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Miscellaneous - 458 WAVERLY ROAD 4/30/2018 (2)
�� N_ O � O � N � I d N � D o v i /� 11 Datel.a....o.9 ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Leo, This certifies that ........................... .......................... has permission to perform .... t.-Mp ....... I ...... ................................... wiring in the building of ...... Le:v. k�� P ............................................. at .... ��Ak �1** ..... 4' ****"**** North Andover, ass. . ..... .... Fee.��;� ........... Lic. No. ...... .. ..... .... ........... ...... ...... EL@ECrRICAL INSPECTOR Check # 9063 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/07] (jPavP hlnnkl APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 52 CMR 12.00 (PLEASE PRWflV INK OR TYPE ALL I7VFO"ATI019 Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number)_r / dor / Owner or Tenant Owner's Address Telephone No q Y- _7610 7/7-7 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building_ M, 1,/ Utili Authorization No. Z..�`.� e> to Z, Existing Service &/, D Amps j jy/yZ p Volts Overhead Undgrd ❑ No. of Meters 1 New Service -2..p o Amps !/O /Z10 Volts Overhead E Undgrd ❑ No. of Meters t Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ....�� «dull y uesirea, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: ' D t3 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVER—AGE. 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: ,�e� _.� s � r� LIC. NO.: Licensee: Signature (If applicable, enter "exempt " in the license number line.) LIC. NO.: Address: Bus. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt L cl. 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/Agent owner's agent. Signature Telephone No. PERMIT FEE: $ I% - Z -a a J0 r ; www.mass.gov/dia . Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le-vibly Name (Businessiorganizad/on/Inndividual): Address: 'VS?GIA ✓car/ r/V . / ,011. r 7`s City/State/Zip•_ &,'—/Th r/cZ V?,,- W4 Phone #:. g 7 0 Are you an employer? Check -the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a.sole proprietor or partner- ship and. have no employees working for me .in any capacity. [No workers' comp. insurance uired-) 3. I am a homeowner doing all work myself. [No -workers' comp. insurance required.] t have tired the sub -contractors listed on the attached sheet x These suit -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 1.52, § 1(4), and we have no .employees. [No workers' comp. insurance required..] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑.Other t• - rr.•w••• ��. —� 5 ooz ff i musr a�so trtt out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are daring all work and then hire outside contractors must submit a new affidavit indicating such. 4contractors that check this box must attached an additional sheet showing the name of the sub-connactois and their workers • tomo mi, I ani an employer that is providing workers' compensation insurance for information my employees; Below is the policy and job site Insurance Company Name: Policy # or Self -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 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 heretic certif� er the pains and penalties? f perjury that the information provided above is true and correct Phone #: Official use only. Do not write in this area, to be completed by city or town official: City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Piumbing Inspector 6. Other Contact Person: Phone #: 1, The Commonwealth of Massachusetts 4- ' ! Department of Industrial Accidents Office of Investigations 600 NWashington Street Boston, MA 02111 r ; www.mass.gov/dia . Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le-vibly Name (Businessiorganizad/on/Inndividual): Address: 'VS?GIA ✓car/ r/V . / ,011. r 7`s City/State/Zip•_ &,'—/Th r/cZ V?,,- W4 Phone #:. g 7 0 Are you an employer? Check -the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a.sole proprietor or partner- ship and. have no employees working for me .in any capacity. [No workers' comp. insurance uired-) 3. I am a homeowner doing all work myself. [No -workers' comp. insurance required.] t have tired the sub -contractors listed on the attached sheet x These suit -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 1.52, § 1(4), and we have no .employees. [No workers' comp. insurance required..] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑.Other t• - rr.•w••• ��. —� 5 ooz ff i musr a�so trtt out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are daring all work and then hire outside contractors must submit a new affidavit indicating such. 4contractors that check this box must attached an additional sheet showing the name of the sub-connactois and their workers • tomo mi, I ani an employer that is providing workers' compensation insurance for information my employees; Below is the policy and job site Insurance Company Name: Policy # or Self -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 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 heretic certif� er the pains and penalties? f perjury that the information provided above is true and correct Phone #: Official use only. Do not write in this area, to be completed by city or town official: City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Piumbing Inspector 6. Other Contact Person: Phone #: 1, 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 of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority," Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if ` necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the J members or partners, are not required to carry workers' compensation insurance. if an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, notthe 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 (.if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit- The ffidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-774 www.mass.gov/dia Date--�� 0"' TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies th .1 ............. has permission to perform ................. plumbing in the buildings of .............. a ........... North Andover, Mass. Fee. ... .............. /�L U Lic. No.. . . /INPNSPECTOR Check # - 116"7 5611 v MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING K3(T�ypeor print) NORTH ANDOVER, MASSACHUSETTS 4' Date �'.3a"� Building Location — Owners Name Permit # 1011 Amount Type of Occupancy New Renovation Replacement ® Plans Submitted Yes NoEl FIXTURES (Print or type) r� ^� r Check one: Certificate Installing Company Name \ _ •"+•M� 1-1 Corp. �ME lrl Name of Licensed Plumber: Insurance Coverage: Indicate the type of ' coverage by checking the appropriate box: Liability insurance policy 0 er type of indemnity D Bond D i Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above a three insurance Signature Owner Agent 0 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumb >�ig�ode and C apter 2 ott�Ct6ral Laws. ;D (OFFICE USE ONLY of Plumbing License Master Journeyman ®- Location -)�-4 0. Date 40RT#q TOWN OF NORTH ANDOVER Certificate of occupancy $ ss CHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # I 1", 7 9 Building ln.<p'ector TOWN GP NORTH ANDOVER BUILDING DEPARTMENT , APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT. NUMBER. �'-- TE ISSUED: SIGNATURE: -Building Commissionenq Cr of Buildings Date c !`TTllwr 1 L177'r rwrr.+�Te�r ....�.... - -11 ulr V1%1V1Li 11\11\ i 1.1 Property Address: j1.2 Nei tJev,owq Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Fronta e ft 1.6 BUILDING SETBACKS ft Name (Print) Address for Service : Front Yard Side Yard I Rear Yard Required Provide R 'red Provided Re red Provided Name Print Address for Service: II 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone p CL�!•Ti�wr � t.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ `1 r n i i v yr 1'l ZnarlIr/AU l nUfuz,1N l AUBA d 2.1 Owner of Record 3 Name (Print) Address for Service : I Signature Telephone 978?- tlk.2- . 91 2.2 Owner of Record. Name Print Address for Service: II Signature Telephone SECTION 3 -CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 0hr7 e Licensed Construction Supervisor: License Number It Address ?>ttgnature Telephone Expiration Date r3.2 RegisterW Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Signature Telephone Expiration Date `1 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 ail applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: f1'0)V 10 4 Ve, ,Jroa m 0 n� �a If 6 6 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b permit applicant Svc r pFFICIAI IISEONLY +. '-.x , K 4Wi� 1. Building ` / (/ (� O 0 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) 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 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My be 1-i matters re to uthorized by this building permit applicatio Signature of Owner Dat 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 Siaature of Owner/Agent NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 sr 2ND 3 SPAN DEVIENSIONS OF SILLS DIWNSIONS 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 i 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 -70 - :?Alkl L� R�� ( PHONEy LOCATION: Assessor's Map Number Odc9- PARCEL c;2-r`D SUBDIVISION LOT (S) STREET L4 V, -f,/XML, ST. NUMBER O`• (9 _ ************************************OFFICIAL USE ONLY*********************************** I B9COMMENDATIONS OF TOWN AGENTS: N ADMINISTRATOR COMMENTS _I1J VL - TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT /FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm RECEIVED Town of North Andover JOYCE B.RADSHAWOfflce of the Zoning Board of appeals T© �� e�` munity Development and Services Division NORTH ASD , e 27 Charles Street 200E MAY I 'b P 2* 48. North Andover, Massachusetts 01845C,4„s D. Robert Nicetta Telephone (978) 688-9541 Building Commissioner Fax (978) 688-9542 Any appeal shall be filed Notice of Decision within (20) days after the Year 2001 date of filing of this notice in the office of the Town Clerk. Property at: 458 Waverley Road NAME: Jo -Ann Leavitts DATE: 5/9/2001 ADDRESS: 458 Waverley Road PETITION: 012-2001 . Nlorffi .ndovice.-, MIA 019,15 - H'EARMG; 5/8/2001 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, May 8, 2001 at 7:30 PM upon the application of Jo -Ann Leavitts, 458 Waverley Road, North Andover, MA requesting a dimensional Variance from Section 7, Paragraph 7.3 of Table 2 for relief of a right side setback and for a Special Permit from Section 9, Paragraph 9.2 to allow for the extension of a proposed 1 '/2 rear story addition of a bedroom on a pre-existing, non -conforming structure and lot within the R-4 Zoning District. The following members were present: William J. Sullivan, Walter F. Soule, Raymond Vivernio, Robert Ford, John Pallone. Upon a motion made by Raymond Vivenzio and 2nd by John Pallone the Board voted to GRANT a dimensional Variance for relief of a side setback of 6' on both the North and South side, .and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. The Board voted to GRANT a Special Permit from Section 9, Paragraph 9.2 to allow for the extension of a proposed 1 %2 rear story addition of a bedroom on a pre-existing, non- conforming structure and lot. In accordance with the Plan of Land by: Stephen E. Stapimb, RLS, #29876, Merrimack Engineering Services, 66 Park Street, Andover, MA. dated: 3/7/2001. In accordance with the elevation drawing by: Anthony DiFrancisco, #3284, Registered Architect, ADF Architects, Inc., Haverhill, MA., dated: 01/03/2001. Voting in favor: WJS/WFS/RV/RF/JP. The Board finds that the applicant has satisfied the provisions of Section 9 Paragraph 9.2 of the zoning bylaw and that such change, extension or alteration shall not be substantially .more detrimental than the existing structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a . Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. ml/Decisions2001/15 Town of North Andover Board of Anneals. William J. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HE. L A 688-9540 PLANT ING 688-9535 D. Robert Nicetta Building Commissioner (978) 688-9545 -.-:(978) 688-9542 Fax Please print,// DATE b/ D r uwl! ul i-iw Eii Hnaover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION JOB LOCATION �J I/t/4vel-, Number "HOMEOWNERJ-0 o)A/Al Name PRESENT'MAILING ADORESS 7 - City Town Street Address /VO✓�rl �i'Id d U�',/ s 97F -�'f2� r�9� Home Phone e✓. Map / lot Work -) e r fp Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homegwners 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 SIGNATUR APPROVAL OF BUILDING OFFIC C/) m TJ m U) m 0 m y .p co 0Z CD o wa, rtwwr,, W _ n� .p .p o o p CD Q CCD 0 .. a O cm CD N "0 CD O --1 = d 0 _ -o 0 C O y d CD 0 _ CD v y� CD CIS O CCD O CD 007 U rrz7 0 cn 0 W m x CA .O CT d OCD .0 y -•.1 O m O y C7 a n CD C')O m ° oCv Cif o a ° wG a ] �= ,r CD r sm m H = m CA CD O � O • r co c CD _ = CDCD E, O t0 0 'y` O : Z C, y C-) W =0 =C CL n a u a �• to O CD dc Ca CA 1 ; V t to O m .0 ` W O N p� Cfl :CL � c O •- CD CD d CO) :c :C 1-0mL �— QC,: 0 � Co. CD o C 4/ '0 o CD H :s► .G CD c : — �_CD 03 c. C,�. G_'~ c C=2 I C, = At :ry: 0 S•: 3a ° . °OQ ° °' ° oCv Cif o a ° wG � ] �= ° aGa a- °c CL 0• Q7 � b n x O h-� JU 0 c ,AORTec ro4,a°° d"o Zoning Bylaw Review Form Town Of North Andover Building Department n? 'a4027 Charles St. North Andover, MA. 01845 SS"`"vsf• Phone 978-688-9545 Fax 978-688-9542 Street: Item Ma /Lot: zlz Applicant: 2-0 A W -W li<v� Request: Lot Area Date: F rico" uC aUV1bUU L114L drier review OT your Application Plans your Application is DENIED for the following Zoning Bylaw reasons: Zoning Rem Item # for the above is checked below. Special Permits Site Plan Review Access other than Frontage Exceptioi Common Drivewat Congregate Housir Continuing Care R Board Item # Variance it I I Setback V, Lot Special Permit Special Permit Special Permit Independent Elderly Housing Special Permit Large Estate Condo Special Permit Planned Development District Special Permi Planned Residential Special Permit R-6 Density Special Permit Watershed SDeciai ParW7 Lot Area Variance Height Variance Variance for Sian I Permits Zoning Board Permit Non-Conformin Use ZBA amoval Special Permit ZBA Permit Use not Listed but Similar Permit for Sian Other Sic. al: Supply Additional Information The above review and attached explanation of such is based on the plans, request for or 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 this action. 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 b, refWe.buildin epartment will retain all. plans and documentation for the above file. ilding DeOfficio SignatureApplication Received Application Denied Denial Sent:' If Faxed Phone Number/Date: Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting 2 Frontage Complies 3 Lot Area Complies 3 Preexisting frontage w 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed *_S G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required 3 Preexisting CBA �{ 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height `�IS 4 Right Side Insufficient qe 5 4 Insufficient Information 5 Rear Insufficient I Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed 4 Insufficient Information 2 In Watershed j Sign 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district �S 2 - Parking Complies 3 Insufficient Information Rem Item # for the above is checked below. Special Permits Site Plan Review Access other than Frontage Exceptioi Common Drivewat Congregate Housir Continuing Care R Board Item # Variance it I I Setback V, Lot Special Permit Special Permit Special Permit Independent Elderly Housing Special Permit Large Estate Condo Special Permit Planned Development District Special Permi Planned Residential Special Permit R-6 Density Special Permit Watershed SDeciai ParW7 Lot Area Variance Height Variance Variance for Sian I Permits Zoning Board Permit Non-Conformin Use ZBA amoval Special Permit ZBA Permit Use not Listed but Similar Permit for Sian Other Sic. al: Supply Additional Information The above review and attached explanation of such is based on the plans, request for or 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 this action. 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 b, refWe.buildin epartment will retain all. plans and documentation for the above file. ilding DeOfficio SignatureApplication Received Application Denied Denial Sent:' If Faxed Phone Number/Date: Plan Review Narrative The following narrative is provided to further explain the reasons for the action on the property indicated on the reverse side: Fire Conservation Planning Other ZoningBylawDenia12000 ,eam '_oning Board )e artment of Public Works iistorical Commission BUILDING DEPT M RR M© -x 'r - � r � w a U v� F — a CN C U U = C RR M© -x 'r - � r � w a U v� F — a L C U U = C r w c ;n w w O 7 C n 'r � G C F Z w Q - Na we ortki � I Z N G ,1 d 'r � r � w a U v� F — a L C U U = C r w c w Z Q - Na w G1 C C C U CA ui C z z U U U w C C • ,� \ _ C _ G G G ,, N rn � C z Z 'r � r � w a U v� F — a L C U U = 'r I z L Z C r c w Z Q - w G1 C U W W W W W W xxx Nl Ln 0 000 h O O N — N C �rrc rrr nnr U _-- — T �xt5f � 1 r niw 2sc& gear r I Aaw 4.2X4 fh Q to ak �060 Qfi��e �4- H {G•d*l c uwv lq"� 15"+ct6e 14 64&wv' $c, rva tvad) Qew 2x1-0®icooG I901D q-xG Q.Z �Y.i42atoc,C 0twQjY—Uolw.. isaw n ,- ! !C) C pfd I 5� G5 p(; i spa H MN V` ►- r r W W W W W W"der 1� �+/ S 2 T ccc NNN nc+n i I �J I �sZ i^ v .IVC. 28:) ti 05/06x'1999 13:05 5083666442 PAGE �02 M Y �Q N J x cV•� / I I • � I j i) 1 PAGE �02 M Y �Q N J x cV•� • °� Hor±rw •9 k �1rieo ^�.a�0 �SSACHU9ki Zoning Bylaw Review Form Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone 978-688-9545 Fax 978-688-9542 - —Street: yS ua -A U e f, L Map/Lot: 02 a a Applicant: .=r m —awn• ,Ce a �, s ;' Request: Dcc/c Date: — a / — o 3 Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zoning Remedy for the above is checked below Item # Special Permits Planning Board Item Notes _,S- Setback Variance Item Notes A Lot Area Common Driveway Special Permit F Frontage Variance for Sign 1 Lot area Insufficient R-6 Density Special Permit 1 Frontage Insufficient 2 Lot Area Preexisting `-1 e S 2 Frontage Complies 3 Lot Area Complies 3 1 Preexisting frontage e S 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building. Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required Ll r 5 3 Preexisting CBA 5 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting. Height S 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient 4 re 5 15 1 Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage. Complies D Watershed 3 Coverage Preexisting S 1 Not in Watershed ki - 5 4 Insufficient Information 2 In Watershed j Sign 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking A 1 In District review required 1 More Parking Required 2 Not in district `1 e-5 2 Parking Complies 3 Insufficient Information 3 Insufficient Information 4 Pre-existingParking Remedy for the above is checked below Item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit _,S- Setback Variance Access other than Frontage Special Permit Parking Variance. Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Independent Elderly Housing Special Permit Large Estate Condo Special Permit Planned Development DistrictSpecial ecial Permit Planned Residential Special Permit S ecial Permits Zoning Board Special Permit Non -Conforming Use ZBA Earth Removal Special Permit ZBA Special Permit Use not Listed but Similar IS'-eciai Permit for Sign R-6 Density Special Permit Special permit for preexisting nonconforming Watershed Special Permit 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 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 documentation for the above file. You must file a new permit application form and begin the permitting process. 7- 7-,:2j--6)3 Ild ng Department Official SignatV'Te Application Received Application Denied Plan Review Narrative The following narrative is provided to further explain_ thereasons for: DENIAL for the APPLICATION for the property indicated on the reverse side: b� wi ,i' u', 1MRS. k T AIN ya,>��y.?4 5 1 U A .e 14 r.� �-PPeA CS `7 C- ^-I ti '4� y // dl P -c .ti dZ 1-0 - C a A� /11 r A" i �-`J J 7�I` !� C 7` v n 9Y- /� 7L � iS p d%! / see c 74r d,v c tel, pZ p — '7 h 1 /A Referred To: Fire Police Conservation Planning Other Department of Public Works Historical Commission Buildina Department ' p,E�E�jEO 7- /543 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. FILLS OUT THIS SECTION APPLICANT J a -- Or. P, ...l c��g !If �(' PHONE_1 7 & fi_'2� - 12_— � LOCATION: Assessor's Map Number PARCEL_ SUBDIVISION LOT (S) --- STREET_ ST. NUMBERS USE CONSERVATION TOWN PLANNER FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS TOWN AGENTS: TOR DATE APPROVED DATE REJECTED _1001 DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED. DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm DATE Tel: 978-6889545 North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. DATE ,%�- . JOB LOCATfONJ/�✓ Number Street Address "HOMEOWNER Number Home Phone PRESENT MAILING ADDRESS ' s'% y"o - City Town State Section of Town Work Phone Zip . Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF 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 to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures ai HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. a Town of North Andover Q ' Building Department 27 Charles Street North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. DATE ,%�- . JOB LOCATfONJ/�✓ Number Street Address "HOMEOWNER Number Home Phone PRESENT MAILING ADDRESS ' s'% y"o - City Town State Section of Town Work Phone Zip . Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF 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 to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures ai HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A�ONE ¢�yOR TWO FAMILY DWELLING .F.Z S"ns Y S .'. i � i7rQ rH��i"'5") �' �•i �� � � •iNi V �.'���, 4 uric% �! fr*`4 � f -. M � �, •'fzjr eco � '.'. -C'C BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building CommissionEIEEQEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number A/ o l7 h Jo L// e,,-- 1.3 Zoning Information: Zoning DistAct Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regpired Provided Provided -Required 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes —No 2.1 Owner of Record f Name (Print) / Address for Service 92— P 2 Sig re Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable 4;111 - License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone 00 rn M ic z O O z rn go O a r v M r r z 0 w 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 au applicable) New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Desviption of Proposed Work: 1 I SF,CTTON 6 - F,STIMATF,D CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 " —2 Oe 0 . V Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 0i11 as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, n 1 afters relat v 1'wo*,0wVorized by this building permit application. Si nate �of caner 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 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS IS12 ND 3 RD SPAN DIMENSIONS OF SILLS DEVIENSIONS OF POSTS DIMENSIONS OF GIRDERS 1lEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t ,f N z a^� tfT N w W =I U D -s 0 zw Q� 0 � Z r6 C� r / ) Of Ln '- n, F-- N z 3:(,o V I �N wn W� foo v W CL z z r- z O< w F- w z 4� O w O w N CL (!) V1 cf) d- z a^� tfT N 0 Ln (f 1 C� v L/ l z z a^� tfT Date ..... ... a3 ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .......................... ................................................................ has permission to perform ................................................................................ _j7 wiring in the building of .. ............................................................... ........... North Andover, Mass. at ... z1 ,5 ........... .... ....... ..... ............... C/ o'.5 ............. ................................... Fee.�-.� .................. Lic. N --� ........ . -�-' L� i EL-EcTRicAL INspEcm Check # 4 6 "L 9 Official) Use Only Permit No. �%�f`i (j/iiG//Gf!i'�Gy/�i1Z,��%�f V�%��$$�♦%ifTlZ.��i !%$ ae/runtnreort ob �u�lle Sa6edy �'� Occupancy &Fee Checked �S BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number 171s,?- Owner 71s, `" Owner or Tenant `.I o - Owner's Address M Date /—,I - To To the Inspector of Wires: Is this permit in conjunction with a building permit Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing ServiceAmps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work_ �riri �t� � ,•. F OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws y• I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electric I Work$ `So O Work to Start /_$ ' Inspection Date Resquested Rough Final Signed under the Penal ies of perjury: FIRM NAME 1� LIC. NO. r� Lrkensee a a,6Z � �� �.� Signature as LIC. N04Z / Bus. Tel No. Address Aft Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) co Telephone No. PERMITTEE $ 0-3 (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets 1 04 it No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cord Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained. No. of Dishwashers Space/Area Heafing KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP F OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws y• I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electric I Work$ `So O Work to Start /_$ ' Inspection Date Resquested Rough Final Signed under the Penal ies of perjury: FIRM NAME 1� LIC. NO. r� Lrkensee a a,6Z � �� �.� Signature as LIC. N04Z / Bus. Tel No. Address Aft Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) co Telephone No. PERMITTEE $ 0-3 (Signature of Owner or Agent) Name Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02919 Workers' Compensation Insurance Affidavit Please Print City Phone # . I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: Insurance. Co. Policy # Company name: Address City Phone # Insurance Co. Policy # 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' imprisonments vogl_as_cpA penaltiesiinlhelmn4-aSTOPYMDW9RDER-and_afm -cf ($1Do.OD)_ajdayzgaiostme. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the irrforrnabon provided above is true and correct. Signature Date Print name Pbone.# y Official use only do not write in this area to be completed by city or town official' ; City or Town Permit/Ucensing. c� Building Dept nCheck I immediate response is required Licensing Board E] Selectman's Office Contact person: Phone A El Health Department Ei Other