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Home My WebLink AboutMiscellaneous - 5 BUCKLIN ROAD 4/30/2018 5 BUCKLIN ROAD M1( 0010 0000.0 - - - - - - - - i I LaMarche Associates P.O. Box 179 Natick, MA 01760 508-650-9777 Fax: 508-650-9870 March 25, 2010 Building Commissioner/Inspector of Buildings NORTH ANDOVER, MA 01845 Board of Health/Board of Selectmen NORTH ANDOVER, MA 01845 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, cause of loss and LA file number. Insured: GURPREET &JASWINDER SINGH Loss Location: 5 BUCKLIN ROAD NORTH ANDOVER, MA 01845 Policy Number: HP386692 Date of Loss: 3/14/2010 Cause of Loss: Water LA File Number: MA-2-17484 On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Ann Martin Adjuster I LaMarche Associates,Inc.-800-349-1525 Page 1 of 1 Claim # 033652720 Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen Town Hall Town Hall North Andover, MA 01845 North Andover, MA 01845 Re: Insured: Gurpreet Singh Property address: 5 Bucklin Road North Andover, MA 01845 Policy #: 69373400005 Loss of: 2015/10/10 File or Claim No. AD 1938 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000.00 or cause Mass._Gen._Laws,_Chapter_143,_Section_6 to be applicable. If any notice under Mass—Gen_Laws,_Ch._139_Sec._3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indi ted above by first class mail. i gnatu date Safety Insurance Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: GURPREET SINGH and JASWINDER KAUR Property Address: 5 BUCKLIN RD,NORTH ANDOVER, MA Policy c Number: HMA 0321353 Claim Number: BOS00040920 Date of Loss: 1/6/2014 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number; date of loss and claim number. Bryan Savosik Claim Examiner 1/8/2014 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston;MA 02205-5098 Phone: (617) 951-0600 EXT 2070 Fax: (617) 535-5841 Email: BryanSavosik@SafetyInsurance.com , i J Safety Insurance _ E - Form of Notice of Casualty Loss to Building" Under MASS. GEN. LAWS, Ch. 13.9, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 I "RE:- Insured'' �.�GJRPRr;ET-SINGH ana,JASWIIvTDER KAUR- � ---= Property Address BUCKLIN:RD,NORTH AN- DOVER, MAS Policy Number: HMA 0321353 Claim Number: BOS00035714 Date of Loss: 2/11/2013 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may;either:exceed$1;000:00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable: _If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of_the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Allan Leavitt Claim Examiner 2/13/2013 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (6.17) 95,1x-06.00-EXT 3213 :� . Fax:;(6:17) 5:31-889.1 � ,.: _ . -, .. _ -• . . . : a .. .... ,. :;: •-., r Email. AllanLeavitt@Safetylnsurance:com - �a �• f 1 ..n Location G!+!'., Ir�4n No. Date h s MO�,h TOWN OF NORTH ANDOVER s O A i; ' 10 s. Certificate of Occupancy $ Building/Frame Permit Fee $ mf JACMus - Foundation Permit Fee $ Other Permit Fee $ ti ~E. TOTAL $ = /f Check # t 18,621 r ` Building Inspector �� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING �., .. .,,?',r -�,w� ,r,f.e'' .�+5 ,'."'"�, •�r'� .ilR� -r.., , M� d�n �'-" �,�-a F ,tF' 'f r.�.�'^ ;�i �'a' K BUILDING PERMIT NUMBER: O DATE ISSUED. OZ Dp SIGNATURE: - Building Commissioner/InEeedor of Buildings Date SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O-'0010-0000.0 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Reqttired Provide Required Provided RecIttired Provided 1.5. Flood Zone Infomution: v 1.7 Water S 1.8 sew j/ uPPIS M.G LC.40. 34) Zone Outside Flood Zone 0 Municipal 0 l Sys On Site Dis Public ❑ Private ❑ poral system ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT MISToric UIS rIC : es o rn 2.1 Owner of Record Name(Print) Address for Service: O 1 g L1 �w�r� Ea gnature Telephone 2.2 Owner of Record: Name PnntAddress for Service: O z signature Telephone rn SECTION 3-CONSTRUCTION SERVICES 00 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed onsiruction Supervisor: ®y 1 > RA � � l License Number C� }�LtC3 Ad on ess Expiration Date i ature Telephone •� r 3.2 Registered Home Improvement Contractor ` Not Applicable 0 C7 ,_._r��21�LC� Company Name (tel'a C JLI i rn sG �x�— Registration Number r GI J S-1)00 $1 $�~ g� Expiration Date Z n turc Telephone t .. - i 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.......0 No.......0 SECTION 5 Description of i;posed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ ` Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be 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 �O 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 as Owner/Authorized Agent of subject property Hereby authorize e—q.V cue-S o1r1S nJ Po:,jt Seg-0 to S to act on M,_y behalf,in all ma ers relative to k authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property t Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief nt ame �' 1 a� Si ature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlMIBERS 1 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMIENSIONS 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�P r.,r. G c"SO S PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) l rr I�i`�5ti;; STREET S � �c Ltd . (LA ST. NUMBER D4, n OFFICIAL USE ONL N NS OF N AGENTS: C NSERVATION MINISTRATOR DATE APPROVED DATE REJECTED COMMENTS S TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 Jm �=28.30 SBDH R-25.00 ` (Fnd) SBDH l* (Fnd) , 04zo _ q W Map 25 Lot 10 ��50 01 00 5,204 sq.ft. Iron Rod (Fnd) q o � z Ili 18" Tree #5 20.94' 2 Sty. 6.87' Dwelling Iron Rod (Fnd) 18.79' 30' Tree V(I - �l d C �V0* REFERENCES: 0 1) Deed Book 9731 Pg 258. 2) Plan #12309. PLOT PLAN 5 BUCKLIN ROAD Iron Rod NORTH ANDOVER, MA (Fnd) Prepared By OF LeBlanc Survey Associates Inc. c�' G VERNON 16 J, 1 Holten Street � J. Danvers, MA 01923 LeBLANC N (978) 774-6012 N0. 33 00 F S R�- A A Sept. 15, 2005 Scale 1 "=20' HOR. SCALE IN FEET 0 20 50 100 -,&Ayy ' r �� LICENCED CONTRACTOR SUPERVISOR REGISTERED HOME IMPROVEMENT • •' CUSTOMCARPENTRY REPAIRS •• ParsonsSean Board of Building Regulations and Standards HOME IMOROVEMENT CONTRACTOR Registration: 142446 Expiration: 4[5/2006 Type.. DBA BRAVIN HOME SERVICES . SEAN PARSONS 7. 39 BATES RD. SWAMPSCOTT,MA 01907 Administrator ✓�ze lD0%7Y1J209LC!/P.LLLlfL a�✓T/�cza:rac�ic�aell`a 'A x BOARD OF BUILDING REGULATIONS y License: CONSTRUCTION SUPERVISOR 'A- Number:,CS 087726- Birthdate 05/25/1969 s Expires 05/25/2007 Tr. no: 87726 Restricted: 00 _ SEAN P PARSONS 39 BATES RD SWAMPSCOTT, MA 01,907 Commissioner The Commonwealth of Massachusetts Department of Industrial Accidents ~�"`'�, Office of Investigations 600 Washington Street g t, Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): "SQ-c-,y\T 7G C Q Address:3<1 City/State/Zip: cn is, Phone Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 0 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.U 1 am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F-1 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.FOther comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. 1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: P Y 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 hereby y under the pains and penalties of perjury that the information provided above is7o --" a and correct. Si nature Date: Phone#: �� ' g s� �a p � Official use only. Do not write in this area,to be completed by city or town gfficial. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: I 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-contractor(s)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 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, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(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 burn leaves etc.)said person is NOT required to complete this affidavit. 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,NIA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www.mass.gov/dia BRAY N Home Services 100 A Kent Farm Road P.O. Box 682 Hampstead, NH 03841 Sean P Parsons Owner 781-858-8285 HOMEOWNER INFORMATION Gi c err P2`ter Name Street Addre (not PO Box) _- __---_- _- CitylTown--- -- -- . . State-- - Zi Da 'me Phone Evening h e Mailing Address(if different than above) WORK TO BE PERFORMED AND MATERIALS TO BE USED Bravin Home Services agrees to do the following work for homeowner. Materials eAmted V be used: ' Cc y4,14 \ SCHEDULE The following schedule will be adhered to unless circumstances beyond our control arise. Homeowner agrees and understands that, due to unforeseen conditions, Bravin Home Services canno uarantee a specific date for completion: lb WO in / Expected date of completion: TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE Bravin Home Services agreeAo perform the world furnish the material and labor specified above for the Sum of$ Payments will be ma a according to the following schedule oA $ 35(D due upon signing contract $ by_1 or upon completion of 'Rm i r aaOO due upon completion of contract. TERMS AND CONDITIONS 1. Unless otherwise noted within this document, this contract shall not imply that any lien or other security interest has been placed on the residence. 2. Applicable Law This Agreement shall be govemed and construed in accordance with the laws of the Commonwealth of Massachusetts. 3. _Entire A reement These terms and conditions represent the entire and integrated Agreement between Homeowner and Bravin Home Services and supersedes all prior negotiations, representations or agreements, either written or oral, and may be amended only by written instruments signed by both Homeowner and Bravin Home Services. 4. Legal Actions: Should it become necessary for Bravin Home Services to enforce any term of the provisions of this Agreement,or to collect any portion of the amount payable under this Agreement, then all litigation and collection expenses, including but not limited to.witness fees, court-costs, and attorney's fees shall-be paidbythe- - - - Homeowner. 5. Binding Agreement Homeowner and Bravin Home Servicesrespectively, bind themselves,their partners, successors, assigns and legal representatives to the other party to this Agreement and to the partners, successors, assigns and legal representatives of such party with respect to all covenants of this Agreement 6. Severability: If any provisions of this Agreement are 9 held to be in violation of an law or ordinance, Y they shall be deemed stricken and all I remainingrovisions s to be valid and binding upon the parties. p hall continue I understand that this is a legally binding contract and have read and fully understand the terms and conditions contained therein. 0� a� oma r ate vin Home Services _a ili Homeowner Date i 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 at: S J,c u- 1 ,,., R A is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL C 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Lo ation of ility) Signature of Permit Applicant Fire Department Sign off Dumpster Permit Date CUSTOM VIEW CUSTOMER -- SEAN DATE 09/06/05 REF Deck05249 i I I MOYNIHAN LUMBER 12 OLD RD. PLAISTOW NH (800) 555 1212 BEAM LAYOUT MOYNIHAN LUMBER CUSTOMER -- SEAN 12 OLD RD. DATE 09/06/05 REF Deck05249 PLAISTOW NH (800) 555 1212 6' 1/2" A 1' 11 1/2" BEAM BEAM POST POST LABEL LENGTH COUNT SPACING A 15' 10 1/2" 3 7' 9 1/2" Post spacing is measured center-to-center. Depth of concrete footers --- 48" BIT,L Qr MATERIALS --- OTHER MATERIALS CUSTOMER: SEAN y DATE: 09/06/05 DESIGN: DECK05249 REF: /` l SALESMAN # DON --------------------------------------------------------------------------- COMPONENT SKU QUANTITY DESCRIPTION --------------------------------------------------------------------------- 8IN JHANGER 28JH2 16 EA JOIST HANGER WALL ANCHOR HLA4 16 EA 1/2X4" ANCHOR LAG BOLT 6IN LB06 16 EA 1/2"X6" LAG BOLT LOIN SONO TUBE SON010 2 EA SONO TUBE 10"X12 ' 50LB CONCRETE C50 15 BAGS 50LB BAG CONCRETE SHADOETRACK 8FT HD ST03 17 EA SHADOE TRACK MAZE NAILS 2IN ST05 2 LBS 2" GALV NAILS TURBO3 1IN ST07 11 BOXS 1" SS SCREW BAL 2X2X36 PT BALO1 100 EA 2X3X36 SPINDLE 4D NAILS 4D1 1 LBS 1. 5" GALV NAILS 16D NAILS 16D1 2 LBS 3. 5" GALV NAILS 2 . 5IN SCREWS 5251 3 LBS 2 . 5" GALV SCREWS 1/2IN WASHER W12 96 EA FLAT WASHER 1/2IN NUT N12 40 EA HEX NUT 6IN BOLT HB06 40 EA 1/2"X6" BOLT i i BILL QV MATERIALS --- LUMBER 41 CUSTQMER: SEAN DATE: 09/06/05 DESIGN: DECK05249 R` =. S?LESMAN # DON --------------------------------------------------------------------------- COMPONENT SKU QUANTITY DESCRIPTION WOOD TYPE ------------------------------ ------------ -------------- --- ---- DECKING �FIB16 18 EA 5/4X6-16 - ----------- /4X6-16 ' -----------FIBERON-G HORZ RAILS '4~16P 4 EA 2X4 16' P.T. RAIL POSTS till- 4 EA 4X4 10 ' P.T. STAIR POSTS -4-4+8-P' 2 EA 4X4 10' P.T. STAIR POSTS 2 EA 4X4 12 ' P. T. STAIR STRINGER �21216P 3 EA 2X12 16' P. T. STAIR TREAD ,/ FIB16 EA 5/4X6 16' FIBERON-G BEAMS ✓ 2108P ` EA 2X10 8 ' P.T. BEAMS 21016P 2 EA 2X10 16' P.T. JOISTS 'f � 288P 11 EA 2X8 8 ' P.T. FASCIA ✓IVI6DP 2 EA 1X8 16' P.T. RIM BOARD �J/ 288P 2 EA 2X8 8 ' P. T. RIM BOARD ✓ 8.1`6P 2 EA 2X8 16 ' P.T. `2 HORZ RAILS Z�.L2P 3 EA 2X4 12 ' P.T. GROUND POSTS 448P 4 EA 4X4 8 ' P.T. I F NORTH Town of 4Andover N' Im sop *yyC' 4 = ---,v=, overMass. q,.oZ 9► -a oo 4" T O - LA E 1 t. COCHICKEWICK V 7 ADRATED BOARD OF HEALTH jPERMIT T . D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT 4.R.A*�Y.V.40.r.........../(0.4.0-r....................................... ... t 1 sat III has permission to erect.. ... ` buildings on S ..'' k L Ai �............. Rough t0 be occupied as C1. *~ i v y Chimney p ..............................ilKii ............`.... ..........s................. .............................................................. ...... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. CA S /1 O PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS ARTS Rough 00 ................................. " C Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR DiRough splay 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. s ,Location No. Date !V--// y TOWN OF NORTH ANDOVER G p Certificate of Occupancy $ + + Building/Frame Permit Fee $ "4K T j Foundation Permit Fee $ sACHus Other Permit Fee $ Sewer Connection Fee Water Connection Fee $ s TOTAL $ .. f Building Inspector 04/11/94 16._26 ,50 PAID 12 Div. Public Works f #cation No. ! Date "ORT" TOWN OF NORTH ANDOVER -eely, �• oo p Certificate of Occupancy $ 'U Building/Frame Permit Fee $ em-u Foundation Permit Fee $ ` Other Permit Fee $ Sewer oo,Cnnection Fee $ wt ei onnection Fee $ TOTAL fj"D"Gad d4e 1 a Building inspector 7097 Div. Public Works Location YNo. . 4 2�K Date pCltTq TOWN OF NORTH ANDOVER ' `p Certificate of Occupancy $ 4L , ; +' Building/Frame Permit Fee $ cHuS Foundation Permit Fee $ s� e Other Permit Fee $ 4 h10 63. -Sewer Connection Fee $ l t I-lo 3 Water Connection Fee $ /Q)p a TOTALo?60a uild ft Ins ector >` 69•x.5 0 . P� lic Works PEik-?, IT N4-i. 6 7 y APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS///,w V,j/,�,-i_, PAGE 1 MAP d40. LOT NO. �� 2 RECORD OF OWNERSHIPio , (DATE BOOK PAGE ZONE SUB DIV. LO NO. �� f1 � - - -LOCATION PURPOSE OF BUILDING A 141 JA_ OWNER'S NAME NO. OF STORIES / SIZE OWNER'S ADDRESS BASEMENT OR SLABl ARCHITECT'S NAM v 1 SIZE OF FLOOR TIME RS 1ST i-I 2ND 7- �O BUILDER'S NAME ^ t SPAN -- [,�/l. (� DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET 1. POSTS DISTANCE FROM LOT LINES-SIDES REAR T " GIRDERS AREA OF LOT 2 FRONTAGE / J-1 HEIGHT OF FOUNDATION ®� THICKNESS IS BUILDING NEW /> 1� SIZE OF FOOTING 15 "CJS-� IS BUILDING ADDITION `^✓� MATERIAL OF CHIM Y IS BUILDING ALTERATION P 1�l IS BUILDING ON OLID R FILLED LAND WILL BUILDING CONFORM TO REO I MENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER Pr7 - 1 IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INF RMATION j LAND COST SEE BOTH SIDES B1 OG. P[_RZf EST. BLDG. COST i.1i4J G �LBS C11A D i �J EST. BLDG. COST PER t . FT. PAGE 1 FILL OUT SECTIONS 1 - 3 FDA �yti �,� EBT. BLDG. COST PER ROOM PAGE 2 FILL OUT BE 1 - 12 DUE � �petAUT C-1 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DAT FILED / id ?-- I /jl, BOARD OF HEALTH SI NATURE OF OWNER OR AUTHORIZED AGENT F E E 6sA �%�j 7 P PLANNING BOARD PERMIT GR/[(J�N'TE ` v OWNER TEL.# S/ 19 -- CONTR. LIC. BOARD OF SELECTMEN JI �/ •/ j! BUILDING INSPECTOR r y BUILDING RECORD 1 CCUPANCY 12 SINGLE FAMILYS ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. :WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HA RDW D — _ PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT I, AREA FULL : .FIN. B'M'T' AREA _ '/, 1/2 °/, FIN. ATTIC AREA _ NO B M — FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS X B, 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD"J'D _ ASBESTOS SIDING _ COMMCN f VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON`FRAME?. . _ BRICK ON MASONRY, l _ATTIC STRS. & FLOOR _ • "''?i !`� !ti} BRICK ON FRAME I .„ ...... "" CONC. OR CINDER BLK`` STONE ON MASONRY WIRING STONE ON,fRAME 64 SUPERIOR POOR 11 ADEQUATE NONE 5 0 11 10 PYWABING GABLE HIP BATH (3 FIX.) _ GAMBQEI MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. &COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING �- RADIANT H'T'G b UNIT HEATERS ` 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING I M FORM U - LOT REIMWE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: l ��P Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) _ Street C, �I �(Y St. Number 'L ************************Official Use Only************************ 7RECOATI NS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments �Cd Date Approved �'- Town Planner Date Rejected i Comments VA Date Approved Health Agent Date Rejected Comments Public Works - sewer/water connections - driveway perm't /-ZG Fire Department Received b Building fr - �{ TL`� T.�1f y g Inspector r Date i 3 1 M4 , i.. �^ t !. f 708/ II �o r- /l ti 1 4 Ex�s ri,c�C • j � \f � v I i =44:70/ _ . 30, 09 �� e+� ��,� BvcKGIt ��/ F l D 0 Irk 1!1 VING DEPARTMAE • 1 �1c/ �.vST',eU.r,E.vT cSuetiE�! S AEPEBY eleA-, FY TO -.o�L or Rz QN AV TAE B/9.V1r;,V47' /S LGCATEG ON r,�/Ecor.ls.ssni,-,v,4,vo rccor/roa�s covi�aP�rr �,(/ IY/Tf1 T,i/E mow"/- OF.tf�. .a�vGt�vel. ZON�.vG ,c�E6vcAT.l�,t�S ,�� 6r/RO/M; .SETB.IC.CS FEOif1 STREETS',t'GDT U�vES."' '02>=� �iV00✓E / �iSfSS,' S F1/1ClyEl cE.�T/FY T.f� T T•f�/,S OArECL/iV6 /.S�t/OT PFIA LOG9TE0 /N T.yE FE,.��,,��r.�='�.�C,OpO ffAZ•4.�0 A.PE•4. O.PgNA/V fOiP �,.H PA 2/4 BoalvolPy taETE.e►�iN.�rioc! Bo�.vov/et�/.v.�o.P�ys- �E.P.P/rflgGr E".t/G.WEE.P/.[�6 SE.Pf�/�'ES A7-16111 T74,eC-S/ 5POi44 Exisr�.ve ,eE�oeos. 6G �q.P,(�.ST,rEET A.t/ODI�E.� /�JgS.S.4G�l/SE7T.S O/8/O 4400• T �•A ORT T ly 0 o c << over 0 fln io R^L Avert h dower, Mass., �i!?X IL /' 1991P Coc HtcrEwicK ��A�QATE0 �S M : BOARD OF HEALTH 00 PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT...,q. .1.4.L 41104.....,/ o. . e . .Z.,T ... .&e..��.4 ... BUILDING INSPECTOR Foundation has permission to erect.,t 40.0.0P411W.Wbuildings an f.410;04 !1. 4Q. Rough may► to be occupied as• /. 4..� ... e4=i goy Chimney provided that the person accepting this permit shall ih eve respect conform to the erms of the a lication on file in P p p g p � p Final this office, and to the provisions of the Codes and By-Laws relating to the InspecdKRWrF N Xfthb0W1`of Buildings in the Town of North Andover. REGULATED BY PARA. 114.8-S. B.C. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. _ Rough DATE y=�,L SEE PAID - G Final PERMIT EXPIRES IN 6 MONTHS e�,`2/cf-o . a UNLESS CONSTRUCTION STARTS ! ELECTRICAL INSPECTOR Rough PERMIT-FOR FRAME/BUILD6NG 4ile44 .. .........:::...... ..................... Service DATE:_�FEE PAI& �' S-6 BUILDING 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 PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT I CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 074 Date JI-M 1994 -' THIS CERTIFIES THAT 3 THE BUILDING LOCATED ON 5 BUCKLIN ROAD (Lot #11.) MAY BE OCCUPIED AS SINGLE FAMILY DWLELING W/ 1 CAR GA RA ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. O� NORTM ,h CERTIFICATE ISSUED TO ._Hillside Realty Trust : .�'�` °L 733 Turnpike St. , #209 p ADDRESS North AndM-),&-r, Mgt ''sA U'�` Budding Inspector ATownof 4 over NoP. . y ZO LA dover, Mass., APAJZ_ .P 1991/ T � COC HIC HE WICK Ab DRA TE D 'YF I S BOARD OF HEALTH w � `.' Food/Kitchen Septic System ' -.. .r� :a ,y «,f t O THIS CERTIFIES THAT � ..L..sr� WILDING �N CT l �� Foun J fo e ha's` permission to erect.0.4.0APP41GO buildings on f ipL�. '�. ..L-Q!.,�.z�.. Roug at C; h ion A Y f to be occupied as � . ... / 1r ,�.�N.4F��.�!!'f�. . ��.��V.� Chimney provided that the person accepting this permit shall iii ever respect conform to the terms of the lication on file in x P P P 9 P Y P �pp Final ��• this office, and to the provisions of the Codes and By-Laws relating to the InspectiAKRWrEftF ldN11ftl@tM0W1bf Buildings in the Town of North Andover. REGULATED BY PARA 114.8-S. B.C. PLBIN IP ELT 1�» � s d VIOLATION of the Zoning or Building Regulations Voids this Permit. o C�(J' DATE Ly FEE PAID , G PERMIT EXPIRES IN 6 MONTHS e� o . ev o c * ' UNLESS CONSTRUCTION STARTS ELECT ICAL SPECTOR Rough PERMIT-FOR FRAMUBUILDING D :^ 100 ...... Service DATE: FEE PAI ' G BUILDING INSPECTOR f Final ( ► Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises Do Not Remove Rough v 9 No Lathing or Dry Wall To Be Done ''' f Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner 1 A� , \ Street No. . F!'�PLANNING INAL CONSERVATION \� y�ZI Smoke Det. �- SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT