasa.Sam TIONS OF OWN AGENTS now as ■ .aaaaaa .a. a ■• aaaaaa■ wwwa■waasaaaarwaaaawwwafiaaawanaaaaa■ / DATE APPROVED J CQNSERVATTO ADMI NISTR2AT0 DATE REJECTED I/ COMMnNTs DATE APPROVED TOWN PLANNER DATE REJECTED CORrIlyIEINTS . DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED I COr9ulEIN'Is PUBLIC WORKS—SEWER/WATER CONNECTIONS DRIVEWAY PERMIT P/ S P c3,,j it ei. �s ��5 r �e DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE NORTH own of 4Andover No. d99 C, A�o dover, Mass. COCHICMEWICK V -' ' BOARD OF HEALTH PERMIT, T Food/Kitchen Septic System ' 1 BUILDING INSPECTOR THIS CERTIFIES THAT ( two d �.� 1► �........... ................. .. ............................................................... .............. ... ........ Foundation has permission to evert.... IN � . buildi gs on .S Rough '!.V.'! .... ....................... .. ....... ... .... ..... ..... .... to be occupied as E A 1 S DW 1 N . MOdW �Ar Chimney p .......................��.�..... .................. /.R+#1FqL .... ...................... provided that the person accepting this permit shall in every i pest 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. 9614 6 14 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRU N T TS ELECTRICAL INSPECTOR P Rough ... . .. .. .. ... . ... .... . . ..................... Service......... L G INSPECTOR 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. FORM U LOT RELEASE 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT--/� PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) STREET ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RE MMENDATIONS F TOWN AGENTS: CONSERVATION ADMINIS ATOR DATE APPROVED DATE REJECTED a► b a- 0 COMMENTS + r Win Dai o�e� r►, -� e- �T 12� DA de.pCol?I.G DSL 4a. 0 . r"J!J Of resv"rce- 0-re-A.+-b propD-l-ed TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,a .:_ .L ���", Cdr u°ii � 3 k- •� � W� Y BUILDING PERMIT NUMBER: DATE ISSUED. SIGNATURE: Building Commissioner/InEeEtor of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: S'y SfEvEiyS /Vd(tm 'ANt nv ea i * ©r �(� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: f-.3 Qc15460-Tr4z_ gS763 �f. Zo Zonin District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft I, Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided a >9�.Zo 210 I I 30 o 1.7 Water Supply M.G.L.C.40. 54) 1.5. blood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside blood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record S TE--yews 5r. /1(3."o V6V(, Name(Plr Address for Service: U Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date ic= Signature Telephone rM 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number M Address Expiration Date z^ Signature Telephone V 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.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I 5CCu.vO FWo zo,u Tb &kr_ MV SM V.rLAC V IX z Y A D_M(M ? F2otil Nag AD.sr -Vy 1. 'x 3 f SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee 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 ,4 00 b o y Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, t.., 'KEUJ� as Owner/Authorized Agent of subject property Hereby authorize AL` the to act on My behalf; 11 matters rela ' authorized y this building pennit appli atio '. /#Llf/0 a. Si nature ff 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 Signature of Owner/Agent Date MWF 77a NO.OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TEvIBERS 1 2 3 SPAN DRVIENSIONS OF SILLS DINIENSIONS 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 Town of North Andover Building Bepartm�nt .�..� .;., 27 Charles Street North Andover, MA. 0184.5 * � _ D. Robert Niceaa 4 4 Building Commissioner �cFress ttti (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please prirTt DATE Loa SOB LOCATION 7 J�V J�1/ � S7`. A0, AAA-)44 Number Street Address � ! 6 Map/lot IOMEOWNER Name Home Phone ESENT MAILING ADDRESS -S1/y Work Phone City Town r State ZiP Code The current exem on for"h of two units or less nd.to allow seueh�ers"was ended to include comer evwners to engage an individual Wed dwelbngs not possess a license, provided that the owner acts as su hwe'Who does pervisor (State ung Code Section 108.3.5.1) DEF►N1TlON OF HQ(1�E}/VOWNER: B Person(s)who owns a Parcel of land on which he/she resides or intends to there is, or is intended to be, a one or two cessory to such use and/or farm , ding,attached or reside,' which two-year period shalt not be A Person ho structs detached stnxtu� - considered a homeowner morethanone.hone in a The undersigned "homeowner"assumes res Applicable codes, b responsibility for compkance with the Stere Buildin y-laws, rules and regu►ations, g Code and other The undersigned "homeowner"certifies that he/she and Building Department minimum inspection erstands the Town d NO Andover �PtY with said procedures and requirements_ and requirements and that helshe will ' IOMEOWNER'S SIGNATURE 'PRO','/,AL OF BUILDING OFFICIAL W.LlL �Sci6+4$T CouNtktTbA I.��'E`�JS� � LjYL- v C4A,,Tg If !r - - - - - - - - - -- rx ffi umBill...................... ............ FIN. rlm-l-. Fl, TOO r Cfoe NMI (03 FT I HVIN�i 9100M NOVld .�Nr�C�1�'�12 ,Mk 1,"rC:K � { L �.8-PCO✓ C,3ATHIc l w Olz _..—._ ..=-__����=��___-- -- —_— -------- r�1�.�,✓ --: �' way-cwL, .---__----- ---_ —__---_---- vx.–t4 ------•----�------ i [L-Wil -ro a PATH S -- I- V—-t= CL, �:� CL. , c�5- vy ---- IS ------- ------ 'A.,cc5 --- CarCNOOM I FI�A*V.)FOP, Q VINI E AINE P N(J WR NN N 7 ....... . ... ........ ..... El M FIN, r_�AAIF. N-01,` P� ......... 1:112mm: :H-Mll IM: KE Ill-oil ' AT 77 �'\T V I N FLAW POKIM' - - - - - - - - - - --- - '_)T�VFN15 -MFE - - - - - - - - -- - F , Mh --------------- �� - - - - - - - - - - - --------- -- t)aetl LEEZ __ MA.)Onzeww" =n3 [C IIE L ITT' I&J I s vi :I'Alf P?a10:ru:";r- ;1�D;l•k;�:5 f'�i1:; r 116" G.C.. dN MONA t212,GF 1•, \ 1 2 RA-'1�Ft 5 AT 16' Ct.C. CC':i F'LY'�VC?G'C Shl�rrl INC " 0 Est Ifr._r rel f��L 2 .K--AT 16 ' O.C. -- _ CE=1.ING JC%515 000 C("d I Y.x -� I X.—_ INF F.SSC IA FUll-„1Ju”04;:if IL' \� I X-- INF 5G)FF•I-r CZ r.1lNJOU5 5OFFIT V'F'.NT +V".FrA.. Pa�F; ;PCIF I /VVATF F MFMl3r'.,=�\IF: AT-F,AyE--5 GU rTFl2,�5 r 1C?fFC'ON F:.i-F'VArirc N r?1,Vi1NG5 APOr N,gIL & 6LIJF`TO FF �dPilNc"r 2 X—_,AT 6" C.C. FL ..JO-:P-- � --------------------------•---------•�------------------ �� ---- �®�� �. — " - X 10 f 1F.�t�C F t 1 IC1� T`1,ICA- FXTFrl"-: `JVALL: 3LIILG'IN:e \11,V P 3. 1/ 2" f-PX r'L°N'✓ v'9i `I rF,�T1ft lU 2"K A 5t1aG5✓tr 16" 0,C, Ir�t 'cn( IN`�JL ;-nf3N POLY VP PC V I`3AF'121F Iv F lr•l%I 15T I`TC°,1: —����,��� ��e.�.®m..����..�..�®��� � .�.�� —-•-�---------.—.._-SILL f �SF:,'V1E3L.�----�----------- 2 - 2 X 6 N-SAPA: _�_- "2 X ----_.�� '� ' ' SILL sE AL. Int sU..7110N t✓,41KFT" "` — .nr I SFF E=OTJTtNUZ7L:z W[ Orel -10 5T ' r30X SILL IT , CA/n4-/;hN t?F C F 0'-r ANCHOR. I.! '_ z Gl C� 1F F il_l-F> 51FI- CGL lJiVSN -� PAIN -4, If i:.4 -- T 1F111i °JV✓G'J 'O'» �\ 9 r-11C:GiNC: 1F: s.,rF _•___.__.___.--...r.-..._-.-------- -----FC LNCATIO N :3. r001'I1,46 — ---- ' \� POLY"✓�;F'OFc G''�°,12F3CF" J _I<�'i us 8" �ikPfiJUI_Ar.':P.A5F`. FIN. G,Ml", _ __ « ___ _______ _____ �--.—..•--._ ,4' CI%;PvIF=11;-1-: r'Frf�C1ft`,T�C3 �'y°C r=1rf — -----._--_------- -- ------ —n•'•y'.ti��irr �� -rrr--- r---------- ,� —'------„�[�[-- —s,—r,— s`• MIA n ,� :t” CF{.I�-iFC% 5rr✓'�JF 1J ' r. � 'if�� � •�e_•_,r..::. ..................................•...,,..... '%�: ? '� .[�c:r -•�� F1L11;� F. 131: F'r.4�.LC��L�F F'Jllr?Ff? CO'JCk'F11 I O yl hJu' ---� I.. w3,. 'API ;�O , r�l<-�I N ��� -------------�"- � r —II"��l -------- VTC-�G1+'</I���Ir-11" - Zrvvvr.Jrr'k7rft r 5(--" 0 FPd°?il`J, CA 'AC-_Y'-- „ r I • I y � i • I +' I '6 • I f --�--� �...•�--��- r.1 ...-• T...I:QTS•�...�..-T.T�I����. '�T�-�... -�'•TT•. ��T� �. --- r 551• 4• ... ........ ....•.•. .....�.�....�................... 35 ........................�................��.......�....... .. ........ ....J... .............. .................... .....� f NORTI{ ;yap Zoning Bylaw Denial Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 3q a��qg Ss�CHUs�t Phone 978=688-9545 Faz 978=68$-9642 ..... .Street: .. Ma /Lot: q� Applicant: • �/ /ieL !N Request: a2 C2`1 G ande ar.� /0 4-) ay %r do/, Boa �o x� /y. RvcX/ Date: a2 i,3 -D a, Please be advised that after review of your Application and Plans that your Application is DENIED for the folio-wing;Zoning Bylaw-reasons: Zoning Item :Notes A Lot Area Item Notes F -Frontage 1 Lot area Insufficient 1.,- ,"Firontage,lnsufficient 2 Lot Area Preexisting e S 27 Frontage"Com lies 3 Lot Area Complies e S 3 Preexisting frontage e s 4 insufficient Information 4 Insufficient Information B Use 5 1 Allowed No access over Frontage G : Contiguous Building Area Njr� 2 Not-Allowed 1 Insufficient Area 3 Use Preexisting, 2 Complies 4 Special Permit Required Ll e5 3 Preexisting CBA 5cientJnfarmation i', C Setback 4-1. Insufficient-Information H Building Height 1 All setbacks coat ply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height, 4 Right Side Insufficient 4 es _ 4 Insufficient Information 5 Rear Insufficient 6 Preexisting setback(s) I Building Coverage 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed y e g 4 Insufficient Information 2 In Watershed � Sign 3 Lot prior to 10/24/94 - N A 4 Zone to be Determined 1 Sign not allowed 5 Insufficient Information2 3 Insufficient Information Sign Complies E Historic District _ K Parking 1 In District review required 1 More Parking Required 2 Not in district L1 eS' 2 Parking Complies 3 Insufficient Information 3 Insufficient Information 4 Pre-existin Parkin Remedy for the above is checked below. Item # Special Permits Planning Board Item # Variance Site Plan Review S ecial Permit C Setback Variance Access other than Fronts e S ecial Permit Frontage Exce tion Lot S ecial Permit Parkin Variance Common Drivewa S ecial Permit - Lot Area Variance Congregate Housing S ecial Permit Hei ht Variance Variance for Si n Continuing Care-Retirement Special Permit Independent ElderlyHousing S eciaL.Permit S ecial Permits Zoning Board S ecial Permit Non-Conformin Use ZBA Large Estate Condo Special Permit Planned Development District S eciai Permit Earth Removal S ecial Permit ZBA Special Permit Use not Listed but Similar Planned Residential S ecial Permit R-6 Densitv Special Permit S ecial Permit for Si n Watershed S ecial Permit S ecial Permit reexistin nonconformin The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by.the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies,misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled"Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans`and:documeritation for the above tile.You must file a new building permit application form and begin the permitting process. '7 j`3 a� Tiding Department ficial Signature Appli tion R eived Application Denied Plan Review Narrative The following narrative is provided to further explain the reasons for denial for the application permit for the property indicated on the reverse side: 1011, A TfsfC,�`y r rt!) G NOW z arta b - �� alv ' G . i' fir, ° q gArL3aK ri N,li z bra d /UDNCOtVAr�I V . SYrvc/c rye Jut- �p u SYv u C� f:a d a� JO/Dor SG�roN g.� 7® ArV4 JQ C/o ver- .Z0N tti 1 -�A '1M2/AtU /Car '-Rt ctGST ICle S�7bAC �D 61 /AY h ©rG� �" ,7-.� N�y r4`Q a ted, �t�or �of�i7`ra�. _ t rf�djrCL1 wrl�- /Vol AA r� 11 .!Y► .• S C, � ` °tel 0 5�j o u� Y". w S - Referred To: Fire Health :ateQ/aagwnN auNd Wed A :tugs ieluea t TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING O BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Igfor of BuildingsDate SECTION. 1-SITE INFORMATION i t t z 1.11 Property Address: 1.2 Assessors Map and Parcel Number: t/ Q SIEVES ST i Map Number Parcel Number /�o2i b�- A.�UOav�, /W� Ofgo1 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Pr osed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard . Side Yard Rear Yard Required Provide Required Provided — Required Provided 1.5. Flood Zone Information: 1.8 Sew a Disposal System: 1.7 Water Supply M.G.L.C.40. 54) � �Po ys Public 0 private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record �--� �v o1�t�2Ttd C/ S6 S wars sr Name(Print) ( Address for Service ' Signature Telephone 2.2 Owner of Record: s Name Print Address for Service: pz Signature Telephone �e, SECTION 3-CONSTRUCTION SERVICES . 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: ` License Number Wn Address Expiration Date �1 Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number M Address rMM GEM Expiration Date z Signature Telephone G) 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 it. Signed affidavit Attached Yes.......❑ No....... ❑ SECTIONS Descri tion of Pro sed Work check altapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ( Accessory Bldg. Q Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 2> f�t7D 'Z c A-2 6R12Ac) AAA Fi9M LY oc A l SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be � � �' t QFFLCIALUSE p1VLY a F Completed b permit a licant Axa 1. Building (a) Building Permit Fee 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 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, 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 NEI%=01111INNs NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2ND 3RD SPAN DIIv ENSIONS OF SILLS DMIENSIONS 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 ' FORM U - LOT RELEASE 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT 1=1/IN 0�{ -1-3 � PHONE �1 _IaWd LOCATION: Assessor's Map Number PARCEL �o SUBDIVISION t� LOT(S) STREET S1'1/t-V.57 i ST. NUMBER_ L USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED- SE 'Ic EJECTEDSEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm { t Location No. x1v 17 Date Na D TOWN OF NORTH ANDOVER 419 :ia ; ; Certificate of Occupancy $ Its °''<�' Building/Frame Permit Fee $ \ i 3 c HU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ q�� t' Check # 7 { 17556 "Building Inspector `�'�'� 1�2- IL/ mac/ Map 96,Parcel 53 I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING e BY LAWS OF NORTH ANDOVER, MA. AT THE TIME OF CONSTRUCTION. 229 04 THE OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR 5 6°-00'00"W ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING I CONFORMITY OR NON-CONFORMITY WHEN CONSTRUCTED. I \ I \ iWA #15A \ I a \ z o \ I o \ #13A`? 1 0 \ I ZONING DISTRICT R3 \ Map 96, Parcel 6 1 AREA=25,000 SF \ PARCEL 'B' I FRONTAGE= 125 FT 1\ X11.1 I FRONT SETBACK=30FT #10A \ AREA=48,763 S.F. I SIDE SETBACK=20 FT \ 00 n.buffer REAR SETBACK= 30 FT HEIGHT=35 FT WETLAND #9A \ j 1�� REFERENCES FLAGGED BY \\� I PLAN #1707 LEAI I BASBANES \\ j0> EROSI( , i ASSESSORS MAP 96 PARCEL 6 #gA \�.� C ROL 1 DEED 5003 PG. 344 t \ I Map 96,Parcel 42 ft7A \ I 454 STEVENS ST SP4 Map 96,Parcel 5 \ I VAILLANCOURT ° �� \� 21' RICHARD M&KATHLEEN A PLOT PLAN OF LAND P6.1 X5`1 \ EXISTING Bk.4154,Pg.70 SUBJECT PROPERTY LOCATION sTRp.Ayi V DWELLING u Sd'3 \ 106 _ _ _ __ _ 02HSE.#430 - KEVIN DOHERTY 450 STEVENS STREET -- .a4' 450 STEVENS STREET NORTH ANDOVER, MA 3A ---- -- 118, Bk. 5939,Pg. 2 PREPARED FOR \ ASSESSORS MAP 96 SP2 KEVIN DOHERTY , \ iM 2A o oSP1 `_— ;w I PARCEL 6 FRANK S. GILES I DATE: I(broken branch) f>ROSI98 CONTROL JANUARY 6, 2005 SCOTT L. GILES � �as: 98'20 �P�� ss REVISIONS: s 6°-°°�00"W ?� A � FRANK S. GILES S SURVEYING EXISTING DRIVEWAY o GI ll ' 1 (NOT TO BE ALTERED) STEVENS " N 93 STREET Q� SCALE: 1"=40' s�oa Q 50 DEERMEADOW ROAD s 0, ' FLAG �4MD sUF1Vw aa� 40' 80' NO. ANDOVER, MA 01845 (978) 683-2645 vmr� 00 E-mail: FrankGilesSurvey@comcast.net JUN-01-2004(TUE) i2.35 PFS CORP. (FAn)5 r0 7845961 Commonwealth of Massachusetts Board of Building Regulations and Standards tared Buildins Pro am Manuf ac o' � � <, 'THMD PA.IZTYINSPECRONAGENCY CERTIFICATION B[ILK LABELS - TJNrfS MAY NOT BE a.. e r.l..�cd�..T{+;r.7 P-.+F�.T_+`;r+e''1-,pn �O.`rt�S/-Ple se nrinM nr t-I c iauk�cC hvii � c COiaai.���.. .. ..- SHIPPED UNTIL THIS CERTIFICATION IS COMPLETL'D and COMPONENTS ARE LABELED SECTION 1—MANUFACIZJRER INI OI'`tv1ATION (Bbrs\forms2\nlfg 1&6LPartYcert-Apra,2004) Manufacturer Name. IMC# 089 Epoch Corporation Address I p 0 B X Telephone I 603 225-3907 Fay — E Mail Address I Jame M T —Q SECTION 2—BUILDING INFORMATION BBRS\DPS LD. Street Name 8:Number State _ zip y City _ - Use Group R-4 I Construction Type � Tn signing this form below, I hereby certify that the units identified on this form have been inspected and are constructed in accordance with the following codes,as applicable_ Massachusetts Slate Building Code (780 Massachusetts State Electrical Code(527 CMR 12) Massachusetts State Plumbing and Fuel ® Massachusetts Architectural Access Gas Code (247 CMR) Board Regulations (521 CMR) Mfg.Plant Inspector's Name (Print Name) Third Party Inspector (Print Name) James Marsh Cla Mfg Plant Inspector's Signature Thud P pest S ature . SECTION 3- 6ILDSVDEALEIZ/CERTrFIED LN-ST ALLER INF ATION Builder/Dealer 'oP WO AddressLC.G�/'t_ Certified Installer Licensed Construction Supervis �� S'G��d0/t/� License Number: C S-'o 8 3 �/1 a SECTION 4— LABEL INFORMATION (Indicate number of boxes and number of labels required) 6\L Number of Units Libel Numbers Issued: Manufacturer's Serial Number ✓ MnnufacLurerIs Mcdcl Designation The original form shall be mailed to the BBKS/Department of Public Safety 167 Lyman Street/P.O.Box 1063 Westborough.MA 01561